Wednesday, August 7, 2019

Aplisol and Tubersol Shortage. Now What?

Pamela Truscott

Some states are experiencing a shortage in Tubersol and Aplisol, tuberculin purified protein derivatives for intradermal tuberculin testing, and are wondering what to do.  The Center for Disease Control (CDC) is aware of this widespread issue and has issued recommendations on how to deal with the shortage. 

According to the CDC, there is a 3- to 10- month nationwide shortage on tuberculin skin test (TST) antigens (Aplisol and Tubersol).  The recommendations to maintain compliance until the tuberculin supplies can be replenished include:
  • Substitute IGRA blood tests for TSTs. Clinicians who use the IGRA blood tests should be aware that the criteria for test interpretation are different from the criteria for interpreting TSTs.
  • Prioritize allocation of TSTs, in consultation with state and local public health authorities.  Prioritization might require the deferment of testing some persons.  CDC recommends testing only for persons who are at risk for TB.  Groups at high risk for TB infection include:
    • Persons who are recent contacts exposed to person with TB disease
    • Those born in or who frequently travel to countries where TB disease is common
    • Those who currently or previously lived in large group settings (i.e. homeless shelters or correctional facilities)
    • Persons with compromised immune systems, including those with health conditions or taking medications that might alter immunity
    • Children, especially those aged <5 years, if they are in one of the risk groups noted above.
Facilities are encouraged to work with your local health department to confirm recommendations on testing during the shortage.  In addition, facility policies and procedures may need to be reviewed and updated.  Finally, facilities should educate team members on the TST shortage and the changes to the processes during the shortage. 
You can learn more about the CDC recommendations here.

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