Lana Oconnell
Tuberculosis (TB) is a significant global health threat, and colleges and universities are particularly vulnerable to outbreaks due to crowded settings and frequent interactions. While requirements vary by country and institution, TB screening for foreign students is often encouraged or mandated. In the United States, for example, the American College Health Association (ACHA) guidelines recommend TB screening for international students, and some states have enacted statutes requiring TB screening for all higher education students. This is particularly crucial given that foreign-born individuals account for a significant proportion of TB cases in the US. However, the specific requirements and methods of screening may differ, and not all colleges and universities have implemented comprehensive TB testing policies for international students.
| Characteristics | Values |
|---|---|
| TB screening required for foreign students | No standard rule, varies by college/university and state |
| TB screening methods | TB blood test (IGRA, QFT-G, QFT-Plus), Tuberculin Skin Test (TST), Chest Radiography |
| TB risk factors | History of active TB, close contact with someone who had TB, born/travelled to a country with a high incidence of TB |
| ACHA guidelines | 76% of schools aware, 68% reported having TB screening policies |
| State requirements | At least one state requires TB screening for all higher education students and faculty |
| Impact of no screening | 39% of active TB cases in the US are in foreign-born individuals |
| Benefits of screening | Early detection and treatment, prevent spread of TB on campus |
| Drawbacks of no screening | Communicable disease outbreaks due to crowded campus settings |
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What You'll Learn
TB screening for foreign students entering the US
Tuberculosis (TB) is a continuing threat to global health. Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. In 2012, U.S. college health administrators were surveyed about their awareness of ACHA's TB and immunisation guidelines, with 76% of schools reporting that they were aware of the guidelines. More than half (55%) of schools used a screening questionnaire for all incoming students, as recommended by ACHA guidelines.
However, nonimmigrant international students entering colleges in the United States are not required to undergo screening for TB. Despite this, 39% of active TB cases in the United States are in foreign-born individuals. In an effort to minimise the occurrence of active TB on campuses, some colleges have implemented TB-screening policies for all newly enrolled international students.
Some universities require international students from countries with an increased incidence of TB to provide documentation of current TB testing. Students who have lived in or spent time (for a cumulative period of one to three months) in these countries should also be tested. It is recommended that students with any of the following risk factors have TB testing:
- Close contacts of persons known or suspected to have active TB disease
- Visited areas with a high prevalence of TB disease, especially if visits are frequent or prolonged
- Residents and employees of high-risk congregate settings (e.g. correctional facilities, long-term care facilities, and homeless shelters)
- Healthcare workers who serve clients who are at increased risk for active TB disease
All immigrants and refugees are screened for TB using standard protocols before entering the United States.
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TB testing methods
In the United States, colleges and universities are at risk of communicable disease outbreaks due to the high level of person-to-person interaction and crowded dormitory settings. While there is no federal requirement for TB screening for college entry, a large proportion of schools follow the American College Health Association's (ACHA) TB screening guidelines.
There are two types of TB tests: skin tests and blood tests. The tuberculin skin test (TST) is the more common type, but blood tests are becoming more prevalent, especially for healthcare workers and immunocompromised individuals. Both types of tests can show if someone has ever been infected with the Mycobacterium tuberculosis complex, but they cannot differentiate between a latent (dormant) or active TB infection.
TB Skin Test
The TB skin test, also called the Mantoux test or TST, involves injecting a purified protein derivative (PPD) solution or tuberculin under the skin and checking for swelling at the injection site after 48 to 72 hours. The size of the raised skin is used to determine a positive or negative test result. This test checks to see if the immune system has reacted or produced an antibody to tuberculosis. A positive result indicates a likely latent or active TB infection, while a negative result does not rule out an infection.
TB Blood Test
The TB blood test is also known as the Interferon-Gamma Release Assay (IGRA) or Quantiferon-Tb Gold test. It involves sending a sample of blood to a laboratory to determine whether certain immune system cells can "recognize" tuberculosis. Advanced IGRA tests, such as the T-SPOT technology, provide refined analysis of individual immune responses to specific antigens.
Additional Tests
While skin and blood tests can indicate a previous TB infection, further tests are needed to determine if the infection is active. A chest X-ray can reveal irregular patches in the lungs that are typical of active TB. A sample of mucus from coughing, known as sputum, can also be tested to detect the presence of TB bacteria. Additionally, a test of the cerebrospinal fluid surrounding the spine and brain may be conducted.
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ACHA guidelines and recommendations
Colleges and universities are at risk of communicable disease outbreaks due to the high level of personal interactions and crowded settings. In 2012, a survey was conducted to assess the extent to which US colleges and universities were adhering to the ACHA's recommendations for TB screening and immunizations. The survey found that most schools were aware of the ACHA TB screening guidelines, with 76% reporting that they had TB screening policies in place.
