[MCOH-EH] New CDC TB Recommendations Concerning Annual Symptom Surveys

[Lawrence Budnick]

I am sharing this clarification concerning annual symptom surveys included in the CDC TB recommendations issued today, which was in response to a query, with Dr. Njie's approval.

From: Njie, Gibril (CDC/DDID/NCHHSTP/DTE) [mailto:vow9 at cdc.gov]
Sent: Thursday, May 16, 2019 6:57 PM
To: Lawrence Budnick <budnicla at njms.rutgers.edu<mailto:budnicla at njms.rutgers.edu>>
Subject: RE: Recommendation for Annual Symptom Survey for HCP with LTBI

Hello Dr. Budnick,

Thank you for your email and interest in the updated recommendations on TB screening, testing, and treatment of health care personnel.

The updated guidance was based on both a systematic literature review and consultation with experts in TB, infection control, and occupational health.  To our knowledge, there are no studies that have evaluated the effectiveness of an annual symptom screen.  The working group reviewed and discussed the published and unpublished reports of health care personnel with untreated LTBI who later developed active TB resulting in large health care associated exposures.  That is the rationale for placing greater emphasis on treatment for those with known LTBI.  Not all health care workers with LTBI will be willing or able to take LTBI treatment.  In those people with untreated LTBI, the expert consultants agreed that an annual evaluation that includes a symptom screen, targeted education, and a  re-assessment of the risks and benefits of LTBI treatment could help minimize TB transmission in health care settings more than no annual evaluation.

All the best,
Gibril

From: Lawrence Budnick <budnicla at njms.rutgers.edu<mailto:budnicla at njms.rutgers.edu>>
Sent: Thursday, May 16, 2019 3:35 PM
To: Njie, Gibril (CDC/DDID/NCHHSTP/DTE) <vow9 at cdc.gov<mailto:vow9 at cdc.gov>>
Subject: Recommendation for Annual Symptom Survey for HCP with LTBI

Dear Dr. Njie,

I appreciate the updated guidance on TB screening, testing and treatment of health care personnel that was published today.

Since the recommendations are evidence-based, could you please clarify the recommendation concerning annual symptom surveys for those with untreated LTBI? What published studies support this surveillance effort to detect active TB disease, especially during the flu and seasonal allergy seasons? There are no references in the document.

On the contrary, CDC has published a number of case studies of TB outbreaks in which HCP with LTBI have completed the annual symptom survey, developed active TB disease a few months later and then infected others, eg, at Bronx-Lebanon Hospital https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a2.htm?s_cid=mm5450a2_e and St. Luke's Hospital, both in NYC. Similarly, we had a resident and a medical student, both with LTBI, who reported negative symptom surveys and then 5 and 6  months later developed active TB disease.

Lawrence D. Budnick, MD, MPH
Professor of Medicine
Director, Occupational Medicine Service
Rutgers University - New Jersey Medical School
65 Bergen Street, Suite GA-167, Newark, NJ 07107
tel 973.972.2900
fax 973.972.2904
lawrence.budnick at rutgers.edu<mailto:lawrence.budnick at rutgers.edu>

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