Student Tuberculosis Screening and Case Management

Student Tuberculosis Screening and Case Management

 

Policy Statement

Tuberculosis (TB) is an infectious disease that typically occurs in the lungs.  TB is prevalent in many countries around the world.  People who work in health care fields may also be at risk.  Individuals can develop active disease with obvious symptoms or become infected without showing signs of illness (known as latent TB infection).  Latent TB cannot be passed on to others but can turn into active TB which is infectious to others.  Screening and treating both latent and active TB helps keep individuals and the TWU community healthy.   

The Texas Woman's University policy regarding tuberculosis screening and case management reflects the recommendations of the Centers for Disease Control and Prevention (CDC) of the United States Department of Health and Human Services and the American College Health Association (ACHA).

The following students are required to have Tuberculosis (TB) Screening:

  1. International Students: All new and newly transferred international students, and new students considered to be international by TAC §21.25(c) (formerly, HB 1403) or TEC 54.052 due to birth or residence outside of the U.S:
    1. Must complete the TB screening process prior to the first day of class.
    2. Tuberculin Skin Testing is NOT accepted for screening for these students (see Screening Procedure).   
    3. Students who are noncompliant with this policy will be blocked from registration and class attendance until they come into compliance
  2. Health Professional Students and Students Requiring Periodic Screening
    1. Must complete TB screening process before beginning clinical rotations and annually thereafter as required by their individual departments and/or clinical assignments  
    2. Students who are noncompliant with this policy will be blocked from attending clinical rotations until they come into compliance
  3. Students with / suspected of Active Tuberculosis:
    1. Persons with signs or symptoms of active tuberculosis or who have close contact with a person with active tuberculosis will undergo screening as determined by a medical practitioner at Student Health Services, Local Health Department, and /or a pulmonary or infectious disease specialist.

Screening Tests

All screening must take place in the United States.  Two types of tuberculosis screening tests are available based on the following criteria:    

  1. Interferon Gamma Release Assays (IGRAs), (also known as TB Blood Tests)
    1. Acceptable screening for international students and for those requiring periodic TB testing.
    2. IGRAs are blood tests that measure interferon gamma (IFN-γ) release in response to antigens representing Mycobacterium tuberculosis.
    3. Commercially available IGRAs include QuantiFERON-TB Gold (QFT-G), QuantiFERON-TB Gold In-Tube (QFT-GIT) and T-Spot, for example.
    4. All positive, indeterminate or borderline results will be followed by chest x-ray.
      1. Individuals with indeterminate or borderline results may choose to rescreen with a different type of IGRA test (e.g. first test QuantiFERON, second test T-Spot) to see if a definite negative or positive results can be obtained.  If follow up test is negative, chest x-ray is not required.
      2. Students needing chest x-ray or choosing repeat testing are required to meet all compliance deadlines
  2. Tuberculin Skin Tests (TSTs)
    1. Acceptable screening for individuals requiring periodic TB screening who meet the following criteria: 
      1. Individuals born or residing in countries designated as low risk for TB by the World Health Organization (WHO) and/or Centers for Disease Control (CDC)
      2. Individuals who have NOT received BCG
      3. Individuals without history of non-tuberculosis mycobacteria infections
      4. Individuals who have not had a positive TB skin test in the past  
    2. TST is NOT acceptable screening for
      1. International Students and for those who were born or resided in or traveled extensively in countries with a high incidence of TB as designated by the World Health Organization (WHO) and/or Center for Disease Control (CDC)
      2. Individuals who have received BCG
      3. Individuals with history of non-tuberculosis mycobacteria infections
      4. Individuals with prior history of positive TB skin test
    3. The only acceptable tuberculin skin test is the Mantoux test using purified protein derivative (PPD).
    4. All positive TSTs will be followed by IGRA testing.

