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Tuberculosis (TB)

 
TB testing may be referred to as Purified Protein Derivative (PPD), Mantoux, interferon gamma release assay (IGRA) test, Tuberculosis Skin Test (TST), or Tine test (this method of testing is no longer recommended due to its lack of accuracy).

Testing of School Students and Staff
The entire description of the TB testing requirements for schools is located in 28 PA Code, Chapter 23. Information for school students can be found in Section 23.9 and staff in Section 23.44.
 
School student requirements The Pennsylvania Public School Code, Section 1402(a)(4) requires that students be tested for TB. The School Health regulations require that the testing occur upon original entry into school and in grade nine. However, in November of 1997, a joint letter was sent to schools from the Departments of Health and Education encouraging school boards to apply for a modification to the TB testing requirement that would allow for the elimination of all TB testing of students or to only test high-risk students. This modification applies to students only.  A copy of the letter is available at http://www.health.pa.gov/My%20Health/School%20Health/Documents/Communicable%20Diseases/Tuberculosis/TBtesting.pdf
 
All schools must continue to test employees and volunteers as outlined below. If the school is located in an area with a county or municipal health department, there may be requirements or requests from these local health departments to alter TB testing policies. If school policies are changed as a result of these requests or requirements, the school must also submit a request for modification to the Department of Health (as noted below).
 
To request a modification for TB testing of students The school entity must send a letter detailing the specific modification they are requesting to the Division of School Health (1) on school letterhead, (2) signed by the Superintendent/CEO, and (3) confirming that the requested change has been incorporated into the school entity's health policy/procedures with approval by the school board. The letter must be sent to: Director, Division of School Health, 30 Kline Plaza, Harrisburg, PA 17104. Upon receipt of the request the Division of School Health and the Secretary of Health will either deny or approve the request and inform the school entity of the decision in a hard copy letter sent to the Superintendent/CEO.
 
School staff requirements The Pennsylvania Public School Code, Section 1418(b) requires that school personnel be tested for TB. School personnel to be tested include employees and independent contractors who provide direct services to students on behalf of a school, including but not limited to teachers, nurses, administrators, physicians, dentists, dental hygienists, custodians, janitors, cooks, cafeteria workers, bus drivers, librarians, psychologists, audiologists and counselors, and student teachers and volunteers. The Department of Health defines "direct services" as those persons in direct contact with students 10 or more hours/week. The law does not contain a provision to allow modifications for school staff/volunteers. They must be tested "prior to working for the school."
 
The tuberculin test shall be performed by the school physician, or by a physician of the employee's choice. The person shall provide to the school a form that shows the TB test was administered within three months prior to the data the school receives the form. School personnel who have a documented nonsignificant tuberculin test are not required to have further tests unless they are exposed to a case of active TB or are directed otherwise by the Secretary of Health to have an additional test.
 
TB Resources
Pennsylvania Department of Health, Tuberculosis (TB) Fact Sheet
 
Centers for Disease Control and Prevention (CDC) Tuberculosis

Tuberculosis Handbook for School Nurses (2015) From the New Jersey Medical School Global Tuberculosis Institute. Information on whom and when to screen for TB can be found in Appendix C of this handbook. A sample TB risk assessment evaluation and tool can be found in Appendices C and E. 
 

What Parents Need to Know about Tuberculosis in Children From the New Jersey Medical School Global Tuberculosis Institute.  

CDC TB testing and administration of live vaccine The TB test and live vaccines can be administered at the same visit. If a live vaccines has been administered recently, TB testing should be delayed for at least four weeks after vaccination. TB testing can be performed and read before administration of the live vaccine. Scroll down to the last question of the FAQs.
 
Updated: August 2017