State Health Plan Renewal Do We Have to Attest Again

For the General Public:

What is TB?
What are the symptoms of TB?
How is TB spread?
Is there a difference betwixt TB Infection, and TB illness?
What should I do if I accept spent time with someone with TB infection?
What should I do if I have been exposed to someone with TB disease?
How practice I get tested for TB?
Who can administrate a tuberculin skin test (TST)?
How oftentimes can TSTs be repeated?
Where tin I get tested for TB?
What does a positive TB exam mean?
Can I get vaccinated for TB?
What if someone has received the BCG vaccine (which is given in many countries)?
Why is TB infection treated?
How is TB affliction treated?
How many people in Texas have TB?

For Wellness Intendance Professionals

What are the recommendations for screening health care personnel (HCP) for tuberculosis upon hire?
How often should HCP be screened for TB after hire? Is annual testing recommended?
If annual testing with a TST or blood test is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?
How should I screen my employee for TB upon rent if they say they already have a positive TB skin or blood test?
Can a new rent's documented negative tuberculin pare test (TST) result be used in performing a baseline ii-pace TST?
What do I demand to know if my HCW has received a BCG vaccine?
Are routine or annual CXRs even so recommended?
Tin can my employee with a positive TB skin or blood test render to work?
What further actions do I demand to take when HCP are diagnosed with TB infection or TB disease?
Should HCP be treated for TB infection?
Have the updated 2019 guidelines for screening HCP for TB changed the need for a facility risk assessment?
Does DSHS have a sample class that health care facilities may apply to document TB screening, testing, and education?
Where can I observe more information regarding screening health care personnel for TB?

TB and COVID-xix

Practise COVID-xix and TB share similar symptoms?
Are at that place recommendations to delay TB screening in persons recently vaccinated confronting COVID-xix?

Full general Reporting Requirements

How practice I report tuberculosis screening results?

Recommendations for TB Screening of Adults and Children in Various Settings

Are there full general recommendations about which adults should and should non be screened for TB in Texas, and how to screen them?
Are at that place full general recommendations nearly which children should and should non be screened for TB in Texas, and how to screen them?
What are the screening requirements for TB testing in facilities that provide care to children?
What are the screening requirements for TB testing in adult intendance centers such as assisted living facilities?

For Schools

Do all employees in Texas schools however demand a tuberculin peel exam?
Do all new students in Texas schools all the same demand a tuberculin skin test?

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

Other Resources

What are other recommended sites where I tin detect information almost tuberculosis?

For the General Public

What is TB?

Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air. TB commonly affects the lungs, but information technology can also affect other parts of the body, such as the brain, the kidneys or the spine. A person with TB can dice if they practice not get treatment.

What are the symptoms of TB?

The full general symptoms of TB illness include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB affliction of the lungs as well include coughing, chest pain, and the coughing up of claret. Symptoms of TB disease in other parts of the body depend on the area affected.

How is TB spread?

TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks or sings. These germs can stay in the air for several hours, depending on the surroundings. Persons who breathe in the air containing these TB germs can go infected; this is chosen TB infection or latent TB infection (LTBI). If untreated, TB infection can go TB disease.

Is there a difference between TB Infection, and TB disease?

People with TB infection have TB germs in their bodies, but they are not sick because the germs are not agile. These people do not have symptoms of TB disease and they cannot spread the germs to others. However, they may develop TB affliction in the future. They are oftentimes prescribed treatment to forbid them from developing TB illness.

People with TB disease are ill from TB germs that are agile, meaning that they are multiplying and destroying tissue in their body. They commonly have symptoms of TB illness. People with TB disease of the lungs or throat are capable of spreading germs to others. They are prescribed drugs that tin treat TB illness.

What should I do if I have spent time with someone with TB infection?

A person with TB infection cannot spread germs to other people. You lot do not demand to be tested if y'all have spent fourth dimension with someone with TB infection. However, if you have spent time with someone with TB affliction or someone with symptoms of TB, you should contact your md or local or regional health department for TB screening recommendations.

What should I do if I have been exposed to someone with TB disease?

Not everyone who is exposed to TB becomes infected with the TB germs. If you believe yous have been exposed to TB, you should contact your md or the local health department for more than information about screening and testing.

