If Tb Test Is Taken 10 Years Old Do I Need to Take Test Again

For the General Public:

What is TB?
What are the symptoms of TB?
How is TB spread?
Is there a difference betwixt TB Infection, and TB disease?
What should I do if I take spent time with someone with TB infection?
What should I do if I take been exposed to someone with TB disease?
How do I get tested for TB?
Who tin administer a tuberculin peel examination (TST)?
How often tin TSTs be repeated?
Where tin can I get tested for TB?
What does a positive TB test mean?
Can I get vaccinated for TB?
What if someone has received the BCG vaccine (which is given in many countries)?
Why is TB infection treated?
How is TB disease treated?
How many people in Texas have TB?

For Health Care Professionals

What are the recommendations for screening health care personnel (HCP) for tuberculosis upon rent?
How often should HCP exist screened for TB afterward hire? Is annual testing recommended?
If annual testing with a TST or blood test is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?
How should I screen my employee for TB upon hire if they say they already have a positive TB skin or blood exam?
Tin a new hire's documented negative tuberculin skin exam (TST) issue be used in performing a baseline ii-step TST?
What do I demand to know if my HCW has received a BCG vaccine?
Are routine or almanac CXRs notwithstanding recommended?
Can my employee with a positive TB pare or claret test return to work?
What further deportment do I need to accept when HCP are diagnosed with TB infection or TB disease?
Should HCP be treated for TB infection?
Have the updated 2019 guidelines for screening HCP for TB changed the need for a facility run a risk assessment?
Does DSHS accept a sample form that health care facilities may utilise to document TB screening, testing, and educational activity?
Where can I discover more information regarding screening health care personnel for TB?

TB and COVID-nineteen

Do COVID-xix and TB share similar symptoms?
Are there recommendations to delay TB screening in persons recently vaccinated against COVID-19?

Full general Reporting Requirements

How practise I study tuberculosis screening results?

Recommendations for TB Screening of Adults and Children in Various Settings

Are there general recommendations about which adults should and should not be screened for TB in Texas, and how to screen them?
Are there general recommendations about which children should and should not be screened for TB in Texas, and how to screen them?
What are the screening requirements for TB testing in facilities that provide intendance to children?
What are the screening requirements for TB testing in adult care centers such equally assisted living facilities?

For Schools

Do all employees in Texas schools yet need a tuberculin pare test?
Practice all new students in Texas schools still need a tuberculin peel test?

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

Other Resource

What are other recommended sites where I tin can find information well-nigh tuberculosis?

For the General Public

What is TB?

Tuberculosis (TB) is a illness caused past germs that are spread from person to person through the air. TB commonly affects the lungs, but information technology tin also affect other parts of the body, such as the brain, the kidneys or the spine. A person with TB tin can die if they do non get handling.

What are the symptoms of TB?

The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and nighttime sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and the coughing up of blood. Symptoms of TB disease in other parts of the body depend on the area affected.

How is TB spread?

TB germs are put into the air when a person with TB illness of the lungs or pharynx coughs, sneezes, speaks or sings. These germs tin stay in the air for several hours, depending on the surroundings. Persons who exhale in the air containing these TB germs can go infected; this is called TB infection or latent TB infection (LTBI). If untreated, TB infection can become TB disease.

Is at that place a deviation between TB Infection, and TB disease?

People with TB infection have TB germs in their bodies, just they are non sick because the germs are not active. These people do non have symptoms of TB disease and they cannot spread the germs to others. However, they may develop TB disease in the future. They are frequently prescribed treatment to preclude them from developing TB disease.

People with TB illness are sick from TB germs that are agile, significant that they are multiplying and destroying tissue in their body. They commonly have symptoms of TB disease. People with TB disease of the lungs or throat are capable of spreading germs to others. They are prescribed drugs that can treat TB affliction.

What should I exercise if I have spent fourth dimension with someone with TB infection?

