7-15 Tuberculosis Requirement for International Students

• Effective date of this revision: May 1, 2025
• Contact for more information: Office of Global Engagement

BACKGROUND

Tuberculosis (TB) is caused by the Mycobacterium tuberculosis germ and usually affects the lungs but can also affect other parts of the body. TB exists as either latent TB infection (LTBI) or TB disease. According to the Centers for Disease Control and Prevention (CDC), approximately 13 million people in the United States have LTBI with 7 out of 10 TB disease cases occurring in non-U.S.-born persons. Transmission occurs through exhaled droplets from a person with TB disease from coughing, sneezing, speaking or singing. More than 80% of people with active TB disease are the result of untreated LTBI. Early TB disease symptoms include mild cough, fatigue, and weakness; also seen with common acute illnesses.

PURPOSE

To screen all incoming and returning international students for tuberculosis (TB) to prevent TB disease cases on the campus of Central Michigan University (CMU).

DEFINITIONS

1. Latent TB infection (LTBI) – small amount of contained TB bacteria in their body. Persons are not symptomatic or infectious. This is not considered a TB case. Recommended treatment with one or two medications.
2. TB disease – Large amount of active TB bacteria in their body. Persons are symptomatic and infectious. Considered a TB case. Required treatment with four medications.
3. Purified protein derivative (PPD) – Proteins from dead Mycobacterium bovis.
4. Tuberculin Skin Test (TST) – PPD injected intradermally in forearm; reaction is measured in 48-72 hours.
5. Interferon-Gamma Release Assay (IGRA) – blood test measuring immune response to specific TB proteins. More specific than TST; can cost more. Includes QuantiFERON-TB Gold Plus.

POLICY

• Students who have no record of a positive TST/IGRA:
  • TST will be administered by CMU Student Health Services.
    • One (1) screening TST per coverage year (August 1^st – July 31^st) is a covered benefit of the insurance international students are required to carry per CMU Administrative Policy 7-14.
  • Student will return to CMU Student Health Services 48-72 hours later to check for reaction
  • If reaction is negative:
    • Student is cleared. TST only needs to be repeated if student leaves the county for more than thirty (30) days and returns to campus.
  • If reaction is positive:
    • Confirmatory IGRA test will be ordered by CMU Student Health Services and completed by Quest Diagnostics Laboratory.
    • If confirmatory IGRA test negative:
      • Student is cleared. IGRA only needs to be repeated if student leaves the country for more than thirty (30) days and returns to campus. TST is no longer an appropriate screening test for this patient for lifetime.
    • If confirmatory IGRA test positive:
      • If student is asymptomatic, they will be scheduled with a CMU Student Health Services provider same day or within 24 hours for LTBI evaluation and treatment, if indicated.
      • If student is symptomatic, IGRA results, TB Risk Evaluation Form, and patient demographics will be forwarded to the Central Michigan District Health Department (CMDHD) for management of TB disease.
    • Students who have a history of either LTBI or TB disease and completed treatment:
      • Referral made to CMDHD to determine clearance for student. CMDHD will communicate with CMU Student Health Services regarding students TB status.
      • If student is asymptomatic and has written proof of previous positive IGRA:
        • Student scheduled with CMU Student Health Services provider for further evaluation and possible treatment of LTBI.
      • If student is asymptomatic and does not have written proof of positive IGRA:
        • CMU Student Health Services will order an IGRA test for the student to be completed at Quest Diagnostics Laboratory.
        • If IGRA positive, student will be scheduled with a CMU Student Health Services provider within 24 hours for further evaluation and possible treatment of LTBI.

Central Michigan University reserves the right to make exceptions to modify or eliminate this policy and or its content. This document supersedes all previous policies, procedures or guidelines related to this subject.