What are the next steps after a 45-minute car ride with a person who has active Tuberculosis (TB)?

From the Guidelines

If you've been in a car ride for 45 minutes with someone who has active tuberculosis (TB), you should contact your healthcare provider immediately to report this exposure. The next steps include getting a TB skin test or blood test to establish a baseline, followed by another test 8-10 weeks after exposure to check for infection, as recommended by the American Thoracic Society, CDC, and the Infectious Diseases Society of America 1. While waiting for your appointment, monitor yourself for TB symptoms including persistent cough, chest pain, coughing up blood, fatigue, weight loss, fever, and night sweats. TB is caused by Mycobacterium tuberculosis and spreads through airborne droplets when an infected person coughs, sneezes, or talks. The confined space of a car increases transmission risk.

Some key points to consider after exposure to someone with active TB include:

• Contact investigation and appropriate preventive therapy for those persons exposed to infectious (sputum positive) TB, as recommended by the Advisory Council for the Elimination of Tuberculosis 1
• Targeted testing and treatment of latent TB infection (LTBI) for individuals who have been in close contact with someone with active TB, especially children under the age of 5 years 1
• Reporting the exposure to the public health department to facilitate follow-up and continuation of therapy, as recommended by the Centers for Disease Control and Prevention 1

If you're diagnosed with latent TB infection, your doctor may prescribe preventive treatment such as isoniazid (300mg daily for adults) for 6-9 months, rifampin (600mg daily for adults) for 4 months, or a combination of isoniazid and rifapentine weekly for 3 months. For active TB, treatment typically involves a combination of antibiotics including isoniazid, rifampin, ethambutol, and pyrazinamide for 6-9 months. Early intervention is crucial to prevent progression to active disease and further transmission.

From the FDA Drug Label

Indications and Usage Isoniazid is recommended for all forms of tuberculos in which organisms are susceptible. However, active tuberculosis must be treated with multiple concomitant antituberculosis medications to prevent the emergence of drug resistance. Close contacts of persons with newly diagnosed infectious tuberculosis (≥ 5 mm)

The next steps after a 45-minute car ride with a person who has active Tuberculosis (TB) are:

• Get tested for TB infection as soon as possible, as the risk of transmission is high in enclosed spaces like a car.
• Seek medical attention if symptoms of TB infection occur, such as cough, fever, or weight loss.
• Preventive therapy may be considered for close contacts of persons with newly diagnosed infectious tuberculosis, as indicated by a tuberculin skin test reaction of ≥ 5 mm 2.
• Follow local health guidelines for contact tracing and testing, as the risk of transmission and the need for preventive therapy will depend on individual circumstances and local epidemiology.

From the Research

Next Steps After Exposure to Active Tuberculosis (TB)

After a 45-minute car ride with a person who has active TB, the following steps should be taken:

• Get tested for latent TB infection (LTBI) using immune-based tests such as the tuberculin skin test (TST) or interferon gamma release assays (IGRA) 3
• If the test results are positive, consider therapy to reduce the risk of re-activation and development of active TB 3
• The current standard therapy is isoniazid (INH), which can reduce the risk of active TB by as much as 90% if taken daily for 9 months 3
• Alternative regimens, such as 3 months of INH and rifapentine taken once weekly, may also be effective 4
• It is essential to note that the risk of developing active TB depends on various factors, including the period after infection and individual characteristics 5

Important Considerations

• Close monitoring and surveillance are strongly suggested for individuals who have been exposed to active TB, especially in the first few years after exposure 3
• Treatment of LTBI is not recommended unless an individual has been recently infected or is at high risk of developing active TB 5
• Individuals who have been exposed to active TB should be aware of the signs and symptoms of the disease and seek medical attention immediately if they experience any unusual symptoms 6

High-Risk Groups

• Certain groups, such as HIV-infected individuals, those receiving immunosuppressive therapy, and healthcare workers, are at higher risk of developing active TB and may require more aggressive treatment and monitoring 7
• These groups should be prioritized for LTBI testing and treatment, and their treatment regimens should be tailored to their individual needs and risk factors 7