Tb Risk Assessment Form - Stafford County Public Schools Page 2

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SCHOOL BOARD POLICY FOR TUBERCULOSIS SCREENING REQUIREMENTS
I. Students entering school for the first time or returning after three months outside the United States must provide
documentation from a licensed physician, nurse practitioner, physician assistant or registered nurse prior to entry of a:
A. TB Risk Assessment documenting low risk for TB disease. All answers on the Risk Assessment should be
– OR –
negative. BCG vaccination does not exclude student from following protocol.
B. Documentation of a negative TB (Mantoux) skin test or interferon gamma release assay within the past 12 months
– OR –
or after exposure.
C. Written documentation of having successfully completed treatment for active tuberculosis disease.
II. Students shall be excluded from school until the TB policy requirement is met. As part of the risk assessment and
targeted screening process, questions arise concerning the definition “high prevalence country” for the purposes of
completing the risk assessment tool and determining who should receive a test for tuberculosis (either a tuberculin skin
test (TST) or interferon gamma release assay (IGRA).
III. Countries at low-risk for tuberculosis (defined as less than 20 TB cases per 100,000 population)
Current Exception List – March 2015
(case rates from WHO 2014 Global Report)
Test for Latent TB Infection Only if Symptomatic or an Additional Individual Risk Factor is Present
African Region
American Region
Eastern
European
Western Pacific
Southeast Asia
Mediterranean
Region
Region
Region
Albania
Egypt
Antigua & Barbuda
Bahrain
American Samoa
No exception
Andorra
Antilles
Israel
Australia
countries
Austria
Aruba
Jordan
Cook Islands
Belgium
Bahamas
Lebanon
Japan
Croatia
Barbados
Oman
New Caledonia
Cyprus
Bonaire, Saint
Saudi Arabia
New Zealand
Czech Republic
Eustatius and Saba
Syrian Arab
Niue
Denmark
Canada
Republic
Samoa
Finland
Caymen Islands
United Arab
Tokelau
Former Yugoslav
Chile
Emirates
Tonga
Republic of
Costa Rica
West Bank and
Macedonia
Wallis & Futuna
France
Cuba
Gaza Strip
Islands
Germany
Curacao
Greece
Dominica
Hungary
Grenada
Iceland
Jamaica
Ireland
Montserrat
Italy
Puerto Rico
Luxembourg
Saint Kitts & Nevis
Malta
Saint Lucia
Monaco
Sint Maarten
Netherlands
Norway
(Dutch
San Marino
Part)
Serbia
Turks & Caicos
Slovakia
United States
Spain
Virgin Islands (US
Sweden
& BR)
Switzerland
Turkey
United Kingdom
Revised March 2015

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