Guidelines for Decisions Regarding TB Screening of Elementary and Secondary Students

1. Universal screening for tuberculosis (TB), i.e., Mantoux tuberculin skin testing, among all students and/or staff in the school setting is not recommended. This is consistent with national guidelines. [1]
   
   
2. Decisions to conduct screening should be based on an assessment of trends in the local epidemiology of TB and pertinent population demographics (e.g., immigration trends) in the community. The local public health department, in consultation with the Minnesota Department of Health (MDH), should assess their community's incidence and prevalence of TB, identify high-risk groups based on local epidemiology and population demographics, and ascertain the site(s) of most convenient access to any group(s) to which screening will be targeted (e.g., school setting, work site, homeless shelter, etc.). On an annual basis, MDH will provide local health departments with an individualized summary of local epidemiologic TB data to assist in this assessment.
   
   
3. Population-based screening for TB in community settings (including schools), when indicated, is primarily the responsibility of local public health departments. When the school setting is determined to be the site of most convenient access to a high-risk group, the local public health department should work with school nursing staff and school administrators to coordinate any school-based TB screening program. However, local public health agencies should be responsible for overseeing the screening program, ensuring linkages with essential clinical services and financial resources, and ensuring initiation and completion of therapy for latent TB infection, as indicated.
   
   
4. Decisions regarding implementation of a school-based TB screening program should be made jointly by local public health professionals in collaboration with school nurses and school administrators. MDH also is available for consultation, as needed.
   
   
5. A decision to conduct TB screening is a decision to treat latent TB infection, if identified. Targeted screening of persons at high risk for TB infection or disease must be accompanied by a plan for providing necessary follow-up. This plan must include resources for providing a follow-up chest x-ray, medical evaluation, and treatment of latent TB infection or disease, and clinical monitoring during such treatment. A plan to address each of these criteria should be developed before screening is initiated.
   
   
6. Systematic program evaluation is an integral part of any TB screening program. Programmatic indicators that should be evaluated include the number of students with history of prior TB disease or infection, the number of tuberculin skin tests administered, the number of skin tests that are read and the result of each in millimeters of induration, and rates of initiation and completion of treatment of latent TB infection (including reasons for discontinuation among those who fail to complete therapy). These data should be reviewed on an ongoing basis to determine the yield and effectiveness of the screening program. If a low prevalence of TB disease or infection or suboptimal rates of completion of therapy are identified, decisions to continue the screening program should be re-evaluated. MDH is available, as needed, for consultation on implementing a program evaluation system and evaluating resulting data.

References:

1. Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49 (No. RR-6):1,7,22.

These guidelines are based on recommendations of the MDH Work Group on Screening of School Students, December 2000.