Brief Reports
Tuberculin Skin Test Screening in College Students
Source: Hennessey KA, et al. Tuberculin skin test screening practices among US colleges and universities. JAMA 1998;280:2008-2012.
Concerns about the spread of tuberculosis on college campuses because of the prolonged close contact college students have with each other have prompted some schools to require skin testing of their students before matriculation. However, little is known about the extent of tuberculin testing at American colleges and universities. Hennessey and colleagues at the Centers for Disease Control and Prevention in Atlanta conducted a national survey of tuberculin skin testing procedures and results of screening in colleges and universities in the United States in 1992-1996. A stratified, randomized sample of 624 U.S. two- and four-year colleges responded to a self-administered mail and telephone questionnaire concerning whether tuberculin testing was required, the type of skin test, and the number and rate of students with positive skin test results and/or diagnosed as having tuberculosis.
Overall, 378 of 624 (61%) schools required tuberculin testing. It was required for all new students (both U.S. and international students) in 26% of schools; and all new international but not new U.S. residents in 8% of schools. Forty-seven percent of schools required tuberculin testing for students enrolled in specific academic programs such as health care, education, and social work. Tuberculin testing requirements were more likely in four-year compared to two-year schools, and in schools that had a student health clinic. Exemptions from required testing were permitted in 85% of schools for reasons such as reports of prior positive skin test results, a history of BCG vaccination, or religious reasons. Tine or multiple puncture tests were accepted in 25% of schools.
Analysis of screening results was limited to 168 schools that required screening, accepted the Mantoux skin test only, and reported results of their screening programs. A total of 348,368 students were screened and 3.1% of these had a positive test result. The skin positivity rate for U.S. residents was 1.1 per 100,000 students screened; the rate for international students was 35.2 per 100,000 students screened. During the four-year period of the study, 114 cases of active tuberculosis were reported from 68 (11%) of the 624 schools surveyed. Of these 114 cases, only 32 cases were identified as a result of required tuberculin screening and 26% of these cases were in foreign-born students.
Hennessey et al conclude that universal screening of the general American college student population should not be done. Instead, students at higher risk, such as international or foreign-born students from countries with high rates of tberculosis, students working in health care settings, and immunocompromised students, should be tested. Further, only the Mantoux method of skin testing should be used. Because tuberculin reactivity as a result of receiving BCG wanes over time and rarely persists more than 10 years after vaccination,1 students with a history of BCG vaccination, most of whom come from high-risk areas of the world, should be included in any tuberculin skin test screening requirements.
Reference
l. Centers for Disease Control and Prevention. The role of BCG vaccine in the prevention and control of tuberculosis in the United States. MMWR Morb Mortal Wkly Rep 1996;45(RR-4):1-18.
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