Screening Procedure

  1. New International Students and those considered to be international by TAC §21.25(c) (formerly, HB 1403) or TEC 54.052 due to birth or residence outside of the U.S.
    1. Must complete TWU TB Screening Requirement Form for New Students
      1. Individuals who answer YES to any risk factor for TB are required to have IGRA testing
      2. Individuals born or residing in countries at low risk for TB who also answer NO to all risk factor questions submit the only this form (IGRA not required) 
  2. Individuals who require periodic screening
    1. Either TST or IGRA testing may be utilized for periodic screening required by health professional students or workers, student teachers, volunteers but the SAME testing method must be used for each periodic screening. 
    2. Individuals choosing to be screened by TST must meet criteria as noted in Screening Tests. 
  3. International students and / or individuals who have received BCG (Bacille Calmette-Guerin) vaccine
    1. IGRA testing required. The PPD material used in TST testing contains antigens found in BCG which may lead to possible false positive TST readings resulting in unnecessary chest x-rays and lengthy antibiotic usage for TB prophylaxis.
  4. Individuals with a history of non-tuberculosis mycobacteria infections
    1. IGRA testing will be utilized for all individuals with a history of non-tuberculosis mycobacteria infections because the PPD material contains antigens to several strains of non-tuberculosis mycobacteria leading to possible false positive TST readings resulting in unnecessary chest x-rays and lengthy antibiotic usage.
  5. Individuals with past history of positive TB Skin Test who have NEVER taken antibiotics for TB
    1. IGRA testing REQUIRED
      1. IGRA NEGATIVE
        1. NO chest x-ray required
        2. NO Tuberculosis Clearance Statement required
        3. Individual considered NEGATIVE for TB
      2. IGRA POSITIVE
        1. New chest x-ray required
        2. Tuberculosis Clearance Statement signed by US licensed medical provider required
  6. Individuals who have taken antibiotics for positive TB Skin Tests or IGRA tests Antibiotics taken for positive TB Skin Test
    1. Partial Treatment - Antibiotics started but not completed
      1. IGRA testing NOT required
      2. New chest x-ray required
      3. Tuberculosis Clearance Statement signed by US licensed medical provider required
      4. Submit medical records with TB test results
      5. Individual strongly urged to take full course of antibiotics
    2. Full course of antibiotics taken
      1. IGRA testing NOT required
      2. New chest x-ray required
      3. Tuberculosis Clearance Statement signed by US licensed medical provider required
      4. Submit medical records of TB test results and proof of antibiotic completion.
    3. Avoid repeat TST testing because repeat exposure to PPD material may lead to damage of body tissues at or near the site of PPD injection.  
  7. Individuals with symptoms of active TB (fever, weight loss, bloody sputum for example)
    1. Should be given a mask to wear immediately
    2. Have TST placed or IGRA drawn
    3. Send immediately for Chest x-ray with STAT reading
    4. Local County Health Department to be notified within one working day, as per requirements of Department of State Health Services.  TWU Emergency Management will then be notified to help plan the University’s response to this situation.  
    5. Appropriate antibiotic treatment should be initiated as soon as possible in conjunction with the Local Health Department and/or pulmonary or infections disease specialists.
    6. Individual may not return to campus to attend classes or reside in University Housing without signed statement of non-communicability from US licensed medical professional
  8.  Individuals with contact with person(s) with active TB
    1. Local County Health Departments are closely involved with all cases of active TB and will be contacted for guidance in determining all contacts requiring screening, including initial and follow up testing. 

Chest X-Ray

  1. Most students do NOT require chest x-ray for TB screening. 
  2. Chest x-ray is only required for:
    1. Students with symptoms of active TB
    2. Students requiring TB screening who have taken antibiotics for TB
    3. Students requiring TB screening with positive IGRA test results
  3. Students with positive TST results should have IGRA testing.  If IGRA is negative, chest x-ray is NOT required. 
  4. Submitting Chest x-ray without IGRA test results or proof of antibiotics is NOT permitted and student will NOT be considered compliant.
  5. All individuals with positive, indeterminate or borderline IGRA results will have a chest x-ray within 10 days.
  6. Students requiring TB screening who have taken antibiotics require one chest x-ray
    1. Chest x-ray must be performed within 365 days prior to the first day of classes upon entrance to TWU or initial TB screening. 
    2. Chest x-ray must be done in the United States
    3. A written medical interpretation by a US licensed radiologist is required
  7. Yearly chest x-rays are NEVER required for students needing periodic TB screening
    1. After submitting initial chest x-ray, each year student will see a US licensed medical provide to complete a Tuberculosis Clearance Statement.
    2. Chest x-ray is only required if the student develops symptoms consistent with active TB. 

