The recent accounts of tuberculosis in the news have brought considerable visibility to the increase in reported cases of tuberculosis in Orange County. Some of these reports undoubtedly have led to considerable concern and a number of questions on the part of county residents. As your county health officer, I want to be sure that you have the most accurate information regarding this disease.

The resurgence of tuberculosis is not only an Orange County problem but also a statewide and national problem. Tuberculosis in California has increased 54% from 1985 to 1992. California accounts for more tuberculosis cases than any other state (5,382 in 1992), and its rate of 17.2 cases of tuberculosis per 100,000 population is the third highest in the United States. Santa Ana, San Francisco, Oakland and Los Angeles are among the 10 cities in the United States with the highest tuberculosis case rates.

What is tuberculosis?

Tuberculosis (TB) is a bacterial disease that most commonly affects the lungs. Someone with active TB can spread the disease to other persons through coughing, sneezing or singing. While tuberculosis is not easy to spread, it tends to be spread between people sharing a common air space for a prolonged period of time (e.g., home, dormitory rooms, classrooms, enclosed work space.)

The myth that someone testing positive with TB can spread the disease is false. The disease must be active within the lungs before it can be spread by an infected person.

TB is a very treatable disease. Therefore, it is important to recognize the symptoms and seek medical help. The symptoms include: prolonged cough (greater than two to three weeks,) night sweats, weight loss, fatigue, chest pain and coughing of blood.

A recent outbreak of tuberculosis in an Orange County high school illustrates the need for rapid diagnosis, appropriate treatment and prompt reporting.

In 1991, an Orange County high school student with tuberculosis was misdiagnosed. As a result, the student went untreated and unreported and consequently exposed classmates at the student's school. In 1992, a second physician diagnosed the student as having TB but did not treat it appropriately or report the case. When the patient's care was transferred to the county's Health Care Agency in 1993, we found a total of 17 active cases of TB in the school and 177 skin-test positive students.

The following factors contributed to this large outbreak: