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National shortage forces hiatus in routine TB testing

Apr. 11, 2013, 9:38 AM

Due to an unprecedented national shortage of the tuberculosis (TB) skin testing solution Tubersol, Vanderbilt University Medical Center has temporarily paused routine skin testing of health care workers.

The shortage is affecting hospitals and health departments across the nation, and other agencies outside of health care such as the U.S. Military and correctional institutions.
VUMC, directed by the Tennessee Department of Health, will restrict testing to only high-risk patients, like those who have been exposed to someone with active TB and those suspected of having active disease.

This shortage comes during VUMC’s annual job performance evaluation season, which requires that employees be up-to-date on all immunizations and safety compliances.

The Occupational Health Compliance Hot Spots will continue to help faculty and staff obtain necessary screening and vaccination services, but the TB skin testing will not available.

“Faculty and staff who were not able to receive a TB skin test should not be alarmed,” said Melanie Swift, M.D., director of the Vanderbilt Occupational Health Clinic. “No one will be penalized for not being able to have the test administered during the suspension period.

“Occupational Health will make adjustments to all TB skin compliance reporting during this time. Once our supply has been restored, we will notify all employees in need of testing and provide convenient testing options for them.”

The reason for the lack of solution is unknown, but appears to be a manufacturing issue. The duration of the shortage is unknown, but preliminary information from the manufacturer hints at a resolution by summer. Employee testing will resume as soon as the shortage is resolved.

While there are other forms of testing for TB, Swift and the Tennessee Department of Health caution against using the alternative, Aplisol, for baseline testing of health care workers. Although it is available in limited quantities, it is not ideal for use in routine screenings due to the higher rate of false positives it generates.

The Tennessee Department of Health recommends that hospitals and other clinical service providers:

• Reserve existing stock of Tubersol as a diagnostic tool to assess those with clinical symptoms of TB, particularly children younger than age 5.

• Test patients age 5 and older who are suspected of having active TB disease with an FDA-approved IGRA blood test; indeterminate results should be followed up with a repeat test of the same type.

• Continue routine risk assessment and symptom screening for new and continuing health care workers; defer administration of baseline or annual TB skin testing until further notice and track employees for future test administration with Tubersol when supplies are adequate.

Another area of concern is ensuring that the patient population is secure with the health of the people caring for them.

“Anyone who has been exposed to someone with active TB will be given TB skin testing,” Swift said. “Those are folks who fall under the high-risk category. Additionally, anyone with signs/symptoms of the disease will be fully evaluated to make sure they are safe to be in the facility.”

For more information about the shortage, email or call 936-0955.

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