Annual tuberculosis screening no longer required for most health care workers

In 2005, CDC published guidelines on tuberculosis (TB) prevention. As part of the prevention strategy, CDC recommended annual testing for health care workers at risk of exposure to TB while performing their jobs. Despite a lack of evidence on the screening’s effectiveness in reducing TB transmission to this population, the recommendation was adopted across the country. A new update to the guidelines suggests that while baseline screening should continue, serial screenings are not needed for health care workers who do not have latent TB.

The national TB rate decreased by 42% from 1991 to 2005, and data from 1995 to 2007 showed that the TB incidence rate was similar in the general population and health care workers. This indicated that TB rates were falling and that health care workers were likely not at an increased risk of TB transmission at their jobs. As a result, in 2015 the National Tuberculosis Controllers Association and CDC formed a workgroup to determine whether the 2005 guidelines needed to be updated.

The workgroup’s research culminated in an updated set of 2019 recommendations for TB screening and testing of U.S. health care workers.

The new guidelines continue to recommend baseline TB screening of all U.S. health care workers, as this baseline is necessary when interpreting subsequent screenings after a potential or known exposure to Myobacterium tuberculosis. As part of the update to the guidelines, a new individual risk assessment—which helps determine the course of action when a result is positive—is recommended for each positive baseline test.

Postexposure screening and testing are unchanged from the 2005 guidelines.

The most notable changes to the 2019 guidelines are those related to serial screening for health care workers who do not have latent TB. Routine re-screening is no longer recommended annually or at any other interval. Of course, patients with a history of latent TB will continue to require follow-up.

Another important change in the 2019 guidelines is the recommendation to encourage treatment for all health care workers who have untreated latent TB (unless contraindicated). Somewhat surprisingly, the 2005 guidelines did not directly recommend treatment in this case—instead they recommended referral to determine if treatment was indicated. 

This change lends an appropriate amount of gravity to encouraging latent TB treatment. With this stronger wording, local public health departments may have an easier time getting people to treat their latent TB.

For the full article, please visit www.pharmacytoday.org for the August 2019 issue of Pharmacy Today.