When a Tb Test Need to Be Read

For the Full general Public:

What is TB?
What are the symptoms of TB?
How is TB spread?
Is there a difference between TB Infection, and TB disease?
What should I do if I accept spent time with someone with TB infection?
What should I do if I have been exposed to someone with TB disease?
How practise I become tested for TB?
Who tin administrate a tuberculin skin exam (TST)?
How often can TSTs be repeated?
Where tin I get tested for TB?
What does a positive TB test mean?
Tin I get vaccinated for TB?
What if someone has received the BCG vaccine (which is given in many countries)?
Why is TB infection treated?
How is TB disease treated?
How many people in Texas have TB?

For Wellness Care Professionals

What are the recommendations for screening health care personnel (HCP) for tuberculosis upon rent?
How often should HCP be screened for TB after hire? Is annual testing recommended?
If annual testing with a TST or claret test is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?
How should I screen my employee for TB upon rent if they say they already accept a positive TB skin or blood test?
Can a new rent'due south documented negative tuberculin peel exam (TST) result exist used in performing a baseline two-step TST?
What exercise I need to know if my HCW has received a BCG vaccine?
Are routine or almanac CXRs still recommended?
Can my employee with a positive TB peel or blood examination return to piece of work?
What farther actions do I demand to accept when HCP are diagnosed with TB infection or TB disease?
Should HCP be treated for TB infection?
Have the updated 2019 guidelines for screening HCP for TB changed the demand for a facility risk cess?
Does DSHS have a sample grade that health care facilities may use to certificate TB screening, testing, and education?
Where tin I find more than information regarding screening wellness intendance personnel for TB?

TB and COVID-xix

Exercise COVID-19 and TB share like symptoms?
Are in that location recommendations to delay TB screening in persons recently vaccinated against COVID-19?

Full general Reporting Requirements

How do I written report tuberculosis screening results?

Recommendations for TB Screening of Adults and Children in Diverse Settings

Are there general recommendations about which adults should and should not be screened for TB in Texas, and how to screen them?
Are there general recommendations nigh which children should and should not be screened for TB in Texas, and how to screen them?
What are the screening requirements for TB testing in facilities that provide intendance to children?
What are the screening requirements for TB testing in adult care centers such every bit assisted living facilities?

For Schools

Do all employees in Texas schools nevertheless demand a tuberculin peel exam?
Do all new students in Texas schools still demand a tuberculin peel exam?

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

Other Resources

What are other recommended sites where I can find data about tuberculosis?

For the General Public

What is TB?

Tuberculosis (TB) is a disease acquired by germs that are spread from person to person through the air. TB commonly affects the lungs, but it can also touch on other parts of the trunk, such as the brain, the kidneys or the spine. A person with TB tin die if they practice non get treatment.

What are the symptoms of TB?

The full general symptoms of TB illness include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB affliction of the lungs besides include coughing, breast pain, and the coughing up of blood. Symptoms of TB illness in other parts of the body depend on the area afflicted.

How is TB spread?

TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks or sings. These germs can stay in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB germs can become infected; this is called TB infection or latent TB infection (LTBI). If untreated, TB infection can become TB disease.

Is there a divergence between TB Infection, and TB disease?

People with TB infection accept TB germs in their bodies, simply they are not sick considering the germs are non active. These people exercise not have symptoms of TB disease and they cannot spread the germs to others. Even so, they may develop TB disease in the future. They are frequently prescribed treatment to preclude them from developing TB affliction.

People with TB disease are sick from TB germs that are active, significant that they are multiplying and destroying tissue in their torso. They unremarkably have symptoms of TB illness. People with TB affliction of the lungs or throat are capable of spreading germs to others. They are prescribed drugs that tin can care for TB disease.

What should I practise if I have spent time with someone with TB infection?

A person with TB infection cannot spread germs to other people. Yous practise not demand to be tested if you have spent time with someone with TB infection. Nonetheless, if you accept spent time with someone with TB disease or someone with symptoms of TB, you should contact your doc or local or regional health department for TB screening recommendations.

What should I do if I have been exposed to someone with TB illness?

