County’s top doc quells David Douglas High TB fears

Find out what David Douglas High School parents and students learned about a possible case of tuberculosis they’d discovered – and what they’re doing about it …

Dr. Gary Oxman, Multnomah County Health Officer, listens to the concerns of a parent about the potential for the disease tuberculosis, at David Douglas High School.

Story and photos by David F. Ashton
Because the incidence of tuberculosis (TB) in the United States is at an all-time low, the infectious and once-fatal disease is seldom discussed nowadays.

But, the spectre of a TB epidemic centering on David Douglas High School appeared in January, when a student was rumored to carry the disease.

Although a letter sent to the school’s parents on February 5 indicated that a student had possibly contracted TB, it went on to say that the risk of an infectious outbreak was very low. Nevertheless, school officials also announced an informational meeting to help ease fears.

Information to combat rumors
Dr. Gary Oxman, Multnomah County Health Officer, facilitated the meeting, along with officials from Multnomah Education Service District (MESD). The Department of Health and Social Services made a presentation at the school on February 13.

“This meeting is important, said Mark Haner, Vice Principal at David Douglas High School, as he introduced Dr. Oxman, “in case a parent or student has a question about tuberculosis. It’s a disease we’re not with which familiar. When you do hear that someone in the school has tuberculosis, it’s like an ‘alarm’ goes off.”

Those exposed to TB should be tested, Dr. Oxman says, because few people come down with the active disease soon after exposure.

Tuberculosis 101
“Before antibiotics, tuberculosis was a deadly disease,” began Multnomah County’s health officer Dr. Gary Oxman, MD, MPH. “It was a feared disease, because so many people died from it.”

“The scientific name for TB is Mycobacterium Tuberculosis,” Oxman explained. “Some bacteria grow quickly. TB grows very slowly.”

He said TB is spread from person to person when someone with the disease within their lungs coughs. “The bacterium is spewed into the air as an aerosol. As the bacterium dries out, it can ‘hang’ in a room for hours. This is how most people get infected; breathing air infected with the bacterium.”

Two exposure factors: ventilation and time
Chances of exposure to the disease by inhaling TB bacterium out-of-doors are very slim, according to Oxman. “Exposure occurs in a small, poorly ventilated room.”

The other factor is length of exposure. “Family members may have hundreds of hours of exposure, in close contact, with an infected person, and not know it. Even then, they might catch it only after lengthy exposure.”

Not all infected become ill
When an individual is exposed to TB and becomes ill, they get flu-like symptoms, feel run-down, and chronically cough. “At this point, they are contagious; they can spread the disease.” Even though it takes a lot of medicine – up to four antibiotics at the start of treatment; and the cure is lengthy – six months and more – the individual can be cured,” assured Oxman.

Most people who catch the “TB germ” never develop the TB disease, the doctor added. “It can be ‘jailed’ by the body’s immune system for decades. If the body’s defenses ever weaken, the germ may cause TB disease, even decades after the exposure.”

Medication, taken daily for six to nine months, can prevent latent TB from becoming active, he added.

Whether active or latent, TB can be treated and cured by a long course of medication, says Oxman.

Tests expose TB infection
The county’s top health official went on to say that TB exposure or infection can be detected by a skin test, blood test, chest x-ray and sputum sample testing.

When a group of people are exposed to TB, Oxman said, how many people will get sick depends on the extent of the TB sufferer’s illness, the environment of the exposure space, the closeness of others to the infected person, and length of exposure.

“For example, one case study showed that 135 people had moderate exposure to an infected person. Tests showed that 130 of them were not infected. Five were infected, and had the latent – not active – disease.”

Tuberculosis at David Douglas High
Turning to the situation at David Douglas High School, Oxman said that a student was referred to the county health department because they tested positive for TB and had an abnormal chest x-ray. “A Health Department doctor diagnosed the student with TB.

Oxman lays out the situation with the TB-infected student discovered at David Douglas High School.

Risk of spreading
“The student was not ill; not coughing,” stated Oxman. “Lab tests and x-rays on student showed no signs of concerning for spread of TB. They found no germs in the student’s phlegm. Again, the x-ray was not particularly concerning.”

The student began treatment for TB, Oxman continued. “The student has received enough medication to stop potential for spread of TB. The medications typically cause the patient to lose 90% of TB germs in a week; about 98% of germs are killed in a couple of weeks.”

While the County Health Department cleared the student to return to school, the patient will continue to be tested.

Oxman said that students who had closest contact with the student infected with TB have also been tested. “Conclusive results take up to six weeks. If other students are found to be newly-infected, the Health Department might change its recommendations.”

The risk of an outbreak, beyond the single infected student, is slim, Oxman said. “But, we can’t ever say the risk is zero.”

Student not concerned
After the program, we spoke with DDHS student Grace Mustain, at the meeting to report on matter for the school’s newspaper, The HIGHLANDER.

“I think the presentation went pretty well,” Mustain reported. “But there weren’t very many people here; it looks like few people are worried. I feel very comfortable [about the situation]. Knowing what to look out for, and how it can happen, makes me feel okay.”

On the way out, vice principal Haner commented, “If there was a chance that this is a disease that would be spread in our school, I know the health department would be here in no time, taking immediate steps to protect our staff and students. We care, just like our health Department cares, about all of our students.”

Resources
To contact the Multnomah County Health Department TB program, call (503) 988-3417. If you have health-related questions, contact Dr. Gary Oxman at 503-988-3663, ext. 22640.

© 2008 David F. Ashton ~ East Portland News Service

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