CLINICS TURN CORNER IN TB FIGHT : CUTBACKS COULD NULLIFY COUNTY PREVENTION EFFORTS.

Byline: Anne Burke Daily News Staff Writer

Sandra Ramos of Reseda has tested positive for exposure to tuberculosis, but doesn't have the infectious disease. Her mom, Hermelinda, and public health officials want to make sure she never gets it.

So once a month, Hermelinda Ramos drives her 11-year-old daughter to a clean but crude medical clinic in an old chemistry lab at Columbus Middle School in Canoga Park.

The makeshift clinic is one of the front lines in Los Angeles County's battle against tuberculosis.

The numbers of active TB cases in the county have been falling since the epidemic here peaked in 1992. But officials still worry that, with the budget-related closures of dozens of county public health facilities, the numbers could surge again if people who have been exposed to the disease don't get the medicine they need.

Inside the trailer-like building, white-smocked public health nurses distribute free, TB preventive medicine for dozens of mostly low-income neighborhood residents who, like Sandra, have tested positive for TB exposure.

A positive result indicates only that a person has been exposed to the tuberculosis germ. It doesn't mean that the person has the disease or is contagious.

Supervised by a public health nurse, Sandra washes down one pill Isoniazid - known as INH - with a glass of water each morning. When she's completed the course of treatment, she should never have to worry about getting TB.

Preventive medicine

Public health nurse Ida Freelander, who works at the Canoga Park clinic, and other public health nurses have a good reason for making sure that people like Sandra take their pills. Feeling fit and healthy, many patients fail to complete the six- to nine-month pill regimen, especially since their neighborhood county clinic may no longer be open.

Several years ago, the county had more than 40 public health facilities. The number has been slashed to about 10.

``When people feel well, they're not going to go 25 to 30 miles to a clinic,'' especially when they have to take the bus, noted Dr. Shirley L. Fannin, the county's director of communicable disease control.

In the future, if their immune systems are compromised, the disease could break out.

``Preventive medicine is the first line of defense we have against TB,'' said Cindy Chow, a public health nurse for the west San Fernando Valley.

``If it's not taken care of, they will eventually develop TB somewhere down the road. It might be two years, it might be 20 years,'' she said.

County officials believe that their vigilance in the TB war is a factor in the sharp decline in reported cases, which have fallen to approximately pre-epidemic levels.

The epidemic started in 1989, when the number of active cases in the county skyrocketed from 1,190 to 1,681.

By 1992, there were 2,198 reported cases. Particularly hard hit were immigrants from TB-prone countries in Asia and Latin America, people with HIV, and the homeless.

In 1993, the numbers started dropping, to 1,940, then 1,794 in 1994, 1,622 in 1995, and about 1,383 in 1996, according to Laura Knowles, a county epidemiologist.

A nationwide trend

Nationwide, the same trend is evident. Cases peaked at about 26,700 in 1992, dropping to 22,860 in 1995, according to the Centers for Disease Control and Prevention in Atlanta. Last year's figures were not available.

Dr. Paul T. Davidson, the county's director of tuberculosis control, attributed the decline in part to demographic factors, such as a decrease in the rate of immigration among people from TB-prone countries.

But he said the county's aggressive effort to detect and treat TB - particularly among the homeless - figured heavily in the decrease.

To make sure that homeless people complete their TB treatment, the county puts them up in cheap hotels and feeds them while they are taking their medicine, Davidson said.

The annual cost to taxpayers for all efforts to fight TB in the county is at least $24 million, Davidson said. About $6.5 million comes from the federal government, an additional $1.5 million from the state, Davidson said.

But is the crisis in Los Angeles County over? The numbers may not be telling the whole story, officials state.

With the clinic closures, some TB cases may be going unreported, Fannin said.

``We all dearly hope we can say, `Yes . . . hurrah for our side,' '' the epidemic is over, Fannin said. ``But we're a little more cautious about interpreting the numbers.''

One sign that cases could be going unreported: the numbers are dropping precipitously, rather than in a slow curve, Fannin said.

CAPTION(S):

Photo, chart, box

PHOTO (1) Public health nurse Jaimin Kim counts Isoniazid pills, which are prescribed to stop tuberculosis in people who have been exposed to the disease.

Evan Yee/Daily News

Chart: Tuberculosis rates dropping

Box: Tuberculosis at a glance