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Policy Name: Student Tuberculosis Screening and Case Management
Policy No: 6.01
Date Passed: June 6, 2014
Last Reviewed: June 6, 2014
Review Next: August 2017

Student Tuberculosis Screening and Case Management

The Texas Woman’s University policy will become effective on August 23, 2010 for all Health Professional Students, new International Students, except as set out below, and other individuals requiring periodic screening.

The requirement for screening to take place in the United States takes effect on September 16, 2010, and the acceptability of a completed Statement of Tuberculosis Clearance - International Students, signed by a licensed health official from the student's country of origin, ends on September 15, 2010.

For all newly admitted International Students who transfer to Texas Woman's University from another U.S. university or college and for new undocumented students, regardless of the date of entry into the United States, this policy will become effective on January 3, 2011.

This policy supersedes all other information on tuberculosis screening available on the Texas Woman's University website and in other printed materials from Texas Woman's University.

The Texas Woman's University policy regarding tuberculosis screening and case management reflects the recommendations of the Centers for Disease Control and Prevention (CDC) of the United States Department of Health and Human Services and the American College Health Association (ACHA).

  • All new international, newly transferred international students, and undocumented students are required to have completed the appropriate screening process for tuberculosis prior to the first day of class.
    • Students who are noncompliant with this policy will be blocked from registration and class attendance until they come into compliance.
  • Health Professional Students will undergo tuberculosis screening before beginning clinical rotations and annually thereafter as required by their individual departments and/or clinical assignments.
    • Students who are noncompliant with this policy will be blocked from attending clinical rotations until they come into compliance.
  • Persons with signs or symptoms of active tuberculosis or who have close contact with a person with active tuberculosis will undergo screening as determined by a medical practitioner at Student Health Services and/or a pulmonary or infectious disease specialist, in conjunction with the Local County Health Department.

Screening Tests

All screening must take place in the United States.  Two types of tuberculosis screening tests are acceptable. 

  1. Tuberculin Skin Tests (TSTs)
    1. The only acceptable tuberculin skin test is the Mantoux test using purified protein derivative (PPD).
    2. All positive TSTs will be followed by IGRA testing.
  2. Interferon Gamma Release Assays (IGRAs)
    1. IGRAs are blood tests that measure interferon gamma (IFN-0) release in response to antigens representing Mycobacterium tuberculosis.
    2. Commercially available IGRAs include QuantiFERON-TB Gold (QFT-G), QuantiFERON-TB Gold In-Tube (QFT-GIT) and T-Spot, for example.
    3. All positive, indeterminate or borderline results will be followed by chest x-ray.

Screening Procedure

  1. Individuals who require periodic screening
    1. Either TST or IGRA testing may be utilized for periodic screening required by health professional students or workers, student teachers, volunteers at medical facilities, etc.
    2. Individuals choosing to be screened by TST must not have a history of positive PPD testing or treatment for tuberculosis.  TSTs are less expensive and such individuals are permitted to choose this option.
  2. International students and/or individuals who have received BCG
    1. IGRA testing will be utilized for all international and undocumented students as well as those with a history of Bacille Calmette-Guerin vaccine (BCG) given in countries with high prevalence of tuberculosis.  The PPD material contains antigens found in BCG which may lead to possible false positive TST readings resulting in unnecessary chest x-rays and lengthy antibiotic usage for TB prophylaxis.
  3. Individuals with a history of non-tuberculosis mycobacteria infections
    1. IGRA testing will be utilized for all individuals with a history of non-tuberculosis mycobacteria infections because the PPD material contains antigens to several strains of non-tuberculosis mycobacteria leading to possible false positive TST readings resulting in unnecessary chest x-rays and lengthy antibiotic usage.
  4. Individuals who have a history of both a positive TST with negative chest x-ray results who have not completed a course of preventive antibiotics
    1. IGRAs should be used to screen individuals with a history of both a positive TST and negative chest x-ray if the individual did not complete preventive antibiotics.
    2. TST testing must be avoided for these individuals because repeated exposure to the PPD material may lead to damage of body tissues at or near the site of PPD injection.
    3. Medical records documenting the positive TST results are requested.  See Compliance, Item 6, Medical Records.
  5. Individuals with a history of positive TST or IGRA results who have completed preventative antibiotics
    1. Chest x-ray rather than TST or IGRA testing is required for individuals who have completed preventive antibiotics as a result of a positive TST or IGRA test.  See Chest X-Ray for guidelines.
    2. Medical records documenting all test results and antibiotic usage are requested.  See Compliance, Item 6, Medical Records.
  6. Individuals with symptoms of active TB (fever, weight loss, bloody sputum for example)
    1. Should be given a mask to wear immediately
    2. Have TST placed or IGRA drawn
    3. Send immediately for Chest x-ray with STAT reading
    4. Local County Health Department should be notified within one working day, as per Department of State Health Services requirements
    5. Appropriate antibiotic treatment should be initiated as soon as possible in conjunction with the Local Health Department and/or pulmonary or infections disease specailsts.
  7. Individuals with contact with person(s) with active TB
    1. Local County Health Departments are closely involved with all cases of active TB and will be contacted for guidance in determining all contacts requiring screening, including initial and follow up testing.

