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Tuberculosis

Annual TB test recommended?

01/12/2007

Question:

My employer requires an annual TB test. I`ve done it for 24 years. Today the clinic I go to questioned getting it done, saying so many tests could create a false positive and were not necessary anyway. Our agency does operate a recovery program, but not in the same city I work in. My office is a counseling program. What are the laws regarding annual testing, and is it bad for me to have so many tests?

Answer:

The laws for tuberculin skin testing are primarily set up at the State level. For example, The Ohio Administrative Code (3701) requires employee tuberculin skin testing for individuals who work in maternity units, schools, nursing homes, adult care facilities, etc. The frequency of the testing may be set by the institution depending on the risk of transmission of tuberculosis (TB) at the work site.

Sometimes, an individual who may not necessarily be regarded as high risk is asked to get annual testing. For example, daycare center workers, teachers, and college students. So depending on what type of “agency” you work for, they may be following their policy or the law.

It is NOT harmful to get multiple skin tests. Multiple tuberculin skin tests in a short period of time may boost one’s immune response to react. A two-step tuberculin skin testing is performed on new employees who will receive serial testing to reduce the likelihood of mistaking a boosted “true” reaction for a “new” infection. For you, after 24 years, an annual tuberculin skin testing is not likely to cause a false positive reaction.

In the United States, it is estimated that 9-14 million people are infected with tuberculosis (latent tuberculosis infection). Without treatment, approximately 5-10% will progress to active tuberculosis disease at some point in their lifetime. Identifying and treating those at highest risk for developing tuberculosis is an important component of tuberculosis elimination.

The current recommendations by the Centers for Disease Control and Prevention (CDC) is for “Targeted Tuberculin Testing”. Targeted testing programs are designed to find persons at high risk for developing TB disease and would benefit from treatment.

High risk individuals include individuals who are employees or residents of a high risk congregate setting, have had recent close or prolonged contact with someone with infectious TB disease, are foreign-born persons from or recent travelers to a high-prevalence area, have a chest radiograph suggesting inactive or past tuberculosis, have HIV infection or another illness that weakens the immune system, are an intravenous drug user, have medical conditions associated with risk of progression to active TB disease, or anyone with signs or symptoms of active TB disease.

References:

Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection. MMWR June 9, 2000

Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, MMWR December 30, 2005.

CDC Guide for Primary Health Care Providers: Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection.

For more information:

Go to the Tuberculosis health topic, where you can:

Response by:

Shu-Hua   Wang, MD, MPH&TM Shu-Hua Wang, MD, MPH&TM
Clinical Assistant Professor of Infectious Diseases
Clinical Assistant Professor of The Division of Epidemiology
College of Medicine
The Ohio State University

Larry S Schlesinger, MD Larry S Schlesinger, MD
Professor:
Molecular Virology, Immunology and Medical Genetics
Microbiology Administration
Environmental Health Sciences
College of Medicine
The Ohio State University