Tuberculosis Control Program
Sanitary Code Rule Change: TB Testing
A rule change was published for Mandatory Tuberculosis (TB) Testing (LAC 51:II.503 and 505) in the June 2021 State Register.
For more information view the Information for Health Care Professionals section on this website.
TB Reporting Requirements
Tuberculosis is a Class B reportable disease and must be reported within one business day of the diagnosis. Providers and facilities can report suspected or confirmed cases of TB using the Tuberculosis Morbidity Confidential Reporting Form.
Contact Us-Tuberculosis Control Directory
Mission: To protect the health of the people of Louisiana by reducing tuberculosis-related morbidity and mortality in all areas of the state.
Vision: The Tuberculosis Control Program strives to reduce tuberculosis morbidity and mortality by using patient-centered, evidence-based practices for prevention, detection, treatment, and education.
Services provided by the TB Control Program include:
- Surveillance- case finding, screening, case reporting and counting, contact investigations
- Containment- treatment and case follow-up
- Diagnostic Services- skin and blood testing, x-ray services, medical evaluation and treatment, labratory testing services, HIV testing
- Directly Observed Therapy- TB medications are provided to all patients, directly observed therapy (DOT) is used to ensure adherence and monitor patient progress
- Education- for patients, workplace settings, healthcare workers, and the general public
Structure: Louisiana has a centralized TB Control Program that implements TB control activities throughout the state under the direction of a Central Office and Regional Program Managers.
Tuberculosis vs. COVID
What is Tuberculosis (TB)?
TB is an airborne infectious disease. TB is spread from infectious to non-infected persons through the air by droplets containing TB bacteria, when the infectious person coughs, speaks, sneezes, laughs, or sings. TB is not spread by contact such as shaking hands or sharing food or drinks.
There are two types of TB, latent TB infection and active TB disease. Only those with active TB disease are infectious and can spread the disease to others.
What is COVID?
Coronavirus, also known as COVID and COVID-19, is part of a large family of viruses, some causing illness in people and others that circulate among animals. Rarely, animal coronaviruses can evolve and infect people, then spread between people.
COVID spreads from infected to non-infected persons through respiratory droplets produced when coughing or sneezing; close personal contact; touching an object or surface with the virus on it, then touching the mouth, nose, or eyes.
Signs and Symptoms
Vaccination and Treatment
TB: TB is preventable and curable. Treatment regimens are available for TB infection and TB disease.
The BCG vaccine is used in TB-endemic countries, primarily among infants to prevent severe disseminated disease. The vaccine is not widely
used in the U.S.
COVID: There is currently no specific anti-retroviral for the treatment of COVID. Infected persons can receive supportive care and symptom relief.
Vaccines for COVID are available, safe, and effective.
Who's at Risk?
Persons at high risk for TB include close contacts of persons with active TB disease, children under 5 years of age, persons who lived in countries with high levels of TB disease, persons with a history of inadequately treated TB, persons with immunosuppressive conditions, and persons who work in congregate settings.
Infection with TB and COVID can lead to severe complications. It is important to follow local COVID precaution guidelines if you have TB infection or disease.
If you have questions about coronavirus, please contact the Louisiana 211 Network by dialing dial 211.
Or, you can text the keyword LACOVID to 898-211 for the most current information about the outbreak as it becomes available.
Or, visit https://ldh.la.gov/Coronavirus/
For COVID vaccine information visit https://ldh.la.gov/covidvaccine
What is TB?
Tuberculosis (TB) is an airborne communicable disease caused by Mycobacterium tuberculosis. While TB of the lungs (pulmonary TB) is the most common, tuberculosis can affect any organ in the body.
For more information about TB listen to this four minute CDC podcast.
How do you get TB?
TB is spread through infectious droplets or particles that a person with infectious TB disease can spread when he or she coughs, speaks, sneezes, laughs, or sings.
Persons nearby may breathe in these particles and become infected.
