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County of Santa Clara Public Health Department Administration 976 Lenzen Avenue, 2nd Floor San José, CA 95126

Date: April 15, 2014 To:

DATE: April 15, 2014 District Superintendents School Nurses TO: Care Providers District Superintendents Health School Nurses

From: Sara H. Cody, MD, Health Officer Health Care Providers Teeb Al-Samarrai, MD, Tuberculosis Controller Re:

FROM:

Sara H. Cody, MD

Change in the Tuberculosis (TB) School Mandate: Health Officer From Universal Testing to Universal Risk Assessment and Targeted Testing

Teeb Al-Samarrai, MD Controller Beginning June 1, 2014, the Tuberculosis Santa Clara County Tuberculosis (TB) School Mandate will change from a requirement for universal

TB testing to a requirement for universal TB risk assessment. RE: County has required Change the Tuberculosis (TB) School Mandate: Santa Clara TBin testing for students entering school since 1989. This Health Officer Mandate was impleFrom Universal Testing to Universal Risk Assessment Testing early and mented at that time because TB rates rapidly increased. It was intended to ensure that childrenand withTargeted TB were diagnosed treated appropriately when the infection was latent or “silent.” The California Health and Safety Code, § 121515, gives the county Beginning June 1, 2014, the Clara County Tuberculosis (TB) School Mandate will change from Health Officer authority to implement suchSanta mandates. As TBarates have declined the US and Centers for Disease Control TB and risk Prevention (CDC), the American Acadrequirement for in universal TBCalifornia, testing tothe a requirement for universal assessment. emy of Pediatrics (AAP) and the California Tuberculosis Controller’s Association (CTCA) have revised their recommendations. In place of universal TB testing, these now TB recommend thatstudents healthcare providers ask a series questions assess a child’s risk Santa Clara County hasbodies required testing for entering school since of 1989. This to Health of exposure to TB and target TB testing for children at increased risk for TB exposure or developing TB disease. Although Officer Mandate was implemented at that time because TB rates rapidly increased. It was intended to rates of TB have declined Santa Clara County since thediagnosed Mandate was put in place, we continue to have when one of the the highest rates of TB in the ensureinthat children with TB were early and treated appropriately infection was US. Santa Clara County has very few cases of active TB among children, however, children remain vulnerable to being exposed latent or “silent.” The California Health and Safety Code, § 121515, gives the county Health Officer to TB from others and are attogreater risk of progressing to active TB disease if latent or “silent” TB infection is not detected and treated early. authority implement such mandates. In February 2014, the Public Health Department convened a School Mandate Review Task Force — including school representatives and pediatricians community — US to review our local TBthe data, the AAP/CDC/CTCA recommendations, the academic As TB ratesfrom havethe declined in the and California, Centers for Disease Control and Prevention literature, the policies of similar jurisdictions across California and the US, as well as challenges and advantages of different policy (CDC), the American Academy of Pediatrics (AAP) and the California Tuberculosis Controller’s changes. Based on this review and discussion, Santa Clara County will no longer require universal testing but will transition to a Association (CTCA) have revised their recommendations. In place of universal TB testing, these mandate for universal risk assessment and targeted testing. bodies now recommend that healthcare providers ask a series of questions to assess a child’s risk of The new Santa Clara County Public Health Department Risk Assessment for School Entry form will be required for school exposure to TB and target TB testing for children at increased risk for TB exposure or developing TB registration effective June 1, 2014 for all children enrolling in kindergarten or transferring, at any grade level, from outside of disease. Santa Clara County.Although rates of TB have declined in Santa Clara County since the Mandate was put in to have oneTB of School the highest rates ofreplace TB inwith the US. Santa Clara County has very few Please place, discardwe all continue prior references to the Mandate and the following documents: cases of active TB among children, however, children remain vulnerable to being • NEW: TB Risk Assessment for School Entry form (to be completed by healthcare providers) exposed to TB from othersGuidelines and are attogreater risktooftheprogressing to active TB disease if latent or “silent” TB infection is • Revised: Revisions School Mandate and Requirements not detected and treated early. • Revised: Frequently Asked Questions • Revised: Dear Parent Letter In February 2014,County the Public Department • Revised: Santa Clara SchoolHealth Mandate Flow Chartconvened a School Mandate Review Task Force — including school representatives and pediatricians from the community — to review our local TB • Revised: IGRA Fact Sheet data,List theofAAP/CDC/CTCA academic • NEW: school health clinicsrecommendations, and FQHCs in Santathe Clara County literature, the policies of similar California andschool the US, as well as challenges andlocation advantages differentregistration policy is done Please jurisdictions reproduce thisacross entire packet for each in your district as well as any where of centralized for new and transfer students. Please also feel free to post on District or School websites. These materials will also be available at www. Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian sccphd.org/tb. County Executive: V. Smith If you have questionsJeffrey about these changes, please contact the TB Prevention and Control Program at (408) 885-4214. Thank you for helping us protect the health of children in Santa Clara County. 22 | THE BULLETIN | MAY/JUNE 2014

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