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    TB and Hansen's Disease Branch

    MC 1939
    P.O. Box 149347
    Austin, TX 78756-9347

    Phone: 512-533-3000
    Fax: 512-533-3167


    Email the TB Program

Frequently Asked Questions About TB

General Questions About Tuberculosis (TB)

For Health Care Professionals

General Reporting Requirements

For Schools

For Licensed Adult and Child Care Facilities

For Other Congregate Settings

For Correctional Settings

Other Resources



General Questions About Tuberculosis (TB)

What is TB?

Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air.  TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys or the spine.  A person with TB can die if they do not get treatment.

 

What are the symptoms of TB?

The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats.  The symptoms of TB disease of the lungs also include coughing, chest pain, and the coughing up of blood.  Symptoms of TB disease in other parts of the body depend on the area affected.

 

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 difference between TB Infection, and TB disease?

People with TB infection have TB germs in their bodies, but they are not sick because the germs are not active.  These people do not have symptoms of TB disease and they cannot spread the germs to others.  However, they may develop TB disease in the future.  They are often prescribed treatment to prevent them from developing TB disease.

People with TB disease [CDC] are sick from TB germs that are active, meaning that they are multiplying and destroying tissue in their body.  They usually have symptoms of TB disease.  People with TB disease of the lungs or throat are capable of spreading germs to others.  They are prescribed drugs that can treat TB disease.

 

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

A person with TB infection cannot spread germs to other people. You do not need to be tested if you have spent time with someone with TB infection. However, if you have spent time with someone with TB disease or someone with symptoms of TB, you should contact your doctor or local or regional health department for TB screening recommendations.

 

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

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

 

How do I get tested for TB?

There are two tests that can be used to help detect TB infection: a skin test or a TB blood test.

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

The TB blood test [CDC], known as the Interferon Gamma Release Assay (IGRA), measures how the patient’s immune system reacts to the germs that cause TB when present. There are currently two Federal Drug Administration (FDA) approved blood tests on the market: the QuantiFERON®–TB Gold In-Tube test (QFT-GIT) and the T-SPOT®.TB test (T-Spot).

Although the tuberculin skin test has been the most common screening method in Texas, many health departments now use the IGRA test as the standard tool. When choosing a skin test or blood test, consideration can be made based on age, health status (see policy TB 1004), BCG status, and other factors of the person needing the test. 

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

 

How often can TSTs be repeated?

In general, there is no risk associated with repeated tuberculin skin test placements. If a person does not return within 48-72 hours for a tuberculin skin test reading, a second test 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 get tested for TB?

In general, Texas Department of State Health Services does not recommend that low risk individuals be tested for tuberculosis. If a test is needed or recommended, the general public may ask their primary care provider, local clinics, or pharmacies, among other sites. You may also contact your local or regional health department for recommendations regarding individual testing needs.

 

What does a positive TB test mean?

A person with a positive TST or blood test has the TB germ in their body. It does not tell whether or not the person has TB infection or TB disease. Other tests, such as a chest x-ray, symptom screening and a testing of sputum (phlegm), are needed to determine whether the person has TB infection or TB disease.

 

Can I get vaccinated for TB?

There is a vaccine for TB, however it is not generally recommended for use in the United States. Bacille Calmette-Guérin, or BCG [CDC], is a vaccine used in many countries with high rates of TB. BCG vaccination does not completely prevent people from getting TB, but 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 [CDC] 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 effect of the BCG vaccine [CDC] wanes overtime and may have little to no effect on positive TST results among adults who received the vaccine as a child.  

A person with a history of BCG vaccination can be tested and treated for TB infection if they react to the TST. TST reactions [CDC] should be interpreted based on risk stratification regardless of BCG vaccination history. IGRAs use M. tuberculosis specific antigens that do not cross react with BCG, and therefore, do not cause false positive reactions in BCG recipients—this means a blood test, or IGRA, is preferred for BCG vaccinated individuals.

 

Why is TB infection treated?

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

 

How is TB disease treated?

TB disease can be treated by taking multiple drugs for several months, generally 6 to 12 months. It is very important that people who have TB disease finish the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the germs that are still alive 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 watch them take their medications. This is called directly observed therapy (DOT). DOT helps the patient complete treatment in the least amount of time.

