TB: Non-Risk-Based (Required) Screening and Testing

The Centers for Disease Control and Prevention (CDC) 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, are present.

The Wisconsin TB Program (WTBP) encourages clinicians to use the resources below, for the screening and testing of active TB disease or LTBI.

 

Doctor discussing medical form with patient

 

Please see the 2019 updated CDC guidance on screening and testing for health care personnel page for new national guidelines and resources.

 Does the individual need to be tested if no risk factors are found on the risk assessment?

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.

 What are the regulatory requirements for screening in different settings (schools, corrections, etc)?

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) and Tuberculosis Screening and Testing: Residents of Care Facilities (P-02382A) 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, and risk assessment, F-02314a, forms, please 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
School Nursing and Health Services Consultant
Wisconsin Department of Public Instruction
PO Box 7841
125 S. Webster St.
Madison, WI 53707
608-266-8857

 What is the purpose of a risk assessment if testing is required anyway?

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.

 When do we need to perform a chest x-ray and collect sputum?

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) 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.

 What is the treatment?

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.

Latent LTBI Treatment Regimens
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.

Typical Regimens for Drug-Susceptible, Uncomplicated Pulmonary TB Disease
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

CDC Centers of Excellence (COE) Resources

DPI Resources

Department of Health Services, Division of Public Health Resources

Reporting Forms

Questions about TB? Contact us!
Phone: 608-261-6319 | Fax: 608-266-0049

Last Revised: February 10, 2021