Original Article

Risk-Based Screening for Latent Tuberculosis Infection

Authors: Connie A. Haley, MD, MPH, Kevin P. Cain, MD, Chang Yu, PhD, Katie F. Garman, MPH, CHES, Charles D. Wells, MD, Kayla F. Laserson, ScD

Abstract


Background: National guidelines recommend targeted tuberculin testing and treatment of latent tuberculosis infection (LTBI) among high-risk groups but discourage testing low-risk persons.


Methods: We determined the LTBI prevalence (tuberculin skin test [TST] reaction ≥10 mm) among adults with and without TB exposure risk factors screened in Tennessee from 1/2/2002 to 4/19/2005. We then quantified LTBI risk among groups at high-risk for TB using multivariate analysis.


Results: Of 53,061 adults tested, the LTBI prevalence was 34% among foreign-born persons, compared with 3.2% among nonforeign-born persons (prevalence odds ratio [POR] 15.7, 95% confidence interval [CI] 14.5–16.8). Among nonforeign-born adults, Asian race (POR 11.7, 95% CI 5.9–23.4), and Hispanic ethnicity (POR 11.7, 95% CI 9.0–15.2) were most strongly associated with LTBI. Only 2.4% of low-risk persons had LTBI.


Conclusions: Risk-based screening can effectively distinguish persons who will benefit from LTBI testing and treatment. Targeted testing programs should prioritize foreign-born persons. Testing of low-risk persons is unnecessary.


Key Points


* The prevalence of latent tuberculosis infection (LTBI) is substantially higher among the foreign-born compared to other groups at high risk for tuberculosis (TB) exposure.


* To have the greatest impact in preventing future TB disease, targeted tuberculin testing programs aimed at identifying and treating persons with LTBI should thus prioritize the foreign-born.


* Risk-based screening of nonforeign-born persons can effectively identify others who will benefit from tuberculin testing and treatment of LTBI.


* The prevalence of LTBI is low among persons without TB exposure risk factors and tuberculin testing of such persons is thus not necessary.



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