Re: Re: TB testing singles out migrant workers' Kids

February 8, 2006

Hi Hilda,

Can you believe that there is this type of discrimination! I wonder if

there will come a day when this kind of thing doesn't happen any more.

thanks for the article.

At 11:33 AM 2/8/2006, you wrote:

Wednesday, February 8, 2006

Brewster school

district TB testing singles out migrant workers' kids

Action taken without state,

county consultation

Graman

Staff writer

February 8, 2006

The school district in Brewster,

Wash. – already named in a federal civil rights lawsuit brought by the

parents of Latino students – now has singled out the children of migrant

workers for tuberculosis testing as a condition of enrollment, without

consulting state or county health officials, according to those

officials.

Selectively testing one population is

not standard practice, especially when no one shows symptoms of

tuberculosis, said Dr. Kim Thorburn, Spokane County health officer.

" If you are insistent (on

testing), it should be all students, " Thorburn said. " There are

all these policy considerations that should have been worked out. It's

just not the way we do TB control. "

Concerned about October news reports

of a case of tuberculosis at Coeur d'Alene High School, Brewster school

Superintendent Jim kept at least four students who tested positive

for tuberculosis out of school " until a doctor can assure us in

writing that they do not actually have TB, " according to a Jan. 17

e-mail sent to Kim Field, tuberculosis program manager for the

Washington Department of Health.

wrote Field that " 13 of my

migrant students " were tested, and seven tested positive. Of those,

three students had transferred to another school district, leaving four

in the Brewster district. It's unclear whether more than the 13 have

since been tested.

" I assume we will get letters

from doctors indicating it is safe for these students to return to

school, " wrote. " If so, we may not have a problem. If

not, what steps should we be taking in order to protect the rest of our

students? Notification of parents? Testing of all students? "

The testing, apparently done by a

local health care provider, occurred without consulting either the

Department of Health or the Okanogan County Health District, Field said.

Only migrant students were tested.

was out of town on Tuesday and

unavailable for comment. Brewster school board member Dina Divas declined

to comment other than to say, " We are testing. "

According to 's e-mail to the

Department of Health, 80 percent of the Brewster School District's

student body is Hispanic and 40 percent are the children of migrant

workers.

Mexico has a higher

tuberculosis rate than the United States. For this reason, Mexican

children often are inoculated with the Bacillus Calmette-Guerin, or BCG

vaccine, which can cause skin tests to read positive. According to the

Spokane Regional Health District, there are other reasons for false

positives, and a positive test does not mean an individual has active

tuberculosis or can infect others.

More than 30 students, faculty and

staff of Coeur d'Alene High School showed positive reactions to tests

after a student was hospitalized with an active case of tuberculosis

believed to have been contracted outside the country, The

Spokesman-Review has reported. None of those has shown symptoms of the

bacterial disease, and none was kept out of school.

In a follow-up telephone conversation

with Field, spoke of steps the Brewster School District took to

protect its students against tuberculosis. Field summarized the

conversation in a Jan. 19 e-mail to other public health officials

including Thorburn:

" Community members raised the

issue of concern for TB when they heard about the Idaho

student. "

" The school decided to screen

all migrants (from Mexico). "

" This individual ()

excluded all the students from school initially – and said they had to be

released back to school. "

" The individual went to our DOH

Web site to 'learn' about TB and discovered the difference between

infection and disease. "

" He stated he has allowed the

children to return to school unless they 'have symptoms.' "

" He stated that as a school

district they will continue to screen all migrant children for school

entry. "

Field said that she thought

called to say he had reversed his decision to continue screening, but

that was not the case.

" I referred him to the local

health officer and local health department, " said Field, adding that

still had not notified the Okanogan County Health District.

" I was a little upset that we

weren't notified, " said Lauri , public health nurse for the

health district.

said she knew of no other

school district in Okanogan County testing students, but that Brewster

has the largest Latino population in the county.

Field, who has been with the state's

tuberculosis program since 1993, also said such testing is not standard

practice in Washington state. Because positive tests for TB are not

required to be reported under state law, the Department of Health has no

record of who was tested or who did the testing.

None of the district's three clinics

contacted by The Spokesman-Review provided the tests, according to their

spokespersons.

The Brewster School District,

and high school Principal Randy were named as defendants in a

civil rights lawsuit filed in U.S. District Court in Spokane in October.

Eight Latino parents allege the district discriminated against their

children by singling them out for disciplinary action not imposed on

non-Latino students.

Please see our web site at

www.LULAC.org for more

information.

