Health Alert
PPD SOLUTION SHORTAGE

Background

On April 12, 2013 the Centers for Disease Control and Prevention (CDC) announced a nationwide shortage of Tubersol^®, one of two Purified Protein Derivative (PPD) tuberculin used in the Tuberculin Skin Test (TST) to diagnose TB infection. A shortage of Aplisol^®, the second brand of PPD solution, was announced shortly after. The shortage of PPD is now widespread and projections for a return to normal supply by the end of May 2013 did not materialize. The duration of the shortage is unknown at this time.

Recommendations for Responding to Tuberculin Shortage

Until normal supplies of Aplisol^® and Tubersol^® are restored, the recommendations below (based on CDC guidance) will remain in place.

Available PPD should be reserved for high-priority groups such as:

• Contacts to a person with pulmonary or laryngeal TB;
• Persons infected with HIV;
• Persons who are immunocompromised (including use of medications such as prednisone, TNF-alpha Inhibitors, or cancer chemotherapy).

Annual TB screenings should be deferred until sufficient tuberculin is available.  If practical, you may opt to screen high-risk persons for LTBI using an Interferon Gamma-Release Assay (IGRA): QuantiFERON‐GIT^® or T‐Spot^®, instead of TST.

While serial testing is temporarily deferred, TB symptom screening using a screening questionnaire should be initiated. A sample questionnaire is available at:  http://www.dhss.delaware.gov/dhss/dph/dpc/tbelimination.html

Additional Recommendations

As much as possible, the same product (Tubersol® OR Aplisol®) and the same method (TST OR IGRA) should be used in serial testing programs such as health care worker or inmate screening. A change in product or method may make interpretation of changes in test results difficult.

If testing is deferred, the healthcare provider must check with the supplier regularly to determine if PPD solution is available and recall all patients with deferred TST placement as soon as is practical.

Prior to deferring or changing methods in a required serial testing program, all facilities (skilled nursing facilities, home health care, etc.) should verify that the suggested process change is acceptable to their regulatory authority. 

FAQs and other resources regarding the PPD shortage are available at:  http://www.dhss.delaware.gov/dhss/dph/dpc/tbelimination.html

Questions:  Call or email Jeannie Rodman, RN, MSN

Delaware’s Division of Public Health TB Elimination Program TB Nurse Consultant/Program Mgr.,jeanette.rodman@delaware.gov  (302) 744-1050

References:

1. CDC. Nationwide Shortage of Tuberculin Skin Test Antigens: CDC Recommendations for Patient Care and Public Health Practice. Health Alert Network message issued April 12, 2013. http://emergency.cdc.gov/HAN/han00345.asp
2. CDC. Updated Guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection — United States, 2010. MMWR 2010; 59 (RR-5). http://www.cdc.gov/mmwr/PDF/rr/rr5905.pdf
3. CDC. Interferon-Gamma Release Assays (IGRAs) -Blood Tests for TB Infection (fact sheet). http://www.cdc.gov/tb/publications/factsheets/testing/IGRA.htm.

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