How do I get tested for TB?

There are two tests that can be used to assist notice TB infection: a skin test or a TB blood test.

The Mantoux tuberculin skin exam (TST) is performed by injecting a pocket-sized amount of fluid (chosen tuberculin) into the peel in the lower office of the arm. A person given the TST must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm; this must be done in-person.

The TB claret test, known equally the Interferon Gamma Release Assay (IGRA), measures how the patient'due south immune system reacts to the germs that cause TB when nowadays. In that location are currently two Federal Drug Administration (FDA) approved claret tests on the market place: the QuantiFERON®–TB Gold In-Tube test (QFT-GIT) and the T-SPOT®.TB test (T-Spot).

Although the tuberculin skin test has been the about mutual screening method in Texas, many health departments at present use the IGRA test as the standard tool. When choosing a skin exam or blood test, consideration tin be made based on age, health status (meet policy TB 1004), BCG status, and other factors of the person needing the test.

A positive TST or IGRA simply tells yous if yous have TB germs in your body. Other tests may be needed to tell if y'all have TB disease, such as a chest ten-ray (CXR) and other laboratory testing of sputum.

Who can administer a tuberculin skin test (TST)?

A tuberculin skin test (TST) is considered a medical human action and should only be performed by an private working under the lodge of a licensed physician. There is no requirement for the individual to be a licensed health care worker. DSHS recommends those that administer a TST see knowledge and clinical skills requirements, have received training, and demonstrated competency earlier administering a TST.

The Texas DSHS TB Program recommends that anyone who administers a TST has reviewed, is familiar with, and able to readily admission the recommendations within the post-obit documents:

CDC Fact Canvass "Tuberculin Skin Testing"
CDC fact canvas "Targeted Tuberculin Testing and Interpreting Tuberculin skin Test Results"
CDC Mantoux Tuberculin Pare Testing Facilitator Guide
Tubersol package insert (PDF)
Aplisol package insert (PDF)

In person training on how to administer a TST is available through the Heartland National TB Centre. Please visit the Heartland National TB Center website for a list of training opportunities.

How often tin TSTs be repeated?

In general, there is no take a chance associated with repeated tuberculin skin test placements. If a person does not return inside 48-72 hours for a tuberculin peel test reading, a second examination can be placed every bit soon every bit possible. There is no contraindication to repeating the TST, unless a previous TST was associated with a severe reaction.

Where tin I get tested for TB?

In general, Texas Department of Land Health Services does non recommend that low risk individuals exist tested for tuberculosis. If a test is needed or recommended, the general public may ask their main intendance provider, local clinics, or pharmacies, amid other sites. You may besides contact your local or regional health department for recommendations regarding individual testing needs.

What does a positive TB test mean?

A person with a positive TST or blood test has the TB germ in their body. It does not tell whether or non the person has TB infection or TB affliction. Other tests, such equally a chest x-ray, symptom screening and a testing of sputum (phlegm), are needed to decide whether the person has TB infection or TB disease.

Can I become vaccinated for TB?

In that location is a vaccine for TB, notwithstanding it is not generally recommended for utilize in the Usa. Bacille Calmette-Guérin, or BCG, is a vaccine used in many countries with high rates of TB. BCG vaccination does non completely prevent people from getting TB, but information technology is used to protect infants and young children from serious, life-threatening diseases, specifically miliary TB and TB meningitis.

What if someone has received the BCG vaccine (which is given in many countries)?

In many parts of the world where TB is common, Bacille Calmette-Guérin, (BCG) vaccine is used to protect infants and young children from serious, life-threatening diseases, specifically miliary TB and TB meningitis. However, information technology does non completely foreclose people from getting TB.

The issue of the BCG vaccine wanes overtime and may have little to no event on positive TST results amongst adults who received the vaccine as a child.

A person with a history of BCG vaccination can be tested and treated for TB infection if they react to the TST. TST reactions should be interpreted based on risk stratification regardless of BCG vaccination history. IGRAs use M. tuberculosis specific antigens that practise non cross react with BCG, and therefore, do not cause false positive reactions in BCG recipients— this means a claret test, or IGRA, is preferred for BCG vaccinated individuals.

