CDC Guidance on TB Screening for US Healthcare Personnel

SUMMARY:

The CDC performed a systematic review of TB screening, specifically for healthcare personnel and have reassessed the need for serial TB testing.

Updated Recommendations Include

TB screening with an individual risk assessment and symptom evaluation at baseline (preplacement)

TB testing with an interferon-gamma release assay (IGRA) or a tuberculin skin test (TST) for persons without documented prior TB disease or latent TB infection (LTBI)

No routine serial TB testing at any interval after baseline in the absence of a known exposure or ongoing transmission

Encouragement of treatment for all health care personnel with untreated LTBI, unless treatment is contraindicated

Annual symptom screening for health care personnel with untreated LTBI

Annual TB education of all health care personnel

Postexposure Screening and Testing (adequate personnel protection was not used)

SYNOPSIS:

The updated CDC recommendations are based on a comprehensive systematic review of the literature. TB screening includes TB risk assessment, symptom evaluation and TB testing for M. tuberculosis infection.  The CDC also recommends workup for positive TB results or symptoms compatible with TB disease.

KEY POINTS:

  • Recent data suggest that unlike in previous eras, US health care personnel may not be at increased risk for LTBI and TB disease from occupational exposures
    • TB rates: 2017 rate has decreased by 73% from 1991 rate and by 42% from 2005
    • CDC Surveillance data (1995-2007): TB incidence rates among health care personnel were similar to those in the general population
    • Recent retrospective cohort study (n=40,000) at a tertiary U.S. medical center in a low TB-incidence state found an extremely low rate of TST conversion (0.3%) with most not attributable to occupational exposure
    • Evidence exists that IGRAs and TSTs have limitations when it comes to serial testing of health care personnel at low risk for LTBI and TB disease
  • Baseline (preplacement) screening and testing is required to
    • Provide a basis for comparison in the event of a potential or known exposure to M. tuberculosis
  • For healthcare personnel with a positive test and who are asymptomatic
    • If risk assessment is ‘low risk’, follow up with second test (IGRA or TST)
    • Health care personnel should be considered infected only if both the first and second tests are positive

Learn More – Primary Sources:

Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019