Not everyone who is exposed to TB becomes infected with the TB germs. If you lot believe you have been exposed to TB, you should contact your dr. or the local wellness department for more information nigh screening and testing.

How do I go tested for TB?

There are 2 tests that can exist used to help observe TB infection: a skin exam or a TB blood exam.

The Mantoux tuberculin skin test (TST) is performed by injecting a small corporeality of fluid (called tuberculin) into the skin in the lower office of the arm. A person given the TST must return within 48 to 72 hours to have a trained health intendance worker look for a reaction on the arm; this must be done in-person.

The TB blood examination, known every bit the Interferon Gamma Release Analysis (IGRA), measures how the patient's immune system reacts to the germs that cause TB when present. There are currently 2 Federal Drug Assistants (FDA) approved claret tests on the market: the QuantiFERON®–TB Aureate In-Tube test (QFT-GIT) and the T-SPOT®.TB test (T-Spot).

Although the tuberculin pare test has been the most mutual screening method in Texas, many wellness departments now apply the IGRA test as the standard tool. When choosing a skin test or claret test, consideration can be made based on historic period, health status (see policy TB 1004), BCG condition, and other factors of the person needing the test.

A positive TST or IGRA simply tells you if yous have TB germs in your body. Other tests may be needed to tell if you have TB disease, such equally a chest ten-ray (CXR) and other laboratory testing of sputum.

Who tin administer a tuberculin skin test (TST)?

A tuberculin pare test (TST) is considered a medical deed and should only be performed past an individual working under the guild of a licensed physician. There is no requirement for the individual to be a licensed health intendance worker. DSHS recommends those that administer a TST come across noesis and clinical skills requirements, take received training, and demonstrated competency before administering a TST.

The Texas DSHS TB Programme recommends that anyone who administers a TST has reviewed, is familiar with, and able to readily access the recommendations within the following documents:

CDC Fact Sheet "Tuberculin Peel Testing"
CDC fact sheet "Targeted Tuberculin Testing and Interpreting Tuberculin pare Test Results"
CDC Mantoux Tuberculin Skin Testing Facilitator Guide
Tubersol package insert (PDF)
Aplisol package insert (PDF)

In person training on how to administer a TST is bachelor through the Heartland National TB Heart. Please visit the Heartland National TB Center website for a listing of training opportunities.

How often tin can TSTs be repeated?

In general, there is no chance associated with repeated tuberculin skin test placements. If a person does not return within 48-72 hours for a tuberculin skin test reading, a 2d examination can be placed as soon as possible. There is no contraindication to repeating the TST, unless a previous TST was associated with a severe reaction.

Where can I go tested for TB?

In general, Texas Department of State Health Services does non recommend that depression take chances individuals be tested for tuberculosis. If a test is needed or recommended, the general public may ask their master intendance provider, local clinics, or pharmacies, among other sites. You may also contact your local or regional health department for recommendations regarding private testing needs.

What does a positive TB test mean?

A person with a positive TST or claret test has the TB germ in their torso. It does not tell whether or not the person has TB infection or TB disease. Other tests, such as a chest 10-ray, symptom screening and a testing of sputum (phlegm), are needed to make up one's mind whether the person has TB infection or TB affliction.

Tin I get vaccinated for TB?

At that place is a vaccine for TB, however it is not generally recommended for utilise in the The states. Bacille Calmette-Guérin, or BCG, is a vaccine used in many countries with loftier rates of TB. BCG vaccination does not completely prevent people from getting TB, only it is used to protect infants and young children from serious, life-threatening diseases, specifically miliary TB and TB meningitis.

What if someone has received the BCG vaccine (which is given in many countries)?

In many parts of the world where TB is common, Bacille Calmette-Guérin, (BCG) vaccine is used to protect infants and young children from serious, life-threatening diseases, specifically miliary TB and TB meningitis. However, it does not completely prevent people from getting TB.

The consequence of the BCG vaccine wanes overtime and may have little to no upshot on positive TST results amongst adults who received the vaccine as a kid.

