Nationwide Shortage of Tuberculin Skin Test Antigens - Minnesota Dept. of Health

Nationwide Shortage of Tuberculin Skin Test Antigens

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The Centers for Disease Control and Prevention (CDC) is expecting a 3 to 10 month nationwide shortage of APLISOL®, a product of Par Pharmaceuticals. APLISOL® is one of two purified-protein derivative (PPD) tuberculin antigens that are licensed by the United States Food and Drug Administration (FDA) for use in performing tuberculin skin tests.

Even during this shortage, it remains important to detect and treat LTBI.

MDH Recommendations for Prioritizing Tuberculin Use in Specific Settings

Setting Group Recommendations
All Settings All groups Do NOT administer TSTs to persons with a documented previous history of positive TST, IGRA, or TB disease.
Correctional Facilities Residents At time of admission: Conduct TB symptom screen. Perform TB screening test; use IGRA if available. If IGRA not available, administer one TST (county jails should postpone TST until day 11 or 12 of confinement).  If tuberculin supply is low, defer second step TST until shortage resolves. If not able to obtain any tuberculin, defer both TSTs until shortage resolves.
Annual re-testing: Conduct TB symptom screen. Perform TB screening test; use IGRA if available. If IGRA not available, defer annual TST in the absence of TB symptoms until shortage resolves.
Testing residents is a higher priority than testing employees. If necessary, use limited supplies for testing residents and defer employee testing until shortage resolves.
Correctional Facilities Employees At time of hire: Conduct TB symptom screen. Perform TB screening test; use IGRA if available. If IGRA not available, administer one TST and defer second step TST until tuberculin shortage resolves. If not able to obtain any tuberculin, defer both TSTs until shortage resolves.
Annual re-testing: Conduct TB symptom screen. Perform TB screening test; use IGRA if available. If IGRA not available defer annual TST until shortage resolves.
Testing offenders is a higher priority than testing employees. If necessary, use tuberculin for testing offenders and defer employee testing until shortage resolves.
Boarding Care / Nursing Homes Residents At time of admission: Conduct TB symptom screen. Perform TB screening test; use IGRA if available. If IGRA not available, administer one TST. If tuberculin supply is low, defer second step TST until shortage resolves. If not able to obtain any tuberculin, defer both TSTs until shortage resolves.
Health Care Settings Employees At time of hire: Conduct TB symptom screen and individual TB risk assessment. Perform TB screening test; use IGRA if available. If IGRA not available, administer one TST and defer second step TST until tuberculin resolves. If not able to obtain any tuberculin, defer both TSTs until shortage resolves.
Annual re-testing for employees with increased occupational risk for TB (see 2019 CDC guidance): Conduct TB symptom screen. Perform TB screening test; use IGRA if available. If IGRA not available, defer annual TST until tuberculin shortage resolves.
All Settings Contact investigation Conduct TB symptom screen. Continue to use IGRA (preferred) or TST to evaluate close contacts of persons with infectious (i.e., pulmonary or laryngeal) TB disease. Consult MDH or local health department for guidance in identifying who should be included in contact testing.
Public Health Class B and refugee health assessments Conduct TB symptom screen. Perform TB screening test; use IGRA if available. If not available, do one TST. Two-step TST testing is not indicated. Conduct TB symptom screen and other testing, as medically indicated.
Clinical Practice Asymptomatic adults at increased risk for TB infection USPSTF recommends all adults at increased risk for TB infection be screened for latent TB infection (LTBI). These groups include persons born in, or are former residents of, countries with increased tuberculosis prevalence and persons who live in, or have lived in, high-risk congregate settings (e.g., homeless shelters and correctional facilities). Conduct TB symptom screen. Perform TB screening test; use IGRA if available. If not available, do one TST.
Clinical Practice Asymptomatic children at increased risk for TB infection The American Academy of Pediatric outlines risk factors that should prompt consideration of LTBI screening among asymptomatic children. At a minimum, these include children born, or visiting friends or relatives for >1 week, in Africa, Asia, Latin America, or eastern Europe, children exposed to persons with infectious TB disease. Perform TB screening test; use IGRA if available and age >2 years. If IGRA not available or age 2 years, do one TST.

See Regulations for TB Control in Minnesota Health Care Settings for full guidance.

Updated Friday, 14-Jun-2019 07:36:03 CDT