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C.43 Tuberculosis (TB) Screening and Education Tool
This screening tool for tuberculosis (TB) exposure risk is to be used annually to determine the need for tuberculin skin testing. In areas of high TB prevalence, the screening tool need not be done at visits for which tuberculin skin testing is required: 1 year of age, once between 4 through 6 years of age, and once between 11 through 17 years of age.
The questions in this screening tool are intended as a minimum screen. Follow-up questions may be necessary to clarify hesitant or ambiguous responses. Questions specific to TB exposure risks in the child's community may need to be added.
• If all the answers are unqualified negatives, the child is considered at low risk for exposure to TB and will not need tuberculin skin testing.
•If the answer to any question is "Yes" or "I don't know," the child should be tuberculin skin tested.
•In the case of the child for whom an answer in the past of "Yes" or "I don't know" prompted a skin test, which was negative, the skin test may not have to be repeated annually.
•The decision to administer a skin test must be made by the medical provider based upon an assessment of the possibility of exposure. A negative tuberculin skin test never excludes tuberculosis infection or active disease.
•Bacillus of Calmette and Guérin (BCG) vaccinated children should also have the screening tool administered annually. Previous BCG vaccination is not a contraindication to tuberculin skin testing. Positive tuberculin skin tests in BCG vaccinated children are interpreted using the same guidelines used for non-BCG vaccinated children.
•Children who have had a positive TB skin test in the past (whether treated or not), should be re-evaluated at least annually by a physician for signs and symptoms of TB.
Care of children who are newly discovered to be tuberculin skin test positive includes:
•An evaluation for signs and symptoms of TB.
•A chest X-ray to rule out active disease.
•Oral medications to prevent progression to active disease or multi-drug therapy if active disease is present.
•Referral for consultation by a pediatric TB specialist is recommended if active disease is present.
•A report to the local health authority for investigation to find the source of the infection.
Feel free to photocopy the screening and education tool from this publication.
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