A person with a history of BCG vaccination tin be tested and treated for TB infection if they react to the TST. TST reactions should exist interpreted based on risk stratification regardless of BCG vaccination history. IGRAs utilize Yard. tuberculosis specific antigens that practise not cantankerous react with BCG, and therefore, do not cause false positive reactions in BCG recipients— this means a blood examination, or IGRA, is preferred for BCG vaccinated individuals.

Why is TB infection treated?

If you have TB infection merely not TB disease, your doctor may want you to take a drug to kill the TB germs and prevent y'all from developing TB disease. The decision about taking treatment for TB infection volition be based on your chances of developing TB disease. Some people are more likely than others to develop TB affliction once they have TB infection. This includes people with HIV infection, people who were recently exposed to someone with TB disease, and people with sure medical conditions.

How is TB illness treated?

TB illness tin be treated past taking multiple drugs for several months, generally 6 to 12 months. Information technology is very important that people who have TB illness finish the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they tin can become sick again; if they practice non accept the drugs correctly, the germs that are withal live may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat. In some situations, local health department staff meets regularly with patients who have TB to spotter them have their medications. This is called direct observed therapy (DOT). DOT helps the patient complete treatment in the least corporeality of time.

DSHS provides TB medications to public health clinics across Texas. These clinics treat patients with TB illness. Also, people who are presumed to have TB may exist given handling while their clinicians perform further testing to confirm or dominion out TB disease.

How many people in Texas have TB?

Each year, DSHS provides information on numbers of TB cases per county. The most current information is found on the TB statistics page.

For Health Care Professionals

What are the recommendations for screening wellness care personnel (HCP) for tuberculosis upon hire?

The Section of Land Wellness Services (DSHS) in partnership with the National Tuberculosis Controllers Association (NTCA) and Centers for Disease Control and Prevention (CDC), recommend that both paid and unpaid health care personnel (HCP) receive the following upon hire:

A unmarried blood examination known equally an interferon gamma release assay (IGRA) or a two-footstep tuberculin peel test (TST);
An individual chance assessment to determine baseline chance for TB and interpret the IGRA or TST results; and
A signs and symptoms screening assessment.

DSHS has adult a sample Baseline Tuberculosis Assessment for Health Intendance Personnel course (PDF) that may be used past health care facilities. DSHS likewise recommends completing the Tuberculosis Screening Results and Work Clearance for Wellness Care Personnel (PDF) after performing a baseline TB assessment.

These recommendations may exist used by health care facilities and other entities to guide the evolution of their internal TB screening policies. These recommendations should non be interpreted equally DSHS policies.

How often should HCP be screened for TB subsequently hire? Is annual testing recommended?

Almanac TB testing using an IGRA or TST is not routinely recommended. Health intendance facilities should perform TB testing and complete a signs and symptoms assessment later on known or ongoing exposure to TB or complete a signs and symptoms cess annually for HCP with untreated TB infection. HCP should also be educated about TB treatment options for TB infection.

DSHS has developed a sample After Rent Tuberculosis Assessment for Health Intendance Personnel grade (PDF) that may exist used for HCP with untreated TB infection or anytime a HCP is tested for TB subsequently hire.

*Annual TB testing using an IGRA or TST and symptom screening may be considered for HCP with significant occupational chance, such as pulmonologists or respiratory therapists in high chance settings, or in settings where TB exposures take occurred in the by (i.e. emergency departments). This decision should be adult past the wellness care staff responsible for infection control and may be done in collaboration with your local wellness department.

If annual testing with a TST or claret test is no longer routinely recommended, should HCP exist checked for symptoms of TB periodically?

DSHS recommends that facilities consider the local epidemiology of TB in their county (PDF), including risk factors for TB (PDF) [CDC] in their staff, and any past TB exposures in the facility when deciding to implement periodic TB screening after baseline testing. The purpose of screening for TB using a signs and symptoms assessment questionnaire is to ensure agile TB is identified early on. Anyone with symptoms of TB should be referred for medical evaluation.

How should I screen my employee for TB upon hire if they say they already have a positive TB skin or blood exam?

HCP with documentation of a previous positive TST or IGRA result, or documentation confirming completion of handling for TB infection or disease, should be screened for TB in the following way:

Complete a TB signs and symptoms cess.
Have a baseline chest x-ray (CXR) performed (unless a recent copy is bachelor).

