CDC Guidance on Tuberculosis Testing and COVID-19 Vaccinations

Many of our members have expressed concern about whether COVID-19 vaccinations could affect processes surrounding tuberculosis testing, which many states require for newly hired Direct Support Professionals (DSPs) before they can begin supporting individuals with intellectual / developmental disabilities. We anticipate this resource from the Centers for Disease Control and Prevention will be helpful to our members who have shared these concerns. A key highlight from this document states that:

“The mRNA COVID-19 vaccine should not be delayed because of testing for TB infection. Testing for TB infection with one of the immune-based methods, either the tuberculin skin test (TST) or an interferon release assay (IGRA), can be done before or during the same encounter as the mRNA COVID-19 vaccination. When testing with TST or IGRA cannot be done at the same time as mRNA COVID-19 vaccination, these tests should be delayed ≥4 weeks after the completion of mRNA COVID-19 vaccination but generally should not be cancelled.

Patients who have active TB disease or an illness that is being evaluated as active TB disease can receive an mRNA COVID-19 vaccine (note: the presence of a moderate or severe acute illness is a precaution to administration of all vaccines). Whereas a TST or IGRA test is part of a comprehensive evaluation for TB disease, positive TST or IGRA results are not required to diagnose active TB diseaseexternal icon.

When considering a tuberculin skin test or interferon-gamma release assay:

• The TST is not expected to have an effect on the safety or the effectiveness of the mRNA COVID-19 vaccine. IGRAs are blood tests and thus do not affect vaccine safety or effectiveness.
• The reliability of a positive TST or IGRA result after mRNA COVID-19 vaccination is expected to be the same as without the vaccination. mRNA COVID-19 vaccination is not expected to cause false positive results from a TB test that is done at the same encounter as or after mRNA COVID-19 vaccination.
• The reliability of a negative TST or IGRA result after mRNA COVID-19 vaccination has not been studied.
• The TST is not a vaccine. The guidance for separating other vaccines from mRNA COVID-19 vaccination by at least 2 weeks in time does not apply to the TST because the TST is not a vaccine.

When a tuberculin skin test or interferon gamma release assay is required by policy:

• A TST or IGRA to meet administrative requirements, (for example, for healthcare employment or for admission to long-term care), can be done prior to mRNA COVID-19 vaccination or at the same encounter. The mRNA COVID-19 vaccine should not be delayed because of testing for TB infection.
• A TST or IGRA should be deferred until ≥4 weeks after the completion of mRNA COVID-19 vaccination. If testing requirements or policies cannot be modified for the COVID-19 pandemic to accept this delay in TST or IGRA testing, it should be understood that a false negative TST or IGRA cannot be excluded, and consideration should be given to repeating negative TST or IGRA tests at least 4 weeks after the completion of COVID-19 mRNA vaccination. If TST was the initial test, boosting could be a factor if the result of the repeat test is positive.

When a tuberculin skin test or interferon gamma release assay is indicated for medical care:

• The decision as to whether a TST or IGRA that is being done for medical diagnosisexternal icon of latent TB infection, (for example, during a contact investigation after exposure to contagious TB disease) should be delayed for 4 weeks after completion of COVID-19 mRNA vaccination is at the discretion of the responsible medical provider and local tuberculosis program overseeing the contact investigation. Medical providers and local tuberculosis programs may not wish to delay testing for persons at high risk for progression to TB disease. However, patients who have a negative result in this context should be considered for retesting >4 weeks after the completion of mRNA COVID-19 vaccination.
• Patients who have symptoms or diagnostic findingsexternal icon consistent with active TB disease should receive further medical evaluation, for example, with chest radiography and sputum bacteriology for Mycobacterium tuberculosis, regardless of TST or IGRA results.”