[MCOH-EH] TB testing and COVID-19 vaccine: update from CDC

[Wendland, Douglas]

Thank you Melanie.
I have to admit that this hasn’t been an issue for us for a few months so it hasn’t been high on my list for research. Things are again getting a bit crazy up North.  We have started mandating COVID-19 vaccination so our workload is greatly multiplied.

Appreciate your attention and take care.

Doug

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Swift, Melanie D., M.D., M.P.H. via MCOH-EH
Sent: Thursday, September 09, 2021 4:25 PM
To: 'MCOH-EH' <mcoh-eh at mylist.net>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu>; Richard Goldberg <Richard.Goldberg at EnvisionHealth.com>
Subject: Re: [MCOH-EH] TB testing and COVID-19 vaccine: update from CDC


CAUTION: External Sender - This email originated from outside of St. Luke's.
Please do not click links or open attachments unless you recognize the sender and know the content is safe.
Doug, that was the original stance, which was just modified this week. The updated guidance has not yet percolated through all CDC pages. The link you shared below is from an older FAQ buried in the site which hasn’t yet been updated. Note that the link to the “Dear Colleague” letter takes you to Terry Chorba’s original letter from January, where on that site they have posted a notice stating the guidance has recently changed and they direct people to go to the main Clinical Considerations for COVID-19 Vaccines page for the latest guidance. (I’ve attached Dr. Chorba’s updated letter from August 31).

That main Clinical Considerations page is here: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.cdc.gov%2fvaccines%2fcovid%2d19%2fclinical%2dconsiderations%2fcovid%2d19%2dvaccines%2dus.html&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-e92290a69d62e724b437a7f83ca3679df5840c62> You’ll see a list of the changes that were made August 31 in the green box near the top. The last on the list is updating the guidance around timing of TB testing and COVID vaccines.

So really, truly, CDC is NOT any longer recommending that facilities delay TB testing – either skin testing or IGRAs – following COVID vaccine.

I know it’s been a challenge for CDC over the course of the pandemic to unravel outdated guidance from all the places it might live on their vast website, but I’m sure they will get to it.
Best,
Melanie

From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Wendland, Douglas
Sent: Thursday, September 09, 2021 12:49 PM
To: 'MCOH-EH' <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Richard Goldberg <Richard.Goldberg at EnvisionHealth.com<mailto:Richard.Goldberg at EnvisionHealth.com>>
Subject: [EXTERNAL] Re: [MCOH-EH] TB testing and COVID-19 vaccine: update from CDC

https://search.cdc.gov/search/index.html?query=TB%20testing%2C%20COVID-19%20vaccine&siteLimit=coronavirus%2F2019-ncov&dpage=1#:~:text=Yes.%20Testing%20for,of%20all%20vaccines<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fsearch.cdc.gov%2fsearch%2findex.html%3fquery%3dTB%2520testing%252C%2520COVID%2d19%2520vaccine%26siteLimit%3dcoronavirus%252F2019%2dncov%26dpage%3d1%23%3a%7e%3atext%3dYes.%2520Testing%2520for%2cof%2520all%2520vaccines&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-565abb8739fba7f21c19f2dec62e4abf9fdce169>).

Yes. Testing for TB infection with one of the immune-based methods, either the TST or an IGRA, can be done before or during the same encounter as COVID-19 vaccination. It is recommended that the TST be placed or blood drawn for the IGRA before administration of the COVID-19 vaccination. If it is not possible to test with TST or IGRA at the same time as COVID-19 vaccination, these tests should be delayed ≥4 weeks after the completion of COVID-19 vaccination with either the 2-dose mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) or single dose viral vector COVID-19 vaccine (Janssen). However, the decision whether a TST or IGRA that is being done for medical diagnosis of latent TB infection (for example, during a contact investigation<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.cdc.gov%2fmmwr%2fpreview%2fmmwrhtml%2frr5415a1.htm&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-821bdfbf14f0ae0b6b823f4a1d331af7aeeeb5e3> after exposure to contagious TB disease<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.cdc.gov%2ftb%2ftopic%2fbasics%2fexposed.htm&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-e29bf16ff10325089de38cb1e3a8f90581592416>) should be delayed for 4 weeks after completion of COVID-19 vaccination is at the discretion of the responsible medical provider and local tuberculosis program<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.cdc.gov%2ftb%2flinks%2ftboffices.htm&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-ec38f46062d09f8d4f08704b7e90ef0262dc94e2> overseeing the contact investigation.
The reliability of a positive TST or IGRA result after COVID-19 vaccination is expected to be the same as without the vaccination. COVID-19 vaccination is not expected to cause false positive results from a TB test that is done at the same encounter as or after COVID-19 vaccination. It should be noted that the reliability of a negative TST or IGRA result after COVID-19 vaccination has not been studied. If these tests cannot be done at the time of COVID-19 vaccine administration or delayed until ≥4 weeks after administration, a false negative TST or IGRA cannot be excluded, and consideration should be given to repeating negative TST or IGRA tests at least 4 weeks after the completion of COVID-19 vaccination. For more information, please refer to the CDC’s Division of Tuberculosis Elimination “Dear Colleague” Letter<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.cdc.gov%2ftb%2fpublications%2fletters%2fcovid19%2dmrna.html&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-54d404a06ef9ae81626033cf13ff378b746c116f>.
Patients who have active TB disease or an illness that is being evaluated as active TB disease can receive a COVID-19 vaccine (note: the presence of a moderate or severe acute illness is a precaution to administration of all vaccines<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.cdc.gov%2fvaccines%2fhcp%2facip%2drecs%2fgeneral%2drecs%2fcontraindications.html&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-c3812b85e4e21ab82f870623ebfef210405fbdba>).

