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Latent Tuberculosis Infection, Screening, 2016

* Indicates an old grade definition


Recommendations: Screening for Latent Tuberculosis Infection

  • Latent Tuberculosis Infection: Screening -- Asymptomatic adults at increased risk for infection
    Grade: B
    Specific Recommendations:
      The USPSTF recommends screening for latent tuberculosis infection (LTBI) in populations at increased risk.
  • Rationale:

    Importance

    In the United States, tuberculosis remains an important preventable disease, including active tuberculosis, which may be infectious, and latent infection (LTBI), which is asymptomatic and not infectious but can later reactivate and progress to active disease. The precise prevalence rate of LTBI in the United States is difficult to determine; however, based on 2011–2012 National Health and Nutrition Examination Survey data, estimated prevalence is 4.7% to 5.0%.1 Tuberculosis is spread through respiratory transmission. Approximately 30% of persons exposed to Mycobacterium tuberculosis will develop LTBI and, if untreated, approximately 5% to 10% of these persons will progress to active tuberculosis disease or reactivation of tuberculosis.2-6 Rates of progression may be higher in persons with certain risk factors or medical conditions. An effective strategy for reducing the transmission, morbidity, and mortality of active tuberculosis disease is the identification and treatment of LTBI to prevent its progression to active disease. Traditionally, prevention of tuberculosis has relied on public health systems; however, more recently, screening for LTBI has become a relevant primary care issue.

    Detection

    The USPSTF found adequate evidence that accurate screening tests are available to detect LTBI. Screening tests include the Mantoux tuberculin skin test (TST) and interferon-gamma release assays (IGRAs); both are moderately sensitive and highly specific.

    Benefits of Early Detection and Treatment

    The USPSTF found no studies that evaluated the direct benefits of screening for LTBI. The USPSTF found adequate evidence that treatment of LTBI with regimens recommended by the Centers for Disease Control and Prevention (CDC) decreases progression to active tuberculosis; the magnitude of this benefit is moderate.

    Harms of Early Detection and Treatment

    The USPSTF found no direct evidence on the harms of screening for LTBI. The USPSTF found adequate evidence that the magnitude of harms of treatment of LTBI with CDC-recommended regimens is small. The primary harm of treatment is hepatotoxicity.

    USPSTF Assessment

    The USPSTF concludes with moderate certainty that the net benefit of screening for LTBI in persons at increased risk for tuberculosis is moderate.

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