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TB Control Program Home

  • Services Provided

  • The State Hygienic Lab (SHL), formerly known as the University Hygienic Lab (UHL), serves as the main lab for the Iowa TB Control Program. The TB Control Program requests that clinicians who suspect a patient has TB utilize the SHL for rapid identification of M. tuberculosis complex isolates using rapid method such as DNA probe, nucleic acid amplification or HPLC.

    Additional Services

    • reporting of AFB smear results to health-care providers within 1 day;
    • reporting of culture identification of M. tuberculosis complex within 21 days;
    • reporting of drug-susceptibility test results within 30 days; and
    • reporting of all positive test results to the specimen submitter within 1 working day from the date of report.

    Lab results are directly communicated to the Iowa TB Control Program allowing for timely consultation with clinicians and local public health agencies.

    SHL also provides TB Blood testing using the QuantiFERON®-TB Gold In-Tube test (GFT-GIT) and T-SPOT®.

  • Who We Are

  • The mission of the TB Control Program is to eliminate TB disease in Iowa. The TB Control Program collaborates with clinicians and local public health agencies (LPHAs) to minimize the spread of TB in Iowa by promoting effective diagnosis and treatment for persons afflicted with TB infection or disease.

    The TB Control Program makes progress towards this mission by:

    • Collect, analyze and report surveillance data
    • Develop effective TB control policies
    • Provide consultation and technical assistance to LPHAs and clinical providers
    • Provide case management oversight of active TB disease cases to ensure appropriate treatment completion, and thorough contact investigations of infectious cases of TB disease
    • Provide TB medications and approved treatment regimens for all persons afflicted with TB infection or disease
    • Coordinate services for refugees and immigrants who enter Iowa with a history of TB infection or disease to ensure they receive clinically appropriate treatment

    Click here for basic TB Facts

  • Consultation Options

  • The Iowa TB Control Program provides education and consultation upon request. Normal business hours are 8:00 AM to 4:30 PM daily, excluding weekends and state holidays. TB Control Program staff can be reached at the following telephone numbers:

    • TB Control Manager: 515-281-7504
    • TB Nurse Consultant: 515-281-8636

    The TB Control Program has access to experts in the diagnosis and treatment of TB, notably Dr. Douglas Hornick, Director of the TB Chest Clinic at the University of Iowa Hospital and Clinics. Consultation with Dr Hornick is available upon request by contacting the TB Control Program.

    The Iowa TB Control Program partners with the Mayo Clinic Center for Tuberculosis to provide medical and nursing consultation and technical assistance with various aspects of TB control at no cost to physicians, nurses, and other health care professionals. Click here for information and how to contact Mayo Clinic Center for Tuberculosis for medical consultation.

  • TB Control Program Annual Reports

  • The purpose of the TB Control Program Annual Report is to provide a summary of TB in Iowa and the activities and achievements of the TB Control Program and our partners during the calendar year. The report provides Iowa-specific TB rates, funding sources, and program-specific data. The annual report will serve as an informational resource for stakeholders, local partners, policy makers and the general public.

  • Tuberculosis Standard Operating Procedure

  • The TB Control Program has developed a standard operating procedure (SOP) for local public health agencies to assist in education and case management. This document is intended to provide a framework of how to investigate and treat cases of latent TB infection and active TB disease in Iowa and represent the policies and procedures of the Iowa Department of Public Health TB Control Program.

  • Introduction

  • Treatment of Latent TB Infection (LTBI)

  • Treatment should be initiated after the possibility of TB disease has been excluded. Treatment regimens use isoniazid (INH) or rifampin (RIF). Of those regimens, INH for 9 months is the preferred regimen. Treatment must be modified if the patient is a contact of an individual with INH or multidrug-resistant TB.

  • Introduction

  • The Iowa TB Control program strongly recommends TB screening be conducted in all college, community college, and university campuses in Iowa. These screening and testing recommendations are consistent with the Centers for Disease Control and Prevention, American Thoracic Society and the American College Health Association. “Screening” refers to the process of identifying persons at high-risk for TB infection and disease. Screening is conducted for all incoming students and employees to identify those with identified risk factors for TB infection and disease. For those students and employees with identified risk factors, testing for TB infection should be conducted.

