TB skin test antigens shortage continues.

What should employers do?

The CDC recommends any of three general approaches for addressing the shortages of tuberculin skin test antigens:

1. Substitute IGRA blood tests for TSTs. The cost associated with using the blood tests can be greater than the cost of TST because the per-unit cost of the IGRA test materials is greater than for those of TST and, unlike TST, IGRAs entail services external to the point of care in some settings. The blood tests require phlebotomy, preparation of blood specimens, and specific laboratory services for analysis; therefore, these tests are not available in all practice settings. Clinicians who use the IGRA blood tests should be aware that the criteria for test interpretation are different from the criteria for interpreting TSTs. IGRAs do not utilize the risk-stratified cut-off measurements that are used for TST. Both IGRA products that are licensed in the United States can give indeterminate results, and one of these can also give borderline results (results between positive and negative). TST does not yield indeterminate or borderline results.

2. Substitute APLISOL® for TUBERSOL® for skin testing if APLISOL® is available. In studies, the two products give similar results for most patients. The fixed availability of APLISOL® has created a relative shortage because of increased demand at sites where TUBERSOL® is unavailable, thus limiting the feasibility of this approach.

3. Allocate TSTs to priority usages, such as TB contact investigations, as determined by public health authorities. Priorities can be set in accordance to relative TB risks (4) and local TB epidemiology. A priority strategy might require deferment of testing some persons, and it might require modification of public health rules, regulations, or policies. CDC does not recommend testing persons who are not at risk for TB.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. .

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