Reducing the Tuberculosis Burden: A Focus on TB Blood Testing

QUEST WEBINAR

Title: Reducing the tuberculosis burden: A focus on TB blood testing

Presenter: Ann E. Salm, M (ASCP), MSc, PhD, Director, Medical Science Liaison for Infectious Disease and Immunology , Quest Diagnostics

0:02
My name is Doctor Ann Salm and I'm the Director of Medical Science Liaison for Infectious Disease and Immunology at Quest Diagnostics.

0:11
I'm here to talk to you about how TB blood testing can reduce the population burden of the of tuberculosis in the United States.

0:23
In this presentation, I will review statistics on TB burden in the US and compare active versus latent TB cases.

0:32
I will then work into providing basics on TB pathogenesis and compare active versus latent TB symptoms.

0:39
This will lead into highlighting who and when to conduct TB blood test screening, followed by the relevant TB testing guidelines and testing solutions available to you through Quest.

0:55
The TB burden in the United States.

0:57
The current statistics on USTB cases indicate a 16% increase of reported TB cases from 2022 to 2023.

1:08
The CDC estimates that 13 million, or 5% of the US population has asymptomatic or latent TB.

1:17
Of note, 2023 is the third consecutive year that the USTB incidence has been on the rise.

1:25
Segmented by age, the highest incidence rates are in those individuals 65 and older, and there was a 24% increase or jump in incidence for 15 to 25 year-olds from the years 2021 to 2022.

1:41
This would suggest a particular need in considering young adults and elderly populations with regards to TB screening protocols.

1:51
Additional challenges to TB testing and surveillance #1 treating for TB often requires infectious disease specialists to oversee prescribing and therapeutic compliance or oversight, while simultaneously balancing the reality that 80% of US counties lack access to such ID specialists.

2:13
In addition to age and geographic location, TB disproportionately affects people by race and living conditions.

2:24
Tuberculosis Basics Who and when to screen Tuberculosis is caused by the Organism Mycobacterium tuberculosis, or MTB.

2:35
It is airborne, making it highly transmissible from person to person.

2:39
It is most contagious when infecting the lungs, but can also infect other tissues in the body.

2:46
Anyone exposed to even small amounts of MTB Organism can develop active T tuberculosis infection.

2:53
However, individuals with a healthy immune system can fight TB infections into latency, wherein MTB forms granulomas, a sort of protective, walled off cavity of MTB Organism that lays dormant or latent in the lungs.

3:11
Such individuals recover from the symptoms associated with active TB, making it difficult without a clinical diagnosis to differentiate latent TB from a clinically cured cold or flu.

3:25
Let's take a closer look and compare latent versus active TB from a clinical perspective.

3:33
In active TB, patients are experiencing cough, fever, and weight loss.

3:38
They should test positive for MTB in lower respiratory sputum samples, and the TB skin or blood tests should also produce a positive result.

3:48
The noteworthy difference in patients with latent TB in comparison to active TB is that the patient experiences no symptoms, is not contagious, may or may not have appreciable granulomas on X-ray, but should be treated based on risk of reactivation or spread.

4:08
While active TB is a nationally notifiable disease.

4:11
TB reporting requirements Latent TB reporting requirements vary by state.

4:19
Let's take a closer look at latent TB.

4:22
Approximately 80% of TB cases in the US have been attributed to reactivation of latent TB acquired in the past, often outside of the US.

4:34
Revisiting the state of the United States, remember 13 mil and 16%, 13 million people in the US are estimated to have latent TB and there was a 16% increase in TB cases from 2022 to 2023.

4:50
We, the US can't estimate, can't eliminate TB by managing active cases alone.

4:58
Clinicians and public health efforts must be laser focused on identifying and treating LTBI cases as well.

5:09
Who is at risk of active or latent TB?

5:12
This can be summarized by the three I's.

5:15
Immigrants, individuals impacted by social or and or economic determinants of health, and immunocompromised patients.

5:24
Immigrants, those who have come to the US from countries where TB is endemic, individuals impacted by socioeconomic determinants of health.

5:35
This would include persons who have lived or currently live or work in high risk congregate settings, for example, homeless shelters, hospitals or health systems or correctional facilities.

5:49
And finally, immunocompromised individuals.

5:51
These would include people with, for instance, diabetes, end stage renal disease, HIV or cancer.

6:01
TB screening guidelines Let's look at TB testing guidelines from United States Preventative Task Force or USPSTF, Centers for Disease Control and Prevention or CDC and US Citizenship and Immigration Services or the USCIS.

6:18
While either TB skin test and blood tests are both considered comparable for TB screening, USPSTF takes a strong position in support of screening.

6:29
Asymptomatic individuals or adults at risk for TBCDC recommends TB blood testing over skin test when accessible and particularly in immigrants who have received the BCG or TB vaccine.

6:46
Finally, USCIS requires TB blood testing for immigrant for immigration exams.

6:55
Advantages of TB blood testing also known as igra or interferon gamma release assays.

7:02
IGRA requires just one visit, one draw and one tube of blood, saving providers and patients time.

7:11
It performs better in patients who receive the BCG or TB vaccine.

7:18
Quest Diagnostics is the only national reference lab that offers both FDA approved TB blood tests Quantiferon TB Gold Plus and T Spot TB.

7:28
The package inserts, including instructions for use and safety information, are linked at the bottom of this page and readily accessible online.

7:40
TB blood test requires special handling and Quest Logistics is here for it.

7:46
We've optimized our ordering and kitting of and supplies for both Quantiferon and T Spot to ensure you get the supplies you need to optimize your office workflow.

7:58
We have boots and wheels on the ground and wings in the air to give you the turn-around time you need and deserve.

8:06
In summary, TB cases are on the rise in the US and screening for latent and is as important as active TB in decreasing the overall TB burden in the US and globally.

8:19
Remember, the three Is when you think of screening for TB immigrants, individuals impacted by socioeconomic determinants of health, and immunocompromised LTBI patients at risk of reactivation should be treated.

8:35
USPSTFCDC and USCIS all support TB blood testing over skin test whenever it is accessible and particularly in immigrants and in BCG vaccinated individuals.

8:49
Quest offers both FDA approved TB blood tests in the US: Quantiferon and T Spot.

8:56
Thank you.

8:57
Thank you for taking time to learn about the TB burden in the US and how we Quest can assist you in your TB testing needs.