USPSTF finalizes recommendation on latent tuberculosis screening

Key takeaways:

• USPSTF said those who have an increased risk for TB should be screened for latent TB infection.
• One expert said the recommendation highlights the key role primary care plays in TB prevention.

Adults who have an increased risk for tuberculosis should be screened for latent TB infection, according to a final recommendation statement from the U.S. Preventive Services Task Force.

The B-grade recommendation, published in JAMA, aligns with the task force’s 2016 guidance.

Latent TB infection is when people are infected with TB bacteria but remain asymptomatic and noncontagious, according to the USPSTF. When left untreated, those with latent TB can eventually develop active TB.

The exact prevalence of latent TB in the United States is “difficult to determine,” according to the recommendation statement, but it is estimated to be about 13 million people. The task force concluded with moderate certainty that screening for latent TB in those at an increased risk for TB infection offers a moderate net benefit in preventing active TB.

Most cases of active TB occur in people who were born outside of the U.S., according to the USPSTF. In 2020, the most common countries of birth among people living in the U.S. with new cases of TB were China, India, Mexico, the Philippines and Vietnam.

“People at increased risk for tuberculosis who would benefit from screening include people born or who have lived in countries with increased rates of TB and those who have lived in certain group settings, like prisons or homeless shelters,” Michael Barry, MD, USPSTF chair, said in a press release. “Importantly, anyone who screens positive needs further clinical tests to rule out active TB and confirm [a latent TB infection] diagnosis.”

In the U.S., there are two types of latent TB screening tests: a blood test (the interferon-gamma release assay) and the tuberculin skin test. Both appear to be safe and effective, the task force said. For treatment, antibiotics can typically clear the infection before it progresses to active TB.

The recommendation is based on an evidence review conducted by Daniel E. Jonas, MD, MPH, a primary care physician and health services researcher at Ohio State University, and colleagues, who analyzed 113 studies comprising 69,009 participants.

No studies directly evaluated the harms and benefits of screening for latent TB compared with no screening, Jonas and colleagues wrote, but the tuberculin skin test and interferon-gamma release assays were moderately sensitive and highly specific.

Pooled estimates for specificity of screening tests ranged from 0.95 to 0.99. Meanwhile, the pooled estimates for sensitivity of the tuberculin skin test ranged from 0.6 (95% CI, 0.46-0.74) to 0.8 (95% CI, 0.74-0.87). For the interferon-gamma release assays, pooled sensitivity estimates ranged from 0.81 (95% CI, 0.79-0.84) to 0.9 (95% CI, 0.87-0.92).

In a related editorial, Priya B. Shete, MD, MPH, an associate professor in residence, medicine and epidemiology at the University of California, San Francisco, and colleagues wrote that the recommendation “highlights the critical role of primary care in tuberculosis prevention.”

“The importance of this recommendation, particularly for immigrant communities who bear the disproportionate burden of this disease, cannot be overstated,” they wrote.

Shete and colleagues added that, although it may seem simple, “this recommendation includes several important nuances that, if operationalized, will mitigate gaps in tuberculosis preventive care that inhibit tuberculosis elimination in the U.S.”

“This updated tuberculosis screening recommendation provides a renewed opportunity for the public health and medical communities to work together and take action against tuberculosis and its disproportionate toll on immigrants and other marginalized communities,” they wrote. “We must not squander it.”

References:

• Jonas DE, et al. JAMA. 2023;doi:10.1001/jama.2023.3954.
• Shete JB, et al. JAMA. 2023;doi:10.1001/jama.2023.4967.
• Task force issues final recommendation statement on screening for latent tuberculosis infection. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/latent-tb-screening-final-rec-bulletin.pdf. Published May 2, 2023. Accessed May 2, 2023.