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Guide for Primary Health Care Providers: Targeted
Tuberculin Testing and Treatment of Latent Tuberculosis Infection
2005
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Targeted Tuberculin Testing
Targeted tuberculin testing is an essential TB prevention and control
strategy. Finding and treating those with LTBI reduces the number
of potential TB cases; however, unfocused testing is not cost-effective
or useful. Targeted testing programs should be designed to find
persons at high risk for developing TB disease and who would benefit
from treatment. Once TB disease has been ruled out, treatment of
LTBI should be offered to patients regardless of their age. Tuberculin
testing programs should be conducted only among high-risk groups,
with the intent to treat if LTBI is detected.
However, there may be instances in which health care providers
are asked to test individuals who are not necessarily regarded as
high risk (e.g., daycare center workers, teachers, and college students).
A few simple questions will help health care providers assess a
patient’s risk for LTBI. Appendix
A contains a sample risk assessment tool.
The two available methods of testing for M. tuberculosis infection
are the tuberculin skin test (TST) and an approved blood test: QuantiFERON®-TB
test and QuantiFERON®-TB Gold test (QFT).
Identifying Persons at Risk for Developing TB
Disease
Generally, persons at high risk for developing TB disease fall
into two broad categories: those who have been recently infected
and those with clinical conditions that increase the risk
of progression from LTBI to TB disease.
The risk of progression is greatest in the first 1 or 2 years after
exposure. Persons likely to have been recently infected with M.
tuberculosis include the following:
- Close contacts of a person with infectious TB
- Recent TST converters (persons with baseline testing results
who have an increase of 10 mm or more in the size of the TST reaction
within a 2-year period)
- Persons who have immigrated from TB-endemic regions of the world
(see Appendix B)
- Children ≤ 5 years of age who have a positive TST result
- Persons who work or reside in facilities or institutions with
people who are at high risk for TB, such as hospitals, homeless
shelters, correctional facilities, nursing homes, or residential
facilities for patients with AIDS
Also at risk are those with certain conditions associated with
progression from LTBI to TB disease. These conditions include
- HIV infection
- Injection drug use
- Radiographic evidence of prior healed TB
- Low body weight (≥ 10% below ideal)
- Other medical conditions, such as silicosis, diabetes mellitus,
chronic renal failure or on hemodialysis, gastrectomy, jejunoileal
bypass, solid organ transplant, head and neck cancer, and other
conditions that require prolonged use of prednisone or other immunosuppressive
agents such as TNF-α antagonists.
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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