TUBERCULOSIS AND TESTING
See also International Mandatory Tuberculosis Screening
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How to test at University Health Service
TB skin testing is available Monday, Tuesday, Wednesday and Friday
(no Thursday testing), morning clinic hours only.
No appointment is necessary but hours are limited. See Allergy,
Immunization and Travel Health Clinic for morning clinic hours.
The clinic is located on the first floor of UHS (across from the
Pharmacy). If you are a student, bring your UM ID card with
you. You will need to return in person 48-72 hours after the
test. Your arm will be examined to evaluate the results of the test.
Cost is $10.
Frequently asked questions about
testing
How is testing done? An easy,
inexpensive skin test can indicate TB infection, either past or
present. University Health Service (UHS) uses the most reliable
skin test, the Mantoux PPD. A small amount of fluid (called purified
protein derivative or PPD) is injected under the top layer of skin
on the lower arm with a small needle. After 48-72 hours,
the test reaction must be measured, so you must return in person
to have the test read.
What do results mean? Possible
results from a TB skin test are:
- Negative (non-reactive) -- No further testing required.
- Positive (reactive) -- A chest x-ray is required to check for
active TB in the lungs. Possible chest x-ray results are:
- Normal x-ray without symptoms indicates inactive TB. Treatment
is recommended.
- Normal x-ray with symptoms may require additional tests and/or
treatment.
- Abnormal x-ray may require additional tests and/or treatment.
What are side effects of the test?
The TB skin test will not make you sick. It may cause swelling,
itching or tenderness at the site of injection, which usually disappears
within a week.
If I’ve had a positive skin test
in the past, should I have another test? It maybe necessary
to repeat the skin test if no medical records are available and
proof of TB status is required. The reaction may be stronger if
repeated frequently, so it is important to keep your record of a
positive skin test so you can refer to it in the future.
Can I do normal activities after
the test? Yes, you can do your normal activities, including
washing your arm.
Does vaccination cause a positive
skin test ? The vaccine (called BCG) generally does not
cause a positive skin test if you were vaccinated more than ten
years ago. TB infection causes most positive skin tests. Many international
students received BCG vaccine, which reduced their TB risk as children.
However, BCG vaccine effectiveness declines with time. Almost all
international students who develop active TB have received the vaccine.
Will TB affect my visa status?
TB test results do not affect your visa status. UHS must report
cases of active TB (but not inactive TB) to county health departments
to be investigated for possible contagion of others. Beyond that,
health records at UHS are confidential and cannot be released without
your consent.
What is tuberculosis and how
is it transmitted? Tuberculosis (TB) is a disease caused
by TB bacteria. It usually affects the lungs. It can also affect
other body parts such as the brain, kidneys or spine.
TB is spread from person to person through the air. The bacteria
(in the form of droplets) are put into the air when a person with
TB coughs or sneezes. People who are nearby inhale droplets and
may become infected. TB is not as easily transmitted as colds.
What is the difference between inactive
TB and active TB? In inactive (latent) TB, TB
bacteria are alive but inactive in the body. The body builds walls
around these bacteria, the way a scab forms over a cut. TB bacteria
can stay alive inside these walls for years.
A person with inactive TB can develop active TB if they do not
receive treatment (the lifetime risk is 1 in 10).
People with inactive TB:
- Have no symptoms
- Do not feel sick
- Cannot spread TB to others
- Have a positive (reactive) skin test
- Can develop active TB
In active TB (TB disease), TB bacteria become active and
multiply. Active TB is very serious, causing permanent damage and
even death. A person with active TB can spread TB to others.
People with active TB may:
- Have a bad cough longer than 3 weeks
- Have pain in the chest
- Cough up blood and sputum
- Feel weak or tired
- Lose appetite and weight
- Have chills, fever or sweat at night
Who is at risk? If you have
lived in a country where TB is relatively common, you have a significant
chance of having inactive TB. On average, TB is 20 times more common
in Africa, Asia and Central and South America than in the US, Canada,
Europe, Australia and New Zealand.