The ACHA provides guidelines and recommendations to help colleges and universities develop effective TB risk assessment and management programs. These guidelines are updated by the ACHA TB Workgroup, which is comprised of members of the Vaccine-Preventable Diseases Committee. The ACHA recommends screening and targeted testing for TB to prevent and control infections on campuses and in the surrounding communities. According to the ACHA, TB screening should include clinical evaluation, treatment management, public health response, and patient education.
The ACHA also provides a list of criteria for TB screening, which includes a history of active TB, a history of a positive TST or IGRA test, close contact with someone who had TB, being born in or having travelled to a country with a high incidence of TB, and other factors. The ACHA's guidelines are comprehensive and provide valuable guidance to colleges and universities in their efforts to prevent and manage TB on their campuses.
While the ACHA's guidelines are widely recognized, there is still room for improvement in their implementation. Evaluations of the facilitators and barriers to adopting recommended health policies can help colleges and universities enhance their TB prevention and management strategies. Additionally, state-level initiatives, such as mandatory vaccine requirements and screening programs, can play a crucial role in preventing outbreaks in colleges and universities.
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State-mandated TB screening
Colleges and universities are at risk of communicable disease outbreaks due to the high level of person-to-person interaction and crowded settings. In the US, there is no federal requirement for TB screening or testing for college entry. However, at least one state has enacted a statute requiring TB screening and targeted testing for all higher education students and faculty. This state-mandated TB screening aims to promote student health and prevent the spread of communicable diseases on college campuses.
The state-mandated TB screening requirement is a targeted approach rather than universal screening. The guidelines emphasise that screening should focus on students at the highest risk for TB, including those with a history of active TB, a positive TST or IGRA test, close contact with a TB patient, birth in a country with a high TB incidence, or travel to such countries. This targeted strategy ensures that resources are allocated efficiently while still contributing to disease prevention on campuses.
Minnesota, for example, has developed guidelines for TB screening in post-secondary schools, including colleges and universities. They recommend targeted tuberculin skin testing for international students from or travelling to countries where TB is endemic. This targeted approach recognises the increasing number of TB cases among foreign-born persons, with over 80% of TB cases in Minnesota reported in this population.
Colleges and universities play a crucial role in preventing TB outbreaks. While universal screening may not be recommended, targeted screening programs, supported by comprehensive follow-up plans, can effectively identify and manage TB infections in high-risk student populations, especially those with a high proportion of international students. These institutions, with their healthcare infrastructure, can provide convenient access to TB screening and treatment services for specific subgroups, contributing to overall campus health.
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TB screening policies at US colleges
Colleges and universities are at risk of communicable disease outbreaks due to the high degree of person-to-person interactions and crowded dormitory settings. In 2012, a survey was conducted to assess US college health administrators' TB screening and immunization requirements. The survey found that 76% of schools were aware of the American College Health Association (ACHA) TB screening guidelines, and 68% reported having TB screening policies. However, only 55% of schools used a screening questionnaire for all incoming students, as recommended by ACHA guidelines.
The ACHA guidelines provide recommendations for transmission and treatment of latent tuberculosis infection (LTBI) and TB disease. While no states required TB screening or testing for college entry when the survey was conducted, at least one state has since enacted a statute requiring TB screening and targeted testing for all higher education students and faculty. Other states may follow this example to promote student health and prevent the spread of communicable diseases on college campuses.
Colleges and universities can play a crucial role in preventing the transmission of Mycobacterium tuberculosis by implementing TB screening programs. In the context of student health, the Tuberculin Skin Test (TST) and Interferon-Gamma Release Assay (IGRA) are commonly offered tests for TB screening. The choice between TST and IGRA depends on factors such as the individual's history of BCG vaccination and the potential for false positive or negative results.
In addition to baseline TB screening upon entry into a college or university, certain high-risk groups may require ongoing TB testing. For example, homeless shelters have been associated with TB outbreaks, and individuals with a history of close contact with someone who had TB may also be considered high-risk. "Cough Alert Policies" and regular risk assessments can help identify active cases of TB and prevent its spread within college campuses.
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Frequently asked questions
While there is no federal requirement for colleges and universities to screen foreign students for TB, many institutions have their own policies in place. In 2012, 55% of schools surveyed reported using a screening questionnaire for all incoming students. Additionally, some states, such as Minnesota, have their own guidelines that recommend targeted TB screening for international students and students travelling from countries where TB is endemic.
The specific requirements vary by institution and state. Some colleges and universities may require foreign students to provide documentation of a recent negative TB test result, while others may administer their own screenings. The preferred method for testing is generally a TB blood test (IGRA) rather than a tuberculin skin test (TST).
TB is a serious health threat that can spread easily in crowded campus settings. Foreign-born individuals are at a higher risk of developing active TB, with 72% of TB cases in the US occurring in this population. Early detection and treatment through proper screening can help prevent the spread of TB and protect the health of all students, faculty, and staff.
