1. (a) TB screening at initial enrollment.

   1. (1)

      1. (A) Students without a documented previous tuberculin skin test reaction of ten millimeters (10 mm) or more induration or a positive interferon-gamma release assay (IGRA) must have a tuberculin test.
      2. (B) Tuberculin tests.

2. (i) A tuberculin skin test with five tuberculin units (5TU) of purified protein derivative applied by the Mantoux method and read after forty-eight (48) to seventy-two (72) hours with the reading reported in millimeters (mm) of induration.

   1. (ii)
3. (a) (a) When a student has an undocumented history of a positive tuberculin reaction, he or she may, at the option of the provider administering the test, be tested initially with a half-dose of two and five-tenths tuberculin units (2.5TU) of PPD.

4. (b) (b) If this test causes less than ten millimeters (10 mm) of induration, the student must be retested with the full dose of five tuberculin units (5TU) PPD.

   1. (iii) A student may be tested using an interferon-gamma release assay (IGRA) to measure how the immune system reacts to the bacteria that cause TB.

      1. (C) When a tuberculin skin test causes ten millimeters (10 mm) or more of induration or an interferon-gamma release assay (IGRA) is positive, the student must have a radiograph that must be interpreted by:

         1. (i) A physician associated with the Department of Health; or
         2. (ii) A State Board of Health-eligible:
5. (a) (a) Radiologist;

6. (b) (b) Pulmonologist; or

   1. (c) (c) Infectious disease specialist;

   2. (2)

      1. (A) Students with a previous documented tuberculin skin test reaction of ten millimeters (10 mm) or more or a previous positive interferon-gamma release assay (IGRA).

      2. (B) A radiograph, which must be interpreted by:

         1. (i) A physician associated with the Department of Health; or
         2. (ii) A board-eligible:
7. (a) (a) Radiologist;

8. (b) (b) Pulmonologist; or

   1. (c) (c) Infectious disease specialist;

   2. (3)

      1. (A) Students who have radiographic findings consistent with TB disease.

      2. (B)

         1. (i) Additional evaluation and/or treatment as required to assure that the student does not pose a risk of TB infection to others, as determined by the State Tuberculosis Control Officer.
         2. (ii) No student in this group may begin attending or continue to attend classes or reside in communal housing under the college’s control without the approval of the control officer.

9. (b) Follow-up TB screening for TST reactors and positive interferon-gamma release assays.

   1. (1) Tuberculin-positive students are required to have an annual radiograph meeting the requirements of subdivision (a)(2) of this section, above.
   2. (2) Exception. Students who can document completion of an adequate course of treatment for latent TB infection with a negative initial radiograph.

   3. (3) Only the control officer or his or her designee may determine the adequacy of:

      1. (A) A course of treatment; or

      2. (B) Documentation of treatment.

         1. (c) Follow-up TB screening for active disease.

   4. (1)

      1. (A) Any student who has a history of TB disease should present documentation that he has completed an adequate course of treatment.
      2. (B) If he or she is unable to present such documentation, he or she must undergo screening just as if he or she did not have the history of TB.
      3. (C) Such students will not be excused from meeting the deadlines for completing the requirements for screening due to difficulties in obtaining documentation or any other reason.
      4. (D) If the original documentation is not in English, a translator approved by the control officer must translate it.
      5. (E) The student will be responsible for all costs of translation and for arranging for payment with the translator.

   5. (2)

      1. (A) Students who have a history of TB disease are required to have an annual screening for two (2) years following completion of an adequate course of treatment.
      2. (B) The screening will include a chest radiograph and bacteriologic studies to rule out relapse of disease, as well as such other evaluation the control officer directs.

   6. (3) Only the control officer or his or her designee may determine the adequacy of a course of treatment or of documentation of treatment.

      1. (d) Follow-up TB screening for HIV-positive students. Any student who is HIV-positive must receive a chest radiograph initially and annually regardless of tuberculin test results.

10. (e) Screening facilities.

    1. (1) TB screening may be done by any of the following:

       1. (A) Department facilities;

       2. (B)

          1. (i) College and university student health services that are approved by the department.
          2. (ii) Obtaining approval will require that one (1) or more individuals employed by the service be certified to:
11. (a) (a) Apply and read tuberculin skin tests; and

12. (b) (b) Draw and properly handle tuberculosis blood test specimens; and

    1. (C) Licensed physicians.

    2. (2)

       1. (A) When necessary, more than one (1) provider or type of provider may provide TB screening services to a student; e.g., a college health service might perform tuberculin testing, but refer students with positive tests to another facility for chest radiography.
       2. (B) In such a case, the college health service would retain overall responsibility for assuring that the student fully complies with the requirements of this part.

       3. (C) The college’s responsibility will be discharged if it:

          1. (i) Refers the student to the department; and
          2. (ii) Conditions continued enrollment on the student’s cooperation with the department for prompt completion of the screening required by this part.

Codification Notes: "HIV" means human immunodeficiency virus. "PPD" means purified protein derivative. "TB" means tuberculosis. "TST" means tuberculin skin test.