Tuberculosis Screening in Schools Recommendations
Assessing the risk of TB in school children should continue to be a service determined by the prevalence of risk factors for TB infection in school age children in each community. Working with the public health system, school districts can determine whether or not to establish a TB screening program. TB screening programs’ access to TB testing resources should be assessed in consultation with the local or regional health department or the TB Elimination Division of the TDH.
Decisions to screen school children should be made on the basis of sound public health principles and guidelines. To this end, Centers for Disease Control and Prevention, the American Thoracic Society and the American Academy of Pediatrics recommend that only high-risk children be skin tested.
A universal questionnaire to identify children at high risk for TB infection has been developed by experts working with the Texas Department of Health (attachment). This questionnaire should be used to determine a child’s risk for TB infection and thus target TB skin testing to identified high risk individuals. Any new affirmative answers to a part of the questionnaire should trigger referral for or placement of a tuberculin skin test and appropriate follow up.
TB skin testing programs should be developed if follow up services including access to medical evaluation and treatment are provided. Once identified, children with a positive skin test will require a chest x-ray and medical evaluation. To skin test and not offer such services defeats the public health purpose of TB testing.
Skin test positive children who do not have signs or symptoms of TB disease should not be excluded from school while medical evaluation ids in progress.
TB screening and / or skin testing programs for school children should include a system to keep track of data collected and tools to evaluate and analyze the data and the program on a regular basis. Collaboration with local / regional health departments to develop such data tracking systems is encouraged. (Such systems would include a list of variables, a contact name to receive and review submitted data and answer questions, and a method for periodic data analysis and evaluation)
Because screening programs have a social impact, the managers of such programs must have in place strategies that prevent implications of discrimination and disenfranchisement of individuals screened. Information gained from use of a screening questionnaire should be subject to the same standards for confidentiality that are observed for other school medical records. Administration of the questionnaires should be sensitive to the cultural and language differences of the individuals screened.
If a TB screening program is indicated, school districts must join the public health system in sharing the burden of implementation for such a program.
Policies for evaluating for TB infection in children will be periodically examined (every 2 years) by the Blue Ribbon Committee on Childhood Tuberculosis.
Download TB Questionnaire.pdf