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General TB Questions

For answers to general tuberculosis questions visit the CDC’s Questions and Answers About TB at

FAQ’s for the TB health care provider

Commonly asked TB-related questions for health care providers are listed below by topic. Based on calls placed to our consultation hotline, more FAQ’s will be added in the future.

Pediatric Contacts

Two children, 3 and 4 year olds, are close contacts to an active case of pulmonary TB. Both children have a negative TST, a normal chest x-ray and are asymptomatic. What does the health care provider do next?

Children younger than 5 years of age should be treated for Latent Tuberculosis Infection (LTBI) until the follow-up TST is done 8-10 weeks after the child’s last contact with the infectious case. Treatment is usually with INH (Isoniazid) 10-20mg/km (300mg maximum dose) daily for 9 months. Twice weekly dosing is 20-40mg/km (900mg maximum dose) for 9 months and should be given by Directly Observed Therapy. If the follow-up TST is positive (>5mm) continue the treatment for the recommended period of time; if the test is negative, the treatment should be discontinued.

MMWR Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis, December 16, 2005 /Vol.54/No. RR-15

MMWR Targeted Tuberculin Testing and Treatment of latent Tuberculosis Infection, June 8, 2000 / Vol. 49 / No. RR-6

Pregnancy, BCG, Skin Testing

An OB physician calls about a 24 year old pregnant woman who has recently arrived in this country from Russia (in 2005). She gives a history of BCG vaccination. Should she have a TST?

This person, who is a recent immigrant from a high risk country, should receive a TST. A history of BCG is not a contraindication to a Tuberculin Skin Test nor is pregnancy. If the TST is positive (>10mm), the patient should be assessed for signs and symptoms of TB, have a chest x-ray done and be considered for treatment for LTBI. For women at risk for progression to TB disease, especially those with HIV or recent infection, starting therapy should not be delayed on the basis of pregnancy alone, even during the first trimester. For women at a lower risk to progress to TB disease, some experts recommend waiting until after delivery to start treatment for LTBI.

New Jersey Medical School National Tuberculosis Center / CD Guide for primary Health Care Providers: Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection, 2005

MMWR Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection, June 9, 2000 / Vol. 49 / No. RR-6

CDC Core Curriculum on Tuberculosis (2000)

A school nurse calls because a 17 year old student, who was skin tested prior to participating in a health occupation training program, has a 7mm Tuberculin Skin Test (TST). The student has no risk factors for TB infection and no signs or symptoms of TB disease. The nurse wants to know if this is a positive skin test.

This would be a negative TST. The student can participate in a serial skin testing program with a baseline of 7mm. In order for the skin test to be considered positive there would need to be an increase of 10mm to a result of 17mm.

MMWR Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection, June 9, 2000 / Vol. 49 / No. RR-6

Use of Multiple puncture Tests

A family practice physician calls wanting to know if Tine tests can still be used to screen for TB infection

Multiple puncture tests are not the standard of care for identifying TB infection. The Mantoux skin test and blood assay for M. tuberculosis tests (BAMT) are the only tests recommended by the Centers for Disease Control for use in identifying TB infection.

Tine tests and other multiple puncture tests inject tuberculin into the skin using tiny prongs. There is no way of knowing exactly how much tuberculin is injected into the skin; therefore the result of the test is unreliable. Any reaction to a Tine test or other multiple puncture tests must be followed up by a Mantoux skin test.

CDC Core Curriculum on Tuberculosis (2000)

MMWR Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, December 30, 2005, / Vol.54 / No.RR-17, p. 84

Tuberculin Skin Testing and Live Virus Vaccines

Can a Tuberculin Skin Test (TST) be given at the same time as measles vaccine?

A TST and measles-containing vaccines can be administered at the same visit. Placing the TST and giving the measles-containing vaccine at the same time does not interfere with reading the TST result at 48-72 hours.

If the measles-containing vaccine has been administered recently, TST placement should be delayed >4 weeks after vaccination.

Following the guidelines for measles-containing vaccines when scheduling a TST and administering other parenteral live attenuated virus vaccines is prudent.

Mucosally administered live attenuated virus vaccines (e.g., OPV and intranasally administered influenza vaccine) are unlikely to affect the response to TST. Contact your local TB program for your state policy regarding mucosally administered live attenuated virus vaccines.

MMWR General Recommendations on Immunizations, Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP), February 8, 2002 / Vol.51 / No. RR-2

MMWR Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, December 30, 2005 / Vol. 54/ No. RR-17, p. 84

Staggered Tuberculin Skin Testing

The infection control nurse at the local hospital calls wanting to know if she can do annual skin testing on all the staff on each unit on the same day in the same month.

Stagger follow-up screening (rather than testing all staff at the same time each year) so that all staff who work in the same area are not tested in the same month. Staggered screening (on employment anniversary or birthday) increases the likelihood of earlier detection of TB transmission.

MMWR Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, December 30, 2005 / Vol. 54 No. RR-17, p. 30, p. 83

Where Is It Written? 2004, Jodi Davis, RN, MA, Nurse Consultant, Kentucky Tuberculosis Control Program

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