Tuberculosis (TB) and Latent TB (LTBI) in a Child 2 Years of Age or Younger

Reporting Information

Class B

Report a case, suspected case, and/or positive laboratory result to the local TB control unit in which the patient resides by the close of the next business day. If patient residence is unknown, report to the local TB control unit in which the reporting healthcare provider or laboratory is located.

Reporting Form(s) and/or Mechanism

The Ohio Disease Reporting System (ODRS) should be used to report cases and lab findings to the Ohio Department of Health (ODH). For healthcare providers without access to ODRS, the Ohio Confidential Reportable Disease Form (HEA 3334) may be used.

The Positive Laboratory Findings for Reportable Disease Form (HEA 3333) may be used for laboratories without access to ODRS or electronic laboratory reporting (ELR) to report positive results.

Local TB control units report all information on the Report of Verified Case of Tuberculosis (RVCT; CDC 72.9A, 72.9B, 72.9C) which is the national TB surveillance reporting form. All the fields in RVCT form are available in ODRS. The RVCT form has 3 sub-components:

  1. Form 72.9A to report the initial evaluation of a TB case/suspect such as demographics, initial laboratory specimens collected, initial radiography evaluation, risk factors for TB, and initial treatment regimen.
  2. Form 72.9B, Follow-Up Report 1, required for all culture-positive cases to report initial drug susceptibilities and genotyping.
  3. Form 72.9C, Follow-Up Report 2, should be completed for all TB cases to report ongoing treatment monitoring, response to treatment, and treatment completion. It should also be completed for all suspect cases on treatment, to document treatment end date and reason treatment stopped or to report that a suspect case does not have TB.

Key Fields for ODRS Reporting

  • Patient address.
  • Race, ethnicity.
  • Patient country of birth and date arrived in the U.S. if born outside the U.S..
  • Did patient live outside of the U.S. for >2 months, and if yes, in which countries.
  • Guardian country of birth (for pediatric patients).
  • Site of disease.
  • Was lab testing done for TB including all smear, culture, and drug susceptibility results.
  • Type of specimen.
  • Collect date.
  • Result.
  • Result date.
  • Organism (when applicable).
  • Treatment regimen and date treatment started.
  • Chest radiograph or CT scan results.
  • Mantoux skin test results.
  • Interferon gamma release assay (IGRA) test results.
  • HIV status.
  • Sputum culture conversion.
  • Did the patient move during treatment.
  • Was patient on directly observed therapy (DOT) or self-administered therapy.
  • Number of doses in intensive and continuation phase if DOT.
  • Reason treatment stopped and date treatment stopped.
  • TB risk factors.
  • Drug and alcohol use.
  • Resident of a correction facility at the time of diagnosis.
  • Resident of a long-term care facility at time of TB diagnosis.
  • Primary occupation within past year.
  • Additional TB risk factors.
  • Count status.
  • Should this suspect be confirmed as a positive TB case.
  • How should this suspect be confirmed as a case (e.g., culture, clinical, or provider diagnosis).
  • Linking state case number.
  • Notes with provider diagnosis information.
  • Other relevant clinical information not included on the RVCT form.

Agent

Mycobacterium tuberculosis complex, which includes M. tuberculosis, M. bovis, M. bovis BCG, M. africanum, M. microti, M. canetti, and M. pinnipedii.

Case Definitions

TB

Clinical Description

A chronic bacterial infection caused by a member of the M. tuberculosis complex, usually characterized pathologically by the formation of granulomas. The most common site of infection is the lung, but other organs may be involved.

Clinical Case Definition

A case that meets all of the following criteria:

  • A positive tuberculin skin test (TST) or positive interferon gamma release assay (IGRA) for M. tuberculosis and
  • Other signs and symptoms compatible with TB (e.g., abnormal chest radiograph, abnormal chest computerized tomography scan or other chest imaging study, or clinical evidence of current disease) and
  • Treatment with two or more anti-TB medications and
  • A completed diagnostic evaluation.

Laboratory Criteria for Diagnosis

  • Isolation of M. tuberculosis complex from a clinical specimen1 or
  • Demonstration of M. tuberculosis complex from a clinical specimen by nucleic acid amplification (NAA)2 or
  • Demonstration of acid-fast bacilli in a clinical specimen when a culture has not been or cannot be performed or is falsely negative or contaminated.

1 Use of rapid identification techniques for M. tuberculosis (e.g., DNA probes and mycolic acid high-pressure liquid chromatography [HPLC] performed on a culture from a clinical specimen) are acceptable under this criterion.

