USPSTF Latent TB Screening Recommendation

CDC Statement on USPSTF Latent TB Screening Recommendation - September 6, 2016

Statement from Philip LoBue, MD, FACP, FCCP
Director of Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Today the U.S. Preventive Services Task Force (USPSTF) issued a recommendation in the Journal of the American Medical Association (JAMA) encouraging providers to test for latent tuberculosis (TB) infection in populations at increased risk. This recommendation will increase efforts to find and treat people who have latent TB infection and is an important step forward in our national strategy for eliminating TB.

As a nation, the United States has made great progress against TB in recent decades – but eliminating this disease requires that we both strengthen existing systems to track and stop transmission of infectious TB disease and expand efforts to address latent TB infection. This dual approach is essential to eliminating TB as a health threat in the United States.

Latent TB infection (LTBI) is a condition in which a person carries the TB bacteria, but does not have active TB disease and cannot spread it to others. However, if these bacteria become active and multiply, LTBI can turn into TB disease.

CDC estimates that as many as 13 million people in the U.S. have LTBI. Without treatment, about 10 percent of these individuals will develop TB disease, but people with certain risk factors or medical conditions have a higher chance of progression to TB disease. Fortunately, treatment for LTBI is 90 percent effective in preventing activation of TB disease.

The new USPSTF recommendation aligns with CDC recommendations to provide targeted LTBI testing for:

• People who were born in or frequently travel to countries with high TB prevalence
• People who have lived in large group settings, such as homeless shelters and correctional facilities

In addition, CDC recommends LTBI tests:

• For healthcare workers
• For contacts of people with confirmed or suspected TB disease
• As part of disease management for people with certain conditions such as HIV and diabetes
• As indicated before the use of certain medications.

By firmly establishing screening for LTBI as part of the routine preventive care package for people at risk, the new USPSTF recommendation will play a key role in protecting patients from the often-severe consequences of active TB disease. Ensuring that people are aware of their infection is a critical step in linking them to needed preventive treatment. With medical improvements in testing and treating LTBI – including an improved blood test and shorter courses of antibiotics – addressing latent TB infection has never been easier for physicians and patients.

While state and local public health departments have traditionally led TB control and prevention efforts, many people who need testing and treatment for LTBI receive care from private healthcare providers and community health centers. The new USPSTF recommendation offers an opportunity for these private health care providers to expand the reach of traditional testing programs and move us one step closer to TB elimination in the United States.