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TB Screening and Testing of Health Care PersonnelEspañol (Spanish)							Updated August 30, 2022
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										**The COVID-19 vaccine should not be delayed because of testing for TB infection.** TB skin tests and TB blood tests are not expected to affect the safety or the effectiveness of the COVID-19 vaccine. Visit Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States for more information.Health care workers
Tuberculosis (TB) screening and testing of health care personnel is recommended as part of a TB Infection Control Plan and might be required by state regulations. For TB regulations in your area, please contact your state or local TB control program.
TB screening programs should include anyone working or volunteering in healthcare settings, including:
inpatient settings,
outpatient settings,
laboratories,
emergency medical services,
medical settings in correctional facilities,
home-based health care and outreach settings,
long-term care facilities, and
clinics in homeless shelters.All U.S. health care personnel should be screened for TB upon hire (i.e., preplacement). The local health department should be notified **immediately** if TB disease is suspected. Annual TB testing of health care personnel is **not** recommended unless there is a known exposure or ongoing transmission. Treatment for latent TB infection (LTBI) is strongly encouraged for health care personnel diagnosed with latent TB infection. Shorter treatment regimens, including once-weekly isoniazid and rifapentine for 3 months and daily rifampin for 4 months, should be used as they are more likely to be completed when compared to the traditional regimens of 6 or 9 months of isoniazid.
CDC and the National TB Controllers Association released updated recommendations for TB screening, testing, and treatment of health care personnel on May 17, 2019. These recommendations update the health care personnel screening and testing section of the 2005 CDC Guidelines for Preventing the Transmission of *Mycobacterium tuberculosis* in Health-Care Settings. CDC has developed supporting resources and tools including: Frequently Asked Questions and a Baseline Individual TB Risk Assessment FormFrequency of TB Screening and TestingTB Blood TestTB Skin Test: Two-Step TestingBaselineTBScreening-Testing
**Baseline TB Screening and Testing**
All U.S. health care personnel should be screened for TB upon hire (i.e., preplacement). TB screening is a process that includes:
A baseline individual TB risk assessment,
TB symptom evaluation,
A TB test (e.g., TB blood test or a TB skin test), and
Additional evaluation for TB disease as needed.Information from the baseline individual TB risk assessment  should be used to interpret the results of a TB blood test or TB skin test given upon hire (i.e., preplacement). Health care personnel with a positive TB test result should receive a symptom evaluation and a chest x-ray to rule out TB disease. Additional workup may be needed based on those results.
Health care personnel with a documented history of a prior positive TB test should receive a baseline individual TB risk assessment and TB symptom screen upon hire (i.e., preplacement). A repeat TB test (e.g., TB blood test or a TB skin test) is not required.
**Annual Screening, Testing, and Education**
Annual TB testing of health care personnel is **not** recommended unless there is a known exposure or ongoing transmission at a healthcare facility. Health care personnel with untreated latent TB infection should receive an annual TB symptom screen. Symptoms for TB disease include any of the following: a cough lasting longer than three weeks, unexplained weight loss, night sweats or a fever, and loss of appetite.
Healthcare facilities might consider using annual TB screening for certain groups at increased occupational risk for TB exposure (e.g., pulmonologists or respiratory therapists) or in certain settings if transmission has occurred in the past (e.g., emergency departments). Facilities should work with their state and local health departments to help make these decisions.
All health care personnel should receive TB education annually. TB education should include information on TB risk factors, the signs and symptoms of TB disease, and TB infection control policies and procedures. TB education materials can be found through CDC, the TB Centers of Excellence for Training, Education, and Medical Consultation, NTCA, State TB Programs, and the Find TB Resources website.
**Post-Exposure Screening and Testing**
All health care personnel with a known exposure to TB disease should receive a TB symptom screen and timely testing, if indicated.
Health care personnel with a previous negative TB test result should be tested immediately and re-tested 8 to 10 weeks after the last known exposure. For consistency, the same type of TB test (e.g., TB blood test or TB skin test) should be used upon hire (i.e., preplacement) and for any follow-up testing.
Health care personnel with a documented history of a positive TB test result do not need to be re-tested after exposure to TB. They should receive a TB symptom screen and if they have symptoms of TB, they should be evaluated for TB disease.TB-BloodTest
**Baseline Testing**
The process for baseline testing using a TB blood test is as follows:
Administer TB blood test following proper protocol
Review result
Negative — consider not infected
Positive — consider TB infected and evaluate for TB disease*
Document resultUsing a TB blood test for baseline testing does not require two-step testing. Additionally, TB blood tests are not affected by the BCG vaccine.
