TB Infection (LTBI)

Reporting

Beginning November 14, 2018, Tuberculosis (TB) infection or latent TB infection will be reportable in Virginia among persons of any age and not just in children younger than four years of age. Diagnosing tuberculosis infection requires that active TB has been ruled out. Results of a test for TB infection (tuberculin skin test or interferon gamma release assay) as well as chest x-ray results and a lack of active TB symptoms should be included in morbidity reports. TB infection will also be added to the list of conditions reportable by laboratory directors.

Virginia Reportable Disease List Updated November 2018

View the Health Commissioner Update: Disease Regulations Update. 

For Local Health Districts:



Testing

There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin test (TST) and TB blood tests.  A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria. It does not tell whether the person has latent TB infection (LTBI) or has progressed to TB disease. Other tests, such as a chest x-ray and a sample of sputum (if symptomatic), are needed to see whether the person has TB disease.  -CDC, 2018


CDC Fact Sheets


National Guidelines and Recommendations



Treatment

People with latent TB infection do not have symptoms, and they cannot spread TB bacteria to others. However, if latent TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. For this reason, people with latent TB infection should be treated to prevent them from developing TB disease.

  • Treatment of latent TB infection is essential to controlling TB in the United States because it substantially reduces the risk that latent TB infection will progress to TB disease. In the United States, up to 13 million people may have latent TB infection. Without treatment, on average 1 in 10 people with latent TB infection will get sick with TB disease in the future. The risk is higher for people with HIV, diabetes, or other conditions that affect the immune system. More than 80% of people who get sick with TB disease in the United States each year get sick from untreated latent TB infection.
  • Treatment of latent TB infection should start after excluding the possibility of TB disease.
  • As of 2018, there are four CDC-recommended treatment regimens for latent TB infection that use isoniazid (INH), rifapentine (RPT), and/or rifampin (RIF). All the regimens are effective. Healthcare providers should prescribe the more convenient shorter regimens, when possible. Patients are more likely to complete shorter treatment regimens. Treatment must be modified if the patient is a contact of an individual with drug-resistant TB disease. -CDC, 2018

The Centers for Disease Control and Prevention's Division of Tuberculosis Elimination (DTBE) has partnered with Medscape, a leading online resource for physicians and healthcare professionals, to produce an expert video commentary featuring DTBE Director, Dr. Philip LoBue.  The video provides information for physicians on the new updated recommendations for use of once-weekly isoniazid-rifapentine for 12 weeks (3HP)for treatment of latent TB infection.  Dr. LoBue discusses the updated recommendation, as well as available DTBE resources for healthcare providers. The video is a great way to share information with healthcare providers on the 12-dose regimen and the importance of latent TB infection treatment. You can find the video online: Once-Weekly Isoniazid-Rifapentine for 12 Weeks (3HP) Video


CDC Medication Fact Sheets and Treatment Regimens


VDH Guidelines and Recommendations


National Guidelines and Recommendations