Senthllingam M.; (2016), "Ending TB: The race to control a disease in hiding". London School of Hygiene and Tropical Medicine
Source: World Health Organization; Image credit: Rebeccah Robinson
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. doi:10.1001/jama.2016.11046. Stating "...accurate screening tests for LTBI are available, treatment of LTBI provides a moderate health benefit in preventing progression to active disease, and the harms of screening and treatment are small."
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.
College and University Student
TB Risk Assessment
and User Guide PDF
CDPH, CTCA Dec 2017
California TB Risk Assessment
CDPH, CITC, CTCA Dec 2017
School staff and volunteers with frequent and prolonged contact with students are required to submit to this TB risk assessment or choose to be tested for TB at hire and every four years, to protect children from active TB disease and to eliminate TB testing those without risks for TB. A frequently asked questions document is provided. More information about related laws can be found here.
School Staff and Volunteer TB Risk Assessment and User Guide PDF
CDPH, CTCA October 2016
School Staff and Volunteer TB Risk Assessment Frequently Asked Questions PDF
CDPH, CTCA October 2016
A Fact Sheet is available to use in your office, clinic or community center.
(Print on both sides of the paper and use "actual size.")
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 is not contraindicated for persons who have been vaccinated with BCG. The presence or size of a TB skin test reaction in these persons does not predict whether BCG will provide any protection against TB disease. Furthermore, the size of a TB skin test 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.
For more information on who to test for TB go to: cdc.gov/tb/publications/factsheets/testing/skintestresults.pdf
Avoid testing persons at low risk
Routine testing of low risk populations is not recommended and may result in unnecessary evaluations and treatment because of falsely positive test results.
Prioritize persons with risks for progression
If health system resources do not allow for testing of all foreign-born persons from a country with an elevated TB rate, prioritize patients with at least one of the following medical risks for progression: diabetes mellitus, smoker within past 1 year, end stage renal disease, leukemia or lymphoma, silicosis, cancer of head or neck, intestinal bypass/gastrectomy, chronic malabsorption, body mass index ≤ 20, history of chest x-ray findings suggestive of previous or inactive TB (no prior treatment). Includes fibrosis or non-calcified nodules, but does not include solitary calcified nodule or isolated pleural thickening. In addition to LTBI testing, evaluate for active TB disease.
If LTBI 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 Calfornia Department of Public Health TB Control Branch information about the 12 dose treatment
Additonal information for Health Care Providers:
Additional guidance for the care and control of TB in California can be found through the following linked pages on this website:
CDPH-CTCA Joint Guidelines
IGRA Fact Sheet
CDC TB Fact Sheets; TB Elimination