    Iowa, like most states, continues to identify students/faculty with TB disease almost every year. The implementation of effective TB screening and testing programs on all college and university campuses in Iowa is the best method available to identify those persons with TB infection and disease and prevent the potential spread of TB to others.

    Medication for the treatment of TB infection and disease is available from the TB Control Program. Click here for more information on how to order medication.

    Detailed screening recommendations, including sample screening and testing forms, are available at the following at the American College Health Association Web page.

    Although TB testing programs should be conducted only among high-risk groups, certain individuals may require TB testing for employment or school attendance. An approach independent of risk assessment is not recommended by CDC or the American Thoracic Society. For details on screening and targeted testing see ACHA Guidelines: Tuberculosis Screening and Targeted Testing of College and University Students.

  • Homeless Shelters

  • Homeless shelters have been associated with TB outbreaks in the United States including Iowa. Homeless persons are included in the high-risk classification for developing TB disease by CDC as they suffer disproportionately from a variety of health problems, including TB. There is substantial potential for TB transmission in shelters, especially in the winter when they are likely to be more crowded and ventilation from the outside may be diminished.

    Detecting, treating, and preventing TB in this special population benefits not only persons who are homeless, but society at large. The goal of prevention and control of TB among the homeless is difficult and challenging, but it can be achieved.

    Shelter staff play an important role in communicable disease detection and prevention. Staff who screen guests for signs/symptoms of TB disease and follow “Cough Alert Policies” help to find active cases of TB and prevent the spread of TB to others. Observe shelter guests for signs of TB and refer individuals who are coughing for 3 weeks or more or who have other signs of TB to the local health department for evaluation.

    The TB Control Program recommends Homeless Shelters in Iowa consider implementing the following screening and testing recommendations. These recommendations are adapted from Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 MMWR December 30, 2005 / 54(RR17);1-141:

  • Introduction

  • There are two kinds of tests that can be used to help detect TB infection - the TB skin test (TST) and TB blood tests or Interferon-Gamma Release Assays (IGRAS) (i.e., QuantiFERON®-TB Gold test (QFT-G), QuantiFERON®-TB Gold In-Tube test (GFT-GIT) and T-SPOT®.TB test).

    IGRAS and TSTs should be used as an aid in diagnosing infection with M. tuberculosis. A positive test result suggests that M. tuberculosis infection is likely; a negative result suggests that infection is unlikely. For IGRA test results either an indeterminate or borderline test result (T-SPOT® only) indicates an uncertain likelihood of M. tuberculosis infection.

    A diagnosis of Latent Tuberculosis Infection (LTBI) requires that TB disease be excluded by medical evaluation. This should include checking for signs and symptoms suggestive of TB disease, a chest x-ray, and, when indicated, examination of sputum or other clinical samples for the presence of M. tuberculosis. Decisions about a diagnosis of M. tuberculosis infection should also include epidemiological and the patient’s medical history.

  • TB Administrative Rules

  • The TB Control Program worked extensively on rule changes with the Bureau of Substance Abuse and Department of Inspections and Appeals which are consistent with published recommendations from the Centers for Disease Control (CDC) Division of TB Elimination. The rules provide uniform TB screening, testing, and serial testing procedures for health care workers (HCWs) and residents of licensed health care and substance abuse facilities.

    For most hospitals and health care facilities, the new rules will diminish the frequency of serial testing of HCWs while assuring that Iowa’s HCWs are properly screened and evaluated for TB infection and disease.

  • Education Opportunities

  • TB 101 for Health Care Workers is an interactive course designed to educate health care workers about basic concepts related to TB prevention and control in the United States. The target audience for the course includes newly hired TB program staff and health care workers in areas related to TB (such as individuals who work in correctional facilities or HIV/AIDS clinics).

    The Core Curriculum is intended for use as a self-study guide and reference manual for clinicians and other public health professionals caring for people with or at high risk for TB disease or infection. The Core Curriculum was revised in 2011 to reflect new guidelines for TB prevention, treatment, testing, diagnosis, and patient management and public health practice.

