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Posted on: December 4, 2023

Health Advisory: Tuberculosis testing for people who were previously incarcerated

Please see below advisory we are sharing from the Washington State Department of Health regarding tuberculosis (TB) testing for individuals who were previously incarcerated.

Provider advisory: tuberculosis testing for people who were previously incarcerated

November 27, 2023

The Washington State Department of Health (DOH), Washington State Department of Corrections (DOC), and local health jurisdictions continue to work to address a large tuberculosis (TB) outbreak within the state prison system. Since July 2021, 28 people have been diagnosed with active TB; during the outbreak investigation, DOH and DOC identified over 2900 potentially exposed contacts. 

Over 800 exposed individuals were released from prison prior to their exposure being identified or declined testing while in prison. While local health jurisdictions have worked to notify these individuals of their exposure and offer testing, many individuals have not been successfully notified or tested. Thus, we are asking healthcare providers in Washington to help ensure that all previously incarcerated people are offered TB testing. 

The United States Preventive Services Task Force (USPTF) recommends TB screening testing for individuals at increased risk, including people were who were born in, or have lived in, countries with high TB prevalence, as well as people who live in, or have lived in, high-risk congregate settings (e.g., homeless shelters or correctional facilities). The Centers for Disease Control and Prevention (CDC) also recommends TB screening testing for people who work in correctional facilities. 

Washington State healthcare providers are requested to: 

1. Ask patients about risk factors for TB exposure (country of birth, history of living in a country with high TB prevalence, history of living or working in a correctional facility, history of living in a homeless shelter). 

2. Offer TB screening testing to patients at increased risk of TB (unless they have a known history of TB infection or disease). Depending on test availability and the clinical situation, screening testing can be performed using tuberculin skin testing (TST) or interferon gamma release assays (IGRA). 

3. Patients who test positive should receive a clinical evaluation and chest X-ray to rule out active TB disease. If active TB disease is ruled out, initiate treatment for latent TB infection if clinically appropriate. If active TB disease is suspected or diagnosed, contact your local health jurisdiction. 

Healthcare providers can contact their local health jurisdiction with questions about TB testing and treatment (https://doh.wa.gov/about-us/washingtons-public-health-system/washington-state-local-health-jurisdictions).

Additional resources 

Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement: https://jamanetwork.com/journals/jama/fullarticle/2804319

Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5509a1.htm

CDC guidance on TB diagnosis: https://www.cdc.gov/tb/topic/testing/diagnosingltbi.htm

CDC guidance on treatment of latent TB infection: https://www.cdc.gov/tb/topic/treatment/ltbi.ht

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