Antibiotics

  1. Individuals who have positive IGRA testing with a negative chest x-ray and no signs or symptoms of TB will generally be diagnosed with latent tuberculosis infection or LTBI. 
  2. Having LTBI means that a person has been exposed to tuberculosis at some point in life and is now infected with the bacteria that can cause the disease, but the disease remains dormant in the person’s body and the person is NOT contagious. 
  3. LTBI can become active tuberculosis disease that can be infectious.  A person with latent infection has a 10% lifetime risk of developing active tuberculosis disease; at least 50% of this risk occurs within the first 1-2 years after infection. 
  4. All students with indeterminate or borderline IGRA results are encouraged to repeat IGRA testing at a later date to determine if TB infection has or has not occurred.
  5. All individuals with positive IGRA testing and a negative chest x-ray are strongly encouraged to take antibiotics to prevent latent TB infection from developing into active disease.  It is especially critical for all individuals who are or who will be involved in health professions to give this serious consideration to avoid the possibility of infecting others.

Compliance

  1. Acceptable sites for TB screening include TWU Student Health Services, TWU subcontracted health clinics in Dallas and Houston, U.S. licensed private physicians, U.S. licensed medical clinics are all acceptable sources for screening.
  2. New International students [including newly transferred and those considered to be International  by TAC §21.25(c) (formerly, HB 1403) or TEC 54.052]
    1. Submit TWU TB Screening Requirement Form for New Students and all required documentation to TWU Immunizations Coordinator by personal delivery, mail or fax as noted on Form. SHS will notify International Office and/or Student Life Office to remove compliance hold on registration after ALL required documentation has been received and reviewed. 
    2. Documentation required based on TB Screening Form responses:
      1. IGRA results
        1. Negative test results – no other testing or documentation required
        2. Positive or Equivocal results – test results AND
          • Chest x-ray required
          • Tuberculosis Clearance Statement required
      2. Students who have taken TB antibiotics submit
        1. Current chest x-ray required
        2. Tuberculosis Clearance Statement required
        3. Medical records with TB test results and documentation of antibiotics taken, including duration required
      3. NO risk factors for TB – no additional testing or documentation required
  3. Students requiring periodic TB screening
    1. Submit all required documentation to SHS Immunizations Compliance Specialist by submitting to the TWU Patient Portal https://patient-twu.medicatconnect.com/default.aspx. SHS will notify students’ academic departments regarding compliance status.
    2. Documentation required
      1. Negative TST or IGRA results – no additional testing documentation required.
        1. Those submitting TST results must ensure that meet criteria as outlined above in Screening Tests section 
        2. The SAME testing method must be used for each periodic screening. 
      2. Positive TST – IGRA test results required
        1. IGRA results negative – no additional documentation required
      3. Positive or Equivocal IGRA results – test results AND
        1. Chest x-ray required
        2. Tuberculosis Clearance Statement required
    3. Students who have taken TB antibiotics submit
      1. Chest x-ray required for initial submission only
      2. Tuberculosis Clearance Statement required yearly, or other interval as required for periodic screening.
      3. Medical records with TB test results and documentation of antibiotics taken, including duration required
        • Students without copies of records who do not already have copies of their records may use Student Health Services Release of Medical Information form (https://www.twu.edu/media/documents/student-health/medical_records_release_request.pdf)
        • Individuals who cannot provide required medical records must contact the TWU Immunizations Compliance Specialist or other Student Health Services personnel, who may be able to assist with the retrieval of records or determine other appropriate measures to ensure compliance with the TB policy  
  4. Compliance cannot be given until ALL required tests are known; it is not given at the time the test is placed or taken.
  5. All submitted documentation is individually reviewed by the TWU Immunizations Compliance Specialist and/or other Student Health Service personnel.  Students’ records are updated and appropriate TWU departments notified regarding TB compliance.  At peak times, such as near the beginning of semesters, this may take several business days and students are strongly encouraged to plan accordingly.
  6. Noncompliance with the Student Tuberculosis Screening and Case Management Policy requirements may result in a student being blocked from registering and/or attending classes. 

Resources

  1. Information on Tuberculosis https://www.cdc.gov/tb/
  2. SHS website https://www.twu.edu/student-health-services/ 
  3. TB information for International students https://www.twu.edu/student-health-services/international-students/
  4. Tuberculosis (TB) Screening Requirement Form for New Students https://www.twu.edu/student-health-services/tuberculosis-screening/
  5. Tuberculosis Clearance Statement https://www.twu.edu/media/documents/student-health-services/Tuberculosis-Clearance-Statement-04-30-2018.pdf
  6. TWU Patient Portal link https://patient-twu.medicatconnect.com/default.aspx
  7. Request for Release of Medical Information https://www.twu.edu/media/documents/student-health/medical_records_release_request.pdf

Details

Article ID: 34896
Created
Tue 8/8/17 12:45 PM
Modified
Thu 2/14/19 3:21 PM