DSHS provides TB medications to public health clinics across Texas. These clinics treat patients with TB disease. Also, people who are presumed to have TB may be given treatment while their clinicians perform further testing to confirm or rule 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 recommendations for screening health care workers (HCWs) for TB upon hire?

The Department of State Health Services (DSHS) follows recommendations from the Centers for Disease Control (CDC) for screening health care workers (HCWs) for tuberculosis (TB), however specifications for employee TB screening may be required from your licensing, credentialing or insurance policy.  The Department of State Health Services TB Program does not determine these requirements. 

The CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings (2005) [CDC] recommend that both paid and unpaid health care workers should:

Receive a two-step tuberculin skin test [CDC] or single blood test (called an IGRA) [CDC] when they start work in a health care setting, along with a symptom screening questionnaire. HCWs with a newly positive test result for M. tuberculosis infection should receive one chest radiograph (CXR) to exclude TB disease. HCWs who report signs or symptoms of TB, regardless of skin or blood test result, should be referred for evaluation for TB disease.

 

How do I screen a HCW with a history of a previous positive skin or blood test upon hire?

HCWs with documentation of a previous positive skin test or IGRA result, or documentation of completing treatment for TB infection or disease, should not be re-tested upon hire with a skin or blood test. They should receive a signs and screening questionnaire, and a CXR (unless a recent CXR copy is available) to exclude active disease. After a baseline assessment, serial or routine chest radiographs (CXRs) are not recommended; however, symptoms of TB disease warrant a CXR regardless of history. 

 

What do I need to know if my HCW has received a BCG vaccine?

The tuberculin skin test (TST) and blood tests to detect TB infection are not contraindicated for persons who have been vaccinated with BCG. However, the BCG vaccination may cause a false-positive reaction to the TST, which may complicate decisions about diagnosing TB infection and prescribing treatment.  IGRAs (blood tests for TB) use M. tuberculosis specific antigens that do not cross react with BCG, and therefore, do not cause false positive reactions in BCG recipients – this means an IGRA test is preferred for BCG vaccinated individuals. More information can be found on the CDC website [CDC].

 

How often should HCWs be screened for TB after hire? Is annual testing recommended?

The frequency with which Health Care Workers (HCW) receive additional tuberculosis tests should be determined by the risk of exposure to persons with active TB disease in their work setting. This is done by performing a Risk Assessment [CDC]. The DSHS Congregate Settings Tuberculosis Risk Assessment form may also be used to guide facilities in determining their risk and the frequency of TB testing.

 

Are routine or annual CXRs still recommended?

No, people who have a positive IGRA or tuberculin skin test result should not have repeat chest radiographs performed routinely. Health care workers, patients or institutional residents with a baseline positive or newly positive IGRA or tuberculin skin test result should receive one chest radiograph to exclude a diagnosis of TB disease. Afterwards, it is up to your facility to determine how frequently CXRs should be performed, or how long a CXR will be considered acceptable [CDC]. Again, repeat radiographs are not needed unless signs or symptoms of TB develop, or a clinician recommends a repeat chest radiograph, or after a new exposure to M. tuberculosis. 

Health care institutions’ policies and procedures should include routine symptom screening as part of a comprehensive TB screen for employees and volunteers. The frequency of a comprehensive TB screen should be determined by the Risk Assessment [CDC] for the facility. A comprehensive TB screen includes documented responses on symptoms associated with TB including the results of an IGRA or tuberculin skin test. 

Health care workers who have a previously positive IGRA or tuberculin skin test result and who change jobs should carry documentation of the results of their IGRA or tuberculin skin test, chest radiograph and documentation of treatment history for TB infection, if applicable, to their new employers.

 

Can my health care worker (HCW) with a positive TB skin or blood test return to work?  What further actions do I need to take after my HCW tests positive?

HCWs with a positive skin or blood test should be referred for a CXR and medical evaluation to rule out active TB disease. Once a diagnosis of latent TB infection is made (positive skin or blood test, no symptoms of TB disease, and a CXR that is not consistent with active TB disease), a HCW may return to work, as TB infection is not contagious.

If a HCW has TB infection, treatment should be considered in accordance with CDC guidelines [CDC]. TB infection is reportable to the local or regional health department.  

