Practice Guidelines

Tuberculosis Screening, Testing, and Treatment in U.S. Health Care Professionals: CDC Releases Updated Recommendations

 

Am Fam Physician. 2020 Mar 1;101(5):312-313.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Health care professionals should be assessed for TB risk with baseline TB testing and confirmation of positive results in low-risk patients.

• Health care professionals with LTBI are strongly encouraged to receive treatment.

• Routine serial TB testing is no longer recommended for health care professionals.

From the AFP Editors

Although U.S. health care professionals previously had a higher risk for tuberculosis (TB) and latent TB infection (LTBI) due to occupational exposure, this may no longer be true. The annual national TB rate in 2017 (2.8 per 100,000 population) shows a substantial decline, with a 42% decrease from 2005 and a 73% decrease from 1991. According to 1995–2007 surveillance data reported to the Centers for Disease Control and Prevention (CDC) and National Tuberculosis Controllers Association work group, TB incidence rates in health care professionals were similar to those in the general population.

Methods and Findings

Findings from a 2018 systematic review show that 3% of U.S. health care professionals have positive tuberculin skin test (TST) results and that 0.7% change from negative to positive with serial testing. For the interferon-gamma release assay (IGRA), 5% of health care workers test positive, and 4% change from negative to positive during serial testing. For those with positive initial testing, repeat testing was negative in 48% of cases by IGRA and 62% by TST. Whereas the clinical implications of conflicting test results have not been studied, none of the 63,975 U.S. health care professionals studied experienced TB disease.

Updated Recommendations

For health care professionals without documented previous LTBI or TB disease, TB screening includes TB risk assessment, symptom evaluation, and TB testing for Mycobacterium tuberculosis infection by IGRA or TST. The CDC does not differentiate between IGRA and TST as the preferred test.

BASELINE (PREPLACEMENT) SCREENING AND TESTING

Baseline TB screening for all U.S. health care professionals includes testing with IGRA or TST and individual risk assessment. Increased risk for TB disease occurs if a person has any of the conditions listed in Table 1.

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TABLE 1.

Risk Factors for Tuberculosis in Health Care Professionals

Residence for more than one month outside the following countries:

 Australia

 Canada

 New Zealand

 United States

 Western or Northern Europe

Current or planned immunosuppression, including:

 HIV infection

 Receipt of organ transplant

 Steroid use (equivalent to prednisone, 15 mg daily for one month)

 Tumor necrosis factor inhibitor use (infliximab [Remicade], etanercept [Enbrel])

 Use of any other immunosuppressive medication

Close contact with someone who has infectious tuberculosis

TABLE 1.

Risk Factors for Tuberculosis in Health Care Professionals

Residence for more than one month outside the following countries:

 Australia

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

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