Country/study [ref.]# | Risk assessment examination CXR | TST | TST details | Positive TST | IGRA testing | Who should receive prophylaxis? | LTBI treatment¶ | Time delay before TNF antagonist therapy | |
LTBI | Active TB | ||||||||
France 116 | All patients | All patients | One step | 10 mm | No | TST+, history of TB treated before 1970 or not treated for min. 6 months; CXR lesions >1 cm3 with no history of treatment | 2RZ 3RH 9H | >3 weeks after starting prophylaxis | >2 months after completion of TB treatment |
Germany 177 | All patients | Only if discrepancy between strong epidemiological evidence of prior TB exposure and negative IGRA | >5 mm | Yes | IGRA+, abnormal CXR suggestive of past TB inadequately treated; history of exposure | 9H or 4R | 1–2 months after starting prophylaxis | ||
Ireland 117 | All patients | All patients | One step | 10 mm, 5 mm for IS, no change for BCG vaccinated | If available | TST+ | 9H 4R 4RH | As long as possible after starting prophylaxis | On completion of TB treatment |
Portugal 107 | All patients | All patients | Two step | 5 mm | In progress | TST+, consider prophylactic treatment in TST-negative patients | 9H | 1 month on prophylaxis | >2 months on TB treatment |
Spain 7, 115 | All patients | All patients | Two step | 5 mm | No | TST+, abnormal CXR suggestive of past TB inadequately treated; history of exposure | 9H | 1 month but consider days after or at same time as starting prophylaxis | |
Switzerland 20 | All patients | Not recommended | Yes | IGRA+, abnormal CXR suggestive of past TB inadequately treated; history of exposure | 9H or 4R | 1 month after completion of prophylaxis | |||
UK 113 | All patients | Not for patients on IS as unreliable | One step | 5 mm in unvaccinated, 15 mm in vaccinated | No (update due 2010 by NICE) | TST+ stratified for risk; previous TB inadequately treated or abnormal CXR; IS patients stratified for risk | 6H or 3HR | If abnormal CXR or history of TB, complete prophylaxis. If normal CXR or IS can start concurrently | >2 months on TB treatment |
USA 114 | All patients | All patients | One step | 5 mm if IS, 10 mm if risks, e.g. new immigrant, drug users 15 mm if low risk | No | TST+ in presence of clinical suspicion, TST- if clinical or epidemiological risks | 9H | Preferably complete prophylaxis | Preferably complete TB treatment |
TBNET consensus statement | All patients | TST in individuals without a history of BCG vaccination | One step | ≥10 mm | Yes | IGRA+ or TST ≥10 mm | 9–12H or 3 RH | >4 weeks after initiation of prophylaxis | Preferably complete TB treatment |
CXR: chest radiograph; TST: tuberculin skin test; IGRA: interferon-γ release assay; LTBI: latent infection with Mycobacterium tuberculosis; TNF: tumour necrosis factor; TB: tuberculosis; IS: immunosuppressed/immunosuppression; BCG: bacille Calmette–Guérin; NICE: National Institute for Clinical Excellence; min.: minimum; RZ: rifampicin plus pyrazinamide; RH: rifampicin plus isoniazid; H: isoniazid: R: rifampicin. #: screening pre-TNF antagonist therapy; ¶: the number denotes the number of months of LTBI treatment.