Tuberculosis screening, testing, and treatment of U.S. health care personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019

Abstract

The 2005 CDC guidelines for preventing Mycobacterium tuberculosis transmission in health care settings include recommendations for baseline tuberculosis (TB) screening of all U.S. health care personnel and annual testing for health care personnel working in mediumrisk settings or settings with potential for ongoing transmission. 1 Using evidence from a systematic review conducted by a National Tuberculosis Controllers Association (NTCA)-CDC work group, and following methods adapted from the Guide to Community Preventive Services, 2,3 the 2005 CDC recommendations for testing U.S. health care personnel have been updated and now include (1) TB screening with an individual risk assessment and symptom evaluation at baseline (preplacement); (2) 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); (3) no routine serial TB testing at any interval after baseline in the absence of a known exposure or ongoing transmission; (4) encouragement of treatment for all health care personnel with untreated LTBI, unless treatment is contraindicated; (5) annual symptom screening for health care personnel with untreated LTBI; and (6) annual TB education of all health care personnel. BACKG ROU N DHistorically, U.S. health care personnel were at increased risk for LTBI and TB disease from occupational exposures; however, recent data suggest that this might no longer be the case. TB rates in the No claim to original US government works. Surgeons 2384 | CDC@AJT United States have declined substantially; the annual national TB rate in 2017 (2.8 per 100 000 population) represents a 73% decrease from the rate in 1991 (10.4) and a 42% decrease from the rate in 2005 (4.8). 4,5 Surveillance data reported to CDC during 1995-2007 revealed that TB incidence rates among health care personnel were similar to those in the general population, 6 raising questions about the cost-effectiveness of routine serial occupational testing. 7 In addition, a recent retrospective cohort study of approximately 40 000 health care personnel at a tertiary U.S. medical center in a low TB-incidence state found an extremely low rate of TST conversion (0.3%) during 1998-2014, with a limited proportion attributable to occupational exposure. 8 Moreover, IGRAs and TSTs have well-documented limitations for serial testing of health care personnel at low risk for LTBI and TB disease. 9,10 ME THODSIn 2015, an NTCA-CDC work group comprising experts in TB, infection control, and occupational health was formed to discuss potential updates to recommendations for health care personnel TB screening and testing. The work group included representation from CDC, state and local public health departments, academia, and occupational health associations. During 2015-2016, the work group met periodically to discuss where updates were needed to the 2005 CDC recommendations and to establish a plan for the review of evidence. In January 2017, the work group commenced a systematic li...

Serial testing of health care workers for tuberculosis infection: A prospective cohort study

“…Finally, it should be noted that the last update of the CDC guidelines in 2019 [25] suggests that in situations where the risk of infection is low, it is not recommended to routinely perform serial screening of HCW. Only at hiring, and in high-risk workers.…”

Tuberculosis: The Interrelationship with Oral Health

“…It is usually secondary to pulmonary or extrapulmonary TB resulting from the bloodstream or by direct extension. 14 It is found as nasal discharge, stuffed nose and formation of crust along with epistaxis. It resembles as fluctuant swelling, i.e.…”

Tuberculosis septic shock, an elusive pathophysiology and hurdles in management: A case report and review of literature

“…The incidence of TB septic shock (TBSS) though not reported, is sporadic. The Center for Disease Control and Prevention have reported a declining incidence in the diagnosis of TB [9] . The rarity of TBSS makes this case series novel.…”