Resources for Medical Providers
Who To Test:
Persons with a 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) Tuberculosis Control Branch (TBCB), and the Curry International Tuberculosis Center (CITC) worked with CTCA volunteers to create four TB risk assessments. The risk assessments identify those in California at risk for TB infection which can become TB disease. We aim to find and treat TB infection before TB disease develops.
The 5/6/20 update to the School Staff and Volunteer Risk Assessment, User Guide, Certificate of Completion, and FAQs states telehealth/remote visits are an option for face to face administration of this Risk Assessment.
BCG, or Bacille Calmette-Guérin, is a vaccine for TB given to many born outside of the United States.
TB blood tests (interferon-gamma release assays or IGRAs), are not affected by prior BCG vacinnation, unlike the TB skin tests. IGRAs are not expected to give a false-positive result in persons who have received prior BCG vaccination.
BCG vaccine may cause a positive reaction to the TB skin test, complicating decisions about 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.
More on who to test and BCG
Links to Additional Resources on CTCA.ORG
If TB test is positive and TB disease is ruled out, LTBI treatment may be recommended. Consult with your public health department TB Control Program, and see California Department of Public Health TB Control Branch treatment information (last updated Sep 2018)
TB Screening Matters
One out of four people alive today 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. (page updated May, 2016)
On September 6, 2016, the Recommendation: Screening for Latent Tuberculosis Infection in Adults was published here JAMA. 2016;316(9):962-969.