Many countries have developed guidelines which incorporate the use of interferon gamma release assays (IGRA) such as T-SPOT.TB. The information below is provided as an abbreviated guide to these guidelines. However, we recommend you read the guidelines appropriate for your country.
On 24 March 2011, The National Institute for Health and Clinical Excellence (NICE) published their new clinical Guidelines for TB control in England and Wales. They are available online at http://guidance.nice.org.uk/CG117/Guidance/pdf/English and are titled ‘Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control’.
In recognition of the mounting clinical evidence in favour of IGRA technology, the new guidelines recommend going straight to an IGRA test in a number of specified indications including:
In addition, the new guidelines recommend that an IGRA test be considered for initial use in individuals for whom Mantoux testing may be less reliable, such as those who have been BCG vaccinated, and for use in individuals whose Mantoux test result is positive.
If your laboratory is in the UK and is not yet able to provide a blood test, then send your samples to Oxford Diagnostic Laboratories National TB Testing Services.
In May 2011 new Guidelines were issued. (Neue Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose. Diel R et al. Pneumologie 2011; DOI: 10.1055/s-0030-1256439.
They recommend that the routine use of a TST be replaced by an IGRA for contact tracing in the following cases and situations:
In November 2005 the Swiss Lung Association released recommendations for the diagnosis of TB infection in contact investigations using blood tests in Bulletin 45/10 of the Office Federal de la Sante Publique. The main points are:
In December 2007 the following guidelines were released for the use of IGRA to screen patients prior to administration of anti-TNF alpha therapies.
The CDC produced IGRA guidelines in June 2010. The main points are as follows:
Guidelines for LTBI were released in 2013:
Recommendations for the identification of LTBI were released jointly by the Associazione di Microbiologia Clinica Italiana (AMCLI) and the Federazione Italiana per le Malattie Polmonari Sociali e la Tubercolosi (FIMPST) in May 2006. The main points are:
Dutch guidelines for contact tracing and screening were released in February 2008. The main points are:
In July 2011 the Haute Autorite de Sante updated guidelines concerning the use of IGRAs tests. It recommend the use of IGRAs tests in the following situations:
If your laboratory is in France and is not yet able to provide a blood test, then send your samples to T-SPOT.TB Service.
Draft guidelines published in July 2008 proposed that IGRA can be used in the following settings: