Texas Health and Human Services / Texas Health Steps

Tuberculosis Screening and Testing During Checkups

Child and adolescent TB is often overlooked by health providers and can be difficult to diagnose and treat.

World Health Organization (2021)

Key TB Facts

Although TB is no longer a widespread killer, it remains a dangerous disease that can cause disability or death if untreated. About one-fourth of the world’s population is infected, and untreated infected individuals have a 5 to 10 percent risk of developing TB disease at some point (WHO, 2021).

Young children are far more likely than adults to develop TB disease once they are infected, and they get sick more quickly (CDC, 2021).

In 2020, Texas reported 882 TB disease cases among children and adults — 12.3 percent of the 7,163 cases nationwide (Texas Department of State Health Services, 2021).

TB screening is a required component of each Texas Health Steps preventive medical checkup beginning at age 12 months through age 20 years, with testing required if TB risk is identified.



Isla 4 years

Isla is in your office for her 4-year Texas Health Steps preventive medical checkup. Isla’s mother fills out the Texas Health Steps TB Questionnaire as shown below.

TB QUESTIONNAIRE
Check the box that matches your answer: Yes No Do Not Know

  1. Has your child been tested for TB? If yes, when? Please tell us the date ___ /___ /___

 ☐ ☑ ☐

  1. Have you ever been told that your child had a positive tuberculin skin test (TST)? If yes, when? Please tell us the date ___ /___ /___

 ☐ ☑ ☐

  1. TB can cause fever that can last days or weeks. It can cause weight loss, a bad cough (lasting over two weeks), or coughing up blood.
  1. Has your child been around anyone with any of these problems?
 ☐ ☑ ☐
  1. Has your child been around anyone sick with TB?
 ☐ ☑ ☐
  1. Has your child ever had any of these problems or do they have them now?
 ☐ ☑ ☐

  1. Was your child born in another part of the world like Mexico or Latin America, the Caribbean, Africa, Eastern Europe, or Asia?

 ☐ ☑ ☐

  1. Has your child been to Mexico or any other country in Latin America, the Caribbean, Africa, Eastern Europe, or Asia for more than 3 weeks? Which country or countries did your child visit?

☑ ☐ ☐

  1. Do you know if your child has spent more than 3 weeks with anyone who:
  • Uses needles for drug use?
 ☐ ☑ ☐
  • Has AIDS?
 ☐ ☑ ☐
  • Was or is in jail or prison?
 ☐ ☑ ☐
  • Has just come to the United States from another country?
 ☐ ☑ ☐

Isla’s mother tells you they recently spent several weeks visiting family in Haiti, which you are aware has a high rate of TB. During your physical exam, you note that Isla appears healthy and does not display signs of TB.

Based on the TB Questionnaire and Isla’s physical exam, what is your next step to protect Isla from TB infection?

Make a note in the medical record to check Isla for symptoms of TB infection at her next checkup.

Perform a tuberculin skin test (TST) and schedule an appointment in 48 to 72 hours to read the results.

Perform an Interferon-Gamma Release Assay (IGRA) blood test and submit the sample for analysis.

Refer Isla for posterior-anterior and lateral view chest x-rays.

Why it Matters

Infants and young children are more likely than older children and adults to develop life-threatening forms of TB disease, such as TB meningitis. Among children, the greatest numbers of TB cases occur in children ages 4 years and younger, and in adolescents ages 11 years and older (CDC, 2021). Take our CE course Tuberculosis Screening, Testing and Treatment to learn more about how Texas Health Steps providers can prevent TB disease from affecting Texas children and families.

References

Centers for Disease Control and Prevention. 2021. TB and Children.

Texas Department of State Health Services. 2021. TB Data and Statistics.

World Health Organization. 2021. Tuberculosis Key Facts.

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