A nationwide shortage of a tuberculosis skin test has health departments in the San Joaquin Valley giving the exam only to people at high risk for the lung disease and offering temporary clearances to others so they can stay on jobs.
And in many cases, workers at jobs requiring the skin test — health professionals, teachers and public safety workers — are paying for a more expensive blood test, health officials said.
"We're assessing and triaging," said Van Do-Reynoso, the Madera County public health director. "If we don't find you to be in the high-risk groups, come back later or you can choose to get the blood test."
The TB skin test is one of the most common tests administered at health departments. Last year in Madera County, 5,986 tests were given, Do-Reynoso said.
Government officials expect shortages of a skin test made by Sanofi Pasteur Limited to remain until at least the end of October. Another drug manufactured by JHP Pharmaceuticals is available in restricted quantities, according to the federal Centers for Disease Control and Prevention.
Tuberculosis is a bacterial infection of the lungs that can be fatal if not treated.
This is the second time this year that Valley health departments have scrambled when a tuberculosis drug has been scarce. Earlier, a nationwide shortage of the common anti-tuberculosis drug, isoniazid, had public health officials in the central San Joaquin Valley limiting treatment. Only people with active TB were assured of getting it.
The shortage of isoniazid ended midyear, but almost immediately supplies of the skin test became spotty.
For the past few months, Fresno County has been able to order only two, 10-test vials of skin test product every 35 days, said Tom Booth, supervising public health nurse in the TB and immunization programs. In the past, he would order 10 vials at a time "so we would have 100 (tests) on hand," he said.
Fresno County used to have enough of the tests to share with other agencies, such as community colleges, where nursing students and instructors at the schools need the test to work in health institutions. Now, Booth said, he doesn't have enough to share.
Fresno City College has had to prioritize who receives the skin tests, said Mary Smith, a college nurse. But so far, nursing students have not been turned away, she said.
The health center at California State University, Fresno, has had enough skin tests, said Wendy Oliver, the director of nursing.
Public schools, such as Fresno and Clovis school districts, escaped the shortage by ordering large quantities of the test in the spring before supplies dwindled nationwide.
But health departments have to constantly replenish supplies for people walking in for skin tests.
Tulare County had adequate supplies of the skin test last week, health officials there said. But in neighboring Kings County, the health department had about 16 skin tests — and they were earmarked for people at high risk for TB, such as those in close contact with people with active disease.
Anyone coming in for a TB test for school or employment reasons was offered the blood test, said Marlene Ayers, a licensed vocational nurse in the TB clinic.
The county has been able to keep the cost of the blood test at $39 by contracting with Tulare County to process the tests, she said. The skin test is $23.
But paying cash for the test at a private lab costs a lot more. "If you had to pay cash, it's around $300," Ayers said. Insurance plans, however, usually cover the tests, she said. "We only send people over to (a private lab) who do have insurance coverage."
Dr. Michael MacLean, health officer for Kings County, said the skin test shortage is another example of critical medicines being in short supply.
"I've given up trying to look at why they have manufacturing problems," he said. "We continually have these problems where the pharmaceutical companies fail us."
The reporter can be reached at (559) 441-6310, firstname.lastname@example.org or @beehealthwriter on Twitter.