* Note: An individual TB risk assessment should be used to help interpret test results and determine whether health care personnel are at increased risk for TB. Low-risk health care personnel who test positive for TB infection should have a second TB test to confirm the result. For example, health care personnel who do not have any TB symptoms, are unlikely to be infected, and are at low risk for progression to TB disease should receive a second TB test if their first test is positive. If the second test is also positive, the health care personnel is considered to have TB infection and they should be evaluated with a chest x-ray and TB symptom screen.
For more information on TB testing and diagnosis, please refer to the 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.TB-SkinTest
**Baseline Testing: Two-Step Test**
If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used. This is because some people with latent TB infection have a negative reaction when tested years after being infected. The first TST may stimulate or boost a reaction. Positive reactions to subsequent TSTs could be misinterpreted as a recent infection.
**Step 1**
Administer first TST following proper protocol
Review result
Positive — consider TB infected, no second TST needed; evaluate for TB disease.*
Negative — a second TST is needed. Retest in 1 to 3 weeks after first TST result is read.
Document result**Step 2**
Administer second TST 1 to 3 weeks after first test
Review results
Positive — consider TB infected and evaluate for TB disease.
Negative — consider person not infected.
Document result******Two-Step TST Testing**
Two-Step-TST-Testing* Note: An individual TB risk assessment should be used to help interpret test results and determine whether health care personnel are at increased risk for TB. Low-risk health care personnel who test positive for TB infection should have a second TB test to confirm the result. For example, health care personnel who do not have any TB symptoms, are unlikely to be infected, and are at low risk for progression to TB disease should receive a second TB test if their first test is positive. If the second test is also positive, the health care personnel is considered to have TB infection and they should be evaluated with a chest x-ray and TB symptom screen.
For more information on TB testing and diagnosis, please refer to the 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.Related LinksFact Sheets on Tuberculosis
Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC
TB Infection Control
TB Screening, Testing, and Treatment of U.S. Health Care Personnel: Frequently Asked Questions (FAQs)
Infographic: Updated Recommendations for Tuberculosis TB- Screening, Testing, and Treatment
Medscape CDC Expert Commentary: Updated Tuberculosis Guidelines for Healthcare Workers
Whiteboard video: Updated TB Testing and Treatment Recommendations for Health Care Personnel
Dear Colleague Letter: May 16, 2019
Tuberculosis among healthcare personnel, United States, 2010–2016
Guidelines for preventing the transmission of *Mycobacterium tuberculosi*s in health-care settings, 2005
State TB Control Offices
Testing and Diagnosis Guidelines
Using the Isoniazid/Rifapentine Regimen to Treat Latent Tuberculosis Infection (LTBI)
Questions and Answers About TB
CDC Info
National TB Controllers Association
							
					
						Page last reviewed:  May 16, 2019					Content source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeTuberculosisBasic TB Factsplus iconHow TB SpreadsLatent TB Infection and TB DiseaseSigns & SymptomsTB Risk FactorsExposure to TBTB PreventionVaccinesTB & HIV CoinfectionTB and DiabetesTB TermsPersonal StoriesTesting & Diagnosisplus iconWho Should be TestedTesting for TB InfectionTesting in BCG-Vaccinated PersonsTB Screening and Testing of Health Care PersonnelTesting During PregnancyDiagnosing latent TB infection and TB diseaseTreatmentplus iconDeciding When to Treat Latent TB InfectionTreatment Regimens for Latent TB Infection (LTBI)Treatment for TB DiseaseAdverse EventsTB Treatment of Persons Living with HIVTB Treatment and PregnancyTB Treatment for ChildrenFrequently Asked QuestionsDrug-Resistant TBResearchplus iconTB Epidemiologic Studies Consortiumplus iconResearch ProjectsPublicationsTB Trials Consortiumplus iconStudy DescriptionsBackgroundBehavioral & Social Science ResearchHealth Care Settingsplus iconTB Infection Control in Health Care SettingsResources for TB Screening and Testing of Health Care Personnelplus iconFrequently Asked QuestionsTB in Specific Populationsplus iconHealth DisparitiesAsian PersonsBlack or African American PersonsHispanic or Latino PersonsChildrenPregnancyCorrectional FacilitiesPeople