To Post a message, send it to:

Groups

To Unsubscribe, send a blank message to:

-unsubscribe

February 8, 2006

This is not a new policy. I know this is an issue we documented as a

barrier for the West Palm Beach School District back in the 1990s, where

advocates felt that migrants were being unfairly singled out. In fact, I

found out that it is part of almost every state's TB program and because

migratory farmworkers and their children have been found to test

positive for TB (sometimes because they received a TB vaccination in

Mexico, making them look TB positive), this is a priority population.

Not everyone has the same relative risk of TB, due to medical and

migration history, so they don't test everyone equally.

I don't know how the rest of you feel about this. I'm just sharing our

experience.

A

Hilda Ochoa Bogue wrote:

> <http://www.spokesmanreview.com/>

>

> Wednesday, February 8, 2006

>

> *Brewster school district TB testing singles out migrant workers'

> kids *

>

> *Action taken without state, county consultation*

>

> Graman

> <http://www.spokesmanreview.com/news/bylines.asp?bylinename=%20Graman>

> Staff writer

> February 8, 2006

>

> The school district in Brewster, Wash. – already named in a federal

> civil rights lawsuit brought by the parents of Latino students – now

> has singled out the children of migrant workers for tuberculosis

> testing as a condition of enrollment, without consulting state or

> county health officials, according to those officials.

>

> Selectively testing one population is not standard practice,

> especially when no one shows symptoms of tuberculosis, said Dr. Kim

> Thorburn, Spokane County health officer.

>

> " If you are insistent (on testing), it should be all students, "

> Thorburn said. " There are all these policy considerations that should

> have been worked out. It's just not the way we do TB control. "

>

> Concerned about October news reports of a case of tuberculosis at

> Coeur d'Alene High School, Brewster school Superintendent Jim

> kept at least four students who tested positive for tuberculosis out

> of school " until a doctor can assure us in writing that they do not

> actually have TB, " according to a Jan. 17 e-mail sent to Kim

> Field, tuberculosis program manager for the Washington Department of

> Health.

>

> wrote Field that " 13 of my migrant students " were tested, and

> seven tested positive. Of those, three students had transferred to

> another school district, leaving four in the Brewster district. It's

> unclear whether more than the 13 have since been tested.

>

> " I assume we will get letters from doctors indicating it is safe for

> these students to return to school, " wrote. " If so, we may not

> have a problem. If not, what steps should we be taking in order to

> protect the rest of our students? Notification of parents? Testing of

> all students? "

>

> The testing, apparently done by a local health care provider, occurred

> without consulting either the Department of Health or the Okanogan

> County Health District, Field said. Only migrant students were tested.

>

> was out of town on Tuesday and unavailable for comment. Brewster

> school board member Dina Divas declined to comment other than to say,

> " We are testing. "

>

> According to 's e-mail to the Department of Health, 80 percent of

> the Brewster School District's student body is Hispanic and 40 percent

> are the children of migrant workers.

>

> Mexico has a higher tuberculosis rate than the United States. For this

> reason, Mexican children often are inoculated with the Bacillus

> Calmette-Guerin, or BCG vaccine, which can cause skin tests to read

> positive. According to the Spokane Regional Health District, there are

> other reasons for false positives, and a positive test does not mean

> an individual has active tuberculosis or can infect others.

>

> More than 30 students, faculty and staff of Coeur d'Alene High School

> showed positive reactions to tests after a student was hospitalized

> with an active case of tuberculosis believed to have been contracted

> outside the country, The Spokesman-Review has reported. None of those

> has shown symptoms of the bacterial disease, and none was kept out of

> school.

>

> In a follow-up telephone conversation with Field, spoke of steps

> the Brewster School District took to protect its students against

> tuberculosis. Field summarized the conversation in a Jan. 19 e-mail to

> other public health officials including Thorburn:

>

> " Community members raised the issue of concern for TB when they heard

> about the Idaho student. "

>

> " The school decided to screen all migrants (from Mexico). "

>

> " This individual () excluded all the students from school

> initially – and said they had to be released back to school. "

>

> " The individual went to our DOH Web site to 'learn' about TB and

> discovered the difference between infection and disease. "

>

> " He stated he has allowed the children to return to school unless they

> 'have symptoms.' "

>

> " He stated that as a school district they will continue to screen all

> migrant children for school entry. "

>

> Field said that she thought called to say he had reversed his

> decision to continue screening, but that was not the case.

>

> " I referred him to the local health officer and local health

> department, " said Field, adding that still had not notified the

> Okanogan County Health District.

>

> " I was a little upset that we weren't notified, " said Lauri ,

> public health nurse for the health district.

>

> said she knew of no other school district in Okanogan County

> testing students, but that Brewster has the largest Latino population

> in the county.

>

> Field, who has been with the state's tuberculosis program since 1993,

> also said such testing is not standard practice in Washington state.

> Because positive tests for TB are not required to be reported under

> state law, the Department of Health has no record of who was tested or

> who did the testing.

