September 27, 2023
The California Department of Public Health (CDPH) issued a notice that the United States Preventive Services Task Force (USPSTF) has updated guidance on screening for latent tuberculosis infection (LTBI) in adults. Tuberculosis (TB) incidence in California continues to be higher than in the rest of the country, causing pain and death even though it is preventable. Therefore, USPSTF recommends screening for LTBI in asymptomatic adults ages 18 and older to stop new cases of active TB.
Who to test for LTBI
USPSTF recommends testing for TB infection in:
- Asymptomatic adults with risk factors. This includes births or those who live in countries with high TB rates.
- Persons who have lived in high-risk congregate settings.
- Close contact or immunosuppressed persons should also be tested for TB infection by public health programs or by clinical standards of care.
What tests are effective
Instead of using the TB skin test, the Centers for Disease Control and Prevention (CDC) states that the interferon release assays (IGRA) should be given to test adults. The IGRA offers increased specificity, single blood draw and requires no return visit to read the test.
LTBI treatments available
There is no effective vaccine against LTBI. The Bacille Calmette-Guerin (BCG) vaccine doesn't offer lifetime protection. The best tool to date is diagnosing and treating LTBI. The USPSTF evidence summary suggest:
- Treating LTBI with 3-4 month rifamycin-based therapies instead of isoniazid monotherapy.
- Isoniazid monotherapy is associated with poor completion rates and higher rates of liver damage.
Questions?
Please contact CDPH TB Control Branch with any questions.
Resources with additional information
- CDC LTBI Treatment Guidance - Provides several treatment regimens recommended for LTBI.
- Recommendations from the National Tuberculosis Controllers Association and CDC.
- CDC Guidelines for Diagnosis of Tuberculosis in Adults and Children - Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. This is a clinical abstract with an executive summary for providers.
- California TB Adult Risk Assessment and California TB Pediatric Risk Assessment - Provides a risk assessment form and users guide.
- Prevent Tuberculosis in 4 Steps: A Guide for Medical Providers - A clinical algorithm for medical providers on how to test and treat patients for LTBI, produced by the California Department of Public Health.
- How to Talk to Patients about LTBI - Adult and Pediatric: A clinical tool on how to counsel patients about LTBI testing and treatment, produced by the California Department of Public Health.
