TB: Non-Risk-Based (Required) Screening and Testing
The CDC (Centers for Disease Control and Prevention) recommends screening only those populations at risk for tuberculosis (TB). However, people without risk factors may need screening as a condition of employment, enrollment in school, admission to a health care facility, or for other reasons.
Screening often consists of the following components:
- A risk assessment
- Symptom evaluation
- Testing, if indicated or required
Other components may also be included, such as chest radiography and collecting specimens for microbiologic examination. For testing, tuberculin skin tests (TSTs) or interferon gamma release assay (IGRA) blood tests can be used. Neither TSTs nor IGRAs, if positive, can differentiate whether an individual has latent TB infection (LTBI) or active TB disease. Individuals with sufficient clinical signs and symptoms of active TB disease but negative testing should still be fully evaluated, especially if risk factors, F-02314 (PDF) are present.
See the 2019 updated CDC guidance on screening and testing for health care personnel page for new national guidelines and resources.
The Wisconsin TB Program (WTBP) encourages clinicians to use the resources below, for the screening and testing of active TB disease or LTBI.
Testing low-risk persons is not generally recommended due to the high likelihood of false positives (see CDC 2017 Testing & Diagnosis guidelines). However, testing may be required for employment upon hire, for enrollment in school, for admission into health care facilities, for intake into correctional facilities, before starting certain medications, or for other reasons. Baseline testing should still be performed for these persons regardless of the results of the risk assessment. Previous documented negative results may be accepted in certain situations.
Please see the resources below for CDC and Wisconsin Department of Health Services, Division of Public Health (DPH), recommendations on screening and testing for health care personnel, residents of care facilities, and corrections.
There are many Wisconsin statutes and administrative codes regulating TB screening and testing, based on the setting or facility type. Please see the TB-Related Wisconsin Statutes and Codes webpage to search for regulations pertinent to your setting.
If you are a health care worker employed in health care or a care facility not listed in the statutes, please see the Tuberculosis Screening and Testing: Health Care Personnel and Caregivers, P-02382 (PDF) and Tuberculosis Screening and Testing: Residents of Care Facilities, P-02382A (PDF) for WTBP screening recommendations.
For correctional staff and detainees, facilities may have their own screening and testing policies based on facility type, risk, and detainee population. See CDC 2006 Screening and Testing in Correctional and Detention Facilities guidelines for recommendations.
For questions regarding the Wisconsin Department of Public Instruction (DPI) school employee examination, F-02284 (PDF), and risk assessment, F-02314a (PDF), forms, see the Resource section (below), the Department of Public Instruction website, or contact the State School Nurse and Health Services Consultant:
Louise Wilson, MS, BSN, RN, NCSN
Louise.Wilson@dpi.wisconsin.gov
School Nursing and Health Services Consultant
Wisconsin Department of Public Instruction
PO Box 7841
125 S. Webster St.
Madison, WI 53707
608-266-8857
The initial risk assessment helps clinicians interpret the results of required testing and decide next steps. For example, for persons who report close contact to an active TB case, the clinician should use the lower 5mm positive TST cut-off instead of the higher 10 or 15 mm cut-off. Furthermore, for a low-risk asymptomatic person with a baseline positive TB test, the CDC recommends performing a second, confirmatory test before diagnosing the person with LTBI (see CDC 2017 Test and Diagnostic guidelines).
In contrast, the primary purpose of the risk assessment in the general population is to help clinicians decide when to perform a TB test.
Performing a chest radiograph and collecting sputum help rule out active disease and confirm that the individual is not infectious.
All persons with a newly positive TB test and persons reporting symptoms of active TB disease should have a chest radiograph. Additionally, people who are reporting symptoms of active TB disease or have an abnormal chest radiograph consistent with TB should have a series of three sputum specimens collected and submitted for smear and culture.
Signs and symptoms of active TB disease in the lungs include:
- A bad cough, lasting three weeks or longer
- Pain in the chest
- Coughing up blood or phlegm from deep inside the lungs (sputum)
- Weakness or fatigue
- Weight loss
- No appetite
- Fever, chills, sweating at night
Please see Sputum Collection: Spontaneously Produced, P-02380 (PDF) for sputum collection instructions (watch instructional video). If sputum specimens are collected, the WTBP advises waiting for both smear and culture results before prescribing treatment for LTBI. Clinicians should also notify the client's local health department of a person with suspected TB.
Both LTBI and active TB disease are treatable. LTBI treatment is strongly encouraged to prevent progression to active TB disease. Many regimens are available, depending on the person's medical history and the susceptibility of the bacteria to antibiotics, if known.
