Table 43.1. Criteria for Determining Need for Preventive Therapy by Category and Age Group

CategoryAge Group (Years)
< 35> 35
With risk factor * Treat at all ages if reaction to 5 TU purified protein derivative >10 mm (or >5 mm and recent TB contact, HIV-infected, or has radiographic evidence of old TB)
Without risk factor
High-incidence group **
Treat if PPD >10 mmDo not treat
Without risk factor
Low-incidence group
Consider treating
if PPD >15 mm***
Do not treat

* Risk factors include: HIV infection; recent (within past 3 months) contact with infectious person; radiograph other than entirely normal; injection drug abuse; certain medical risk factors; and recent skin-test conversion. Recent converters are defined as: infants and children younger than 4 years of age with a 10-mm PPD; children and adults younger than 35 years of age with an increase in PPD reaction of >10 mm within a 2-year period; or adult >35 years of age with an increase in PPD reaction >15 mm within a 2-year period. Medical risk factors include: HIV infection, diabetes, end-stage renal disease, hematologic and reticuloendothelial diseases, prolonged steroid use, immunosuppressive therapy, and conditions associated with rapid weight loss (intestinal bypass surgery, gastrectomy, peptic ulcer disease, chronic malabsorption, chronic alcoholism, carcinomas of the oropharynx and upper gastrointestinal tract that prevent adequate nutrition).

** High-incidence groups include: foreign-born persons from high-prevalence countries; medically underserved low-income populations (including high-risk racial or ethnic minority populations, especially African Americans, Hispanics, and American Indians); and residents of long-term care facilities.

*** Consider treatment with isoniazid (INH) based on individual assessment of risks and benefits.

Adapted from: Centers for Disease Control. The use of preventive therapy for tuberculosis infection in the United States: recommendations of the Advisory Committee for the Elimination of Tuberculosis. MMWR. 1990;39:(No. RR-8):9-12.

Information also incorporated from: American Thoracic Society. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med. 1994;149:1359-1374. Official journal of the American Thoracic Society. Copyright American Lung Association.

From: 9, Tuberculosis (Including Prophylaxis and BCG Vaccination)

Cover of Clinician's Handbook of Preventive Services
Clinician's Handbook of Preventive Services. 2nd edition.
US Public Health Service. Office of Disease Prevention and Health Promotion.

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