HCP with documentation of a previous positive TST or IGRA effect should not be re-tested with a TST or IGRA.

After the baseline screening, serial or routine CXRs are non recommended; notwithstanding, persons exhibiting symptoms of TB disease require a CXR regardless of history.

HCP without documentation of the previous examination upshot should undergo baseline screening with a 2-pace TST or an IGRA. An individual chance assessment (PDF) and signs and symptoms screening assessment should also be completed (refer to Baseline Tuberculosis Assessment for Health Care Personnel (PDF)). Copies of the TB screening results and responses to the symptom screen and individual risk assessment should be kept past the employee as documentation in instance of future screenings.

Tin a new hire'south documented negative tuberculin skin test (TST) result be used in performing a baseline ii-pace TST?

Yes, a new hire'due south documentation of a negative TST result can exist recorded every bit step i of the ii-step TST when administered any time during the previous 12 months, if the result was documented in millimeters (mm). The TST administered at hire volition exist recorded equally step two of the two-pace TST.

For more details, refer to the Guidelines for Preventing the Transmission of M. TB in Health-Intendance Setting, 2005 (PDF) [CDC] TB Infection-Control Surveillance.

What exercise I need to know if my employee has received a BCG vaccine?

The IGRA and TST are not contraindicated for persons who have been vaccinated with Bacillus Calmette–Guérin (BCG). The effectiveness of BCG wanes overtime just it may cause a fake-positive reaction to the TST, which may complicate decisions about diagnosing TB infection and prescribing treatment. IGRAs use Grand. tuberculosis specific antigens that practise not cross react with BCG, and therefore, exercise not cause simulated positive reactions in BCG recipients. This means an IGRA test is preferred for BCG vaccinated individuals. More information tin be establish on the CDC website.

Are routine or annual CXRs still recommended?

No, breast ten-rays should not be performed routinely or annually for persons with a positive IGRA or TST. Health care personnel, patients or institutional residents with a baseline positive or newly positive IGRA or TST result who are likely to be infected with TB should receive one breast radiograph to exclude a diagnosis of TB disease. Repeat chest x-rays are not needed unless signs or symptoms of TB develop, or a clinician recommends a repeat breast radiograph, or afterwards a new exposure to TB.

Health intendance personnel who have a previously positive IGRA or TST outcome and who change jobs should carry documentation of the results of their IGRA or TST, breast radiograph and documentation of treatment history for TB infection, if applicable, to their new employer.

Can my employee with a positive TB skin or blood examination return to work?

HCP who are probable * infected with TB based on a positive TST or IGRA result and individual risk, should exist referred for a CXR and medical evaluation to rule out active TB prior to returning to work. If a diagnosis of TB infection is made, HCP may return to work, equally TB infection is not contagious. They should exist educated on treatment options for TB infection to minimize their chance of developing TB disease.

HCP who are asymptomatic, unlikely* to be infected with TB, and who are at depression risk for progression to TB disease based on individual take chances, should take a 2nd test (either an IGRA or a TST) if their first examination is positive. Merely when the 2nd test is positive in low gamble individuals is TB infection considered an accurate diagnosis (PDF).

What farther actions do I demand to accept when HCP are diagnosed with TB infection or TB disease?

TB infection, TB affliction, and suspicion of TB disease are all reportable to your local health section. See How exercise I report TB? for reporting requirements.

Should HCP be treated for TB infection?

Treatment for TB infection should exist considered in all persons to prevent the progression to TB disease. This decision should be fabricated between the HCP and their health care provider.

When facilities screen for TB, DSHS recommends that an annual education component is included in the screening programme. Pedagogy tin can include information on signs and symptoms of TB, the divergence between TB infection and affliction, TB chance factors, and the risks for developing TB disease if not treated.

Have the updated 2019 guidelines for screening HCP for TB changed the need for a facility adventure assessment?

No, facility risk assessments are even so recommended. The results of the assessment are no longer used to determine frequency of TB screening but are useful in documenting infection control in facilities. Refer to the CDC website for more details on the use of the hazard cess and updates to the 2019 guidelines.