Latent TB infection
See below for common LTBI treatment regimens. See CDC website for more detailed information.
| Drugs | Duration | Frequency |
|---|---|---|
| Isoniazid (INH) and Rifapentine (RPT) | 3 months | Once weekly, usually by directly observed therapy (DOT) |
| Rifampin (RIF) | 4 months | Daily |
| Isoniazid (INH) | 6-9 months | Daily |
Active TB disease
Shown below are the typical regimens for drug-susceptible, uncomplicated pulmonary TB disease. Treatment completion measured by number of doses completed by directly observed therapy (DOT). See current CDC treatment guidelines for more detailed information.
| Intensive Phase | Continuation Phase | Comments | ||
|---|---|---|---|---|
| Isoniazid (INH), Rifampin (Rif), Pyrazinamide (PZA), and Ethambutol (E) | 7 doses/week for 56 doses (8 weeks), or 7 doses/week for 14 doses (2 weeks) then 5 doses/week for 30 doses (6 weeks) | Isoniazid (INH), Rifampin (Rif) | 5-7 doses/week for 18-31 weeks (130-182 doses) | Preferred regimen for patients with new pulmonary TB. |
| Isoniazid (INH), Rifampin (Rif), Pyrazinamide (PZA), and Ethambutol (E) | 7 doses/week for 56 doses (8 weeks), or 7 doses/week for 14 doses (2 weeks) then 5 doses/week for 30 doses (6 weeks) | Isoniazid (INH), Rifampin (Rif) | 3 doses/week for 18-31 weeks (94-110 doses) | Preferred alternative regimen for situations in which frequent DOT is difficult to achieve |
Resources
CDC resources
- NEW 2019 Screening and Testing of Healthcare Personnel guidelines
- NEW Screening and Testing of Healthcare Personnel infographic
- 2005 Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings
- 2006 Screening and Testing in Correctional Settings guidelines
- 2017 Testing and Diagnosis of TB guidelines
- Other CDC guidelines: list of guidelines, covering topics from managing MDR to HIV co-infection
CDC Centers of Excellence (COE) resources
- Curry International Tuberculosis Center: Contains clinical products available for download and ordering; contains link to Drug Resistant TB: A Survival Guide for Clinicians (3rd ed.),
- Mayo Clinic Center for Tuberculosis: Wisconsin's CDC-designated Center of Excellence for TB, provides educational webinars and support for the management of TB and LTBI.
- Southeastern National Tuberculosis Center: The southeast Center of Excellence for TB that provides educational webinars for the management of TB and LTBI.
- Clinical Algorithms and Short Clinical Guides, Heartland National TB Center: An assortment of clinical resources and references.
- Rutgers Global TB Center: Contains an assortment of training guides and archived webinars on TB.
- Skin Test Calipers and Rulers, Southeastern National TB Center: You can order tools for reading TB skin tests here.
DPI resources
- Wisconsin Tuberculosis (TB) Risk Assessment Questionnaire Screen for Wisconsin School Employees, F-02314A: (PDF) Use this form to assess TB risk for new school employees.
- Record of School Employee Examination, F-02284: (PDF) Use this form to document health examinations for new school employees.
- Guidance on School Employee Examinations: (PDF) Use these instructions for screening, testing, and examining school employees.
Department of Health Services, Division of Public Health resources
- TB Risk Assessment and Symptom Evaluation, F-02314 (in English and Spanish): A worksheet to determine a person's risk for TB infection and disease.
- TB Risk Assessment and Symptom Evaluation for Annual Employment Screening, F-02314E (PDF) A worksheet to determine need for repeat TB testing after baseline for health care personnel.
- Tuberculosis Screening and Testing: Health Care Personnel and Caregivers, P-02382 (PDF) A fact sheet outlining recommendations for screening health care workers in Wisconsin.
- Decision Tree: Tuberculosis Screening of Health Care Personnel (HCP) and Caregivers upon Hire, P-02530 (PDF): An algorithm outlining TB screening for HCP and caregivers in Wisconsin.
- Tuberculosis Screening and Testing: Residents of Care Facilities, P-02382A (PDF): A fact sheet outlining recommendations for screening residents of nursing homes, assisted living, and other care facilities.
- Decision Tree: Tuberculosis Screening of Patients/Residents upon Admission to Care Facilities, P-02529 (PDF): An algorithm outlining TB screening for admission of patients/residents to Wisconsin facilities.
- Positive TST-What's next? P-02288 (PDF): A fact sheet outlining steps to take after a positive skin test result.
- Positive IGRA-What's next? P-01182 (PDF): A fact sheet outlining steps to take after a positive IGRA result.
- LTBI FAQ Sheet, P-02429 (PDF): Frequently asked questions about LTBI.
- Latent Tuberculosis Infection (LTBI) Treatments, P-01181 (PDF): See this fact sheet for information on recommended treatment for LTBI.
- Sputum Collection: Spontaneously Produced, P-02380 (PDF): See this fact sheet for spontaneously produced sputum collection instructions.
- Sputum Collection: Nebulized Induction, P-02381 (PDF): See this fact sheet for nebulized sputum induction instructions.
- TB Infection Initial Request for Medication, F-00905: (PDF) Fill out this form to request medication for LTBI from the WTBP.
- Tuberculosis (TB)-Related Wisconsin Statutes and Administrative Codes: A webpage with TB-related Wisconsin regulations requiring TB screening based on setting.
- Local Public Health in Wisconsin: A link to local public health departments in Wisconsin.
Reporting forms
- TB Suspect Case Data form, F-42001 (PDF): A form for reporting suspected active cases of TB.
- Latent Tuberculosis Infection (LTBI) Confidential Case Report form, F-02265 (PDF): Use this form to report cases of LTBI to your local health department.
- Latent Tuberculosis Infection (LTBI) Follow-up form, F-44125 (PDF): Use this form to communicate and document follow-up at the end of LTBI treatment.
- See Reporting and Surveillance webpage for more information on reporting TB in Wisconsin.
Questions about TB? Contact us at DHSWITBProgram@dhs.wisconsin.gov
Phone: 608-261-6319 | Fax: 608-266-0049