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U.S. Department of Health and Human Services

  

Guide for Primary Health Care Providers: Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection
2005

Appendix A

Sample TB Risk Assessment Tool

Persons with any of the following risk factors are candidates for tuberculin testing, unless there is written documentation of a previous positive TST or QFT.

Risk Factor Yes No
Recent close or prolonged contact with someone with infectious TB disease    
Foreign-born person from or recent traveler to high-prevalence area    
Chest radiographs with fibrotic changes suggesting inactive or past TB    
HIV infection    
Organ transplant recipient    
Immunosuppression secondary to use of prednisone (equivalent of ≥ 15 mg/day for ≥ 1 month) or other immunosuppressive medication such as TNF-α antagonists    
Injection drug user    
Resident or employee of high-risk congregate setting (e.g., prison, LTC facility, hospital, homeless shelter)    
Medical conditions associated with risk of progressing to TB disease if infected (e.g., diabetes mellitus, silicosis, cancer of head or neck, Hodgkin’s disease, leukemia, and end-stage renal disease, intestinal bypass or gastrectomy, chronic malabsorption syndrome, low body weight [10% or more below ideal for given population])    
Signs and symptoms of TB    
Adapted from a form developed by Minnesota Department of Health TB Prevention and Control Program

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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