    National Jewish Health - Denver TB Course

  • Code Citation: IDPH Substance Abuse/Problem Gambling Program

  • The Department of Public Health’s Substance Abuse/Problem Gambling Program made administrative rule changes regarding TB testing effective November 7, 2012. These rules provide changes regarding TB testing for health care workers and residents of Iowa licensed substance abuse facilities.

    Click here for contact information for the Bureau of Substance Abuse

  • Iowa TB Cases by County of Residence Data and Maps

  • The Iowa TB Control Program publishes aggregate data on active TB cases annually. The total number of cases in the state by county, and incidence rate for the state and counties are available below.

  • TB Risk Assessments for Shelters

  • Annually, each shelter should conduct a TB risk assessment to evaluate the risk for transmission of TB. The risk assessment should include the number of person with infectious TB encountered in the shelter.

    Shelter Risk Classification

    The shelter risk classification is used to determine frequency of TB screening and testing. The shelter risk classification may change due to an increase or decrease in the number of TB cases during the preceding year. The shelter risk classification may also change due to a change in adherence or lack of adherence to recommended TB Control measures. The shelter should determine if they are either Low or Medium risk classification. The TB Control Program can assist shelters in determining their risk classification. Contact the Program Manager at 515-281-7504 to discuss.

    Low Risk

    Shelters are classified as low risk if one or less infectious TB patients were encountered in the shelter during the preceding year and all of the following TB Control measures apply:

    • Shelter guest are screened for signs/symptoms of TB disease upon admission
    • Cough alert policy is in effect
    • The local public health agency (LPHA) has confirmed exposure occurred in the shelter during the preceding year - the LPHA conducted a contact investigation

    Medium Risk

    Shelters are classified as medium risk if two or more infectious TB patients were encountered in the shelter in the preceding year or either one of the following measures are not in effect:

    • Shelter guest are not screened for signs/symptoms of TB disease upon admission
    • Cough alert policy is not in effect
  • Chapter One: Iowa Refugee Health Assessment

  • Baseline Laboratory Testing

  • Baseline laboratory testing (measurements of serum AST, ALT, and bilirubin) are not routinely necessary

    Laboratory testing at the start of LTBI therapy is recommended for patients with any of the following factors:

    • Liver disorders
    • History of liver disease (e.g., hepatitis B or C, alcoholic hepatitis, or cirrhosis)
    • Regular use of alcohol
    • Risks for chronic liver disease
    • HIV infection
    • Pregnancy or the immediate postpartum period (i.e., within 3 months of delivery)

    Baseline testing can be considered on an individual basis, especially for patients taking other medications for chronic medical conditions.

    After baseline testing, routine periodic retesting is recommended for persons who had abnormal initial results and other persons at risk for hepatic disease.

    At any time during treatment, whether or not baseline tests were done, laboratory testing is recommended for patients who have symptoms suggestive of hepatitis (e.g., fatigue, weakness, malaise, anorexia, nausea, vomiting, abdominal pain, pale stools, dark urine, chills) or who have jaundice. Patients should be instructed, at the start of treatment and at each monthly visit, to stop taking treatment and to seek medical attention immediately if symptoms of hepatitis develop and not to wait until a clinic visit to stop treatment.

    AST or ALT elevations up to 5 times normal can be accepted if the patient is free of hepatitis symptoms, and up to 3 times normal if there are signs or symptoms of liver toxicity.

  • What to Report

  • Both clinically suspected and laboratory confirmed tuberculosis disease are to be reported.

    • Cases of both pulmonary and extrapulmonary disease should be reported to IDPH within one working day.
    • Latent tuberculosis infection (LTBI) is not reportable in Iowa, however IDPH does provide medication to treat LTBI to prevent progression to disease.

    IDPH provides medication free of charge to treat both LTBI and TB disease. Click here for information on prescription services.

  • Directly Observed Therapy (DOT)

  • The Iowa TB Control Program provides incentive funding to LPHAs to perform DOT for suspected/confirmed cases of TB disease. Clinical benefits of DOT include significant reductions in disease relapse, treatment failure, and development of multidrug-resistant TB (MDR-TB). A cost benefits analysis demonstrates it cost $2,500 to treat drug susceptible TB and $250,000 to treat MDR-TB.

