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JADA Continuing Education

An Update on the Centers for Disease Control and Prevention Guidelines

Background. Although rates of tuberculosis (TB) in the United States have decreased in recent years, disparities in TB incidence still exist between U.S.-born and foreign-born people (people living in the United States but born outside it) and between white people and nonwhite people. In addition, the number of TB outbreaks among health care personnel and patients has decreased since the implementation of the 1994 Centers for Disease Control and Prevention (CDC) guidelines to prevent transmission of Mycobacterium tuberculosis. In this article, the authors provide updates on the epidemiology of TB, advances in TB diagnostic methods and TB infection control guidelines for dental settings.

Results. In 2008, 83 percent of all reported TB cases in the United States occurred in nonwhite people and 17 percent occurred in white people. Foreign-born people had a TB rate about 10 times higher than that of U.S.-born people. New blood assays for M. tuberculosis have been developed to diagnose TB infection and disease. Changes from the 1994 CDC guidelines incorporated into CDC’s "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005" include revised risk classifications, new TB diagnostic methods, decreased frequencies of tuberculin skin testing in various settings and changes in terminology.

Clinical Implications. Although the principles of TB infection control have remained the same, the changing epidemiology of TB and the advent of new diagnostic methods for TB led to the development of the 2005 update to the 1994 guidelines. Dental health care personnel should be aware of the modifications that are pertinent to dental settings and incorporate them into their overall infection control programs.

Key Words: Tuberculosis; epidemiology; diagnosis; dentistry; infection control; guidelines

Abbreviations: AII: Airborne infection isolation • BAMT: Blood assay for Mycobacterium tuberculosis • BCG: Bacille Calmette-Guérin • CDC: Centers for Disease Control and Prevention • DHCP: Dental health care personnel • EPA: Environmental Protection Agency • HCP: Health care personnel • HEPA: High-efficiency particulate air • HIV: Human immunodeficiency virus • IGRA: Interferon gamma release assay • LTBI: Latent tuberculosis infection • MDR TB: Multidrug-resistant tuberculosis • NIOSH: National Institute for Occupational Safety and Health • RP: Respiratory protection • TB: Tuberculosis • TST: Tuberculin skin test • UVGI: Ultraviolet germicidal irradiation • XDR TB: Extensively drug-resistant tuberculosis