This is the link to the FAQ section of the CDC website and the actual response to question.  I did not find a reference to unqualified TB testing relative to COVID-19 mRNA vaccine.

Doug

From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Richard Goldberg via MCOH-EH
Sent: Wednesday, September 8, 2021 3:10 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Richard Goldberg <Richard.Goldberg at EnvisionHealth.com<mailto:Richard.Goldberg at EnvisionHealth.com>>
Subject: Re: [MCOH-EH] TB testing and COVID-19 vaccine: update from CDC


CAUTION: External Sender - This email originated from outside of St. Luke's.
Please do not click links or open attachments unless you recognize the sender and know the content is safe.
Thanks for sharing of this information.  Wendy - I was looking at the attached CDC link you sent but don't see the actual place where the information on TB tests and COVID vaccine timing is discussed.  Can you direct us to where in the CDC document it states your quote below (especially with Dr. Wendland's comments that suggest it may only apply to evaluation for TB infection and exposure)?

Thank you

​Please note that my email address has changed to richard.goldberg at envisionhealth.com<mailto:richard.goldberg at envisionhealth.com>

Richard Goldberg, MD MPH
Medical Director
United Occupational Medicine

Director of Occupational Medicine
Infinity Healthcare - Division of Envision Healthcare

________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> on behalf of Wendland, Douglas <Douglas.Wendland at slhduluth.com<mailto:Douglas.Wendland at slhduluth.com>>
Sent: Tuesday, September 7, 2021 11:46 AM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Wendy Thanassi <wendy.thanassi at gmail.com<mailto:wendy.thanassi at gmail.com>>
Subject: [EXTERNAL] Re: [MCOH-EH] TB testing and COVID-19 vaccine: update from CDC


I believe that this was for evaluation for TB infection and exposure.  I don’t believe that there has been a change in the 4 week wait for those tested as part of “onboarding”.



Douglas M Wendland, MD, MPH

St. Luke's Occupational Medicine



From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Thanassi, Wendy via MCOH-EH
Sent: Friday, September 03, 2021 1:07 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Thanassi, Wendy <Wendy.Thanassi at va.gov<mailto:Wendy.Thanassi at va.gov>>; Wendy Thanassi <wendy.thanassi at gmail.com<mailto:wendy.thanassi at gmail.com>>
Subject: Re: [MCOH-EH] TB testing and COVID-19 vaccine: update from CDC



CAUTION: External Sender - This email originated from outside of St. Luke's.
Please do not click links or open attachments unless you recognize the sender and know the content is safe.

Yes and Hallelujah (it should never have been published). Thanks for disseminating this.



From: MCOH-EH <mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net<mailto:mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net>> On Behalf Of Rolando, Lori
Sent: Thursday, September 2, 2021 5:51 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: [EXTERNAL] [MCOH-EH] TB testing and COVID-19 vaccine: update from CDC



Hi all,



Just in case folks hadn’t seen this, wanted to let the list serve know that the CDC has officially updated their guidance on TB testing in the context of recent COVID-19 vaccination.

We no longer need to consider when someone has had a COVID-19 vaccine when administering a TB test as noted below:

“Use of immune-based tests for tuberculosis infection, such as the tuberculin skin test and interferon-gamma release assay

