CDC updates tuberculosis screening, testing recommendations for health care personnel

The CDC recently updated recommendations for screening and testing health care personnel for tuberculosis.

A systematic review of evidence published after release of the 2005 CDC guidelines for preventing Mycobacterium tuberculosis transmission in health care settings found that a low percentage of health care workers have a positive tuberculosis test at baseline and upon serial testing. The CDC published its conclusions in the May 17 Morbidity and Mortality Weekly Report.

Health care workers should be considered to be at increased risk for tuberculosis if they answer “yes” to any of the following statements: residence for a month or more in a country with a high tuberculosis rate; current or planned immunosuppression, including HIV, receipt of an organ transplant, treatment with a tumor necrosis factor-alpha antagonist, chronic steroids, or other immunosuppressive medication; or close contact with someone who has had infectious tuberculosis since the last test.

Using evidence from the systematic review, which was conducted by a National Tuberculosis Controllers Association (NTCA)-CDC work group, and following methods adapted from the Guide to Community Preventive Services, the CDC's recommendations for testing U.S. health care personnel have been updated to include:

1. 1. tuberculosis screening with an individual risk assessment and symptom evaluation at baseline (preplacement),
2. 2. tuberculosis testing with an interferon-gamma release assay or a tuberculin skin test for people without documented prior latent tuberculosis,
3. 3. no routine serial tuberculosis testing at any interval after baseline in the absence of a known exposure or ongoing transmission,
4. 4. encouragement of treatment for all health care personnel with untreated latent tuberculosis, unless treatment is contraindicated,
5. 5. annual symptom screening for health care personnel with untreated latent tuberculosis, and
6. 6. annual tuberculosis education of all health care personnel.

To update the recommendations, researchers did a literature search that resulted in 36 studies in the analysis. Sixteen (44%) of these had been conducted in the U.S., with the remaining studies from Australia (one), Europe (17), Israel (one), and New Zealand (one). Thirty-four (94%) studies had been conducted in a hospital setting; most used either a retrospective cohort or cross-sectional design.