Kepivance and Tuberculin

Treatment of latent TB infection previously referred to as “preventive therapy” or “chemoprophylaxis”.

ATS and CDC recommend tuberculin testing in high-risk groups and generally discourage such testing in those at low risk to maximize use of resources and minimize false-positive results.

ATS, CDC, and IDSA recommend tuberculin testing in the following high-risk individuals or groups:

Close contacts (i.e., those sharing same household or other closed environment) of known cases of clinical TB or individuals suspected of having TB

HIV-infected individuals; consider annual testing in such individuals at high risk of continued exposure to TB, beginning at 3–12 months of age

Other individuals with medical conditions or factors that increase risk of latent TB infection progressing to active TB, including diabetes mellitus, chronic renal failure, certain hematologic or reticuloendothelial disorders (e.g., leukemias, lymphomas), certain other malignancies (e.g., head and neck or lung cancer), immunosuppression (e.g., organ transplant recipients, individuals receiving prolonged high-dose corticosteroid therapy, tumor necrosis factor, or other immunosuppressive agents), silicosis, weight >10% below ideal body weight, gastrectomy or jejunoileal bypass

Illicit-drug users and other locally identified high-risk substance users (e.g., crack cocaine users); required in all individuals enrolled in methadone detoxification or maintenance treatment program

Residents and employees of high-risk congregate settings (e.g., correctional facilities, nursing homes, mental institutions, other long-term residential facilities [e.g., for HIV-infected patients], homeless shelters); routine (at least annual) testing recommended

Foreign-born individuals (e.g., legal immigrants and refugees with class B1 and B2 TB notification status), including children who recently arrived (≤5 years) from countries with high incidence or prevalence of TB and those adopted from outside US

Certain medically underserved, low-income populations (e.g., migrant farm workers, homeless persons)

Individuals with pulmonary fibrotic lesions on chest radiographs (consistent with healed TB)

Children <5 years of age or infants, children, and adolescents exposed to adults in high-risk categories; annual testing recommended in high-risk pediatric patients (e.g., individuals from countries with high prevalence of TB, low-income groups, children infected with HIV, incarcerated adolescents)

All health-care workers (baseline and postexposure screening); ongoing periodic screening recommended according to risk

History of BCG vaccination does not rule out use of tuberculin testing to aid diagnosis of TB infection. (See False-positive Reactions under Cautions.)