2 Nucleic acid amplification (NAA) tests must be accompanied by culture for mycobacteria species for clinical purposes. A culture isolate of M. tuberculosis complex is required for complete drug susceptibility testing and genotyping. However, for surveillance purposes, CDC will accept results obtained from NAA tests approved by the Food and Drug Administration (FDA) and used according to the approved product labeling on the package insert, or a test produced and validated in accordance with applicable FDA and Clinical Laboratory Improvement Amendments (CLIA) regulations.

Case Classification

Suspected

A person with signs or symptoms of TB that are sufficient for the physician to suspect that the individual has TB prior to the completion of diagnostic studies, or a person with or without a positive Mantoux TST or a positive IGRA who meets any of the following criteria:

  • Has a specimen that is positive for acid-fast bacilli (AFB) on smear or
  • Has been prescribed anti-tuberculosis medications for the treatment of active TB or
  • Has a radiologic finding consistent with active TB or
  • Has clinical symptoms or findings consistent with active TB.
Confirmed

A case that meets the clinical case definition or is laboratory confirmed. A suspected TB case may also be confirmed when it does not meet either the laboratory or clinical case definition if a provider diagnoses TB. This is confirmed as a "Provider Diagnosed" case.

Not a Case

This status will not generally be used when reporting a case but may be used to reclassify a report if investigation revealed that it was not a case.

Comments

A case should not be counted twice within any consecutive 12-month period. However, a case occurring in a patient previously diagnosed with TB disease should be reported and counted again if more than 12 months have elapsed since the patient completed therapy. A case should also be reported and counted again if the patient was lost to supervision for greater than 12 months and TB disease can be verified again. Mycobacterial disease other than those caused by M. tuberculosis complex should not be counted in TB morbidity statistics unless there is concurrent tuberculosis.

LTBI in a Child 2 Years of Age or Younger

Clinical Description

An inactive bacterial infection caused by a member of the M. tuberculosis complex. People with LTBI are asymptomatic and typically have normal chest radiographs and negative sputum smears and cultures.

Clinical Criteria

No clinical evidence compatible with TB disease, including: 

  • No signs or symptoms consistent with TB disease and
  • Chest imaging without abnormalities consistent with TB (chest radiograph or CT scan) or abnormal chest imaging that could be consistent with TB disease with microbiologic testing that is negative for M. tuberculosis complex and
  • Where TB disease has been clinically ruled out.

Laboratory Criteria for Diagnosis

  • A positive tuberculin skin test (TST) or
  • A positive interferon gamma release assay (IGRA).

Case Classification

Suspected
  • A case that meets one or more of the laboratory criteria and
  • M. tuberculosis complex was not isolated from, or demonstrated by NAA in a clinical specimen, if a specimen was collected.
Confirmed
  • A case that meets one or more of the laboratory criteria and
  • M. tuberculosis complex was not isolated from, or demonstrated by NAA in a clinical specimen, if a specimen was collected and
  • Meets the clinical criteria. 
Not a Case

This status will not generally be used when reporting a case but may be used to reclassify a report if investigation revealed that it was not a case.

Comments

A new LTBI case is an incident TB infection case that meets the suspected or confirmed case criteria and has not previously been diagnosed or treated for TB infection or previously treated for TB disease.

Signs and Symptoms

M. tuberculosis complex infection is divided into two conditions: LTBI (also called inactive TB) and TB disease. Clinical symptoms are absent in LTBI. Indications of TB range from a significant TST test or IGRA test in an asymptomatic patient to fever, night sweats, weight loss, cough with or without sputum production (especially if lasting 3 weeks or longer), hemoptysis, chest pain, and extensive infiltration with cavitation in the lung on chest x-ray in the very ill patient. M. tuberculosis complex can cause disease in any organ of the body. Most patients with TB disease will experience symptoms of malaise, fatigue, anorexia, productive cough, and a low-grade fever. More specific symptoms will depend on the organs involved and the extent of disease process.

Without treatment, approximately 5-10% of people with LTBI will develop TB disease in their lifetime. People at higher risk for developing TB disease include people with recently acquired M. tuberculosis complex infection (within the last 2 years), people with a history of untreated or inadequately treated TB disease, young children, and people who are immunocompromised.

Diagnosis

LTBI can be detected by TST or IGRA. However, a positive TST or IGRA cannot distinguish between LTBI and TB disease. Further clinical evaluation is needed to rule out TB disease, including: medical history, physical examination, chest radiograph, and sputum examination, if indicated.

The definitive diagnosis of TB disease requires the isolation of M. tuberculosis complex from the patient. The greatest single problem in recovering mycobacteria from clinical specimens is the presence of large numbers of contaminating microorganisms. This problem is partially solved by obtaining a fresh specimen and by refrigeration of any specimen that cannot be processed promptly.

