Ohio University College of Osteopathic Medicine (OU-COM) requires annual screening for tuberculosis and follow-up for reactions ≥ 10mm of all students. Requirements are based on current recommendations of the Centers for Disease Control and Prevention (CDC) for health care workers. Pregnancy does not exclude students from annual TB screening. To facilitate record-keeping, health care providers at OU-COM will be responsible for the administration and reading of summer scholars’, 1st, 2nd and 3nd year medical students’ TB screenings. I. I. Screening for Summer Scholars
A single Mantoux tuberculin skin test (TST) will be administered and read by OU-COM health care providers at the beginning of the Summer Scholars program. A reaction ≥ 15 mm will be considered positive. Students who test positive (≥ 15 mm) must follow up the screening with a chest x-ray or QuantiFERON®-Gold (QFT-G) test, or have documentation of at least 6 months of isoniazid (INH) or other appropriate chemoprophylaxis.
Students born outside the United States in a country where tuberculosis is common may have documentation of bacille Calmette-Guérin (BCG) vaccination given during childhood. A history of BCG is not grounds for waiving screening but will be handled as follows:
A student with a documented history of having received BCG as a child accompanied by a history of a positive TB skin test(s) may elect to have a blood test to identify antibodies to the TB mycobacterium, called QuantiFERON®-Gold (QFT-G), at his/her expense. A negative QFT-G will require no further follow-up.
A student with a documented history of having received BCG as a child but with no history of skin tests or only negative results will be skin tested for TB. If the test result is ≥ 15 mm, the student may elect to have QFT-G at his/her expense in lieu of a chest x-ray. A negative QFT-G will require no further follow-up.
Students who have not had BCG but have a documented prior history of a positive TB skin test must provide a chest x-ray dated no earlier than one month prior to the beginning of the Summer Scholars program or a negative QFT-G test or provide documentation of at least 6 months of INH chemoprophylaxis. II. II. Screening for Entering First-Year Students
All incoming OU-COM students will be screened for tuberculosis (TB) by health care providers at OU-COM. Screening for an incoming student may be one of the following:
A. A two-step Mantoux tuberculin skin test (TST) will be administered and read within 48 to 72 hours by OU-COM health care providers if documentation of a TST, signed by a licensed health care provider and administered in the 12 months prior to matriculation, is not available. In this instance, if the first TST is not significant (< 10mm), a second TST will be administered one to three weeks later. If the second test is positive (≥ 10mm), the student will be considered infected and will require follow-up. If the second test is negative (<10mm), the student/test will be considered negative.
B. A single Mantoux tuberculin skin test (TST) will be administered and read within 48-72 hours by OU-COM health care providers if the student has documentation of prior negative (< 10mm) TST, signed by a licensed health professional, within the 12 months prior to matriculation. A history of bacille Calmette-Guérin (BCG) is not grounds for waiving screening but will be handled as follows: A student with a documented history of having received BCG as a child accompanied by a history of a positive TB skin test(s) will be referred to have QuantiFERON®-TB -Gold (QFT-G) at his/her expense. A negative QFT-G will require no further follow-up and allows the student to receive annual verbal screenings conducted by a trained and licensed health care provider. A student with a documented history of having received BCG as a child but with no history of skin tests or only negative results will be screened for TB using either the TST or the QFT-G. If the TST result is ≥ 10 mm, the student will be referred to have QFT-G at his/her expense in lieu of a chest x-ray. A negative QFT-G will require no further follow-up and allows the student to receive annual verbal screenings. Positive QFT-G results will require follow-up with a chest x-ray and referral to the Very Important Prevention (VIP) program through Hudson Health Center. If QFT-G is indeterminate or positive, nine months of INH therapy are strongly recommended by the CDC. Documentation of treatment for latent TB infection (LTBI) or treatment of active disease will be provided by the student if this was done as follow-up to the positive test reading.
Students who have a documented prior history of a positive TB skin test or who test positive (≥ 10mm) in their initial TST will be referred to have QFT-G at his/her expense. Positive QFT-G results will require follow-up with a chest x-ray and referral to the Very Important Prevention (VIP) program through Hudson Health Center. If QFT-G is indeterminate or positive, nine months of INH therapy are strongly recommended by the CDC. Documentation of treatment for latent TB infection (LTBI) or treatment of active disease will be provided by the student if this was done as follow-up to the positive test reading.
Students who refuse prophylactic treatment will sign a statement, provided by the Director of Clinical and Community Experiences, acknowledging their understanding of the risk they pose to themselves, colleagues and patients by refusing treatment for latent TB infection. The official repository for the signed “Statement of Understanding and Acknowledgement of Risk of Latent Tuberculosis” (Attachment B) is in Academic Affairs along with the student’s Immunization Status Report.
III. Screening for Second, Third and Fourth Year Students Students who have no prior history of a positive (≥ 10mm) TST should be screened annually by OU-COM health care providers.
Students who have a history of a positive (≥ 10mm) tuberculin skin test accompanied by a documented negative QFT-G do not need repeated TST, QFT-G or chest radiographs. Students who have a history of a positive (≥ 10mm) TST along with a negative chest radiograph and documentation of prophylactic treatment or documentation of a completed appointment with a physician at the VIP program as an entering student do not need repeat skin tests or chest radiographs. Students with a documented history of BCG vaccination as children, accompanied by a negative QFT-G, also do not require repeated skin or blood tests of chest radiographs. These students must be screened annually using a questionnaire (Attachment A) about TB symptoms. If a student responds positively to any of the verbal screening questions, the student must undergo a medical evaluation and follow-up treatment as indicated. The student is required to provide written documentation of this evaluation signed by the physician.
Students who develop a positive (≥ 10mm) TB skin test during their clinical rotations in the 3rd and 4th year will be required to contact their local health department regarding recommendations for additional testing and prophylactic treatment.
IV. Other Considerations A student who is under treatment for active TB disease may continue in a course of study only after clearance with appropriate medical consultants and the Associate Dean of Pre-doctoral Medical Education or their CORE Assistant Dean. The student must present annual documentation of continued compliance and ultimate completion of appropriate treatment with satisfactory resolution of disease.
Students who have participated in a trip abroad in a high-risk area are responsible for getting a tuberculin skin test prior to and ten weeks following the trip.
No student will be permitted to participate in Clinical and Community Experiences or clinical rotations until screening and follow-up requirements have been met. A student from another school or department of Ohio University shall be advised of and required to have screening and follow-up prior to any clinical experience at OU-COM.
Attachments: A. TB Screening Questionnaire (revised for 2009) B. Statement of Understanding and Acknowledgement of Risk of Latent Tuberculosis
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