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Tuberculosis (TB) Testing

What is TB?

  • Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis
  • The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.
  • TB bacteria are spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, speaks, or sings. People nearby may breathe in these bacteria and become infected.
  • People with TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers or schoolmates.
  • In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria. The TB bacteria lives in their body without making them sick.  As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease.  
  • Latent TB infection is NOT contagious to others.  TB disease CAN BE contagious and spread to others.
  • Many people who have latent TB infection never develop TB disease; some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria; other people may get sick years later when their immune system becomes weak for another reason.

TB Testing:

  • There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin test and TB blood tests.  
  • A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria. It does not tell whether the person has latent TB infection or has progressed to TB disease.
  • If a person is found to be infected with TB bacteria, other tests are needed to see if the person has latent TB infection or TB disease, such as a chest x-ray.
  • NOTE: If you have recently had a vaccination containing a live virus, such as MMR (Measles, Mumps, Rubella), Varicella (Chickenpox) vaccine, or Yellow Fever vaccine, you must wait 4-6 weeks after vaccination before a TB test can be given in order to avoid false negative reactions. 

tbtesting

The TB Skin Test:

  • Also called the Mantoux (Man-Two) tuberculin skin test.
  • The TB skin test is performed by injecting a small amount of liquid (called tuberculin) just under the top layer of skin on the lower part of the arm using a tiny needle and syringe. This injection creates a small raised bump for a few minutes. 
  • The TB skin test is then “read” 48-72 hours afterwards.  The reading can only be done by a healthcare professional who has received special training to properly measure and interpret test results.
  • Almost everyone can receive a TST, including infants, children, pregnant women, and people living with HIV.
  • People who have had a severe skin reaction to a previous TB skin test should not be receive another TB skin test.  
  • A severe skin reaction to a TB skin test can result in scarring. 
  • TB skin tests can be falsely positive in some people who received the TB vaccine, BCG.  If this happens, one cannot assume that the positive result is from BCG or from latent TB infection, or TB disease. Additional tests are needed.
  • The cost of a TB skin test at TCNJ is $10
  • A TB skin test requires two visits with a health care provider trained to perform TB skin testing. On the first visit the test is placed; on the second visit the health care provider reads the test.
  • The result depends on the size of the raised, hard area or swelling.
  • Positive skin test: This means the person’s body was infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease.
  • Negative skin test: This means the person’s body did not react to the test, and that latent TB infection or TB disease is not likely.

The TB Blood Test:

  • Also called interferon-gamma release assays or IGRAs
  • Two TB blood tests are approved by the U.S. Food and Drug Administration (FDA) and are available in the United States: the QuantiFERON®–TB Gold In-Tube test (QFT-GIT) and the T-SPOT®.TB test (T-Spot).
  • A Student Health Services’ provider will draw your blood in the office and send it for analysis to an off-campus laboratory. We order the T-Spot TB test. The laboratory will bill your health insurance plan.  We do not know what out-of-pocket expenses you may incur after insurance processing.  It is best to call your insurance policy before having the test and inquire.
  • Results take about one week.  You will be notified of the results and provided a copy of the laboratory test report for your records.
  • TB blood tests are the preferred TB test for people who have received the TB vaccine, bacille Calmette–Guérin (BCG).
  • Positive TB blood test: This means that the person has been infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease.
  • Negative TB blood test: This means that the person’s blood did not react to the test and that latent TB infection or TB disease is not likely.

Students need a TB test for a variety of reasons, such as:

  • For clinical/classroom placement in a school or medical facility (e.g., student nurses, student teachers)
  • For participation in TCNJ EMS
  • To satisfy TCNJ pre-entrance health requirements (applies only to students who have answered “yes” to one or more of the questions on the Tuberculosis Screening Questionnaire)
  • Post-travel to a location with a high incidence of tuberculosis
  • Exposure to someone with known active, contagious tuberculosis disease.

Students assigned to N.J. classroom field experiences, including JPE and student teaching:

  • You are required by the New Jersey Department of Education to provide documentation of a negative TB test result in the last 6 months before your first classroom field experience (which usually occurs in your sophomore or junior year) OR documentation of a positive TB test result, regardless of when this test was done, is required.  
  • You do NOT need a TB test if you have less than 20 hours per month of pupil contact.
  • Annual testing is NOT required.
  • Once you have submitted this documentation, retesting is NOT required when transferring between school districts.
  • If the school requires you to provide proof of TB testing that is not in accordance with the above paragraph, please notify Janice Vermeychuk, Director of TCNJ Student Health Services, via e-mail at health@tcnj.edu or contact Student Health Services at (609) 771-2889.

TB Test Opportunities:

  • Students are strongly encouraged to attend a TB skin test clinic offered at the start of the fall and spring semester in Trenton Hall. 
  • Limited individual appointments for TB testing (TB skin test and TB blood test) is available in Student Health Services during the fall and spring semesters for those students who could not attend a TB test clinic. 
  • TB skin testing is not available during winter or summer sessions.
  • Note that TB skin testing requires two (2) visits: one to administer the test and the other to “read” the test 48-72 hours afterwards. 
  • For those students who are required to have the “Two-Step TB Test”, the second test must be administered 1-3 weeks after the first test is “read”.  As an alternative to the “Two-Step Test”, a TB blood test can be used.
  • The cost for a TB skin test is $10. Only cash is accepted at a TB test clinic; Cash, TCNJ GetIt, Visa, MasterCard and Discover credit cards are accepted in the office.  The TB blood test is expensive and may or may not be covered by your particular health insurance plan (please contact your insurance company to inquire before being tested).  

Positive TB Test Results – What’s Next?

  • If your test is positive, you will be scheduled for medical evaluation by a Student Health Services’ health care provider. 
  • Additional tests are needed to determine if you have latent TB infection or TB disease.  This includes a chest x-ray.  
  • It is important for you to know that every year, there are a few TCNJ students who test positive for TB.  They do not have TB disease.   

Diagnosis of Latent TB Infection:

  • A diagnosis of latent TB infection is made if a person has a positive TB test result and a medical evaluation does not indicate TB disease. 
  • You are not contagious – there are no limitations in your activity.  
  • The decision about treatment for latent TB infection will be based on a person’s chances of developing TB disease by considering their risk factors.
  • Treatment may be available at NO COST in Student Health Services.

Diagnosis of TB Disease:

  • TB disease is diagnosed by medical history, physical examination, chest x-ray, and other laboratory tests. 
  • TB disease should be suspected in persons who have any of the following symptoms:

    • Unexplained weight loss
    • Loss of appetite
    • Night sweats
    • Fever
    • Fatigue
  • If TB disease is in the lungs, symptoms may include:

    • Coughing for longer than 3 weeks
    • Hemoptysis (coughing up blood)
    • Chest pain
  • The New Jersey Department of Health will be notified as required by law, and you will be referred off-campus for treatment.  
  • TB disease is treated by taking several drugs as recommended by a health care provider.
  • When no longer infectious or feeling sick, people are able to do the same things they did before they had TB disease. 

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