A person with TB infection cannot spread germs to other people. Yous practice not demand to be tested if you have spent fourth dimension with someone with TB infection. However, if you have spent time with someone with TB disease or someone with symptoms of TB, you should contact your dr. or local or regional wellness section for TB screening recommendations.

What should I do if I have been exposed to someone with TB disease?

Not everyone who is exposed to TB becomes infected with the TB germs. If you lot believe you lot have been exposed to TB, you should contact your dr. or the local wellness department for more information about screening and testing.

How do I become tested for TB?

There are two tests that tin exist used to assist observe TB infection: a pare examination or a TB blood test.

The Mantoux tuberculin pare test (TST) is performed by injecting a pocket-size corporeality of fluid (chosen tuberculin) into the pare in the lower office of the arm. A person given the TST must render within 48 to 72 hours to take a trained health care worker wait for a reaction on the arm; this must exist done in-person.

The TB blood test, known as the Interferon Gamma Release Assay (IGRA), measures how the patient's immune organization reacts to the germs that crusade TB when present. There are currently 2 Federal Drug Administration (FDA) approved claret tests on the market: the QuantiFERON®–TB Golden In-Tube test (QFT-GIT) and the T-SPOT®.TB exam (T-Spot).

Although the tuberculin skin test has been the almost common screening method in Texas, many health departments now use the IGRA test as the standard tool. When choosing a skin test or blood examination, consideration can be made based on age, health status (see policy TB 1004), BCG status, and other factors of the person needing the test.

A positive TST or IGRA only tells you lot if you have TB germs in your body. Other tests may exist needed to tell if you have TB affliction, such every bit a chest x-ray (CXR) and other laboratory testing of sputum.

Who tin administrate a tuberculin skin test (TST)?

A tuberculin pare examination (TST) is considered a medical deed and should only be performed by an individual working nether the order of a licensed doctor. There is no requirement for the individual to be a licensed wellness care worker. DSHS recommends those that administrate a TST meet knowledge and clinical skills requirements, have received grooming, and demonstrated competency before administering a TST.

The Texas DSHS TB Program recommends that anyone who administers a TST has reviewed, is familiar with, and able to readily access the recommendations within the following documents:

CDC Fact Sheet "Tuberculin Skin Testing"
CDC fact sheet "Targeted Tuberculin Testing and Interpreting Tuberculin skin Test Results"
CDC Mantoux Tuberculin Skin Testing Facilitator Guide
Tubersol parcel insert (PDF)
Aplisol package insert (PDF)

In person preparation on how to administer a TST is available through the Heartland National TB Middle. Please visit the Heartland National TB Center website for a listing of training opportunities.

How often tin can TSTs be repeated?

In full general, in that location is no gamble associated with repeated tuberculin pare test placements. If a person does not return within 48-72 hours for a tuberculin pare test reading, a 2d test can be placed as soon every bit possible. There is no contraindication to repeating the TST, unless a previous TST was associated with a severe reaction.

Where tin can I become tested for TB?

In general, Texas Department of State Health Services does not recommend that low risk individuals be tested for tuberculosis. If a examination is needed or recommended, the general public may ask their primary care provider, local clinics, or pharmacies, amid other sites. You may as well contact your local or regional wellness department for recommendations regarding individual testing needs.

What does a positive TB test hateful?

A person with a positive TST or claret test has the TB germ in their torso. It does not tell whether or not the person has TB infection or TB illness. Other tests, such as a chest x-ray, symptom screening and a testing of sputum (phlegm), are needed to determine whether the person has TB infection or TB disease.

Can I get vaccinated for TB?

There is a vaccine for TB, all the same it is not generally recommended for apply in the United States. Bacille Calmette-Guérin, or BCG, is a vaccine used in many countries with loftier rates of TB. BCG vaccination does not completely forestall people from getting TB, but it is used to protect infants and young children from serious, life-threatening diseases, specifically miliary TB and TB meningitis.

What if someone has received the BCG vaccine (which is given in many countries)?

