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 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I know it’s been a challenge for CDC over the course of the pandemic to unravel outdated guidance from all the places it might live on their vast website, but I’m sure they will get to it.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@mylist.net> On Behalf Of Wendland, Douglas
Sent: Thursday, September 09, 2021 12:49 PM
To: 'MCOH-EH' <mcoh-eh@mylist.net>
Cc: Richard Goldberg <Richard.Goldberg@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).

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 after exposure to contagious TB disease) 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 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.

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).

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

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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@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@mylist.net> on behalf of Wendland, Douglas <Douglas.Wendland@slhduluth.com>
Sent: Tuesday, September 7, 2021 11:46 AM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Wendy Thanassi <wendy.thanassi@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@mylist.net> On Behalf Of Thanassi, Wendy via MCOH-EH
Sent: Friday, September 03, 2021 1:07 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Thanassi, Wendy <Wendy.Thanassi@va.gov>; Wendy Thanassi <wendy.thanassi@gmail.com>
Subject: Re: [MCOH-EH] TB testing and COVID-19 vaccine: update from CDC

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

From: MCOH-EH <mcoh-eh-bounces+wendy.thanassi=va.gov@mylist.net> On Behalf Of Rolando, Lori
Sent: Thursday, September 2, 2021 5:51 PM
To: mcoh-eh@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), 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

Thanks so much,

Lori

Lori Rolando MD MPH FACOEM

Director, Vanderbilt Occupational Health Clinic

615-936-0955 (p)

615-936-0966 (f)

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