Why is TB infection treated?

If you have TB infection simply not TB disease, your doctor may want you to accept a drug to kill the TB germs and forestall you from developing TB affliction. The decision about taking treatment for TB infection will be based on your chances of developing TB disease. Some people are more than probable than others to develop TB disease in one case they have TB infection. This includes people with HIV infection, people who were recently exposed to someone with TB disease, and people with certain medical atmospheric condition.

How is TB disease treated?

TB illness can be treated past taking multiple drugs for several months, generally 6 to 12 months. It is very important that people who accept TB affliction finish the medicine, and take the drugs exactly as prescribed. If they terminate taking the drugs too presently, they can become sick again; if they practice not take the drugs correctly, the germs that are still live may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat. In some situations, local health department staff meets regularly with patients who accept TB to sentry them have their medications. This is called directly observed therapy (DOT). DOT helps the patient complete treatment in the least amount of fourth dimension.

DSHS provides TB medications to public health clinics across Texas. These clinics treat patients with TB affliction. Also, people who are presumed to have TB may be given treatment while their clinicians perform further testing to confirm or dominion out TB illness.

How many people in Texas take TB?

Each year, DSHS provides information on numbers of TB cases per canton. The virtually current information is plant on the TB statistics page.

For Health Care Professionals

What are the recommendations for screening health care personnel (HCP) for tuberculosis upon hire?

The Section of State Health Services (DSHS) in partnership with the National Tuberculosis Controllers Association (NTCA) and Centers for Affliction Control and Prevention (CDC), recommend that both paid and unpaid health care personnel (HCP) receive the following upon hire:

A single claret test known equally an interferon gamma release assay (IGRA) or a two-step tuberculin pare examination (TST);
An individual risk assessment to make up one's mind baseline hazard for TB and interpret the IGRA or TST results; and
A signs and symptoms screening assessment.

DSHS has developed a sample Baseline Tuberculosis Cess for Wellness Care Personnel form (PDF) that may be used by health care facilities. DSHS also recommends completing the Tuberculosis Screening Results and Piece of work Clearance for Health Care Personnel (PDF) after performing a baseline TB cess.

These recommendations may be used by health care facilities and other entities to guide the development of their internal TB screening policies. These recommendations should not be interpreted as DSHS policies.

How ofttimes should HCP be screened for TB afterwards hire? Is annual testing recommended?

Annual TB testing using an IGRA or TST is not routinely recommended. Health care facilities should perform TB testing and complete a signs and symptoms assessment afterwards known or ongoing exposure to TB or complete a signs and symptoms assessment annually for HCP with untreated TB infection. HCP should as well be educated most TB treatment options for TB infection.

DSHS has developed a sample Afterward Hire Tuberculosis Assessment for Health Intendance Personnel course (PDF) that may be used for HCP with untreated TB infection or anytime a HCP is tested for TB after hire.

*Annual TB testing using an IGRA or TST and symptom screening may be considered for HCP with significant occupational risk, such as pulmonologists or respiratory therapists in high take chances settings, or in settings where TB exposures have occurred in the past (i.e. emergency departments). This decision should be developed by the wellness care staff responsible for infection control and may be done in collaboration with your local health department.

If annual testing with a TST or blood test is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?

DSHS recommends that facilities consider the local epidemiology of TB in their county (PDF), including risk factors for TB (PDF) [CDC] in their staff, and whatsoever past TB exposures in the facility when deciding to implement periodic TB screening after baseline testing. The purpose of screening for TB using a signs and symptoms assessment questionnaire is to ensure active TB is identified early on. Anyone with symptoms of TB should be referred for medical evaluation.

How should I screen my employee for TB upon hire if they say they already have a positive TB skin or blood test?

HCP with documentation of a previous positive TST or IGRA upshot, or documentation confirming completion of treatment for TB infection or disease, should be screened for TB in the post-obit way:

Consummate a TB signs and symptoms assessment.
Accept a baseline breast x-ray (CXR) performed (unless a recent copy is available).

HCP with documentation of a previous positive TST or IGRA result should not be re-tested with a TST or IGRA.

After the baseline screening, serial or routine CXRs are not recommended; however, persons exhibiting symptoms of TB affliction crave a CXR regardless of history.

