Tuberculosis Screening and Testing During Checkups

Child and adolescent TB is often overlooked by health providers and can be difficult to diagnose and treat.
World Health Organization (2021)

Key TB Facts

Although TB is no longer a widespread killer, it remains a dangerous disease that can cause disability or death if untreated. About one-fourth of the world’s population is infected, and untreated infected individuals have a 5 to 10 percent risk of developing TB disease at some point (WHO, 2021).

Young children are far more likely than adults to develop TB disease once they are infected, and they get sick more quickly (CDC, 2021).

In 2020, Texas reported 882 TB disease cases among children and adults — 12.3 percent of the 7,163 cases nationwide (Texas Department of State Health Services, 2021).

TB screening is a required component of each Texas Health Steps preventive medical checkup beginning at age 12 months through age 20 years, with testing required if TB risk is identified.Next

Case Study

Isla

4 years

Isla is in your office for her 4-year Texas Health Steps preventive medical checkup. Isla’s mother fills out the Texas Health Steps TB Questionnaire as shown below.

Isla’s mother tells you they recently spent several weeks visiting family in Haiti, which you are aware has a high rate of TB. During your physical exam, you note that Isla appears healthy and does not display signs of TB.

Based on the TB Questionnaire and Isla’s physical exam, what is your next step to protect Isla from TB infection?

Make a note in the medical record to check Isla for symptoms of TB infection at her next checkup.

This answer is incorrect.

Isla’s visit to Haiti places her at risk for TB exposure. Although she shows no symptoms, testing for TB must be conducted during this Texas Health Steps preventive medical checkup and not delayed until the next checkup. Results of the screening and testing process must be documented in the medical record.

Perform a tuberculin skin test (TST) and schedule an appointment in 48 to 72 hours to read the results.

This answer is correct.

Isla’s visit to Haiti places her at risk for TB exposure. Texas Health Steps requires the TST to be administered and read when the TB Questionnaire indicates a risk for exposure.

Note: When a Texas Health Steps provider administers the skin test as part of a checkup, the provider may receive separate reimbursement for the TST and for the reading.

Perform an Interferon-Gamma Release Assay (IGRA) blood test and submit the sample for analysis.

This answer is incorrect.

Isla’s visit to Haiti places her at risk for TB exposure. Texas Health Steps requires the TST to be administered and read when the TB Questionnaire indicates a risk for exposure.

Note: When a Texas Health Steps provider administers the skin test as part of a checkup, the provider may receive separate reimbursement for the TST and for the reading. Additional reimbursement is not available for performing an IGRA blood test.

Refer Isla for posterior-anterior and lateral view chest x-rays.

This answer is incorrect.

Isla’s visit to Haiti places her at risk for TB exposure. Although she shows no symptoms of TB, Texas Health Steps requires the TST to be administered and read when the TB Questionnaire indicates a risk for exposure. Diagnostic tests such as chest x-rays should be performed if Isla has a positive result on a TB test or develops symptoms of TB.

Why It Matters

Infants and young children are more likely than older children and adults to develop life-threatening forms of TB disease, such as TB meningitis. Among children, the greatest numbers of TB cases occur in children ages 4 years and younger, and in adolescents ages 11 years and older (CDC, 2021). Take our CE course Tuberculosis Screening, Testing and Treatment to learn more about how Texas Health Steps providers can prevent TB disease from affecting Texas children and families.

References

Centers for Disease Control and Prevention. 2025. Tuberculosis in Children.

Texas Department of State Health Services. 2021. TB Data and Statistics.

World Health Organization. 2021. Tuberculosis Key Facts.