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Laboratory Tests: Tuberculosis (TB) Screening

Children at high risk for tuberculosis include those born in countries where TB is prevalent, those who are African American or Hispanic, and those who are medically underserved.1,2 Poverty and homelessness are among the factors contributing to the rising numbers of TB cases in recent years. The incidence of tuberculosis in children younger than 2 years is twice that in older children.1

 

Periodicity and Guidelines for Tuberculosis Screening

HealthCheck requires a risk assessment for TB annually and testing for TB with the Mantoux skin test (PPD) if at high risk (HIV-infected children/teens; incarcerated teens):

  • Document: TB risk: [low/high]; if high: [PPD ordered]. (Conduct risk assessment for TB yearly, but place PPD only if risk assessment is positive).
Remember to consult and follow the DC Medicaid HealthCheck Periodicity Schedule.

Screening Guidelines

  • Test for TB using the Mantoux method, an intradermal injection of positive protein derivative (PPD).
  • Provide prompt treatment and additional evaluations annually for all children or teens with positive test results.
  • Maintain complete documentation of all TB test results and follow-up evaluations in the medical record.

 

Risk Assessment

Risk Indicators for TB

  • Contact with adults with infectious TB
  • Family immigration, or travel in regions where TB is prevalent
  • Abnormalities on chest roentgenogram suggestive of TB
  • Clinical evidence of TB
  • HIV-seropositive status
  • Immunosuppressive conditions
  • Other medical risk factors (e.g., Hodgkins's disease, lymphoma, diabetes mellitus, chronic renal failure, malnutrition)
  • Current or previous incarceration
  • Frequent exposure to HIV-infected adults, homeless persons, injection drug users, poor and medically indigent city dwellers, nursing home residents, migrant farmers

 

Resources

Risk indicators drawn from the Centers for Disease Control and Prevention and from the American Academy of Pediatrics.

 

References

1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. 1988. Put Prevention into Practice. Clinician's Handbook of Preventive Services (2nd ed.). Washington, DC: Government Printing Office.

2. Centers for Disease Control and Prevention, Division of Tuberculosis Elimination. TB Facts for Health Care Workers: Populations at Risk for Tuberculosis. Available online at www.cdc.gov/nchstp/tb/faqs/tbfacts/population.htm. Cited December 9, 2003.

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