HCP without documentation of the previous examination result should undergo baseline screening with a two-step TST or an IGRA. An individual risk assessment (PDF) and signs and symptoms screening assessment should also exist completed (refer to Baseline Tuberculosis Assessment for Health Care Personnel (PDF)). Copies of the TB screening results and responses to the symptom screen and private hazard assessment should be kept past the employee as documentation in case of hereafter screenings.

Can a new hire's documented negative tuberculin skin exam (TST) effect exist used in performing a baseline two-step TST?

Yep, a new rent's documentation of a negative TST result can be recorded as step one of the 2-step TST when administered any time during the previous 12 months, if the result was documented in millimeters (mm). The TST administered at hire will exist recorded every bit step 2 of the 2-footstep TST.

For more than details, refer to the Guidelines for Preventing the Transmission of M. TB in Health-Care Setting, 2005 (PDF) [CDC] TB Infection-Control Surveillance.

What do I need to know if my employee has received a BCG vaccine?

The IGRA and TST are not contraindicated for persons who have been vaccinated with Bacillus Calmette–Guérin (BCG). The effectiveness of BCG wanes overtime but information technology may cause a faux-positive reaction to the TST, which may complicate decisions well-nigh diagnosing TB infection and prescribing handling. IGRAs use M. tuberculosis specific antigens that practice not cross react with BCG, and therefore, do not crusade false positive reactions in BCG recipients. This means an IGRA test is preferred for BCG vaccinated individuals. More than information can be found on the CDC website.

Are routine or annual CXRs all the same recommended?

No, chest x-rays should not be performed routinely or annually for persons with a positive IGRA or TST. Health intendance personnel, patients or institutional residents with a baseline positive or newly positive IGRA or TST result who are likely to be infected with TB should receive 1 chest radiograph to exclude a diagnosis of TB disease. Repeat chest 10-rays are not needed unless signs or symptoms of TB develop, or a clinician recommends a echo breast radiograph, or after a new exposure to TB.

Health care personnel who accept a previously positive IGRA or TST result and who alter jobs should carry documentation of the results of their IGRA or TST, breast radiograph and documentation of handling history for TB infection, if applicable, to their new employer.

Tin my employee with a positive TB skin or blood exam return to piece of work?

HCP who are likely * infected with TB based on a positive TST or IGRA result and individual risk, should be referred for a CXR and medical evaluation to rule out active TB prior to returning to piece of work. If a diagnosis of TB infection is made, HCP may render to piece of work, as TB infection is not contagious. They should be educated on treatment options for TB infection to minimize their hazard of developing TB disease.

HCP who are asymptomatic, unlikely* to exist infected with TB, and who are at low risk for progression to TB disease based on individual risk, should take a second examination (either an IGRA or a TST) if their first test is positive. Only when the 2d test is positive in low risk individuals is TB infection considered an accurate diagnosis (PDF).

What further actions do I need to accept when HCP are diagnosed with TB infection or TB disease?

TB infection, TB disease, and suspicion of TB disease are all reportable to your local wellness department. Meet How practise I study TB? for reporting requirements.

Should HCP exist treated for TB infection?

Handling for TB infection should exist considered in all persons to forbid the progression to TB disease. This conclusion should be made between the HCP and their wellness intendance provider.

When facilities screen for TB, DSHS recommends that an almanac pedagogy component is included in the screening plan. Education tin can include data on signs and symptoms of TB, the difference between TB infection and disease, TB take chances factors, and the risks for developing TB disease if not treated.

Have the updated 2019 guidelines for screening HCP for TB changed the demand for a facility risk cess?

No, facility risk assessments are nevertheless recommended. The results of the assessment are no longer used to determine frequency of TB screening but are useful in documenting infection control in facilities. Refer to the CDC website for more details on the utilise of the risk cess and updates to the 2019 guidelines.

Does DSHS take a sample course that health care facilities may utilize to document TB screening, testing, and education?

Yeah. DSHS has developed the post-obit forms that facilities may use or modify to fit their need.

