Screening for Tuberculosis

By Jane Farrell

An influential medical panel has recommended the continued use of screening for latent tuberculosis infection (LTBI) for patients who are at increased risk of  the condition.

The panel, the U.S. Preventive Services Task Force (Task Force), said in a news release that the screening is an effective way to stop LTBI from progressing to tuberculosis.

Tuberculosis is a bacterial infection, spread through the air from one person to another, that usually affects the lungs. It is a significant public health concern in the United States. People can be infected with TB bacteria but not have any signs or symptoms or be contagious; this is known as LTBI. If left untreated, people with LTBI can eventually progress to having active TB, which can cause serious health problems and spread to others.

“Screening for latent tuberculosis infection in people at increased risk is an effective way to identify the infection so that it can be treated before it progresses to active TB,” Task Force member Gbenga Ogedegbe, M.D., M.P.H., said in the news release. “The Task Force continues to underscore the importance of LTBI screening in reducing rates of active TB, protecting the health of people nationwide.”

There are two types of screening tests for LTBI in the United States: the tuberculin skin test and the interferon[1]gamma release assay, which is a blood test. Both tests have been shown to be safe and effective. It is important that people who screen positive go on to receive appropriate follow-up and treatment. For people diagnosed with LTBI, antibiotic treatments can help clear the infection safely and effectively so that it does not progress to active TB.

“People at increased risk for tuberculosis who would benefit from screening include people born or who have lived in countries with increased rates of TB and those who have lived in certain group settings, like prisons or homeless shelters,” said Task Force chair Michael Barry, M.D. “Importantly, anyone who screens positive needs further clinical tests to rule out active TB and confirm an LTBI diagnosis.”

In the United States, according to the news release from the task force, the majority of active TB cases occur in people born outside of the country. In 2020, Mexico, the Philippines, India, Vietnam, and China were the most common countries of birth among people living in the United States with new cases of TB. Most new TB cases are thought to be due to the progression of LTBI to active TB rather than the transmission of active TB. Therefore, screening for and treating LTBI are critical to reducing the burden of TB.

The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

Dr. Ogedegbe is the inaugural and founding director of the Institute for Excellence in Health Equity at NYU Langone Health. He is the Dr. Adolph and Margaret Berger Professor of Medicine and Population Health at NYU Grossman School of Medicine. Dr. Ogedegbe is a member of the National Academy of Medicine.

Dr. Barry is the director of the Informed Medical Decisions Program in the Health Decision Sciences Center at Massachusetts General Hospital. He is also a professor of medicine at Harvard Medical School and a primary care clinician at Massachusetts General Hospital.

To learn more about the task force, click here.