Topics and messages for testing

ATTACHMENT 3: TUBERCULOSIS THEMES AND MESSAGES

Topics and Messages for Latent TB Infection Message Testing

Topic A: Basic information on latent TB infection

Messages

• Anyone can get TB. TB germs are spread through the air from one person to another.

• People who are infected with TB but are not sick have a condition called latent TB infection. 

• People with latent TB infection do not feel sick, do not have symptoms, and cannot spread TB germs to others. This is because the TB germs are latent, or inactive, in their body. If their TB germs become active, they can develop TB disease.

  • Potential probe: Some people find the phrase “latent TB infection” unclear. What other words or phrases would you recommend to describe the TB condition where TB germs are latent, or inactive, in the body? (probe: latent tuberculosis infection; TB infection; sleeping TB; dormant TB)

• There are two kinds of tests that are used to detect TB germs in the body: the TB skin test and the TB blood test. A person with latent TB infection has a positive TB skin test or TB blood test.

• People can have latent TB infection for years or decades before getting sick. Many people who have latent TB infection never develop TB disease.

• A person with latent TB infection cannot give TB to others.

• Some people develop TB disease soon (within 2 years) after becoming infected, before their immune system can fight the TB germs. Other people may develop TB disease many years later when their immune system becomes weak for another reason.

• In the United States, up to 13 million people may have latent TB infection, according to estimates from the U.S. Centers for Disease Control and Prevention (CDC). Without treatment, they are at risk for developing TB disease.

• One in four people worldwide may be infected with TB.

Topic B: Risk factors for latent TB infection developing into TB disease

Messages

• Without treatment, on average 1 in 10 people with latent TB infection will get sick with TB disease in the future. For some people, that risk is much higher. (Potential probe: alternative numeric expression “5-10% of people” for clarity)

  • For those with latent TB infection, the risk for getting sick with TB disease is higher for people with HIV, diabetes, other conditions that affect their immune system, or persons receiving immunosuppressive therapy.

• Some people develop TB disease soon (within 2 years) after becoming infected, before their immune system can fight the TB germs. Other people may get sick years later, even more than 10 years after they were infected, when their immune system becomes weak for another reason. This is known as reactivation of latent TB infection. 

• Most TB disease in the United States is caused by reactivation of latent TB infection.

  • TB disease in the United States is most common among people born in countries where TB disease is more common.   

  • CDC estimates that 92% of TB cases among non-U.S.–born persons are caused by reactivation of latent TB infection that was acquired in their home country, years before arrival in the United States. 

• CDC and the U.S. Preventive Services Task Force recommend testing populations that are at increased risk for latent TB infection, including people born in countries where TB disease is common, regardless of how long they have been in the United States.

  • People born in or who frequently travel to countries where TB disease is common, including Mexico, the Philippines, Vietnam, India, China, Haiti, and Guatemala, or other countries with high rates of TB disease.

Topic C: Bacille Calmette-Guérin (BCG) vaccine

Messages

• Bacille Calmette-Guérin (BCG) is a vaccine for TB disease. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common.

• Many people born outside of the U.S. got the BCG vaccine to protect against severe forms of TB as a child. This protection becomes weak over time.

• People who were vaccinated with BCG can get infected with TB and become sick with TB.

• TB blood tests, unlike the TB skin test, are not affected by prior BCG vaccination.  TB blood tests are the preferred method of TB testing for people who have received the BCG vaccine.

• TB blood tests, unlike the TB skin test, are not affected by prior BCG vaccination.  TB blood tests are the preferred method of TB testing for people who have received the BCG vaccine.

Topic D: Latent TB infection testing and diagnosis

Messages

• Anyone can get infected with TB germs. However, some people have a higher risk of getting infected with TB germs. People who should be tested for TB infection include:

• People born in or who frequently travel to countries where TB disease is common, including Mexico, the Philippines, Vietnam, India, China, Haiti, and Guatemala, or other countries with high rates of TB disease.

• People who currently, or used to, live in large group settings, such as homeless shelters or prisons and jails where TB disease is more common.

• Health care workers and others who work in places at high risk for TB transmission, such as hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with HIV.

• Someone who has spent time with a person who has infectious TB disease.

• There are two kinds of tests that are used to detect TB germs in the body: the TB skin test and the TB blood test. The TB skin test requires two visits (one to perform the test and a second for it to be read). The TB blood test requires only a single visit to draw blood.

• A positive TB skin test or TB blood test only tells that a person has been infected with TB germs. It does not tell whether the person has latent TB infection or has progressed to TB disease. More tests, like a chest x-ray, are needed to rule out TB disease.

• A diagnosis of latent TB infection is made if a person has a positive TB skin test or TB blood test result and a medical exam does not indicate TB disease.

Topic E: Treatment for latent TB infection

           

Messages

• People with latent TB infection do not have symptoms, are not sick with TB, and they cannot spread TB germs to others. However, if latent TB germs become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. The good news is there are medicines people can take to treat the latent TB infection that will prevent it from developing into TB disease. This is often referred to as treatment for latent TB infection.

  • Potential probe: Some people find the phrase “treatment for latent TB infection” confusing. Some healthcare providers are concerned that it may minimize a patient’s perception of the importance of taking treatment. What other words or phrases would you recommend to describe treatment for the TB condition where TB germs are latent, or inactive, in the body? (probe: TB preventive therapy; treatment for TB infection; chemoprophylaxis)

• If you have a positive TB skin test or TB blood test, but do not have any other signs and symptoms of TB disease, you may have latent TB infection. If you have TB infection, you may need medicine to prevent getting TB disease later. This is called treatment for latent TB infection (alternative terms: TB preventive therapy; treatment for TB infection; chemoprophylaxis).

• Treatment for latent TB infection is 90% effective in preventing the development of TB disease.

• Treatment will help you stay healthy and keep those you love safe from TB.

• Taking your medications for latent TB infection can prevent you from developing TB disease in the future.

• Taking TB medication is the only way to kill the TB germs in your body.

• Treatment for latent TB infection can take 3 to 9 months, depending on the regimen.

• Most people can take their TB medicine without any problems. However, people respond differently to medications. You could have side effects from the medicine.

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