    There is limited availability for DOT incentive funding for LTBI with high-risk patients (HIV+ individuals, children less than 5 years of age, MDR/XDR-TB contacts).

    It is the expectation that health departments that accept incentive funding for DOT will perform DOT with the patient until treatment completion. Regardless of availability of incentive funding, DOT remains the standard of care. The CDC, IDSA, WHO, and ATS recommend all healthcare providers implement DOT on each active case of TB.

    While there is no incentive funding for extrapulmonary cases of TB disease, DOT is still strongly recommended for the same clinical reasons listed above.

    Contact the TB Program Manager at 515-281-7504 to discuss DOT reimbursement.

  • Tuberculin Skin Test

  • The TB skin test (Mantoux tuberculin skin test) is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm.

  • Code Citations: Iowa Department of Inspections and Appeals (DIA)

  • The Iowa Department of Inspection and Appeals made administrative rule changes to Iowa Administrative Code Chapter 481.59 regarding TB testing effective March 26, 2013. These rules provide changes regarding TB testing for health care workers of Iowa licensed hospitals and health care workers and residents of Iowa health care facilities.

    For questions regarding enforcement of DIA TB Rules please contact DIA at:

  • National TB Data

  • Chapter Two: Discussion for History and Exam

  • How to Report

  • TB Control Program
    Phone: (515) 281-8636 or (515) 281-7504
    Fax: (515) 281-4570
    24/7 disease reporting telephone hotline: 800-362-2736

  • Medication Requests for LTBI

  • When requesting medication for LTBI the following items are needed:

    1. Completed Patient Information Sheet for LTBI (see below for form)
    2. Radiology report of chest x-ray (see below for requirements)
    3. Clinician signature (if the Patient Information Sheet is not signed by the clinician, a separate prescription is required)

    Fax the Patient Information Sheet, x-ray report, and prescriptions to 515-281-4570.

    Chest x-ray requirements: If the patient has no risk factors for TB the chest x-ray must be dated within 6 months of the medication request. If the patient has any of the following risk factors, the chest x-ray must be within 3 months of medication requests.

    • Persons who have immigrated (within the last 5 years) from areas of the world with high rates of TB
    • Children less than 5 years of age who have a positive TB test
    • Groups with high rates of TB transmission, such as homeless persons, injection drug users, and persons with HIV infection
    • Persons who work or reside with people who are at high risk for TB in facilities or institutions such as hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with HIV
    • Substance abuse
    • Silicosis
    • Diabetes mellitus
    • Severe kidney disease
    • Low body weight (less than 10% of Ideal)
    • Head and neck cancer
    • Medical treatments such as corticosteroids or organ transplant
    • HIV infection (the virus that causes AIDS)
    • Close contacts of a person with infectious TB disease
    • Person with changes to CXR consistent with prior TB
    • Organ transplants or other immunosuppressed people
    • Specialized treatment (i.e. meds that depress immune system) for rheumatoid arthritis or Crohn’s disease
  • TB Screening/Testing for Homeless Shelters

  • Staff

    Baseline Screening/Testing for Staff

    All Shelter staff members should receive baseline TB screening upon hire. Baseline TB screening consists of two components: (1) assessing for current symptoms of active TB disease and (2) using two-step TST or a single IGRA to test for infection with M. tuberculosis.

    Serial TB Screening Procedures for Staff

    • Shelters Classified as Low Risk: After baseline testing for infection with M. tuberculosis, additional TB screening of staff is not necessary unless an exposure to M. tuberculosis occurs.

    • Shelters Classified as Medium Risk: After baseline testing for infection with M. tuberculosis, staff should receive TB screening annually (i.e., symptom screen for all staff members and testing for infection with M. tuberculosis for staff members with baseline negative test results). Annual screening recommendation ceases if the shelter attains a low risk classification.


