Management of Persons Exposed to Active TB in Outpatient Settings

Immediate Actions Following Exposure

The Centers for Disease Control and Prevention recommends that persons exposed to active tuberculosis in an outpatient setting should undergo immediate contact investigation with tuberculin skin testing (TST) or interferon-gamma release assay (IGRA) as soon as possible after exposure, followed by repeat testing 8-12 weeks after exposure ends if the initial test is negative 1, 2
Baseline testing should be performed immediately unless a negative TST has been documented within the preceding 3 months 3
Exposed individuals (except those already known to be positive reactors) should receive a Mantoux tuberculin skin test or IGRA as soon as possible after the exposure is identified 1, 3
If the initial test is negative, repeat testing must be performed 8-12 weeks after the exposure ended to detect delayed conversion 1, 3

All exposed persons should be evaluated for symptoms suggestive of active TB, including productive cough, weight loss, fever, fatigue, night sweats, and anorexia 1, 4
Exposed persons with previously known positive skin tests do not require repeat testing unless they develop symptoms suggestive of tuberculosis 3

Immunocompromised persons or young children living with or exposed to an infectious TB patient should be considered for temporary relocation until the source patient has negative sputum smears 1
Healthcare workers exposed during procedures should be included in employer-sponsored follow-up programs with appropriate screening intervals 1, 4

Exposed individuals who must remain in contact with the infectious patient should be instructed that the patient must cover coughs and sneezes 1
If cough-inducing procedures were performed during the exposure, enhanced precautions and closer monitoring are warranted 1, 4
Ventilation assessment of the exposure area should be conducted, particularly in clinics serving high-risk populations 4

The facility should conduct a risk assessment to determine if the exposure represents evidence of ongoing transmission requiring reclassification of facility risk level 2, 7

Exposed individuals with positive TST/IGRA and no evidence of active disease should be offered preventive therapy 5

Exposed persons should be reminded to report any pulmonary symptoms promptly during the follow-up period 1, 3
Those who decline or cannot complete preventive therapy should be counseled about their risk for developing active TB and instructed to seek evaluation if symptoms develop 8, 3

Do not rely on a single negative test immediately after exposure—conversion may take 8-12 weeks 1, 3
Failure to include all potentially exposed persons (including service personnel, volunteers, and contract staff) in the contact investigation 2, 7