USPSTF Recommends Latent TB Screening for Adults at High Risk

The US Preventive Services Task Force (USPSTF) has issued a draft statement recommending that clinicians test for latent tuberculosis (TB) in asymptomatic adults who are at high risk for the infection.

In the statement, the USPSTF notes a number of risk factors for latent infection, including being born in or formerly living in countries where TB is more common, or living in high-risk communal arrangements, such as homeless shelters or correctional facilities, for example. The task force also points out that adults at lower risk for additional TB exposure may only require one screening, while those at a continued risk may need to be tested on an annual basis.
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The task force also found “adequate evidence” that accurate screening tests are available to detect latent tuberculosis, such as the Mantoux tuberculin skin test and interferon-gamma release assays, both of which are moderately sensitive and highly specific. In addition, the USPSTF concluded there are no studies that have evaluated the direct benefits of screening for latent tuberculosis, but did find sufficient proof that treatment of latent tuberculosis with regimens recommended by the Centers for Disease Control and Prevention decreases progression to active tuberculosis. The magnitude of this benefit is “moderate,” according to the USPSTF.

“Primary care practitioners should assess a patient’s risk for latent tuberculosis infection in the primary care setting, to determine if screening is right for the individual,” says Francisco Garcia, MD, a task force member as well as director and chief medical officer of the Pima County Department of Health in Tucson, Ariz.

While the task force did not find compelling evidence to specify a cut-off period for individuals at risk after which risk returns to baseline, “providers are encouraged to use their own clinical judgment in determining who would benefit from screening,” says Garcia. “Factors to consider should include whether the individual has ever been screened before and [the patient’s] ongoing risk of exposure.”

Ultimately, the USPSTF “hopes that this draft recommendation helps primary care practitioners identify patients who are at increased risk for latent tuberculosis,” he says, “so that they can get screened and receive appropriate follow-up.”

—Mark McGraw

Reference:

USPSTF. Draft recommendation statement latent tuberculosis infection: screening. March 2016.
http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement144/latent-tuberculosis-infection-screening.