    • Shelter guest should be screened for signs/symptoms of TB disease upon admission. Use of TB Signs/Symptoms Screening Form or similar is recommended.
    • Classic signs/symptoms of TB disease include a chronic cough (> 3 weeks), chest pain, night sweats/fever and unexplained weight loss.
    • Symptomatic shelter guest should be referred for medical evaluation. Contact your local public health agency for assistance.
    • Routine tuberculin skin testing (TST) or interferon gamma release assay (IGRA) (blood) testing of homeless persons is not necessary.
    • Routine testing of homeless persons should be carefully considered and weighed with the individual’s commitment to completion of treatment. Therapy consists of regular clinical monitoring and taking antibiotics daily for six to nine months.
    • Asymptomatic shelter guests who want TB testing should be referred to the local health department, free clinic or community health center.
  • Contact Investigations

  • LPHAs in Iowa are responsible for conducting investigations of infectious TB. The TB Control Program Manager and Nurse Consultant will provide direct consultation to LPHAs on each case of infectious TB. Consultation consists of:

    • When to initiate a contact investigation
    • Assigning priorities to contacts
    • Diagnostic and public health evaluation of contacts
    • When to expand a contact investigation
    • Data management of contact investigations

    IDSS is the reporting system utilized by IDPH. Once the TB controller has initiated TB case in IDSS the LPHA will be notified and the “TB Contacts” tab will be available for completion.

  • Interferon-Gamma Release Assay (IGRA)

  • Interferon-gamma release assays (IGRAs) are blood tests that measure how the immune system reacts to the bacteria that cause TB. If your health care provider or local health department offers TB blood tests, only one visit is required to draw blood for the test. The QuantiFERON®-TB Gold test (QFT-G), QuantiFERON®-TB Gold In-Tube test (GFT-GIT) and T-SPOT®.TB test are approved TB blood tests by the Food and Drug Administration.

  • 12 Dose Regimen for Treatment of LTBI

  • Code Citations: Reporting Requirements

  • Iowa Code 139A requires laboratories and health care providers to report suspected or confirmed cases of M. tuberculosis.

    Click here for full version of Iowa Administrative Code, Chapter 641.1

  • Chapter Three: Immunization

  • Specimen Submission

  • Clinical specimens should be submitted to State Hygienic Laboratory at the University of Iowa
    UI Research Park - Coralville
    Iowa City, IA 52242-5002
    Phone: 319-335-4500 or 1-800-421-IOWA (4692)
    Fax: 319-335-4555

  • Treatment of TB Disease

  • Treatment options for TB disease vary depending on many factors (HIV status, drug resistance, pregnancy, and in the treatment of children). For full recommendations see the links below.

    Please contact the TB Control Program by phone to discuss ordering medication for the treatment of suspected/confirmed TB disease. Phone: (515) 281-8636 or (515) 281-7504.

  • TB Control Program Forms (TB Disease)

  • BCG Vaccination

  • BCG, or Bacille Calmette-Guérin, is a vaccine for TB disease. Many persons born outside of the United States have been BCG-vaccinated. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease.

  • TB Control Program Forms (LTBI)

  • Chapter Four: Tuberculosis

  • Testing and Treatment for TB in BCG-Vaccinated Persons

  • The question of the effect of BCG vaccine on TST results often causes confusion. TST reactivity caused by BCG vaccine generally wanes with the passage of time, but periodic skin testing may prolong (boost) reactivity in vaccinated persons. A history of BCG vaccine is not a contraindication for tuberculin skin testing or treatment for LTBI in persons with positive TST results. TST reactions should be interpreted regardless of BCG vaccination history.

    IGRAs use M. tuberculosis specific antigens and, unlike the TB skin tests, are not affected by prior BCG vaccination and are not expected to give a false-positive result in persons who have received prior BCG vaccination.

  • Chapter Five: Class B Tuberculosis Follow-up

  • Chapter Six: Hepatitis B

  • Chapter Seven: Sexually Transmitted Infections

  • Chapter Eight: HIV

  • Chapter Nine: Intestinal Parasites

  • Chapter Ten: Malaria

  • Chapter Eleven: Blood Work

  • Chapter Twelve: Lead

  • Chapter Thirteen: IDPH Contact Information

  • Class B Tuberculosis Follow-up

  • Information regarding Tuberculosis Class B Follow-up Worksheets can be found on the IDPH Refugee Health web page. Please click here (scroll to Chapter 5) to access the Class B Follow-up Worksheet, instructions for the worksheet and follow-up recommendations.