Chest X-Ray

  1. All chest x-rays must be done in the United States. A written medical interpretation by a licensed radiologist is required; it is not required to submit a copy of the chest x-ray itself.
  2. Chest x-ray alone, without TST or IGRA testing (either current or by history), is not permitted.
  3. All individuals with positive, indeterminate or borderline IGRA results will have a chest x-ray within 7 days.
  4. All individuals requiring TB screening, who have completed a full course of antibiotics for either a positive PPD or IGRA in the past, must have a chest x-ray done within one year (365 +/- 5 days) prior to the first day of classes upon entrance to TWU or initial TB screening.  A written medical interpretation of the chest x-ray is required.
    1. Note: TWU students requiring annual TB screening in subsequent years are not required to complete a yearly chest x-ray if the student has no symptoms consistent with reactivation of latent TB; a new completed Statement of Tuberculosis Clearance form from a licensed medical professional will suffice.

Antibiotics

  1. Individuals who have positive IGRA testing with a negative chest x-ray and no signs or symptoms of TB will generally be diagnosed with latent tuberculosis infection or LTBI. 
  2. Having LTBI means that a person has been exposed to tuberculosis at some point in life and is now infected with the bacteria that can cause the disease, but the disease remains dormant in the person’s body and the person is not contagious. 
  3. LTBI can become active tuberculosis disease that can be infections.  A person with latent infection has a 10% lifetime risk of developing active tuberculosis disease.  At least 50% of this risk occurs within the first 1-2 years after infection.  Globally there are nearly 9 million new TB cases per year and nearly 2 million TB-related deaths per year.  Drug-resistant TB is of increasing concern and globally there are nearly 500,000 new cases of multidrug resistant TB infections per year.
  4. All individuals with positive IGRA testing and a negative chest x-ray are strongly urged to consider taking antibiotics to prevent latent TB infections from developing into active disease.  It is especially critical for all individuals who are or who will be involved in health professions to give this serious thought to avoid the possibility of infecting others.

Compliance

  1. Acceptable sites for TB screening include TWU Student Health Services, TWU subcontracted health clinics in Dallas and Houston, U.S. licensed private physicians, U.S. licensed medical clinics are all acceptable sources for screening.
  2. Individuals who are not screened at TWU Student Health Services must download and print the appropriate Chest Clearance form available on the TWU Student Health Service website:  (http://www.twu.edu/student-health-services/forms.asp ) for the licensed medical provider to complete.
  3. Health professional students requiring periodic TB screening with negative TST or IGRA results should provide the SHS Immunizations Coordinator with test results by personal delivery, mail or fax, as per (http://www.twu.edu/student-health-services/forms.asp).   Individuals with positive TST or IGRA results (either current or by history) must be evaluated by at one of the sites listed above and a completed Chest Clearance form must be submitted to the Immunizations Coordinator.
  4. International students with a positive IGRA or History of TB treatment/ prophylaxis must complete Statement of Tuberculosis Clearance – International Students (http://www.twu.edu/student-health-services/forms.asp) and submit it to the TWU Immunizations Coordinator by personal delivery, mail or fax.  International students handing in properly completed forms will be given a compliance letter to return to the Office of International Education to remove their compliance hold on registration.
  5. Students with positive TST and/or IGRA results will be managed through the TWU Student Health Service and the Denton, Dallas, or Harris County Health Departments where applicable.
  6. Medical records
    1. Individuals who have taken antibiotics for a positive TST and/or IGRA test are requested to submit these results, along with chest x-ray findings and documentation of any antibiotics taken.
    2. Request for Release of Medical Information form can be found on the TWU Student Health Services web site at (http://www.twu.edu/student-health-services/forms.asp)
    3. Individuals who cannot provide these medical records must contact the TWU Immunizations Coordinator or other Student Health Services personnel, who may be able to assist with the retrieval of records or determine other appropriate measures to ensure compliance with the TB policy.
  7. Compliance cannot be given until the results of all TST, IGRA and/or chest x-ray tests are known; it is not given at the time the test is placed or taken.
  8. The TWU Immunizations Coordinator will update records for health professional students and notify the student’s department of TB compliance.  At peak times, such as near the beginning of semesters, this may take several business days and students are strongly encouraged to plan accordingly.
  9. Noncompliance with tuberculosis screening or with necessary preventive or therapeutic care may result in blocking the student’s attendance to class.

page last updated 6/11/2014 2:49 PM