In many parts of the globe where TB is common, Bacille Calmette-Guérin, (BCG) vaccine is used to protect infants and immature children from serious, life-threatening diseases, specifically miliary TB and TB meningitis. However, information technology does not completely forbid people from getting TB.

The effect of the BCG vaccine wanes overtime and may have little to no effect on positive TST results among adults who received the vaccine equally a child.

A person with a history of BCG vaccination can exist tested and treated for TB infection if they react to the TST. TST reactions should be interpreted based on risk stratification regardless of BCG vaccination history. IGRAs use 1000. tuberculosis specific antigens that do not cantankerous react with BCG, and therefore, practise non cause imitation positive reactions in BCG recipients— this means a blood test, or IGRA, is preferred for BCG vaccinated individuals.

Why is TB infection treated?

If you have TB infection just not TB disease, your doctor may want you lot to take a drug to impale the TB germs and forestall you from developing TB affliction. The decision about taking treatment for TB infection will be based on your chances of developing TB disease. Some people are more likely than others to develop TB disease once they have TB infection. This includes people with HIV infection, people who were recently exposed to someone with TB disease, and people with sure medical conditions.

How is TB illness treated?

TB disease can exist treated by taking multiple drugs for several months, by and large 6 to 12 months. Information technology is very important that people who take TB affliction stop the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become ill once more; if they do not take the drugs correctly, the germs that are nevertheless alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to care for. In some situations, local health department staff meets regularly with patients who have TB to watch them have their medications. This is chosen directly observed therapy (DOT). DOT helps the patient complete treatment in the to the lowest degree corporeality of time.

DSHS provides TB medications to public health clinics across Texas. These clinics treat patients with TB disease. Also, people who are presumed to have TB may be given treatment while their clinicians perform further testing to confirm or rule out TB disease.

How many people in Texas have TB?

Each twelvemonth, DSHS provides information on numbers of TB cases per canton. The well-nigh current information is found on the TB statistics page.

For Health Intendance Professionals

What are the recommendations for screening health intendance personnel (HCP) for tuberculosis upon hire?

The Department of Country Health Services (DSHS) in partnership with the National Tuberculosis Controllers Clan (NTCA) and Centers for Disease Command and Prevention (CDC), recommend that both paid and unpaid health care personnel (HCP) receive the following upon rent:

A single blood exam known as an interferon gamma release analysis (IGRA) or a two-pace tuberculin pare examination (TST);
An individual risk assessment to decide baseline risk for TB and interpret the IGRA or TST results; and
A signs and symptoms screening cess.

DSHS has developed a sample Baseline Tuberculosis Assessment for Health Intendance Personnel form (PDF) that may exist used by wellness care facilities. DSHS also recommends completing the Tuberculosis Screening Results and Work Clearance for Health Care Personnel (PDF) after performing a baseline TB assessment.

These recommendations may be used by health care facilities and other entities to guide the development of their internal TB screening policies. These recommendations should not be interpreted as DSHS policies.

How oftentimes should HCP be screened for TB after hire? Is almanac testing recommended?

Annual TB testing using an IGRA or TST is not routinely recommended. Health intendance facilities should perform TB testing and complete a signs and symptoms assessment later on known or ongoing exposure to TB or consummate a signs and symptoms assessment annually for HCP with untreated TB infection. HCP should likewise be educated about TB treatment options for TB infection.

DSHS has developed a sample After Hire Tuberculosis Assessment for Health Care Personnel course (PDF) that may be used for HCP with untreated TB infection or anytime a HCP is tested for TB afterwards hire.

*Annual TB testing using an IGRA or TST and symptom screening may exist considered for HCP with significant occupational hazard, such as pulmonologists or respiratory therapists in high risk settings, or in settings where TB exposures accept occurred in the past (i.eastward. emergency departments). This decision should be developed by the health intendance staff responsible for infection control and may be done in collaboration with your local health department.

If almanac testing with a TST or blood examination is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?

