TB Screening Matters
One-third of the world’s population is affected by TB. If exposed to infectious TB, anyone can get infected and progress to disease. Most TB disease is diagnosed in private medical settings with city/county public health departments providing case management support and contact investigations to identify related TB infections and disease. Private providers, working with public health personnel provide prevent large and ongoing outbreaks of TB.
The CDC is offering the following web-based CME course, Interactive Core Curriculum on Tuberculosis: What the Clinician Should Know – Continuing Education Activities.
On September 6, 2016, the Recommendation: Screening for Latent Tuberculosis Infection in Adults was published here JAMA. 2016;316(9):962-969.
Image Source: World Health Organization; Image credit: Rebeccah Robinson
– Who to test:
Persons with a risk for TB.
Avoid testing persons at low risk for TB. Routine testing of
Prioritize persons with risks for progression.
If health system resources do not allow for testing of all foreign-born persons from countries with elevated TB rates, prioritize patients with at least one of the following medical risks for progression: diabetes mellitus, smoker within past 1 year,
The California Department of Public Health (CDPH) in collaboration with CTCA and the Curry International Tuberculosis Center (CITC) created the following risk assessments to reduce low-risk testing and to find TB infection, in order to treat those likely to develop TB disease to prevent illness.
- California Adult Tuberculosis Risk Assessment and User Guide (September 2018 version) (PDF)
- California Pediatric Tuberculosis Risk Assessment and User Guide (September 2018 version) (PDF)
- California TB School Staff and Volunteer Risk Assessment, User Guide, Certificate of Completion, and FAQs
- California TB College and University Students Risk Assessment and User Guide (December 2017 version) (PDF)
BCG, or Bacille Calmette-Guérin, is a vaccine for TB disease. Many persons born outside of the United States have been BCG-vaccinated. BCG vaccination may cause a positive reaction to the TB skin test, which may complicate decisions about prescribing treatment. Despite this potential for BCG to interfere with test results, the TB skin test (TST) is not contraindicated for persons who have been vaccinated with BCG. The presence or size of a TST reaction in these persons does not predict whether BCG will provide any protection against TB disease. Furthermore, the size of a TST reaction in a BCG-vaccinated person is not a factor in determining whether the reaction is caused by latent TB infection (LTBI) or the prior BCG vaccination.
TB blood tests (interferon-gamma release assays or IGRAs), unlike the TB skin tests, are not affected by prior BCG vaccination and are not expected to give a false-positive result in persons who have received prior BCG vaccination.
More on who to test and BCG