Dr. Thrasher, attached is the NTCA-ACOEM collaborative guidance document on TB testing and treatment in healthcare personnel. The preplacement evaluation recommendations for HCP with a prior positive TB test begin at the bottom of page e358.
Recommendations are essentially the same for prior treated LTBI and prior treated active TB. Document the dates and confirmation of completed treatment. For active TB they should have a clearance document from their public health department at the completion of therapy. A symptom screen would be recommended, but as long as she is asymptomatic and you have documentation of her prior positive IGRA and/or TST at the time of her original diagnosis, documentation of complete treatment and clearance of the active infection, then there really is no testing or imaging recommended. The key will be obtaining that documentation. If she has none, then as Sally recommends you could get an IGRA now (likely would be positive) and follow your usual clearance process. You can do a single view CXR with abdominal shielding, should records be unavailable and you need to exclude active TB. If you have the records though, no need to image her unless she is symptomatic or her treatment wasn’t complete.
Melanie
Melanie Swift, MD, MPH
(she/her)
Vice Chair, Division of Public Health, Infectious Diseases and Occupational MedicineMedical Director, Mayo Clinic Physician Health Center
Associate Medical Director, Occupational Health Service
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905---------------------------------------
From: MCOH-EH <mcoh-eh-bounces+swift.melanie=mayo.edu@mylist.net> On Behalf Of Sally Foster-Chang
Sent: Wednesday, February 8, 2023 11:20 AM
To: MCOH-EH <mcoh-eh@mylist.net>
Subject: [EXTERNAL] Re: [MCOH-EH] TB screening question
I’d do an IGRA. At least you would have a baseline.
On Wed, Feb 8, 2023 at 12:02 PM dennis thrasher via MCOH-EH <mcoh-eh@mylist.net> wrote:
Any recommendations for a new-hire nurse applicant? She is pregnant and
has previously been treated for active TB.
Thanks.
Dennis Thrasher, MD, MPH
sunnyside@dakotacom.net
520 247 1397
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The MCOH-EH List has always been moderated by members of the ACOEM Medical Center Occupational Health Section. It is currently moderated by Joe Fanucchi MD FACOEM.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh@mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc): http://www.mcoh-eh.net
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
---------------------------------------
List archives (public): http://mylist.net/archives/mcoh-eh/
---------------------------------------
Send administrative requests to: drjoe@meditrax.com
---------------------------------------
When replying to a message, PLEASE delete all footers, and all messages to which you're NOT replying.