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Osceola drops TB test for some immigrant kids
Claudia Zequeira
Sentinel Staff Writer

December 7, 2005

Osceola County schools will no longer require tuberculosis testing for immigrant children -- a sign of how much things have changed in the decades since the lung infection was known as the "White Plague."

School Board members voted 4-0 Tuesday to no longer require TB tests of children who come from, or travel to, countries with a high incidence of tuberculosis. The list has included China, Bangladesh, Russia, Vietnam, the Philippines, Nigeria, Mexico, Haiti, the Dominican Republic and many others.

"This was a question of testing everyone or not testing anyone at all, of not singling out certain students," said Dana Schafer, a district spokeswoman.

Most Florida counties already had stopped routinely testing for tuberculosis in schools.

One reason is the inconclusive nature of the TB test, which involves injecting a protein into a person's arm and interpreting the bump that forms around the spot. The test gives a false positive up to 20 percent of the time, some studies show.

"The yield of positive skin tests is such that you're really not accomplishing anything by doing these tests," said Halsey Rhodes, director of field services for the state's Bureau of Tuberculosis and Refugee Health. "Now, we only test those who are very high risk."

In Miami-Dade County, which has the state's highest tuberculosis rate, schools stopped routinely testing new students in 2002.

In Central Florida, Seminole and Polk stopped requiring proof of TB testing for school enrollment in the 1990s. Officials in Orange, Brevard, Lake and Volusia counties could not recall when their districts required testing of students.

TB has plagued people for centuries, but cases have dropped dramatically in the United States in recent decades. More widely available drugs and the advent of the TB test itself swayed districts to test only those considered at high risk.

That includes people with weak immune systems, prisoners, those who say they were exposed to the virus and recent immigrants, the Florida Department of Health says.

Orange had the largest number of reported cases last year among Central Florida counties -- 98 -- followed by 27 in Polk. Volusia had 14 cases, Seminole 12, Brevard and Lake eight each, and Osceola six.

Despite the general decline of TB, the number of cases in Florida rose 3 percent in 2004, to 1,076. And the number of infections in children 14 and younger jumped from 49 in 2003 to 79 last year. The increase, officials say, is driven largely by immigrants, who made up almost half of tuberculosis cases in Florida in 2004.

Although the state recommends immigrants who have been in the country for less than five years be tested, many slip under the radar of health agencies. In addition, a person who shows no clear symptoms may legally refuse a TB test.

"Most of the children we've seen get sick were at risk for TB and should have been tested, or if they were tested, unfortunately either they or their parents chose not to take the treatment or complete the treatments," said Dr. David Ashkin, the state's TB controller.

"We should err on the side of caution and test," said Dr. Joseph Torres of the Florida State University College of Medicine. "It may be perceived as discriminatory, but would you want your kid to sit next to a kid with TB?"

Local health clinics still test immigrant children for tuberculosis at the request of doctors. And school districts -- Osceola included -- still require physical examinations that include a TB risk assessment.

"I still see the testing is happening," said Catherine Lamprecht, head of pediatric infectious diseases at Nemours Children's Clinic in Orlando. "I don't see any evidence that we're having a major problem."

Many parents, too, think the disease is in check.

"They shouldn't give everybody a test," said Susan Schneider, a mother of three who runs a small day-care center in Kissimmee. "I don't think there's a lot of TB around these days. At least I hope so."

Claudia Zequeira can be reached at czequeira@orlandosentinel.com or 407-931-5934.