Effective July 1, 2012

Purpose

Screening and targeted testing for tuberculosis (TB) is a key strategy for controlling and preventing infection on college and university campuses. Early detection provides an opportunity to promote the health of affected individuals through prompt diagnosis and treatment while preventing potential spread to others. Implementation of a screening and targeted testing program not only addresses this public health concern in campus communities but also contributes to the larger public health goal of reducing the burden of TB in the United States.

Whom To Test

All incoming students will be screened via a paper or electronic form where the student identifies risk factors for TB infection and disease. This screening process will happen through the enrollment/orientation program known as “Hornet Connection” for new domestic students, and “International Orientation” for new international students. As the United States is primarily a low-incidence country, most US born incoming students will not have risk factors and do not need to be tested. Incoming students born in high-incidence countries (defined by the World Health Organization) or with other risk factors must have TB testing done prior to the start of classes. High-risk testing performed at ESU will be done by blood test known as interferon gamma release assay (IGRA). Chest X-rays, PPD’s (skin test), and IGRA tests done outside the U.S. will not be accepted. Tests done in the U.S. must have been done within 6 months of beginning class at ESU to meet these requirements.

Continuing students will be tested only when their activities place them at risk for a new infection (travel to high incidence areas for example) or to meet an academic program requirement.

Students participating in study abroad programs in high incidence areas should be tested prior to departure and 8 to 10 weeks after returning to ESU. A list of students participating in Study Abroad programs will be furnished to Health Services by the Office of International Education, complete with departure and return dates and destinations. Students participating in Study Abroad programs must make an appointment with Health Services for a “Travel Health Consult” at which time appropriate screenings and vaccinations will be addressed.

Students not complying with these requirements may have an administrative hold placed on their enrollment for subsequent semesters.

Procedure for Compliance

All new domestic students are required to complete a brief screening document electronically via their orientation process (currently known as “Hornet Connection”). Students who respond positively to one of these questions will be contacted by Health Services staff for further information regarding their TB risk. Those whose screening reveals increased risk for exposure to Tuberculosis will be required to have TB testing done, including those who:

• Were born in or lived in countries with high prevalence of Tuberculosis
• Travel to high-prevalence countries when travel included living or working among local populations
• Have known close contact with person with active TB
• Report symptoms of active TB

Testing Process

Tuberculin Skin Test(TST) shall only be used with students at low risk of infection or disease. These will primarily be students whose academic program requires it (student teachers, student nurses). The Mantoux test is the only acceptable method, and is performed by injecting a small amount (0.1ml) of purified protein derivative (PPD) intradermally into the volar surface of the forearm. TB Skin testing should be delayed 4 to 6 weeks after administration of live virus vaccine unless administered on the same day.

Interferon Gamma Release Assays (IGRA) Blood tests known as Quantiferon Gold and T-Spot are used for testing high-risk students. It may also be offered to low risk students who have a positive ppd. All positive tests, whether PPD or IGRA, must be followed up with a Chest X-ray.

Interpreting results

Interpretation of the TST depends on both the millimeters of induration and the factors related to risk of exposure to TB disease and risk for progression to TB disease once infected.

>5mm is positive in the following:

● recent close contacts of an individual with infectious TB disease.

● persons with fibrotic changes on a prior Chest Xray, consistent with past TB disease

● organ transplant recipients

● immunosuppressed persons: taking equivalent of >15mg/d of prednisone for>1month; taking TNF-a antagonist.

● persons with HIV/AIDS

>10mm is positive in the following:

● persons born in a high prevalence country or who resided in one for a significant amount of time.

● history of illicit drug use

● mycobacteriology laboratory personnel

● history of resident, worker, or volunteer in high-risk congregate settings

● persons with the following clinical conditions: silicosis, diabetes mellitus, chronic renal failure, leukemias and lymphomas, head, neck or lung cancer, low body weight (>10% under IBW), gastrectomy or intestinal bypass, chronic malabsorption syndromes.

>15mm is positive in the following:

● persons with no known risk factors for TB disease.

IGRA test results are reported as “positive” or “negative”. The quanitferon test will occasionally give an “indeterminate” result, and the T-Spot will occasionally give a “borderline” result. T-Spots done at ESU that are reported as “borderline” will be redrawn at no charge to the student. If the second test remains “borderline” a Chest X-Ray must be done to satisfy compliance.

Management of Positive Tests

All positive results will be reported to Lyon County Public Health and Kansas Department of Health and Environment as required by law. Students with positive TB tests must have a Chest X-Ray. If the Chest X-ray is normal, and the student has no symptoms of TB disease, treatment for Latent Tuberculosis Infection (LTBI) will be offered at no cost. If the Chest X-ray is abnormal, the student must have sputum cultures done through Public Health. Management following sputum results will be at the direction of Public Health.