Experiencing HomelessnessInternational TravelersLaboratory Informationplus iconDrug Susceptibility TestingFalse-Positive Investigation ToolkitInterim Laboratory Biosafety Guidance for XDR  tuberculosis strainsModel Performance Evaluation Program (MPEP)Rapid Molecular Testing to Detect Drug-Resistant TB in the USplus iconExecutive SummaryIntroductionBackground on Tests for Molecular Detection of DRGeneral Considerations and Principles for a Molecular DR Testing ServicePossible Scenarios and Scope of Testing for a Molecular DR Testing ServiceResearch NeedsGeneral Recommendations of the Expert PanelCommunication Plan for the ReportRecommendationsReferencesPanel Members and CDC ParticipantsAppendix 1Appendix 2Appendix 3The Uses of Nucleic Acid Amplification Tests for the Diagnosis of TBplus iconGeneral ConsiderationsGeneral Recommendations of the Expert PanelRecommendations to ACET, CDC, DTBEData & Statisticsplus iconTB Incidence in the United StatesReported TB in the US, 2022 Surveillance Reportplus iconNational DataReporting Area DataRisk FactorsDemographicsTB Treatment and Case OutcomesDrug-Resistant TBMolecular SurveillanceTuberculosis in the United States, 2022 (Slide Set)Archived Surveillance Reports and Slide Sets2021 State and City ReportArchived State and City ReportsProfessional Resources & Toolsplus iconTools for Healthcare ProvidersResources for TB Programsplus iconStrengthening Civil Surgeons’ Capacity to Improve LTBI Surveillance and Outcomes Among Status AdjustersNotice of Funding Opportunity (NOFO)Program EvaluationTB Centers of ExcellenceTB Elimination AllianceTB Genotypingplus iconConventional TB GenotypingWhole Genome SequencingTB GIMSAnalytic ToolsLatent Tuberculosis Infection ResourcesPublications & Productsplus iconPatient and Public MaterialsFact SheetsGuidelinesplus iconControl & EliminationDrug-Resistant TBInfection Control & PreventionLaboratory & GenotypingTB & HIVTB in Specific PopulationsTesting & DiagnosisTreatmentVaccines & ImmunizationsArchived TB GuidelinesGuides & Toolkitsplus iconAggregate ReportsCDC TB Surveillance TrainingCore CurriculumEffective TB Interviewing for Contact InvestigationEthnographic GuidesFalse-Positive Investigation ToolkitForging Partnerships to Eliminate TuberculosisGuide to Application of GenotypingLTBI: A Guide for Primary Health Care ProvidersMantoux Tuberculin Skin Testing ProductsReport of Verified Case of Tuberculosis (RVCT)Self-Study ModulesTB Contact Investigation Interviewing Skills CourseTB eDOT ToolkitUnderstanding the TB Cohort Review ProcessNewslettersplus iconTB Notes, No. 4, 2023TB Notes, No. 3, 2023TB Notes. No. 2, 2023TB Notes. No. 1, 2023TB Notes, No. 4, 2022TB Notes, No. 3, 2022TB Notes, No. 2, 2022TB Notes, No. 1, 2022TB Notes, No. 4, 2021TB Notes, No. 3, 2021TB Notes, No. 2, 2021TB Notes, No. 1, 2021Pamphlets, Brochures, Bookletsplus iconQuestions and AnswersPatient Education SeriesTuberculosis - Get the FactsTuberculosis - The Connection between TB and HIV12-Dose Regimen for Latent TB Infection-Patient Education BrochurePostersplus iconMantoux Tuberculin Skin Test Wall ChartWorld TB DayThink TBStop TBTake on TBReports & Articlesplus iconDTBE Authored Journal ArticlesTuberculosis Laboratory Aggregate ReportsSlide Setsplus iconIntroduction to TuberculosisEpidemiology of Tuberculosis Among Non-U.S.​–Born Persons in the United States, 1993–2016Self-Study Modules on Tuberculosis, 1-5 Slide SetsThe Tuberculosis (TB) in Correctional Settingsplus iconFacilitator GuideIntroduction to TB GenotypingEpidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2017Prevention and Control of Tuberculosis in Correctional and Detention FacilitiesGuidelines for Preventing the Transmission of M. TB in Health care SettingsInvestigation of Contacts of Persons with Infectious TBEpidemiology of Pediatric Tuberculosis in the United StatesTargeted Tuberculosis Testing and Treatment of Latent Tuberculosis InfectionElectronic Tools & ResourcesWeb-Based Courses & Webinarsplus iconTB 101 for Health Care WorkersContent SyndicationInfographicsplus iconSocial Media GraphicsCustomizable Take on TB Infographic with InstructionsEventsWorld TB Dayplus iconU.S. TB ChampionsHistoryFeaturesplus iconTB Risk FactorsTreating Latent TB Infection with Short-Course RegimensWorld Tuberculosis (TB) Day 2021World Tuberculosis (TB) Day 2020Linksplus iconState TB Control OfficesAbout Usplus iconMission Statement and Activitiesplus iconDTBE Strategic PlanNational TB Program ObjectivesOrganization ChartAdvisory Groupsplus iconFederal TB Task Force To receive email updates about this page, enter your email address: Email Address			What's this?				Submit


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