RESCINDING A LONG TERM TB SCHOOL MANDATE

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RESCINDING A LONG TERM TB SCHOOL MANDATE

• Presented by
• Barbara Cole, RN, PHN, MSN
• Director Disease Control Branch
• Riverside County
• Department of Public Health

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OBJECTIVES

• Participants will be able to
• 1. Identify at least three key issues which need
  to be considered when discontinuing a long term
  TB School Mandate.
• 2. List three important factors influencing the
  effectiveness of school based TB screening.

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• HISTORICAL PERSPECTIVE

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ORIGIN OF MANDATE

• Implemented in 1989 in response to increase in
  pediatric cases.
• First year focused on Kindergarteners.
• Subsequently expanded due to identification of
  active TB cases.

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1989-2006
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LEGAL BASIS FOR TB MANDATE

• Authorized under the California Health and Safety
  Code Sections 41327 and 41329
• Local Mandate

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PURPOSE OF MANDATE

• To identify individuals who may have active TB to
  prevent exposure of other students and staff
• To identify individuals with latent TB infection
  to offer treatment to prevent the development of
  active disease

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TESTING REQUIREMENTS

• FIRST TIME ENTRANTS TO A RIVERSIDE COUNTY SCHOOL
  K 12 PUBLIC PRIVATE
• INITIALLY INCLUDED PRE-SCHOOL AND HEADSTART
• EXCEPTIONS TO TB SKIN TEST REQUIREMENTS
• APPLICATION OF TB TESTING REQUIREMENTS TO YOUTH
  WHO FALL UNDER AB 490 NO CHILD LEFT BEHIND ACT.

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SCHOOL AGE TB2 CASES BY COUNTRY OF
ORIGINRIVERSIDE COUNTY - 1991
N 793
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SCHOOL AGE TB2 CASES BY COUNTRY OF
ORIGINRIVERSIDE COUNTY - 1993
N 861
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SCHOOL AGE TB3 CASES BY COUNTRY OF
ORIGINRIVERSIDE COUNTY - 1991
N 23
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SCHOOL AGE TB3 CASES BY COUNTRY OF
ORIGINRIVERSIDE COUNTY - 1993
N 25
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INITIAL ACTION STEPS IN PREPARATION TO ISSUE THE
APRIL 2007 MANDATE

• Reviewed screening data with PHO/DPHO
• Review of Cost Effectiveness of Alternative
  Strategies for Tuberculosis Screening Before
  Kindergarten article
• Met with lead school nurses
• Met with RCMA School Health Committee
• Preliminary evaluation of cost effectiveness of
  mandate.

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• SUBSEQUENT ACTION STEPS

• Written notification to
• Superintendents
• School Nurses
• Preschools
• Medical Community
• Follow-up meeting with lead school nurses
• Meeting with Riverside County Medical
• Association School Health Committee.

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WRITTEN COMMUNICATIONS

• Frequently Asked Questions
• Letter to School Superintendents
• Letter to Local Physicians
• Letter to Head Start and other preschools

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• TB SCREENING RESULTS

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POSITIVE TB SKIN TEST RESULTS, (TB-2) FOR
CHILDREN 17 YEARS AND YOUNGER, RIVERSIDE COUNTY
2004 2006
SOURCE Riverside County, Department of Public
Health, Disease Data compiled from the TB School
Mandate Report
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POSITIVE TB SKIN TEST RESULTS, (TB-2) BY AGE FOR
CHILDREN 17 YEARS AND YOUNGER, RIVERSIDE COUNTY -
2004
SOURCE Riverside County, Community Health
Agency, Department of Public Health,
Disease Control Data compiled from the
INH Registry statistics
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POSITIVE TB SKIN TEST RESULTS, (TB-2) BY AGE FOR
CHILDREN 17 YEARS AND YOUNGER, RIVERSIDE COUNTY -
2006
SOURCE Riverside County, Community Health
Agency, Department of Public Health,
Disease Control Data compiled from the INH
Registry statistics
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POSITIVE SKIN TEST RESULTS (TB-2), BY COUNTRY OF
ORIGIN FOR CHILDREN 17 YEARS AND YOUNGER - 2004
SOURCE Riverside County, Community Health
Agency, Department of Public Health,
Disease Control Data compiled from the INH
registry statistics
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POSITIVE SKIN TEST RESULTS (TB-2), BY COUNTRY OF
ORIGIN FOR CHILDREN 17 YEARS AND YOUNGER - 2006
SOURCE Riverside County, Community Health
Agency, Department of Public Health,
Disease Control Data compiled from the INH
registry statistics
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POSITIVE SKIN TEST RESULTS (TB-2), BY RACE FOR
CHILDREN 17 YEARS AND YOUNGER - 2004
SOURCE Riverside County, Community Health
Agency, Department of Public Health,
Disease Control Data compiled from the INH
registry statistics
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POSITIVE SKIN TEST RESULTS (TB-2), BY RACE FOR
CHILDREN 17 YEARS AND YOUNGER - 2006
SOURCE Riverside County, Community Health
Agency, Department of Public Health,
Disease Control Data compiled from the INH
registry statistics
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TREATMENT OF LATENT TB INFECTION (TB-2) FOR
CHILDREN 17 YEARS AND YOUNGERRIVERSIDE COUNTY -
2004
N 1267
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TREATMENT OF LATENT TB INFECTION (TB-2) FOR
CHILDREN 17 YEARS AND YOUNGERRIVERSIDE COUNTY -
2006
N 1580
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• ACTIVE CASES

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ACTIVE CASES (TB-3)BY COUNTRY, RACE AND AGE 2004
SOURCE Riverside County, Department of Public
Health, Disease Control Data compiled from
the Tuberculosis Information Management System
(TIMS) database.
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ACTIVE CASES (TB-3)BY COUNTRY, RACE AND AGE 2006
SOURCE Riverside County, Department of Public
Health, Disease Control Data compiled from
the Tuberculosis Information Management System
(TIMS) database.
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KEY ISSUES

• Timeframe for discontinuing mandate
• Should there be a transition period?
• Concern of parents, school staff and school
  officials
• Misconception that the TB Mandate identified all
  potential cases

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KEY ISSUES (cont.)

• Schools wanted earlier notification
• TB testing requirement had been added to school
  district board policy. Many districts continued
  testing

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KEY ISSUES (cont.)

• Required change in board policy
• Uncertainty of school staff that rescinding
  mandate did not override other requirements
• HS/Education Code
• State licensing requirements for
  preschools/Headstart
• CHDP Screening Requirements

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KEY ISSUES (cont.)

• Decision whether to issue a news release
  announcing end of TB Mandate
• Potential political backlash if a preventable TB
  exposure occurs in a school setting
• Loss of TB screening data submitted by schools
• Decreased number of children identified for
  treatment of latent TB infection.

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FUTURE DIRECTION

• In-depth cost analysis
• TB Study to evaluate prevalence of latent TB
  infection in select schools confirming positive
  TST results with Quantiferon
• Evaluation of TB data to determine if targeted TB
  testing warranted in Riverside County
• Utilization of case finding strategies to
  identify TB in school aged children.

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Mandatory TB tests for new students waived
RIVERSIDE COUNTY A drop in tuberculosis cases
ends a 17-year public health policy. By PHIL
PITCHFORD Published Friday August 24, 2007