What is the difference between LTBI and TB disease?
Latent TB Infection (LTBI) is when a person is infected with M. tuberculosis but does not have
TB disease. Persons with LTBI are at risk for developing TB disease but do not have symptoms and cannot spread tuberculosis to others.
TB Disease is when a person has a large number of M. Tuberculosis bacteria in his or her body. Once a person progresses to TB disease they can spread tuberculosis to others and will begin experiencing symptoms.
Is there treatment for TB?
Yes, TB is curable and preventable. There are treatment plans for LTBI and TB disease.
Why is treating LTBI important?
Without adequate treatment, persons with LTBI are at risk of developing TB disease.
TB Epidemiology and Statistics
In 2020 Louisiana had 99 incident case of TB disease and a case rate of 2.1 cases per 100,000
For detailed parish information see the Annual Reports below.
Information for the Public
Are you at risk for TB?
TB is spread from infectious to uninfected persons through the air by droplets that contain Mycobacterium tuberculosis. Droplets containing tuberculosis can spread when an infectious person coughs, speaks, sneezes, laughs, or sings. If an uninfected person inhales these droplets
he or she is at risk of becoming infected with tuberculosis.
TB is NOT spread by shaking hands or sharing food or drinks.
Not all those who are exposed to a person with infectious TB will become infected. Four factors influence the transmission of TB from an infectious to an uninfected person.
- How infectious the TB patient is: If the infected person has been taking all medications of their TB treatment, their level of infectiousness will be lower than someone who is not being treated or is not taking the full course of their treatment.
- Environment where exposure occured: If the exposure occured in an enclosed area with poor ventilation, transmission is more likely than if the exposure occured in an outdoor setting with better airflow and sunlight.
- Frequency and duration of exposure: The more time spent with an infectious TB patient, the more likely the disease will spread to the uninfected person.
- Immune status of the uninfected person: If the person exposed to an infectious TB patient has a compromised immune system, potentially caused by HIV/AIDS or taking other medications that suppress the immune system, they are more likely to become infected with tuberculosis.
The following are persons considered at higher risk of becoming infected with TB and developing TB disease, according to national TB standards:
- Close contacts of persons with infectious TB
- Children under 5 years of age
- Persons who have recently visited or immigrated from areas of the world with high rates of TB
- Persons with medical conditions that weaken the immune system
- Persons who work in congregate settings such as hospitals, nursing homes, correctional facilities, etc.
- Persons with a history of inadequately treated TB
Signs and Symptoms of TB
Persons with latent TB infection (LTBI) are infected with tuberculosis but do not experience symptoms.
Persons with TB disease will likely experience the following symptoms.
Initial symptoms can include:
- Weight loss
- Loss of appetite
- Night sweats
- Persistent low grade fever
- General flu-like symptoms
Additional symptoms of Pulmonary TB (TB of the lungs) can include:
- Cough persisting for more than 3 weeks
- Cough producing blood or sputum (phlegm coughed up from the lower airways)
- Tightness or aching in the chest
TB can affect any organ in the body. Symptoms of TB in organs other than the lungs vary among patients and can mimic other infections. Persons experiencing any of these symptoms who have been exposed to a person with infectious TB should notify their nurse or physician when making an appointment.
Testing for TB
The two most common tests for TB are the tuberculin skin test and TB blood test. The skin test is commonly used by employers and schools and universities to screen for TB.
The skin test involves a small injection in the forearm. Results are called "positive" depending on the amount of swelling at the injection site 48-72 hours after the injection. Most persons who are infected with TB will have a positive skin test.
A positive result to a skin test or blood test only means the person may be infected, it does not indicate if the person has active TB disease. Further testing such as X-rays, physical examination, and various sputum tests, will be conducted to determine if the person has LTBI or TB disease. For more information on further diagnostic testing of persons with positive skin or blood tests, visit: https://www.cdc.gov/tb/topic/testing/diagnosingltbi.htm
Testing is considered safe throughout pregnancy.
