When possible, CDC recommends that health care providers (HCPs) test persons at risk for TB using TB blood tests (interferon-gamma release assays), and if a diagnosis of LTBI is made, prescribe a short-course LTBI treatment regimen in preference to longer course 6- or 9-month isoniazid monotherapy ( 2, 6). TB blood tests are not affected by previous BCG vaccination. Having previously received the BCG vaccine can cause a false-positive reaction to TB skin tests, leading to falsely diagnosing TB infection or conversely, misattributing a positive TB test result to childhood BCG vaccination, even though the patient does have TB infection ( 5). This vaccine is often given to infants and small children in countries where TB is common to decrease the risk for childhood TB meningitis and disseminated disease however, it is not thought to prevent pulmonary TB disease in adolescents and adults, and protection wanes over time ( 4). In addition, many persons born outside the United States have received the Bacille Calmette-Guérin (BCG) TB vaccine. Persons who were born in countries where TB disease is common are at increased risk for TB infection ( 3). Since 1992, TB cases have generally decreased in the United States however, ongoing TB prevention and control efforts are needed to continue this trend and achieve TB elimination in the United States (<1 case per million persons annually) ( 2). The most common countries of birth among non–U.S.-born persons with TB have been China India, Mexico, Philippines, and Vietnam.* Efforts to eliminate TB in the United States include finding and treating persons with TB disease, expanding LTBI testing and treatment to prevent progression to TB disease, and addressing disparities among groups disproportionately experiencing impacts of TB. In 2022, approximately three quarters (73%) of reported TB cases in the United States occurred among non–U.S.-born persons ( 2). TB disease is infectious and can be fatal. Approximately 5%–10% of persons with LTBI in the United States who remain untreated will develop tuberculosis (TB) disease at some point in their lifetime. Further efforts are needed to identify and overcome barriers for providers to test for and treat persons at risk for TB.ĬDC estimates that up to 13 million persons in the United States have latent tuberculosis infection (LTBI) ( 1). One third (33.0%) of HCPs reported prescribing recommended short-course LTBI treatment regimens, and 4.0% reported doing none of the treatment practices available for patients with LTBI (i.e., prescribing short-course regimens, longer course regimens, or referring patients to a health department). Approximately one half (53.3%) of HCPs reported routinely testing non–U.S.-born patients for TB, and of those who did, 35.7% exclusively ordered recommended blood tests, 44.2% exclusively ordered skin tests, and 20.2% ordered TB skin tests and blood tests. To assess TB-related practices among health care providers (HCPs) in the United States, CDC analyzed data from the 2020–2022 Porter Novelli DocStyles surveys. In 2022, approximately three quarters (73%) of reported TB cases in the United States occurred among non–U.S.-born persons. CDC recommends testing persons at increased risk for tuberculosis (TB) infection as part of routine health care, using TB blood tests, when possible, and, if a diagnosis of latent TB infection (LTBI) is made, prescribing a rifamycin-based, 3- or 4-month treatment regimen (short-course) to prevent the development of TB disease.
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