Since mycobacteria might be released from the lung sporadically, sputum specimen quality may fluctuate. For this reason, a minimum of three sputum specimens should be collected in 8-24 hour intervals with at least one being an early morning specimen.

In cases where Mycobacterium bovis (BCG) is the suspected causative agent, urine may also be submitted for analysis. The preferred specimen is a first morning, cleanly voided midstream sample. One specimen each day for three consecutive days should be evaluated. Do not use bottles with preservatives. A minimum of 40 mL of urine is required.

The ODH Laboratory, in addition to preparing smears, culturing, detecting mycobacteria by Nucleic Acid Amplification (NAA), and identifying mycobacteria, also provides antibiotic susceptibility testing and confirmatory testing on M. tuberculosis complex isolates. Reference cultures sent to the ODH Laboratory may be shipped at ambient temperatures. To submit a specimen, complete the order request in the eLIMS portal. Print each requisition and send with specimens. If your facility does not have an eLIMS account, please contact the ODH Laboratory at (888) ODH-LABS or ODHLabs@odh.ohio.gov.

Epidemiology

Source

M. tuberculosis complex (M. tuberculosis, M. bovis, M. bovis BCG, M. africanum, M. microti, M. canetti, and M. pinnipedii) is found primarily in humans.

Occurrence

Present in all parts of the world. Incidence normally increases with age, is higher in males than in females, and is higher among people experiencing poverty.

Mode of Transmission

Person-to-person, by inhaling the organism coughed or sneezed into the air by a person with infectious pulmonary disease.

Period of Communicability

As long as infectious tubercle bacilli are being discharged and the patient with TB disease is untreated or inadequately treated, the organism is communicable. People with LTBI cannot spread the infection to others.

Incubation Period

In general, it takes two to ten weeks after infection for a person to develop an immune response measurable with the TST or IGRA. Risk of progressive disease is greatest during the first 1-2 years after infection, but active disease may take only a few weeks to develop in an individual with a compromised immune system.

Public Health Management

Case

Investigation

All pulmonary/laryngeal suspects/cases should be interviewed within three days to identify persons who were exposed during the infectious period, in accordance with Ohio Revised Code (ORC) 339.80. TB cases must be isolated and monitored to ensure that they become non-infectious and complete adequate treatment. Treatment should be provided via directly observed therapy (DOT) in accordance with Ohio Revised Code (ORC) 339.82. When pediatric TB or LTBI is diagnosed, an interview should be done to identify the source case.

Treatment

Treatment should be made available to all individuals with suspected or confirmed TB and their infected contacts, in accordance with Ohio Revised Code (ORC) 339.73. Individuals with LTBI should be treated to prevent the development of TB disease. The most current recommended treatment guidelines from the Centers for Disease Control and Prevention and the American Thoracic Society should be followed, in accordance with Ohio Administrative Code (OAC) 3701-15-03. Resources for the clinical treatment of tuberculosis are available on the CDC website.

Isolation and Follow-Up Specimens

Ohio Administrative Code (OAC) 3701-3-13 (CC) states:

"Tuberculosis (TB): a person with infectious tuberculosis is to be isolated according to Chapter 3701-15 of the Administrative Code until the person has met standards outlined in Chapter 3701-15-03 to be considered non-infectious and the local authorized TB authority, as set out in section 339.72 of the Revised Code, or his or her designee approves that person's removal from isolation."

Isolation is not indicated for LTBI.

Contacts

All persons identified as being exposed to an infectious TB suspected/case should be administered a TST using the Mantoux method or IGRA test. All contacts with an initial non-significant TST or negative IGRA should be retested eight to ten weeks following the last date of exposure to the suspected/active case. If the reaction of either test is significant, a chest x-ray and medical evaluation are necessary to rule out active disease. All contacts who are infected and do not have active disease should be offered treatment for LTBI. Asymptomatic contacts <5 years of age should receive prophylactic treatment, which can be discontinued if the TST is non-significant or the IGRA is negative eight to ten weeks following the last date of exposure to the suspected/active case and the child is at least 6 months of age. If eight to ten weeks since the last exposure have already passed at the time of contact evaluation, a single test with TST or IGRA should suffice.

Prevention and Control

An individual that has been diagnosed with active TB shall be instructed to follow contagion precautions in accordance with section 339.82 of the Revised Code. Contagion precautions should include covering their mouth and nose when coughing and sneezing and adhering to the treatment program as prescribed. Persons suspected or confirmed to have infectious TB disease should be given, and encouraged to use, a surgical mask to minimize the risk of expelling droplet nuclei containing TB bacilli into the air. Respirators (N95, PAPRs) should be used by healthcare workers and close contacts of individuals with suspected or confirmed TB disease.

Revised 10/2025.