6.2 High-risk groups

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    6.2.1 Contacts of a person with tuberculosis

    • If the index patient has bacteriologically confirmed pulmonary TB (PTB): screening should be rapidly performed in all household and close contacts, regardless of age and HIV status.
    • If the index patient has clinically diagnosed PTB or extrapulmonary TB (EPTB): screening should be rapidly performed in household and close contacts under 15 years and/or with HIV infection.

     

    Depending on resources and national recommendations, screening for active TB can be extended to all household and close contacts, regardless of the form of TB of the index patient and regardless of age and HIV status of the contact.

     

    For more information on screening strategies, see Table 6.1.

     

    Box 6.1 – WHO definitions for contacts [1] Citation 1. World Health Organization. WHO operational handbook on tuberculosis. Module 2: screening - systematic screening for tuberculosis disease. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
    https://www.who.int/publications/i/item/9789240022614

     

    • A household contact is a person who shared the same enclosed living space for one or more nights or for frequent or extended periods during the day with the index case during the 3 months before the start of current treatment.

     

    • A close contact is a person who does not live in the household, but who shared an enclosed space, such as a social gathering place, workplace or facility, with the index case for extended periods during the day during the 3 months before the current disease episode commenced.

     

    6.2.2 HIV-infected patients

    • In HIV-infected outpatients, screening for active TB should be performed at each contact with a trained health worker (e.g. counsellor, nurse) [1] Citation 1. World Health Organization. WHO operational handbook on tuberculosis. Module 2: screening - systematic screening for tuberculosis disease. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
      https://www.who.int/publications/i/item/9789240022614             [2] Citation 2. World Health Organization. WHO consolidated guidelines on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
      https://www.who.int/publications/i/item/9789240022676             .
      • For children, screening is based on the presence of symptoms and/or a history of close contact with a person with TB.
      • For adolescents and adults, screening is based on the WHO four-symptom screen (W4SS).
    • In HIV-infected inpatients, upfront diagnostic testing is recommended (lateral flow urine lipoarabinomannan assay and rapid molecular tests, see Chapter 3).

     

    For more information on screening strategies, see Table 6.1.

    6.2.3 Other high-risk groups

    Screening for active TB should be routinely performed in:

    • Detained persons.
    • Miners, and other persons with current or past exposure to silica, and patients with silicosis.

     

    Screening for active TB can be considered, depending on local epidemiology, context, and resources, in:

    • Patients with malnutrition, chronic diseases (e.g. diabetes, chronic obstructive pulmonary disease), persons over 60 years or previously treated for TB.
    • Pregnant women.
    • Staff of health facilities exposed to TB (Chapter 15).
    • Urban population living in slums, homeless people, migrants from countries with a TB prevalence estimated to be 100/100,000 or higher.
    • General population in areas with a TB prevalence estimated to be 500/100,000 or higher.

     

    For more information on screening strategies, see Table 6.1.

     

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