Government and Health Care

County health department offers TB testing

Skin test serum shortage temporarily makes blood screening the only method.

September 27, 2013
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County health department offers TB testing
An unexpected shortage of serum used in tuberculosis skin tests is forcing health care workers to have more expensive blood tests instead. Courtesy Thinkstock

Health care workers and those seeking employment in other areas who need a test for tuberculosis can get one at the Kent County Health Department.

However, that testing will cost more because of a shortage of the serum used in the TB skin test — one of two ways the TB bacteria can be detected. The other method is a blood test, and that is what the health department is offering those who are in need of a screening now.

“We have the ability to take from 60 to 80 (individuals) a month. We’re getting about 200 (inquiries) a month,” said Adam London, administrative health officer for the county’s health department.

The TB skin test involves injecting a small amount of fluid, known as tuberculin, into the skin on the lower part of the arm. If a raised, hard area or swelling appears in the test area within 48 to 72 hours, it could mean the individual has the TB bacteria. More tests are needed to determine if a TB infection or the disease is present. After the skin test is administered, an individual needs a second appointment so the result can be determined.

There is a national shortage of the tuberculin used in the skin tests, so this detection method is being shelved for the time being until the supplies of Tubersol or Aplisol are restocked.

Tubersol is the antigen solution normally used in the skin tests. When that became scarce, a move was made to use Aplisol, which then prompted a shortage of that test serum.

But the county health department is offering one of two blood tests that accomplish the same outcome the skin test provides. The difference is the skin test normally costs $19, but, since checking blood samples is more expensive, county commissioners recently authorized the department to charge $84 for the blood testing.

“The new fee and process will only be in effect until Dec. 31, when it is expected that the skin test shortage will be over,” said Commissioner Jim Talen.

“We’re doing this because of a shortage, so it’s not like we’re arbitrarily increasing this (fee),” said Commission Vice Chairman Jim Saalfeld.

London told commissioners the $84 fee is the health department’s cost to process a sample. He also said Medicaid may cover from $62 to $74 of that fee, but acknowledged that many who need the test likely aren’t covered by the public insurance.

The TB blood tests are called interferon gamma release assays, or IGRAs. The U.S. Food and Drug Administration has approved two IGRAs: the QuantiFERON-TB Gold In-Tube test and the T-Spot.TB test. The health department is offering the T-Spot.TB test.

The good news is the Centers for Disease Control and Prevention reported the IGRAs are the preferred testing method for two types of individuals. First, a blood test is better for those who have received the BCG vaccine for the disease. Second, the CDC said the blood test is better for those who would have a difficult time returning for a second appointment to look for a reaction to the skin test. 

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