>

> None of the district's three clinics contacted by The Spokesman-Review

> provided the tests, according to their spokespersons.

>

> The Brewster School District, and high school Principal Randy

> were named as defendants in a civil rights lawsuit filed in

> U.S. District Court in Spokane in October. Eight Latino parents allege

> the district discriminated against their children by singling them out

> for disciplinary action not imposed on non-Latino students.

>

> © League of United Latin American Citizens.

> Please see our web site at www.LULAC.org for more information.

>

> To Post a message, send it to: Groups

>

> To Unsubscribe, send a blank message to:

> -unsubscribe

>

February 8, 2006

Unfortunately, this series of articles and quotes are filled with

inaccurate information about TB. Alayne is correct in her statement that

most state TB programs screen " all recent immigrants from countries with

high prevalence of TB " . It is a fact that since 2002 over 50% of all active

TB cases in the US occur from reactivation of TB infection that the

individual obtained in their country of birth. The only way to prevent this

reactivation is to screen all recent immigrants (including children) and

offer treatment prophylactically with TB medication (currently now 9 months

of INH or 4 months of Rifampin) to reduce their risk from approximately 10%

lifetime conversion to active TB to less than 1%.

It is inaccurate to state that individuals who have received a BCG

vaccination in their childhood have a positive PPD. In the past several

years, experts in Tuberculosis have come to a consensus to ignore the

history of BCG vaccination when reading a PPD because the incidence of a

positive PPD (greater than 10mm in a foreign born individual from high risk

country) in these individuals is extremely small. Therefore a positive PPD

in these individuals should be considered evidence of " infection with

tuberculosis " .

However, not all " migrant children " need to be tested for TB. Only

those children who are recent immigrants from high risk countries who have

not already tested positive should be tested.

It is true that once you have a positive PPD, you are obligated to rule out

active pulmonary TB usually by history/physical exam/Chest X-ray before a

student returns to the classroom (if the child is totally asymptomatic they

can usually return to the classroom very quickly-within 24-48 hours).

A new screening tool is now available that will eliminate a lot of the

inaccuracies of the PPD (which celebrated it's 100th birthday last year

without any improvement in it's accuracy). Quanti-Feron -TB Gold was

approved by the FDA in May, 2005 and the CDC released a MMWR Guideline Dec.

2005 (Dec. 16, 2005/Vol. 54/No. RR-15). This is a blood test that completely

eliminates the " potential cross positive reaction with BCG and other

Mycobacterium " .

I do agree that it is discriminatory to single out " migrant children "

for TB testing. It is however just good public health to screen all children

who are recent immigrants from high risk countries for tuberculosis and if

they test positive, offer them appropriate antibiotics for prophylaxis to

prevent conversion to active tuberculosis disease.

When children are not offered this protection we run the risk of what

happened to us in Pennsylvania last year when a recent immigrant child from

Russia presented to the ER with a 3 day history of severe headache and died

within the week from TB meningitis.

I would be happy to discuss more details with anyone who has more

questions or more answers.

Ed

Ed Zuroweste MD

Chair National Coalition to Eliminate Tuberculosis

Assistant Professor of Medicine

s Hopkins School of Medicine

Medical Director

Migrant Clinician Network

878 North Street

State College, PA 16803

814-238-6566 (office/fax)

814-571-7395 (cell)

kugelzur@...

----- Original Message -----

From: " Alayne Unterberger " <alayne@...>

< >

Sent: Wednesday, February 08, 2006 2:54 PM

Subject: Re: [ ] Re: TB testing singles out migrant

workers' Kids

> This is not a new policy. I know this is an issue we documented as a

> barrier for the West Palm Beach School District back in the 1990s, where

> advocates felt that migrants were being unfairly singled out. In fact, I

> found out that it is part of almost every state's TB program and because

> migratory farmworkers and their children have been found to test

> positive for TB (sometimes because they received a TB vaccination in

> Mexico, making them look TB positive), this is a priority population.

> Not everyone has the same relative risk of TB, due to medical and

> migration history, so they don't test everyone equally.

>

> I don't know how the rest of you feel about this. I'm just sharing our

> experience.

> A

>

> Hilda Ochoa Bogue wrote:

>

>> <http://www.spokesmanreview.com/>

>>

>> Wednesday, February 8, 2006

>>

>> *Brewster school district TB testing singles out migrant workers'

>> kids *

>>

>> *Action taken without state, county consultation*

>>

>> Graman

>> <http://www.spokesmanreview.com/news/bylines.asp?bylinename=%20Graman>

>> Staff writer

>> February 8, 2006

>>

>> The school district in Brewster, Wash. – already named in a federal

>> civil rights lawsuit brought by the parents of Latino students – now

>> has singled out the children of migrant workers for tuberculosis

>> testing as a condition of enrollment, without consulting state or

>> county health officials, according to those officials.

