Section 696.APPENDIX A    Mantoux Skin Testing Procedures

Mantoux Skin Test.  The Mantoux skin test or other TB screening test shall be used when identifying persons with infection, regardless of whether a BCG vaccination was received in the past.  (See the incorporated publication, The Role of BCG Vaccine.) Multiple puncture tuberculin tests should not be used to determine whether a person has TB infection.  The following applies to Mantoux skin testing only:

a)         Administration.  A trained person shall administer the Mantoux skin test in accordance with the incorporated publication, Core Curriculum.

b)         Reading Reactions.  Mantoux skin test reactions should be read 48 to 72 hours after administration in accordance with Appendix C and the incorporated publication Core Curriculum, and recorded in millimeters of induration.  A positive reaction can be documented up to seven days after the skin test was performed.  A negative reaction shall not be documented beyond 72 hours after the skin test was performed.  A trained person shall read the test.  The recipient of a skin test should not read his or her own skin test, even if the recipient is a trained health care worker.

c)         Interpreting Reactions.  The millimeter reading for defining a positive reaction shall depend on a person's risk factors for TB.  (See Appendix C and the incorporated publications, Screening for High-Risk Populations and Treatment of TB and TB Infection, for further information about interpreting reactions in specific groups.)

            AGENCY NOTE:  Anergy.  The absence of a reaction to the tuberculin skin test does not rule out the diagnosis of TB infection or disease.  Anergy should be considered in immunosuppressed persons who have no reaction to the skin test.

d)         Two-Step Testing.  Testing of persons who will be retested periodically (such as persons at high risk of exposure to TB) and who do not have a documented negative skin test reaction during the preceding 12 months shall be done by two-step testing, except as provided for in Section 696.140(a)(2)(B).  The first Mantoux skin test in two-step testing can be read from 48 hours to seven days after the test is administered.  If the reaction to the first test is positive, a person shall be considered infected.  If the reaction to the first skin test is negative, a second test shall be administered seven to 21 days after the first test was administered.  The second test shall be read 48 to 72 hours after administration. (See Appendix B.)

(Source:  Amended at 32 Ill. Reg. 4010, effective February 29, 2008)