 

Should HCWs be treated for TB infection? 

Treatment for TB infection should be considered in all persons, to prevent them from developing TB disease. This decision [CDC] should be made with the infected person and their health care provider.

When facilities screen for TB, DSHS recommends that an education component is included in the screening. Education can include what it means to have the TB infection in their body, and the risks for developing TB disease if not treated. 

 

Who can administer a TST?

A TST is considered a medical act and should only be performed by a trained individual working under the order of a licensed clinician (within their scope of practice). There is no requirement for the individual who places the test to be a licensed health care worker, but they should be trained. DSHS recommends those who administer, read, and interpret a TST meet knowledge and clinical skills requirements [CDC], have received training, and demonstrated competency before administering a TST, and prior to interpreting results.

TX DSHS TB Program recommends that anyone who administers a TST and is responsible for documenting and interpreting the results of the TST, has reviewed, is familiar with, and able to readily access the recommendations within the following documents:

In-person training on how to administer a tuberculin skin test (TST) is available through the Heartland National TB Center [Heartland].  Please visit their website for a listing of training opportunities [Heartland].

 


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 within one (1) week to the local or regional health department.  A diagnosis of a latent TB infection is NOT complete until the following criteria have been met:

  1. Positive skin test with results written in millimeters and date read, or positive IGRA blood test results; and
  2. Documentation that patient has no current signs or symptoms [CDC] of active tuberculosis disease; and
  3. CXR results that are read as normal, or not consistent with TB; and
  4. There is no suspicion of Active TB disease

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

 


For Schools

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

There is no statewide requirement for teachers or other school employees to have a tuberculin skin test or TB blood test. The Centers for Disease Control 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 [CDC] 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 need a tuberculin skin test?

No. A tuberculosis questionnaire has been developed by Texas Department of State Health Services to identify children at high risk for TB infection. Refer to the list of counties with a high incidence of TB where use of the questionnaire is recommended prior to entering school. As resources allow, school districts in other counties may use the TB questionnaire to identify 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 disease should NOT 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 child's risk of TB exposure with a questionnaire and offer tuberculin skin testing only to at-risk children. The AAP does not recommend routine tuberculin skin testing of children with no TB risk factors for school entry, day care attendance, WIC eligibility, or camp attendance.

A tuberculin skin test may be applied on the same day as routine immunizations. The skin test will need to be read 48-72 hours later. If a skin test is not placed on or before the day of a live virus immunization such as measles-mumps-rubella (MMR), then the skin test should be postponed at least six weeks.
For more information about TB screening for children in school settings visit the following links:

 


For Licensed Adult and Child Care Facilities

What are the screening requirements for TB testing in Child Care Facilities?

State-licensed facilities must abide by the requirements found on the Department of Family Protective Services (DFPS) website under “Minimum Standards.”

Further guidance on recommendations for screening and testing children in various settings can be found on the Texas Department of State Health Services polices page. See policy TB 1003.

If you are unsure of the requirements for your area, or for recommendations on a screening plan, you may contact the TB Program at the Department of State Health Services (DSHS) regional office.  

 

What are the screening requirements for TB testing in Adult Care  Facilities (e.g., Adult Day Cares, Assisted Living, Nursing Homes, etc.)?

State-licensed facilities must abide by the requirements found on the Department of Aging and Disability Services (DADS) website.

Further guidance on recommendations for screening and testing adults in various settings can be found on the Texas Department of State Health Services polices page. See policy TB 1002

In general, consultation with your regional or local health department TB program is also recommended when considering the impact of TB in your area, and to report tuberculosis. 

 


For Other Congregate Settings

How do I screen for TB in adults working in, living in, or attending other settings?

The Texas Department of State Health Services has outlined screening recommendations for settings not described above. This may include food handlers, barber shops, colleges, and other areas. Please see further recommendations written in policy TB 1002

 


For Correctional Settings

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

The law (Chapter 89 of the Texas Health & Safety Code) in Texas requires county correctional facilities that meet any one of three criteria to screen all inmates for TB by the seventh 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:

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

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

 


Other Resources

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

Centers for Disease Control and Prevention:

HIPAA:

Medical Consultation:

 


Last updated September 18, 2017