TB Screening and Testing of Health Care Personnel

Updated August 30, 2022

The COVID-19 vaccine should not be delayed because of testing for TB infection. TB skin tests and TB blood tests are not expected to affect the safety or the effectiveness of the COVID-19 vaccine. Visit Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States for more information.

Tuberculosis (TB) screening and testing of health care personnel is recommended as part of a TB Infection Control Plan and might be required by state regulations. For TB regulations in your area, please contact your state or local TB control program.

TB screening programs should include anyone working or volunteering in healthcare settings, including:

inpatient settings,
outpatient settings,
laboratories,
emergency medical services,
medical settings in correctional facilities,
home-based health care and outreach settings,
long-term care facilities, and
clinics in homeless shelters.

All U.S. health care personnel should be screened for TB upon hire (i.e., preplacement). The local health department should be notified immediately if TB disease is suspected. Annual TB testing of health care personnel is not recommended unless there is a known exposure or ongoing transmission. Treatment for latent TB infection (LTBI) is strongly encouraged for health care personnel diagnosed with latent TB infection. Shorter treatment regimens, including once-weekly isoniazid and rifapentine for 3 months and daily rifampin for 4 months, should be used as they are more likely to be completed when compared to the traditional regimens of 6 or 9 months of isoniazid.

CDC and the National TB Controllers Association released updated recommendations for TB screening, testing, and treatment of health care personnel on May 17, 2019. These recommendations update the health care personnel screening and testing section of the 2005 CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings. CDC has developed supporting resources and tools including: Frequently Asked Questions and a Baseline Individual TB Risk Assessment Form

Baseline TB Screening and Testing

All U.S. health care personnel should be screened for TB upon hire (i.e., preplacement). TB screening is a process that includes:

A baseline individual TB risk assessment,
TB symptom evaluation,
A TB test (e.g., TB blood test or a TB skin test), and
Additional evaluation for TB disease as needed.

Information from the baseline individual TB risk assessment should be used to interpret the results of a TB blood test or TB skin test given upon hire (i.e., preplacement). Health care personnel with a positive TB test result should receive a symptom evaluation and a chest x-ray to rule out TB disease. Additional workup may be needed based on those results.

Health care personnel with a documented history of a prior positive TB test should receive a baseline individual TB risk assessment and TB symptom screen upon hire (i.e., preplacement). A repeat TB test (e.g., TB blood test or a TB skin test) is not required.

Annual Screening, Testing, and Education

Annual TB testing of health care personnel is not recommended unless there is a known exposure or ongoing transmission at a healthcare facility. Health care personnel with untreated latent TB infection should receive an annual TB symptom screen. Symptoms for TB disease include any of the following: a cough lasting longer than three weeks, unexplained weight loss, night sweats or a fever, and loss of appetite.

Healthcare facilities might consider using annual TB screening for certain groups at increased occupational risk for TB exposure (e.g., pulmonologists or respiratory therapists) or in certain settings if transmission has occurred in the past (e.g., emergency departments). Facilities should work with their state and local health departments to help make these decisions.

All health care personnel should receive TB education annually. TB education should include information on TB risk factors, the signs and symptoms of TB disease, and TB infection control policies and procedures. TB education materials can be found through CDC, the TB Centers of Excellence for Training, Education, and Medical Consultation, NTCA, State TB Programs, and the Find TB Resources website.

Post-Exposure Screening and Testing

All health care personnel with a known exposure to TB disease should receive a TB symptom screen and timely testing, if indicated.

Health care personnel with a previous negative TB test result should be tested immediately and re-tested 8 to 10 weeks after the last known exposure. For consistency, the same type of TB test (e.g., TB blood test or TB skin test) should be used upon hire (i.e., preplacement) and for any follow-up testing.
Health care personnel with a documented history of a positive TB test result do not need to be re-tested after exposure to TB. They should receive a TB symptom screen and if they have symptoms of TB, they should be evaluated for TB disease.

Baseline Testing

The process for baseline testing using a TB blood test is as follows:

Administer TB blood test following proper protocol
Review result
- Negative — consider not infected
- Positive — consider TB infected and evaluate for TB disease*
Document result

Using a TB blood test for baseline testing does not require two-step testing. Additionally, TB blood tests are not affected by the BCG vaccine.

* Note: An individual TB risk assessment should be used to help interpret test results and determine whether health care personnel are at increased risk for TB. Low-risk health care personnel who test positive for TB infection should have a second TB test to confirm the result. For example, health care personnel who do not have any TB symptoms, are unlikely to be infected, and are at low risk for progression to TB disease should receive a second TB test if their first test is positive. If the second test is also positive, the health care personnel is considered to have TB infection and they should be evaluated with a chest x-ray and TB symptom screen.

For more information on TB testing and diagnosis, please refer to the Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children.

Baseline Testing: Two-Step Test

If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used. This is because some people with latent TB infection have a negative reaction when tested years after being infected. The first TST may stimulate or boost a reaction. Positive reactions to subsequent TSTs could be misinterpreted as a recent infection.

Step 1

Administer first TST following proper protocol
Review result
- Positive — consider TB infected, no second TST needed; evaluate for TB disease.*
- Negative — a second TST is needed. Retest in 1 to 3 weeks after first TST result is read.
Document result

Step 2

Administer second TST 1 to 3 weeks after first test
Review results
- Positive — consider TB infected and evaluate for TB disease.
- Negative — consider person not infected.
Document result

Two-Step TST Testing

Two-Step-TST-Testing