The Centers for Disease Control and Prevention (CDC) is anticipating a 3 to 10-month nationwide shortage of APLISOL, one of two purified-protein derivative (PPD) tuberculin antigens licensed by the U.S. Food and Drug Administration (FDA) to perform tuberculin skin tests.
In order to prevent a decrease in TB testing capability due to the expected shortage of APLISOL, the CDC recommends the following approaches:
Substitute interferon-gamma release assay (IGRA) blood tests instead of a tuberculin skin test (TST)
Substitute TUBERSOL (another FDA-approved PPD tuberculin antigen) in place of APLISOL when conducting a TST
Prioritize TB testing to only groups that are at a high-risk for TB infection:
recent contacts exposed to persons with TB disease
persons born in or frequently traveling to countries where TB disease is common AND have not had testing since their last period of travel
persons who are immunocompromised
persons who have a history of incarceration or homelessness AND have not had testing since their last incarceration or period of homelessness.
In LA County, please note that individuals who require an assessment for K-12 school entry or employment and volunteers in K-12 settings may meet criteria for TB clearance with a TB risk assessment. If no risk is identified with the risk assessment, no TB test is required. Adult and pediatric risk assessments for LA County can be found Here.
Healthcare personnel in California are still required to undergo annual TB testing as mandated in California Code of Regulations Title 8, Section 5199 (Aerosol Transmissible Diseases Standard) and Title 22.
The LA County TB Control Program recommends that IGRA blood tests:
can be used in place of TST for children 2 years of age and older
are preferred tests in individuals who have been BCG vaccinated
are preferred tests in individuals who are unlikely to return for TST reading.
Clinicians should assess test results based on the person’s likelihood of infection and risk of progression to TB disease, if infected.
For consultation, please contact the LA County TB Control Program at 213-745-0800, (option #1 for English, followed by option #1 again).
The full CDC advisory can be found Here.