Baseline Tuberculosis Assessment for Health Care Personnel (PDF). It is intended for use in health care facilities when assessing employees for TB upon rent.
Later on Hire Tuberculosis Assessment for Health Care Personnel (PDF). It is intended for use in health care facilities when assessing employees for TB any fourth dimension after baseline screening.
Tuberculosis Screening Results and Work Clearance for Health Care Personnel (PDF). It allows facilities to certificate results of baseline and later on hire screening including the recommended annual education.

These forms are not required by DSHS but may be used to guide and document facility screening practices, equally they align with DSHS and CDC recommendations.

Where can I observe more information regarding screening wellness care personnel for TB?

Refer to the Centers for Disease Control and Prevention (CDC) website for more information.

TB and COVID-nineteen

Do COVID-19 and TB share similar symptoms?

Yep, TB and COVID-19 have some similar symptoms such as a cough or a fever. Only a licensed healthcare provider tin determine the cause of symptoms and further testing may exist needed. For healthcare providers, it is of import to "Recall TB" when symptoms and adventure factors for TB are nowadays. See Tuberculosis and COVID-19 Know the Difference (PDF) for details.

Are in that location recommendations to filibuster TB screening in persons recently vaccinated against COVID-19?

No, TB screening should not be delayed for people with risk factors for TB who have been vaccinated against COVID-nineteen. The Centers for Disease Control and Prevention (CDC) has information about TB screening practices and the COVID-nineteen vaccine.

It is recommended that those in charge of TB screening visit the CDC website periodically for any updates regarding TB screening practices. When considering the impact of TB in your expanse, please consult with your regional or local health department (R/LHD). Report suspected and confirmed TB infections to your R/LHD.

General Reporting Requirements

How practise I report tuberculosis screening results?

Both TB infection and TB disease are Notifiable Conditions reportable to the local or regional health section TB Programs. Reporting details can be found on the DSHS website, which include reporting forms.

Tuberculosis Infection- Reportable within one (1) week to the local or regional health department. A diagnosis of a latent TB infection is NOT complete until the post-obit criteria have been met:

Positive skin examination with results written in millimeters and appointment read, or positive IGRA blood test results; and
Documentation that patient has no current signs or symptoms of active tuberculosis disease; and
CXR results that are read as normal, or not consistent with TB; and
At that place is no suspicion of Active TB affliction

TB Disease or Suspicion of TB Affliction- Reportable within one (i) working mean solar day.

Recommendations for TB Screening of Adults and Children in Various Settings

Are at that place general recommendations about which adults should and should not be screened for TB in Texas, and how to screen them?

Yep, the DSHS TB Unit has recommendations for TB screening of adults in Texas, depending on identified TB risk factors. Please refer to information in Tuberculosis Screening Recommendations for Adults in Various Settings (TB-1002) (PDF).

Are there general recommendations almost which children should and should non be screened for TB in Texas, and how to screen them?

Yes, the DSHS TB Unit of measurement has recommendations for TB screening of children in Texas, depending on identified TB take chances factors. Please refer to information in Tuberculosis Screening Recommendations for Children in Various Settings (TB-1003) (PDF).

What are the screening requirements for TB testing in facilities that provide intendance to children?

Facilities with a permit or license from Texas Health and Human Services (HHS) to provide care to children volition bide by the chapters that apply to each type of facility in the Texas Authoritative Code (TAC) Championship 26, Part i.

The Minimum Standards page on the HHS website contains links to the standards related to daycare facilities, 24-hr residential care, and child-placing agencies. These links are located at the lesser of the page.

Any facilities that provide care to children and are non listed above should outset review the Texas Administrative Code for any statutory requirements or check with their licensing or credentialing bureau. Collaboration with a local or regional TB program may aid in developing screening, testing, and treatment plans.

What are the screening requirements for TB testing in developed care centers such as assisted living facilities?