>>

>> Selectively testing one population is not standard practice,

>> especially when no one shows symptoms of tuberculosis, said Dr. Kim

>> Thorburn, Spokane County health officer.

>>

>> " If you are insistent (on testing), it should be all students, "

>> Thorburn said. " There are all these policy considerations that should

>> have been worked out. It's just not the way we do TB control. "

>>

>> Concerned about October news reports of a case of tuberculosis at

>> Coeur d'Alene High School, Brewster school Superintendent Jim

>> kept at least four students who tested positive for tuberculosis out

>> of school " until a doctor can assure us in writing that they do not

>> actually have TB, " according to a Jan. 17 e-mail sent to Kim

>> Field, tuberculosis program manager for the Washington Department of

>> Health.

>>

>> wrote Field that " 13 of my migrant students " were tested, and

>> seven tested positive. Of those, three students had transferred to

>> another school district, leaving four in the Brewster district. It's

>> unclear whether more than the 13 have since been tested.

>>

>> " I assume we will get letters from doctors indicating it is safe for

>> these students to return to school, " wrote. " If so, we may not

>> have a problem. If not, what steps should we be taking in order to

>> protect the rest of our students? Notification of parents? Testing of

>> all students? "

>>

>> The testing, apparently done by a local health care provider, occurred

>> without consulting either the Department of Health or the Okanogan

>> County Health District, Field said. Only migrant students were tested.

>>

>> was out of town on Tuesday and unavailable for comment. Brewster

>> school board member Dina Divas declined to comment other than to say,

>> " We are testing. "

>>

>> According to 's e-mail to the Department of Health, 80 percent of

>> the Brewster School District's student body is Hispanic and 40 percent

>> are the children of migrant workers.

>>

>> Mexico has a higher tuberculosis rate than the United States. For this

>> reason, Mexican children often are inoculated with the Bacillus

>> Calmette-Guerin, or BCG vaccine, which can cause skin tests to read

>> positive. According to the Spokane Regional Health District, there are

>> other reasons for false positives, and a positive test does not mean

>> an individual has active tuberculosis or can infect others.

>>

>> More than 30 students, faculty and staff of Coeur d'Alene High School

>> showed positive reactions to tests after a student was hospitalized

>> with an active case of tuberculosis believed to have been contracted

>> outside the country, The Spokesman-Review has reported. None of those

>> has shown symptoms of the bacterial disease, and none was kept out of

>> school.

>>

>> In a follow-up telephone conversation with Field, spoke of steps

>> the Brewster School District took to protect its students against

>> tuberculosis. Field summarized the conversation in a Jan. 19 e-mail to

>> other public health officials including Thorburn:

>>

>> " Community members raised the issue of concern for TB when they heard

>> about the Idaho student. "

>>

>> " The school decided to screen all migrants (from Mexico). "

>>

>> " This individual () excluded all the students from school

>> initially – and said they had to be released back to school. "

>>

>> " The individual went to our DOH Web site to 'learn' about TB and

>> discovered the difference between infection and disease. "

>>

>> " He stated he has allowed the children to return to school unless they

>> 'have symptoms.' "

>>

>> " He stated that as a school district they will continue to screen all

>> migrant children for school entry. "

>>

>> Field said that she thought called to say he had reversed his

>> decision to continue screening, but that was not the case.

>>

>> " I referred him to the local health officer and local health

>> department, " said Field, adding that still had not notified the

>> Okanogan County Health District.

>>

>> " I was a little upset that we weren't notified, " said Lauri ,

>> public health nurse for the health district.

>>

>> said she knew of no other school district in Okanogan County

>> testing students, but that Brewster has the largest Latino population

>> in the county.

>>

>> Field, who has been with the state's tuberculosis program since 1993,

>> also said such testing is not standard practice in Washington state.

>> Because positive tests for TB are not required to be reported under

>> state law, the Department of Health has no record of who was tested or

>> who did the testing.

>>

>> None of the district's three clinics contacted by The Spokesman-Review

>> provided the tests, according to their spokespersons.

>>

>> The Brewster School District, and high school Principal Randy

>> were named as defendants in a civil rights lawsuit filed in

>> U.S. District Court in Spokane in October. Eight Latino parents allege

>> the district discriminated against their children by singling them out

>> for disciplinary action not imposed on non-Latino students.

>>

>> © League of United Latin American Citizens.

>> Please see our web site at www.LULAC.org for more information.

>>

>> To Post a message, send it to: Groups

>>

>> To Unsubscribe, send a blank message to:

>> -unsubscribe

>>

February 8, 2006