ADH Update on TB Testing

The Arkansas Department of Health is in the process of updating its Tuberculosis (TB) rules based on latest guidelines released by CDC for screening and testing healthcare workers (these include staff at hospitals, nursing home, medical offices, clinics and other related medical facilities). We are also updating rules for other groups whom we consider low risk based on data available with ADH. The process should be completed by late fall of 2019. In the meantime, ADH wanted all stakeholders to be informed of the upcoming changes, especially due to impending shortage of TB testing materials.

Due to the changes in CDC guidelines and our proposed changes to rules regarding TB testing based on this and considering the impending shortage of TB testing materials, ADH will defer from enforcing rules at this period of time.

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. (No retesting is required if you switch jobs and provide proof of baseline testing).
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.
6. Annual TB education of all health care personnel.

Employers are requested to provide employees documentation of TB test results and employees are requested to have copies of these results to avoid retesting at other facilities you may work in.

Due to low risk of transmission in Arkansas, we are also changing rules for the below categories

1. Employees of correctional facilities and also for inmates at these correctional facilities.
2. Employees of homeless shelters.       
3. Employees of child and adult day care centers.

• Substitute IGRA blood tests for TSTs.
• Prioritize allocation of TSTs, in consultation with state and local public health authorities.

Prioritization might require the deferment of testing some persons. CDC recommends testing only for persons who are at risk of TB. High-risk groups for TB infection include:

• People who are recent contacts exposed to persons with TB disease;
• People born in or who frequently travel to countries where TB disease is common;
• People who currently or used to live in large group settings, such as homeless shelters or correctional facilities;
• People with weaker immune systems, such as those with certain health conditions or taking certain medications that may alter immunity;
• Children, especially those under age 5, if they are in one of the risk groups noted above.

Please note that active and latent tuberculosis are reportable to ADH as before. Call the ADH TB program at 501-661-2152 with questions or concerns.

Please see attached schematic to help aid in testing strategies.

Naveen Patil, MD, MHSA, MA, FIDSA

State TB Control Officer

Medical Director

Infectious Diseases Branch

Healthcare Associated Infections

Antimicrobial Stewardship Initiative