Does DSHS accept a sample form that wellness care facilities may apply to document TB screening, testing, and education?

Yes. DSHS has developed the following forms that facilities may use or modify to fit their need.

Baseline Tuberculosis Assessment for Wellness Care Personnel (PDF). It is intended for use in health intendance facilities when assessing employees for TB upon rent.
Afterwards Hire Tuberculosis Assessment for Health Care Personnel (PDF). It is intended for employ in health care facilities when assessing employees for TB any fourth dimension after baseline screening.
Tuberculosis Screening Results and Work Clearance for Health Care Personnel (PDF). It allows facilities to document results of baseline and after rent screening including the recommended annual education.

These forms are not required by DSHS but may be used to guide and document facility screening practices, as they marshal with DSHS and CDC recommendations.

Where can I observe more information regarding screening health care personnel for TB?

Refer to the Centers for Disease Control and Prevention (CDC) website for more information.

TB and COVID-xix

Do COVID-19 and TB share like symptoms?

Yes, TB and COVID-19 have some similar symptoms such as a cough or a fever. Just a licensed healthcare provider can make up one's mind the cause of symptoms and further testing may be needed. For healthcare providers, it is important to "Call up TB" when symptoms and risk factors for TB are present. Run across Tuberculosis and COVID-xix Know the Difference (PDF) for details.

Are at that place recommendations to filibuster TB screening in persons recently vaccinated against COVID-xix?

No, TB screening should not be delayed for people with risk factors for TB who take been vaccinated against COVID-xix. The Centers for Illness Command and Prevention (CDC) has information about TB screening practices and the COVID-19 vaccine.

It is recommended that those in charge of TB screening visit the CDC website periodically for whatever updates regarding TB screening practices. When considering the impact of TB in your area, please consult with your regional or local health department (R/LHD). Written report suspected and confirmed TB infections to your R/LHD.

General Reporting Requirements

How do I report tuberculosis screening results?

Both TB infection and TB disease are Notifiable Conditions reportable to the local or regional health department TB Programs. Reporting details can be found on the DSHS website, which include reporting forms.

Tuberculosis Infection- Reportable inside one (1) week to the local or regional health department. A diagnosis of a latent TB infection is Non complete until the post-obit criteria have been met:

Positive skin test with results written in millimeters and date read, or positive IGRA claret test results; and
Documentation that patient has no current signs or symptoms of active tuberculosis disease; and
CXR results that are read as normal, or not consistent with TB; and
There is no suspicion of Active TB disease

TB Disease or Suspicion of TB Disease- Reportable within one (1) working day.

Recommendations for TB Screening of Adults and Children in Various Settings

Are there general recommendations nigh which adults should and should non exist screened for TB in Texas, and how to screen them?

Yes, the DSHS TB Unit has recommendations for TB screening of adults in Texas, depending on identified TB adventure factors. Please refer to information in Tuberculosis Screening Recommendations for Adults in Various Settings (TB-1002) (PDF).

Are there full general recommendations well-nigh which children should and should not be screened for TB in Texas, and how to screen them?

Yes, the DSHS TB Unit has recommendations for TB screening of children in Texas, depending on identified TB risk factors. Please refer to information in Tuberculosis Screening Recommendations for Children in Various Settings (TB-1003) (PDF).

What are the screening requirements for TB testing in facilities that provide care to children?

Facilities with a permit or license from Texas Health and Human Services (HHS) to provide care to children will abide by the chapters that apply to each type of facility in the Texas Authoritative Code (TAC) Championship 26, Office 1.

The Minimum Standards page on the HHS website contains links to the standards related to daycare facilities, 24-hour residential care, and child-placing agencies. These links are located at the bottom of the page.

Any facilities that provide care to children and are not listed above should commencement review the Texas Administrative Code for any statutory requirements or check with their licensing or credentialing agency. Collaboration with a local or regional TB program may aid in developing screening, testing, and treatment plans.

What are the screening requirements for TB testing in developed care centers such as assisted living facilities?

