Tuberculosis disease (TB) is caused by a bacterial infection affecting several of the body’s organs, primarily the lungs and the respiratory system. Although not all individuals who contract this bacterium show signs and symptoms of the infection, it is still possible for these individuals to develop active TB and become sick; this is referred to as Latent TB infection (LTBI)[1]. Assembly Bill 2132 requires all adult patients receiving primary care services to be offered a TB risk assessment and screening test if TB risk factors are identified and the patient’s health insurance covers it. In accordance with the California Department of Public Health (CDPH) Tuberculosis Control Branch and AB 2132, CenCal Health would like to provide guidance on the necessity of preventive TB screening.
Common High-Risk Factors[2]:
- Individuals born in or who frequently travel to countries where TB is more common
- Living in or having lived in large group settings, such as those experiencing homelessness, shelters, or incarceration
- Those with compromised immune systems
To protect patients from TB disease, CDPH recommends these steps in alignment with the U.S. Preventive Services Task Force, the Center for Disease Control, and the American Academy of Pediatrics:
- Screen all patients for asymptomatic LTBI using the California TB Risk Assessment.
- If a risk factor is identified, Test for LTBI using a tuberculin skin test (TST) OR with an interferon gamma release assay (IGRA) for persons born outside the U.S. who received, or may have received, Bacillus Calmette-Guerin (BCG) vaccination.1
- If the TST/IGRA is positive, OR the person exhibits symptoms of active TB (cough, fevers, night sweats, weight loss, hemoptysis), Test for active TB with a chest X-ray, followed by sputum testing if indicated.
- If active TB is ruled out, Treat LTBI with 3-4 month rifamycin-based therapies.
- 4 months of rifampin OR
- 12 weeks of isoniazid plus rifapentine
CDPH TB Control Branch hosts semi-annual webinar trainings about LTBI best practices, aimed at primary care clinicians. To learn more about the next training, please email: TBFreeCATraining@cdph.ca.gov
For additional information and questions, please contact the CenCal Health Quality Department at: populationhealth@cencalhealth.org