New Guidelines Advise Against Annual TB Testing for Healthcare Personnel

The National Tuberculosis Controllers Association (NTCA), in partnership with the Centers for Disease Control and Prevention (CDC), has released updated recommendations for tuberculosis (TB) screening, testing and treatment of healthcare personnel.

Of note, the updated recommendations advise against annual screening of all healthcare personnel for TB. In an NTCA news release, Dr. Robert Belknap, medical director of the Denver Metro Tuberculosis Clinic, and co-lead of the workgroup that assembled the recommendations states, "The continued routine practice of annual testing has been costly, has resulted in false positive tests for TB infection, and is no longer supported by what we have observed in healthcare settings over time. This movement away from annual testing is long overdue."

As the new recommendations note, "TB rates in the United States have declined substantially; the annual national TB rate in 2017 (2.8 per 100,000 population) represents a 73% decrease from the rate in 1991 (10.4) and a 42% decrease from the rate in 2005. Surveillance data reported to CDC during 1995–2007 revealed that TB incidence rates among healthcare personnel were similar to those in the general population, raising questions about the cost-effectiveness of routine serial occupational testing."

Other recommendations include the following:

  • individual baseline (preplacement) risk assessment;

  • symptom evaluation and testing of persons without prior TB or latent TB infection (LTBI);

  • treatment for healthcare personnel diagnosed with LTBI;

  • annual symptom screening for persons with untreated LTBI; and

  • annual TB education of all healthcare personnel.

The updated recommendations supplement the existing 2005 guidelines for preventing the transmission of TB in healthcare settings.