Facilities licensed by HHS for adult care in Type A and Type B Assisted Living Facilities will abide by Texas Administrative Code (TAC) Championship 26, Role 1, Chapter 553, Subchapter C, Rule §553.41. TB requirements are summarized below; however, each facility should review the TAC for specific details:

Facilities must develop written policies for the control of infectious disease in employees and clients, including TB screening and the provision of a safe and germ-free environment for clients and their families.
Screen employees for TB within two weeks of employment.
After rent, facilities must follow CDC guidance in Tuberculosis Screening, Testing, and Treatment of U.S. Wellness Care Personnel: Recommendations from the National Tuberculosis Controllers Clan and CDC, 2019. Meet FAQs for Health Intendance Professionals.
Facilities must screen residents for TB upon access and later exposure to TB.
Any facilities that provide care to adults and are non listed to a higher place review the Texas Administrative Lawmaking for whatever statutory requirements or check with their licensing or credentialing bureau. Collaboration with a local or regional TB program may help in developing screening, testing, and treatment plans.

For Schools

Do all employees in Texas schools nevertheless need a tuberculin skin test?

In that location is no statewide requirement for teachers or other schoolhouse employees to take a tuberculin skin exam or TB claret test. The Centers for Affliction Command and Prevention (CDC) and DSHS discourage the use of the tuberculin skin testing or IGRA blood test for persons who have no risk factors for TB exposure.

However, anyone with signs or symptoms of TB should be considered for medical evaluation.

Specifications for employee or volunteer TB screening may be required by a licensing, credentialing, or insurance policy, or by the school district's regulations and requirements. Each school should defer to their own policy.

Do all new students in Texas schools still demand a tuberculin skin exam?

No. A tuberculosis questionnaire has been adult by Texas Section of State Health Services to identify children at high risk for TB infection. Refer to the list of counties with a loftier incidence of TB (PDF) where use of the questionnaire is recommended prior to inbound school. As resources allow, school districts in other counties may use the TB questionnaire to place children who should receive a TB skin test prior to school entry.

Children who have a positive reaction to the TB skin test but no symptoms of TB illness should Non be kept out of school while they are being evaluated for treatment of TB infection.

The American Academy of Pediatrics (AAP) recommends that physicians routinely assess a kid's risk of TB exposure with a questionnaire and offer tuberculin pare testing only to at-risk children. The AAP does not recommend routine tuberculin skin testing of children with no TB adventure factors for school entry, day intendance attendance, WIC eligibility, or camp attendance.

A tuberculin skin test may be applied on the same twenty-four hour period as routine immunizations. The pare examination will demand to be read 48-72 hours later. If a skin test is not placed on or earlier the twenty-four hour period of a live virus immunization such equally measles-mumps-rubella (MMR), and then the pare test should exist postponed at least half dozen weeks.

For more information well-nigh TB screening for children in school settings visit the following links:

Recommendations for TB Screening of School Aged Children (PDF)
Tuberculosis Questionnaire in English language (DOC)
Tuberculosis Questionnaire (en Español) (Physician)

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

The law (Chapter 89 of the Texas Wellness & Safe Code) in Texas requires county correctional facilities that run into whatsoever 1 of three criteria to screen all inmates for TB by the seventh mean solar day of incarceration and annually thereafter, and to screen all employees and volunteers both pre-employment and annually thereafter.

The three criteria are as follows:

a capacity of 100 or more than beds,
housing inmates transferred from a county that has a jail with a capacity of 100 or more beds, or
housing inmates from another state.

The law also requires all correctional facilities in the state, including youth detention facilities, regardless of whether they come across the criteria stated above, to written report to the Texas Section of State Health Services, Infectious Affliction Intervention and Control Branch, the release of inmates being treated for TB and so that the Department can arrange for continuity of care.

Other Resource

What are other recommended sites where I can find information about tuberculosis?

Centers for Disease Control and Prevention:

Basic TB Facts
Tuberculosis Fact Sheet
Tuberculosis Fact Sheet (PDF) Courtesy of the CDC

HIPAA:

Frequently asked questions about HIPAA Privacy Dominion

Medical Consultation:

TB Medical Consultation Process

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Source: https://dshs.texas.gov/disease/tb/faq.shtm