What happens if you have TB?
When a case of TB is reported to the Office of Public Health (OPH) TB Control Program, the first two steps are starting the patient on treatment as quickly as possible and conducting a contact investigation. A contact investigation is a process to find out if any of the patient's contacts (friends, family, co-workers, etc.) have also been infected. During contact investigations the original patient's name is not shared with the contacts being interviewed.
The original patient and any contacts also determined to be infected are referred to one of the state's nine regional TB clinics. A patient and any infected contacts are never charged for TB clinic services.
Treatment for TB
Treatments are available for LTBI and TB disease.
Directly observed therapy (DOT) is the standard of care for all TB cases in Louisiana. DOT ensures patients take all doses of their TB treatment regimen by having a health care provider observe the patient taking their medication. During a DOT visit, the health care worker also monitors the patient's response to treatment. DOT can be done in a healthcare facility, the patient's home, or another location agreed upon by the patient and the health care worker.
Standard treatment for LTBI lasts 6 months and is comprised of one drug. Standard treatment for TB disease lasts 6-9 months and is initially comprised of four drugs. Treatment plans can vary if the patient is a young child, has a co-infection such as HIV, or other medical conditions.
Treatment for persons with drug-resistant TB disease is significantly longer than standard treatment regimens. Testing is done before treatment starts to determine if the disease is resistant to any of the standard TB medications. In the event of resistance, the use of second-line drugs are initiated.
Inadequate treatment or lack of adherence to medications can lead to continued infectiousness and transmission, emergence of drug-resistance, or recurrent disease.
For more information about LTBI and TB disease treatment plans see the Louisiana TB Manual or visit https://www.cdc.gov/tb/topic/treatment/tbdisease.htm.
There are two ways a person can come to have drug-resistant TB.
- Primary resistance- the person had contact with and was infected with a strain of TB that was already drug resistant
- Secondary (Acquired) resistance- the person develops resistance after being infected with tuberculosis; this can occur as result of inadequate or incomplete treatment
Drug resistance can make the course of treatment for TB more complicated and longer in duration. This is why DOT is the standard of care for all TB cases in Louisiana. DOT helps prevent incomplete treatment, which helps prevent acquired resistance.
Links to additional information about TB
Information for Health Care Professionals
Diagnosing and Reporting TB
TB disease is still a public health threat. While the number of cases reported each year is decreasing, it is important to keep TB in mind when diagnosing patients with TB symptoms.
Tuberculosis is a Class B reportable disease. Health care practitioners who diagnose active TB are required to report the case to the Louisiana Office of Public Health within one business day of the diagnosis. Providers and facilities can report suspected or confirmed cases of TB using the Tuberculosis Morbidity Confidential Reporting Form.
For more information on how OPH and practicing physicians work together on TB cases, see the aricle, "Is It Tuberculosis" from the Louisiana Morbidity Report.
TB Screening, Testing, and Treatment of Health Care Personnel
In May 2019 Centers for Disease Prevention and Control (CDC) and National Tuberculosis Controllers Association (NTCA), released updated guidance on TB screening, testing, and treatment of healthcare. The Louisiana TB Control Program in reviewing the new CDC guidance and analyzing state data has revised the requirements for TB testing in healthcare facilities.
The updated rule can be found in the June 2021 State Register.
While annual screening with TST or IGRA will no longer be required for most healthcare workers, testing of high risk staff, based on individual facility risk assessment, is still highly recommended.
Information on screening guidelines, example symptom screening forms, example risk assessments, and educational resources can be found on the CDC’s TB Screening and Testing of Health Care Personnel website.
Links to More TB Resources
- World TB Day
- Heartland National TB Center
- Southeastern National Tuberculosis Center
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination
- Louisiana Administrative Code-Title 51: Public Health Sanitary Code