Screening requirements for adults working in these facilities are outlined in the Long-Term Intendance Regulatory Provider Letter (PDF) :

Assisted Living Facility
24-hour interval Activity and Health Services Facility
Intermediate Care Facility for Individuals with an Intellectual Inability or Related Weather condition
Home and Community Support Services Agency
Nursing Facility, and
Prescribed Pediatric Extended Care Center

Facilities licensed by HHS for adult care in Type A and Blazon B Assisted Living Facilities volition abide by Texas Administrative Code (TAC) Title 26 Part 1 Chapter 553 Subchapter Eastward Dominion §553.261B. TB requirements are summarized beneath; however, each facility should review the TAC for specific details:

Facilities must develop written policies for the control of catching diseases in employees and clients, including TB screening and the provision of a rubber and sanitary surround for clients and their families.
Screen employees for TB within 2 weeks of employment.
After hire, facilities must follow CDC guidance in Tuberculosis Screening, Testing, and Treatment of U.S. Health Intendance Personnel: Recommendations from the National Tuberculosis Controllers Clan and CDC, 2019. See FAQs for Health Intendance Professionals.
Facilities must screen residents for TB upon admission and afterward exposure to TB.
Any facilities that provide care to adults and are non listed above review the Texas Administrative Code for any statutory requirements or check with their licensing or credentialing agency. Collaboration with a local or regional TB program may assistance in developing screening, testing, and treatment plans.

For Schools

Do all employees in Texas schools still demand a tuberculin skin examination?

In that location is no statewide requirement for teachers or other school employees to accept a tuberculin skin test or TB blood test. The Centers for Disease Control and Prevention (CDC) and DSHS discourage the apply of the tuberculin skin testing or IGRA blood test for persons who have no take a chance factors for TB exposure.

However, anyone with signs or symptoms of TB should be considered for medical evaluation.

Specifications for employee or volunteer TB screening may exist required by a licensing, credentialing, or insurance policy, or by the schoolhouse district's regulations and requirements. Each school should defer to their own policy.

Practice all new students in Texas schools nonetheless demand a tuberculin pare test?

No. A tuberculosis questionnaire has been developed past Texas Department of State Health Services to place children at high take a chance for TB infection. Refer to the listing of counties with a loftier incidence of TB (PDF) where use of the questionnaire is recommended prior to inbound school. As resources permit, schoolhouse districts in other counties may use the TB questionnaire to identify children who should receive a TB skin test prior to school entry.

Children who have a positive reaction to the TB skin test but no symptoms of TB illness should NOT be kept out of school while they are being evaluated for treatment of TB infection.

The American Academy of Pediatrics (AAP) recommends that physicians routinely assess a kid's risk of TB exposure with a questionnaire and offering tuberculin skin testing only to at-risk children. The AAP does not recommend routine tuberculin skin testing of children with no TB risk factors for school entry, solar day care attendance, WIC eligibility, or camp omnipresence.

A tuberculin peel examination may be applied on the aforementioned day as routine immunizations. The skin test will need to exist read 48-72 hours subsequently. If a skin test is non placed on or earlier the day of a live virus immunization such as measles-mumps-rubella (MMR), and so the peel test should be postponed at least six weeks.

For more than information about TB screening for children in school settings visit the following links:

Recommendations for TB Screening of School Aged Children (PDF)
Tuberculosis Questionnaire in English (DOC)
Tuberculosis Questionnaire (en Español) (Doctor)

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

The police (Chapter 89 of the Texas Health & Safe Code) in Texas requires county correctional facilities that meet whatsoever 1 of three criteria to screen all inmates for TB by the seventh day of incarceration and annually thereafter, and to screen all employees and volunteers both pre-employment and annually thereafter.

The three criteria are as follows:

a chapters of 100 or more beds,
housing inmates transferred from a county that has a jail with a chapters of 100 or more than beds, or
housing inmates from another state.

The law also requires all correctional facilities in the state, including youth detention facilities, regardless of whether they meet the criteria stated above, to report to the Texas Department of Country Wellness Services, Infectious Disease Intervention and Control Branch, the release of inmates existence treated for TB so that the Department can arrange for continuity of intendance.

Other Resource

What are other recommended sites where I can notice information nearly tuberculosis?

Centers for Affliction Command and Prevention:

Basic TB Facts
Tuberculosis Fact Sail
Tuberculosis Fact Sheet (PDF) Courtesy of the CDC

HIPAA:

Frequently asked questions about HIPAA Privacy Dominion

Medical Consultation:

TB Medical Consultation Process

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Source: https://www.dshs.texas.gov/disease/tb/faq.shtm