Tuberculosis Advisory for Healthcare Providers

Posted Nov. 22, 2023. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

The WA Department of Health is asking healthcare providers to be aware of this situation and take the following action:

• Consider tuberculosis (TB) in adult and pediatric patients with compatible clinical symptoms of cough that lasts 2-3 weeks or longer, unexplained weight loss, fever, night sweats and/or radiological findings.
• Exercise higher consideration for TB in patients from Pacific Islander (PI) communities, including persons born in the Pacific Islands or the U.S. (Pacific Island regions include Federated States of Micronesia and Republic of the Marshall Islands).
• For patients with compatible symptoms from PI communities, perform the following tests to rule out TB disease:
• Physical exam
• Chest x-ray
• IGRA or TST
• If radiographic and/or IGRA finds are suggestive of TB disease, collect 3 sputum samples at least 8 hours apart
• Report suspected cases of active TB to the Spokane Regional Health District within 24 hours. Both pulmonary TB and extrapulmonary TB disease are reportable. Do not wait for culture confirmation to report the case.
• Call reports to 509.324.1613 during business hours, or 509.324.1449 (24/7 recorded report line)
• Or fax reports to 509.324.3600

Background: The Pacific Northwest has been experiencing higher than normal diagnoses of TB disease among people from Pacific Islander communities in recent years. On average, five cases of TB disease are diagnosed in Washington each week and an estimated 200,000 people in Washington are infected and at risk of developing disease.

Be aware of persons with increased risk of infection or developing TB disease, including:

• Close contacts of a person with active TB disease.
• Persons who have history of residence or travel to a place with an elevated TB rate. This includes any country other than the United States, Canada, Australia, New Zealand, or a country in western or northern Europe (Refer to table below for TB-endemic countries and territories).
• Children younger than 5 years of age who have a positive TB test.
• Persons who have a history of latent tuberculosis infection (LTBI), especially those diagnosed within the past 2 years.
• Persons who have lived or worked in a shelter, correctional facility, long-term care facility or other congregate setting.
• Persons with HIV.
• Persons with diabetes mellitus.
• Persons who are immunocompromised.

TB-endemic countries and territories based on 2019 incidence per 100,000 population:
(adapted from WHO global list of high burden countries for TB, TB/HIV, and MDR/RR-TB), 2021-2025)