COVID-19 vaccination should not be delayed because of testing for tuberculosis (TB) infection. Testing for TB infection with one of the immune-based methods, either the tuberculin skin test (TST) or an interferon release assay (IGRA)<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2furldefense.com%2fv3%2f%5f%5fhttps%3a%2f%2fimsva91%2dctp.trendmicro.com%3a443%2fwis%2fclicktime%2fv1%2fquery%3furl%3dhttps%2a3a%2a2f%2a2fgcc02.safelinks.protection.outlook.com%2a2f%2a3furl%2a3dhttps%2a253A%2a252F%2a252Fwww.cdc.gov%2a252Ftb%2a252Ftopic%2a252Ftesting%2a252Ftbtesttypes.htm%2a26data%2a3d04%2a257C01%2a257C%2a257C8908a4553b024b9ad76a08d96f026247%2a257Ce95f1b23abaf45ee821db7ab251ab3bf%2a257C0%2a257C0%2a257C637662878316448805%2a257CUnknown%2a257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%2a253D%2a257C3000%2a26sdata%2a3d73XcQ%2a252B6ttxQI%2a252F7iS28q%2a252BVQ%2a252F0Inui8qHCJO6I9%2a252B1R%2a252BHk%2a253D%2a26reserved%2a3d0%26umid%3dF281550B%2dCB1C%2d5D05%2dA525%2d4362B3528C93%26auth%3d0b393771eab4df609f0fdff83b2bfe113ffa6277%2d0a70fd32a4d549cd2ce5877211fcd4c7c6ae198d%5f%5f%3bJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJQ%21%21EZIlbw%21%2dxxKdi44X2LubB1XUSsUiFRpsfv7WvaprqQeuw4xtGrLRAwzMdHflin7gMDHfJTxl7pK%5fg%24&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-d6200ff75299c3e56fdba8b137fdcbdaa40d2489>, can be done before, after, or during the same encounter as COVID-19 vaccination

TSTs and IGRAs were previously recommended to be administered > 4 weeks after completion of COVID-19 vaccination to minimize potential theoretical interference between vaccination and TB testing. This was out of an abundance of caution during a period when these vaccines were new. However, given logistical challenges faced in delaying TB infection testing, the recommendation has been updated so that these tests may now be administered without regard to timing of COVID-19 vaccination.

source:

Interim Clinical Considerations for Use of COVID-19 Vaccines | CDC<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2furldefense.com%2fv3%2f%5f%5fhttps%3a%2f%2fimsva91%2dctp.trendmicro.com%3a443%2fwis%2fclicktime%2fv1%2fquery%3furl%3dhttps%2a3a%2a2f%2a2fgcc02.safelinks.protection.outlook.com%2a2f%2a3furl%2a3dhttps%2a253A%2a252F%2a252Fwww.cdc.gov%2a252Fvaccines%2a252Fcovid%2a2d19%2a252Fclinical%2a2dconsiderations%2a252Fcovid%2a2d19%2a2dvaccines%2a2dus.html%2a26data%2a3d04%2a257C01%2a257C%2a257C8908a4553b024b9ad76a08d96f026247%2a257Ce95f1b23abaf45ee821db7ab251ab3bf%2a257C0%2a257C0%2a257C637662878316448805%2a257CUnknown%2a257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%2a253D%2a257C3000%2a26sdata%2a3drx688YMUQfsCuoOT53l1kBBfvZQiUBeBXZlkGTM89Ys%2a253D%2a26reserved%2a3d0%26umid%3dF281550B%2dCB1C%2d5D05%2dA525%2d4362B3528C93%26auth%3d0b393771eab4df609f0fdff83b2bfe113ffa6277%2dd457397b15e341739aec4490dc595d1a11541c55%5f%5f%3bJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUl%21%21EZIlbw%21%2dxxKdi44X2LubB1XUSsUiFRpsfv7WvaprqQeuw4xtGrLRAwzMdHflin7gMDHfJTWTatuYA%24&umid=23D18EAF-CBAB-1D05-BE71-74E73F63DB01&auth=0b393771eab4df609f0fdff83b2bfe113ffa6277-fb3fcbf1ed6f1dbb0327da2f4d5802514aa310c0>



Thanks so much,

Lori



Lori Rolando MD MPH FACOEM

Director, Vanderbilt Occupational Health Clinic

615-936-0955 (p)

615-936-0966 (f)



This St. Luke's communication is intended for the use of the person or entity to whom it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law.  If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is prohibited.  If you have received this message in error, please notify sender immediately
CAUTION: This email originated from outside of the Envision Healthcare organization. DO NOT click links or attachments unless you recognize the sender’s email address and are expecting its contents. NEVER provide your User ID or password. If you have any questions, please contact the Envision Healthcare Service Desk @ 1-833-893-4357.


________________________________
Confidentiality Notice. The information contained in this transmission contains confidential information. The information is the property of the sender and intended only for use by the individual or entity named above. The recipient of this information is prohibited from disclosing the contents of the information to another party. If you are neither the intended recipient or the employee or agent responsible for delivery to the intended recipient, you are hereby notified that disclosure of contents in any manner is strictly prohibited. If you have received this information in error, please notify the sender immediately and arrange for the return or destruction of these documents.

This St. Luke's communication is intended for the use of the person or entity to whom it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law.  If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is prohibited.  If you have received this message in error, please notify sender immediately
This St. Luke's communication is intended for the use of the person or entity to whom it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law.  If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is prohibited.  If you have received this message in error, please notify sender immediately
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://mylist.net/archives/mcoh-eh/attachments/20210910/90793cad/attachment-0001.htm>