The U.S. Preventive Services Task Force is recommending that clinicians screen for latent tuberculosis infection in at-risk adults aged 18 years and older, including those living in congregate settings.
Tuberculosis remains an important preventable disease in the United States, the task force stated in a final recommendation published Tuesday, May 2. In a recent review, it found that screening at-risk people in the latent stage, when tuberculosis is asymptomatic, results in a moderate net benefit in preventing active disease.
Although the prevalence rate is difficult to determine, the authors reported, it is estimated that up to 13 million people in the United States have latent tuberculosis. In addition, approximately 30% of persons exposed to the bacterium that causes the disease will develop the latent condition. Active disease will develop in 5% to 10% of healthy, immunocompetent people, the authors stated.
Evaluating risk
Risk evaluation for latent tuberculosis is based on increased prevalence of active disease and increased risk of exposure. Candidates for screening include people born in, or former residents of countries with high tuberculosis prevalence; and persons who live in, or have lived in high-risk congregate settings such as homeless shelters or correctional facilities, the USPSTF stated.
People who do screen positive for latent disease should receive followup and treatment in order for increased screening to be successful, it noted.
Nursing home considerations
The task force recommendation does not explicitly mention the nursing home population among high-risk groups, but long-term care facilities are generally considered high-risk congregate settings. In an unrelated 2019 study, researchers noted that “despite advances in diagnosis and treatment, the rate of TB is four times higher in residents of nursing homes than in the general population.”
The USPSTF did not review evidence for populations assumed to be regularly screened for tuberculosis as a standard of care (such as the immunocompromised and patients being treated with chemotherapy) or for healthcare workers who care for symptomatic or high-risk patients, who may already be screened as part of public health or employee health surveillance.
Pregnant nursing home workers
Screening for latent tuberculosis in early pregnancy for women who work in nursing homes is recommended by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists, the USPSTF noted.
The CDC, the American Thoracic Society and the Infectious Diseases Society of America also have screening recommendations for latent tuberculosis, the USPSTF noted.
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