Required TB skin test for students challenged
A Hilo High School freshman was dismissed from school Sept. 1 because she did not have a state-required tuberculosis skin test.
Jackie Lindenbach and Leonard Horowitz, parents of the Hilo student, Alena, contend the state's action was illegal because their daughter had "TB clearance" from a doctor in Idaho.
Janice Okubo, state Health Department spokeswoman, said no child can enter school in Hawaii without taking the TB skin test. There is no alternative to the test, she said.
Lindenbach said by telephone that the TB skin test is invasive. "She (Alena) has a right to be educated without chemicals."
Describing themselves as Christian and Jewish, the couple asked for an exemption on religious grounds, pointing out such exemptions are granted for immunizations.
Attorney Gary Zamber, in a news release by the family, said, "This problem is going to resolve by an examination of medical legal definitions. TB skin testing is a type of immunization by the clear language of these statutes."
Dr. Jessie Wing, chief of the state's TB Control Program, said the U.S. Centers for Disease Control does not consider the TB skin test an immunization because "it doesn't provoke a prolonged immunological response. It is a transient response."
The test, also known as PPD (purified protein derivative), involves injecting tuberculin just under the surface of the skin. The test is read 48 to 72 hours later by looking at the injection site.
Wing said the issue was discussed with state Attorney General Mark Bennett, who said Hawaii administrative rules requiring a TB skin test to go to school must be followed.
"We're not here to keep any child out of school," she said. "We want to make sure we don't have a communicable disease in our schools and in the community."
Hawaii and New York have the highest TB rates in the country because of large immigrant populations.
Isle cases decreased a little last year but are running high again -- at double the national rate, Wing said.
Hawaii has 8.8 cases per 100,000 population, compared with 4.8 per 100,000 population nationally, she said.
Lindenbach said Horowitz, a health researcher and author, called Hilo High School for requirements before the family moved from Idaho and was told a TB clearance was needed from a physician. She said Alena was certified TB-free by a doctor.
Wing said TB clearance is accepted only if data is provided that a tuberculin test was done, with the date, duration and certified practitioner.
She said Horowitz first contacted her in 2002. Alena has been home-schooled until this school year, she said.
Wing said the TB Control Program is working to update the administrative rules to implement the new QuantiFERON-TB Gold blood test approved by the Food and Drug Administration for TB infection.
She said they are also working on improvements for risk assessment and looking at data to see if all populations need to be screened the same way. "We might opt to revise screening for children," she said.
"We're not twiddling our thumbs," she said. "We're trying to revise our long-term administrative rules. We're working on it but it doesn't happen overnight."
