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Tuberculin Skin Test Screening Practices Among US Colleges and Universities
Karen A. Hennessey, PhD, MSPH;
Joann M. Schulte, DO;
Linda Cook, MA;
Marjeanne Collins, MD;
Ida M. Onorato, MD;
Sarah E. Valway, DMD, MPH
JAMA. 1998;280:2008-2012.
Context.— Concern about transmission of Mycobacterium tuberculosis on college campuses has prompted some schools to institute tuberculin skin test screening of students, but this screening has never been evaluated.
Objective.— To describe tuberculin skin test screening practices and results of screening in colleges and universities in the United States.
Design and Setting.— Self-administered mail and telephone questionnaire in November and December 1995 to a stratified random sample of US 2-year and 4-year colleges and universities.
Main Outcome Measures.— Type of tuberculin screening required; types of schools requiring screening; number and rate of students with positive skin test results and/or diagnosed as having tuberculosis.
Results.— Of the 3148 US colleges and universities, 624 (78%) of 796 schools surveyed responded. Overall, 378 schools (61%) required tuberculin screening; it was required for all new students (US residents and international students) in 161 (26%) of 624 schools, all new international students but not new US residents in 53 (8%), and students in specific academic programs in 294 (47%). Required screening was more likely in 4-year vs 2-year schools, schools that belonged to the American College Health Association vs nonmember schools, schools with immunization requirements vs schools without, and schools with a student health clinic vs those without (P<.001 for all). Public and private schools were equally likely to require screening (64% vs 62%; P=.21). In the 378 schools with screening requirements, tine or multiple puncture tests were accepted in 95 (25%); test results were recorded in millimeters of induration in 95 (25%); and 100 (27%) reported collecting results in a centralized registry or database. Of the 168 (27%) of 624 schools accepting only Mantoux skin tests and reporting results for school years 1992-1993 through 1995-1996, 3.1% of the 348,368 students screened had positive skin test results (median percentage positive, 0.8%). International students had a significantly higher case rate for active tuberculosis than US residents (35.2 vs 1.1 per 100,000 students screened).
Conclusions.— Widespread tuberculin screening of students yielded a low prevalence of skin test reactors and few tuberculosis cases. To optimize the use of limited public health resources, tuberculin screening should target students at high risk for infection.
From the Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Hennessey, Schulte, Onorato, and Valway); and the University of Pennsylvania, Philadelphia (Dr Collins and Ms Cook). Dr Hennessey is currently an Epidemic Intelligence Service Officer with the Epidemiology Program Office assigned to the Polio Eradication Activity in the National Immunization Program at the Centers for Disease Control and Prevention.
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