In a July 2008 report prepared by the American College Health Association Tuberculosis Guidelines Task Force, the ACHA advised that students should be screened for risk factors for TB through a screening questionnaire. The United States is primarily a low-incidence country, so most U.S. born incoming students will not have risk factors for TB and will not need TB testing. However, according to the ACHA, international students arriving from countries with an increased incidence of TB should be tested because this subpopulation has been identified epidemiologically as having a higher incidence of latent TB infection (LTBI) and is subsequently at increased risk for developing active TB disease.
According to the ACHA, screening and targeted testing for TB is a key strategy for controlling and preventing infection on college and university campuses. Early detection provides an opportunity to promote the health of affected individuals through prompt diagnosis and treatment while preventing potential spread to others. Implementation of a screening and targeted testing program not only addresses this public health concern in campus communities but also contributes to the larger public health goal of reducing the burden of TB in the United States.
Before this report, The Lewer Agency received a number of calls from client schools checking on LewerMark coverage for TB screening and treatment. At the same time, new screening tests were introduced by the medical community as a replacement for the standard Mantoux skin test, such as the Interferon Gamma Release Assays (IGRAs) blood test. According to the most recent published U.S. Centers for Disease Control and Prevention (CDC) TB infection control guidelines, the sensitivity of the IGRA method for LTBI might be less than the tuberculin skin test (TST), and IGRAs should be used with caution in immunocompromised patients as it has not been used extensively in this group. The ACHA maintains the Mantoux tuberculin skin test is the only acceptable TST at this time.
“Some schools have recently reported TB cases, and they want to make sure there are adequate testing procedures in place," reported LewerMark director, Jeff Crawford. "We attended the ACHA conference in June and this was a topic of discussion because the new blood test has recently become available. According to the report, the skin test is still the preferred procedure. The ACHA also identified a procedure that all schools should consider incorporating into their admissions process. The July 2008 ACHA Guidelines are avaialble on the LewerMark website and provide detailed information regarding this concern on campuses across the country.”
Should a student test positive for TB, Rodney Vallejo, Director of Client Services at Lewer, advises that TB is covered as “any other illness” for LewerMark insureds. “We cover TB as long as the skin test results come back positive,” said Rodney. “The TB skin test is done to screen certain student groups for tuberculosis and at many schools TB testing is routine for all international students. If the skin test results are positive, we cover the follow-up treatment of the infected student including other tests such as chest x-rays and cultures to confirm the diagnosis.”
Should you have questions regarding coverage for TB testing, diagnosis procedures, and treatment, client schools are urged to contact Rodney at 800-821-7715 (Ext 123.)