  • Code Citations: Various TB Iowa Admin. Code & Iowa Code References

  • Code Citations: Iowa Department of Human Services

  • Child Care Provider Physical Examination Form

    For questions regarding enforcement of DHS Child Care Provider TB Testing Rules please contact Ms. Ryan Page at: or 515-281-7714.

  • Code Citations: Various TB Iowa Admin. Code & Iowa Code References

  • Helpful Links

  • Prescription Donation Program

  • Clinicians and Local Public Health Agencies that have unused TB medications are able to send them to the Iowa Prescription Drug Corporation (IPDC) for certification for re-use by the Iowa TB Control Program. Once meds have been certified they are sent back to our pharmacy to be reissued by our program.

    Once the form below is completed, mail it and the medications to the address in the upper right corner of the form. The form only needs to be completed once and will be kept on file at IPDC for any future donations.

  • Shelters and TB: What Staff Need to Know, Second Edition

  • The Curry International Tuberculosis Center (a partner of the CDC) has developed this video and viewer’s guide to help shelters create a healthy and safe environment. The goal of this program is to help address concerns and reduce fears that shelters may have about working with clients, or staff, who may have TB. This fundamental TB infection control information can help you and your staff prevent the spread of TB.

    Please Click here to be directed to the Curry Center web page and the video and viewer's guide.

  • TB Control Program Annual Report

  • The purpose of the TB Control Program Annual Report is to provide a summary of TB in Iowa and the activities and achievements of the TB Control Program and our partners during the calendar year. The report provides Iowa-specific TB rates, funding sources, and program-specific data. The annual report will serve as an informational resource for stakeholders, local partners, policy makers and the general public.

  • TST and Vaccine Administration

    • From the CDC's 12th Edition of the "Pink Book" Epidemiology and Prevention of Vaccine-Preventable Diseases: Infants and children who need a tuberculin skin test (TST) can and should be immunized. All vaccines, including MMR, can be given on the same day as a TST, or any time after a TST is applied. For most vaccines, there are no TST timing restrictions. MMR vaccine may decrease the response to a TST, poten­tially causing a false-negative response in someone who actually has an infection with tuberculosis. MMR can be given the same day as a TST, but if MMR has been given and 1 or more days have elapsed, in most situations a wait of at least 4 weeks is recommended before giving a routine TST. No information on the effect of varicella-containing vaccine or LAIV (live attenuated influenza vaccine) on a TST is available. Until such information is available, it is prudent to apply rules for spacing measles vaccine and TST to varicella vaccine and LAIV. There is a new type of tuberculosis test known as an interferon-gamma release assay (IGRA). Even though this test improves upon the TST because it is less affected by previous doses of BCG vaccine and less affected by previous doses of tuberculosis diagnostic testing, it still may be affected by previous doses of other live vaccines so it is prudent to apply the same spacing rules as for TST.

    • From the CDC's Core Curriculum for TB: Vaccination with live viruses may interfere with tuberculin skin test (TST) reactivity and cause false-negative reactions; this includes measles, mumps, rubella, oral polio, varicella, yellow fever, BCG, and oral typhoid. For persons scheduled to receive TST and live virus vaccines, the testing should be done either on the same day as vaccination or at least 1 month after vaccination to minimize the potential for a false-negative TST reaction.

Contact Information:

Bethany Kintigh RN, BSN
Immunization Program Manager
1-800-831-6292 FAX, or

Use the "Contact Us" page to submit questions online

Program News:

Registration is now open for the 2015 Iowa Immunization Summit!
Posted: Tuesday, Aug 18, 2015

VFC Temperature Monitoring Requirements - Digital Data Loggers
Posted: Monday, Aug 10, 2015

VFC Temperature Monitoring Requirements

Updated Certificate of Immunization Exemption
Posted: Wednesday, Jul 22, 2015

The Iowa Department of Public Health, Immunization Program has made changes to the Certificate of Immunization Exemption. The changes were made to clarify the provisions of the certificate. The Certificate of Immunization Exemption has become two separate documents; Certificate of Immunization Exemption - Medical and Certificate of Immunization Exemption - Religious.

2015 VFC Program Re-enrollment
Posted: Tuesday, Jun 02, 2015

HPV and HPV Vaccine Resources