Major policy changes in latent tuberculosis (TB) infection (LTBI) diagnosis and treatment 1993–2013

Period (revision)Policy (guideline)Target group
1993–2004Source and contact investigationClose contacts, excluding persons born before 1945, immigrants from endemic areas#, BCG-vaccinated persons
Healthcare workers and other professional contacts of risk groupsHealthcare workers and other professional contacts of risk groups (such as staff asylum reception centres, prison staff), pre-exposure and periodic screening
Travellers to TB endemic areas#Long-term travellers (>3 months), pre- and post-exposure
Pre-BCG examinationChildren aged 6 months to 12 years with a parent from an endemic area (children aged 6–12 months only when travelled in endemic area)
2004Preventive treatment of persons with inactive fibrotic lesions with no history of previous TB treatmentNew immigrants arriving from TB endemic countries
2004Screening before treatment with TNF-α inhibitorsPatients starting TNF-α inhibitor treatment
2005Source and contact investigationExpansion of eligibility for LTBI screening to persons vaccinated with BCG during infancy and immigrants having lived <12 years in TB endemic areas
2008Screening HIV-infected personsHIV-infected persons
2009Introduction of short-course preventive treatment regimen with 3 months of rifampicin/isoniazid and 4 months of rifampicin (LTBI treatment guideline)All persons eligible for preventive treatment
2010IGRA officially included in diagnostic algorithm for LTBIBCG-vaccinated persons, close TB contacts originating from TB endemic areas, persons born before 1945
2013Travellers to TB endemic areas#,Post-exposure for travellers with high risk of exposure to TB determined by: risk setting, length of stay and TB incidence
  • BCG: bacille Calmette–Guerin; TNF: tumour necrosis factor; IGRA: interferon-γ release assay. #: endemic area defined as estimated TB incidence according to the World Health Organization of more than 50 per 100 000 population; : pre-exposure examination of travellers was abolished and post-exposure screening only for specified high-risk travellers.