If you have inactive TB, your risk of developing TB disease in
the US is highest during your first two years after arrival. About
35 per 100,000 international students have active TB when they arrive
in the US. An additional 20-30 per 100,000 develop active TB each
year of their stay.
More than 50% of cases of active TB in the US are in people born
in countries with a higher prevalence of TB than the US.
Other situations that may put you at risk are:
- Close contact with a person who has active TB
- Working or living in group facilities such as jails or prisons,
nursing homes, hospitals, homeless shelters
- Having health conditions including HIV infection, silicosis,
diabetes mellitus, chronic renal failure, some blood disorders,
some cancers, low body weight (>10% below ideal), gastrectomy
and jejunoileal bypass, prolonged corticosteroid therapy, other
immunosuppressive therapy
- Injecting illicit drugs
Testing for American Travelers American travelers
who anticipate prolonged stays (3 months or longer) in countries where tuberculosis is common should have TB skin testing
pre-departure, and again 12 weeks after returning. For additional information, see recommendations from the
Centers for
Disease Control and Prevention.
Treatment for inactive TB
In the US, treatment is recommended for those with inactive TB to
prevent the development of active TB. In other countries where TB
is more prevalent, treatment for inactive TB is not available or
recommended because active TB is the greater priority.
An inexpensive antibiotic called isoniazid (INH) is recommended
to eliminate TB germs. INH is recommended for people with:
- Known recent infection (a positive skin test within two years
of previous negative skin test)
- Evidence of previous TB on chest x-ray
- Other medical conditions that compromise the immune system,
including:
- Certain types of cancer
- Diabetes
- HIV infection
- Rapid weight loss
- Certain medications (e.g. cortisone treatment)
INH must be taken daily for nine months. To avoid side effects,
you should also take vitamin B6 (10-50 mg) daily, eat a balanced
diet, avoid Tylenol (acetaminophen) and avoid daily consumption
of alcohol.
Side effects of INH are uncommon. However, INH may affect the
liver or nervous system. Liver inflammation (hepatitis) is the major
concern. The risk is rare in young people and increases with age.
Liver function can be monitored with blood tests. Side effects are
usually reversed when INH is stopped. In the United States, TB specialists
believe that the risk of active TB is greater than the risk of side
effects of INH.
For people who cannot take INH, alternative drugs are available.
It is important to complete treatment, both to prevent active
TB and to prevent development of strains that are resistant to antibiotics.
If you are considering stopping treatment, please notify your clinician.
If you choose not to take INH and later develop symptoms, inform
your clinician about the symptoms and positive TB skin test as soon
as possible.
Treatment for active TB
Antibiotics can almost always cure active TB. However, antibiotic
resistant strains of TB are increasing. Taking antibiotics as directed
is critically important to success. Your clinician will give you
more information if active TB is diagnosed.
Prevention TB has declined
in the US, but it remains a threat to public health.
If you have inactive TB, get treated to protect your own health,
plus your family, friends and co-workers. Treatment eliminates TB
bacteria from your body so it cannot develop into active TB.
Here's how you can prevent TB and other respiratory infections:
Cover your nose and mouth with a tissue every time you cough
or sneeze. Throw the used tissue in a wastebasket. If you don’t
have a tissue, sneeze or cough into your sleeve.
After coughing or sneezing, always clean your hands with soap
and water or an alcohol-based hand cleaner.
Avoid touching your eyes, nose or mouth.
Do not share eating utensils, drinking glasses, towels or other
personal items.
Stay home when you are sick.
If possible, avoid close contact with people who are sick.
Further information
Tuberculosis Screening Requirement
UHS Allergy, Immunization and Travel
Health Clinic
Offers TB testing
734-764-8304
Note: Language interpretation is available
UM North Campus Family
Health Service
Offers TB testing
734-647-1636
UM International Center
734-764-9310
Washtenaw
County Health Department
Offers TB testing
734-544-6770
World
Health Organization
Centers for
Disease Control and Prevention
Information in other languages from
the Minnesota Department of Public Health
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