Guidelines for Decisions Regarding TB Screening of Elementary and Secondary Students
- Universal screening for tuberculosis (TB), i.e.,
Mantoux tuberculin skin testing, among all students and/or
staff in the school setting is not recommended. This
is consistent with national guidelines. [1]
- Decisions to conduct screening should be based on an
assessment of trends in the local epidemiology of TB and
pertinent population demographics (e.g., immigration trends)
in the community. The local public health department,
in consultation with the Minnesota Department of Health
(MDH), should assess their community's incidence and prevalence
of TB, identify high-risk groups based on local epidemiology
and population demographics, and ascertain the site(s) of
most convenient access to any group(s) to which screening
will be targeted (e.g., school setting, work site, homeless
shelter, etc.). On an annual basis, MDH will provide local
health departments with an individualized summary of local
epidemiologic TB data to assist in this assessment.
- Population-based screening for TB in community settings
(including schools), when indicated, is primarily the responsibility
of local public health departments. When the school
setting is determined to be the site of most convenient
access to a high-risk group, the local public health department
should work with school nursing staff and school administrators
to coordinate any school-based TB screening program. However,
local public health agencies should be responsible for overseeing
the screening program, ensuring linkages with essential
clinical services and financial resources, and ensuring
initiation and completion of therapy for latent TB infection,
as indicated.
- Decisions regarding implementation of a school-based
TB screening program should be made jointly by local public
health professionals in collaboration with school nurses
and school administrators. MDH also is available for
consultation, as needed.
- A decision to conduct TB screening is a decision to
treat latent TB infection, if identified. Targeted screening
of persons at high risk for TB infection or disease must
be accompanied by a plan for providing necessary follow-up.
This plan must include resources for providing a follow-up
chest x-ray, medical evaluation, and treatment of latent
TB infection or disease, and clinical monitoring during
such treatment. A plan to address each of these criteria
should be developed before screening is initiated.
- Systematic program evaluation is an integral part of any TB screening program. Programmatic indicators that should be evaluated include the number of students with history of prior TB disease or infection, the number of tuberculin skin tests administered, the number of skin tests that are read and the result of each in millimeters of induration, and rates of initiation and completion of treatment of latent TB infection (including reasons for discontinuation among those who fail to complete therapy). These data should be reviewed on an ongoing basis to determine the yield and effectiveness of the screening program. If a low prevalence of TB disease or infection or suboptimal rates of completion of therapy are identified, decisions to continue the screening program should be re-evaluated. MDH is available, as needed, for consultation on implementing a program evaluation system and evaluating resulting data.
References:
- Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49 (No. RR-6):1,7,22. Attention: Non-MDH link
These guidelines are based on recommendations of the MDH Work Group on Screening of School Students, December 2000.
