Section 696.150  Management of Persons with Tuberculosis Infection

a)         Preventive Therapy.  Before therapy is started, persons with a positive TB screening test result shall receive a diagnostic evaluation for TB disease.  See Appendix C for information on how to interpret skin test results.  If there is no evidence of disease, persons with TB infection should be considered for preventive therapy.  Preventive therapy shall be conducted in accordance with the incorporated publication, Treatment of TB and TB Infection.

1)         The following persons with positive TB screening test results should be considered for preventive therapy regardless of age:

A)        Persons with HIV/AIDS and persons with risk factors for HIV/AIDS whose HIV infection status is unknown;

B)        Close contacts of persons with newly diagnosed infectious tuberculosis;

C)        Recent tuberculin skin test converters (equal to or greater than a 10 mm increase within a two-year period for persons younger than 35 years of age; equal to or greater than a 15 mm increase for persons 35 years of age or older);

D)        All infants and children younger than four years of age with a skin test reaction equal to or greater than 10 mm;

E)         Persons with medical risk factors that may increase the risk of tuberculosis (e.g., diabetes mellitus, prolonged therapy with adrenocorticosteroids, immunosuppressive therapy, some hematologic and reticuloendothelial diseases such as leukemia or Hodgkin's disease), injection drug users known to be HIV-seronegative, end-stage renal disease, and clinical situations associated with substantial rapid weight loss or chronic undernutrition;

F)         Adults with positive results from a TB screening test with abnormal chest radiographs that show fibrotic lesions likely representative of old healed tuberculosis and adults diagnosed with silicosis.  These persons should usually receive 4-month multiple-drug chemotherapy.  Alternatively, such persons may receive 12 months of isoniazid preventive therapy.

G)        Persons converting from a negative to a positive TB screening test result, other than a Mantoux skin test.

2)         In the absence of risk factors listed in subsections (a)(1)(A) through (G) of this Section, the following persons younger than 35 years of age with a positive TB screening test result should be considered for preventive therapy:

A)        Foreign-born persons from high-prevalence countries including those in Latin America, Asia, and Africa;

B)        Medically underserved low-income populations, including high-risk racial or ethnic minority populations, especially blacks, Hispanics and Native Americans;

C)        Residents of high-risk congregate settings; and

D)        Persons with no risk factors.

3)         The following persons with a negative TB screening test result should be considered for preventive therapy:

A)        Children who have been close contacts to infectious cases within the last three months.  If the TB screening test remains negative after 12 weeks and there has been no continued exposure, preventive therapy need not be continued; and

B)        Anergic HIV-infected adults.

4)         All persons in high-risk groups, with a positive TB screening test result, should be considered for preventive therapy.  (See Appendix C and the incorporated publications, Screening High-Risk Populations and Treatment of TB and TB Infection.)

b)         BCG Vaccine and Preventive Therapy.  A diagnosis of TB infection and the use of preventive therapy should be considered for any BCG-vaccinated person with a positive TB screening test result.  (See the incorporated publication, The Role of BCG Vaccine.)

c)         Directly Observed Preventive Therapy (DOPT).  In settings where DOPT can be given by a responsible and trained employee or volunteer, twice-a-week DOPT should be considered.  DOPT should especially be considered for persons who are at  high-risk for TB disease, or at high-risk of nonadherence to preventive therapy.

d)         Monitoring for Adverse Reactions.  At a minimum, patients should be seen monthly during therapy and evaluated for adverse drug reactions.

(Source:  Amended at 32 Ill. Reg. 4010, effective February 29, 2008)