DSHS recommends that facilities consider the local epidemiology of TB in their county (PDF), including take chances factors for TB (PDF) [CDC] in their staff, and whatsoever past TB exposures in the facility when deciding to implement periodic TB screening after baseline testing. The purpose of screening for TB using a signs and symptoms assessment questionnaire is to ensure agile TB is identified early. Anyone with symptoms of TB should be referred for medical evaluation.

How should I screen my employee for TB upon rent if they say they already have a positive TB skin or blood examination?

HCP with documentation of a previous positive TST or IGRA result, or documentation confirming completion of treatment for TB infection or disease, should be screened for TB in the following fashion:

Complete a TB signs and symptoms assessment.
Have a baseline breast x-ray (CXR) performed (unless a recent copy is bachelor).

HCP with documentation of a previous positive TST or IGRA result should non be re-tested with a TST or IGRA.

Afterward the baseline screening, serial or routine CXRs are non recommended; however, persons exhibiting symptoms of TB affliction crave a CXR regardless of history.

HCP without documentation of the previous test result should undergo baseline screening with a 2-pace TST or an IGRA. An individual risk assessment (PDF) and signs and symptoms screening assessment should also be completed (refer to Baseline Tuberculosis Assessment for Health Care Personnel (PDF)). Copies of the TB screening results and responses to the symptom screen and individual take a chance cess should be kept by the employee as documentation in case of future screenings.

Can a new hire'due south documented negative tuberculin pare examination (TST) effect be used in performing a baseline two-step TST?

Yep, a new hire's documentation of a negative TST result can be recorded every bit stride one of the ii-step TST when administered whatsoever time during the previous 12 months, if the outcome was documented in millimeters (mm). The TST administered at rent will exist recorded as step two of the ii-step TST.

For more details, refer to the Guidelines for Preventing the Transmission of M. TB in Wellness-Care Setting, 2005 (PDF) [CDC] TB Infection-Control Surveillance.

What do I need to know if my employee has received a BCG vaccine?

The IGRA and TST are not contraindicated for persons who accept been vaccinated with Bacillus Calmette–Guérin (BCG). The effectiveness of BCG wanes overtime but it may cause a false-positive reaction to the TST, which may complicate decisions about diagnosing TB infection and prescribing handling. IGRAs utilise M. tuberculosis specific antigens that do not cross react with BCG, and therefore, practice not cause false positive reactions in BCG recipients. This means an IGRA test is preferred for BCG vaccinated individuals. More information can be found on the CDC website.

Are routine or annual CXRs still recommended?

No, chest x-rays should not exist performed routinely or annually for persons with a positive IGRA or TST. Wellness intendance personnel, patients or institutional residents with a baseline positive or newly positive IGRA or TST upshot who are likely to exist infected with TB should receive one chest radiograph to exclude a diagnosis of TB affliction. Repeat chest x-rays are not needed unless signs or symptoms of TB develop, or a clinician recommends a repeat breast radiograph, or after a new exposure to TB.

Health care personnel who have a previously positive IGRA or TST result and who alter jobs should deport documentation of the results of their IGRA or TST, chest radiograph and documentation of treatment history for TB infection, if applicable, to their new employer.

Tin my employee with a positive TB skin or blood test return to piece of work?

HCP who are likely * infected with TB based on a positive TST or IGRA effect and private adventure, should be referred for a CXR and medical evaluation to rule out active TB prior to returning to work. If a diagnosis of TB infection is made, HCP may return to work, as TB infection is not contagious. They should be educated on treatment options for TB infection to minimize their chance of developing TB illness.

HCP who are asymptomatic, unlikely* to be infected with TB, and who are at low take chances for progression to TB illness based on individual risk, should have a 2nd test (either an IGRA or a TST) if their first exam is positive. Only when the 2d test is positive in low run a risk individuals is TB infection considered an accurate diagnosis (PDF).

What farther actions practice I need to take when HCP are diagnosed with TB infection or TB disease?

TB infection, TB illness, and suspicion of TB disease are all reportable to your local health department. Encounter How do I written report TB? for reporting requirements.

Should HCP be treated for TB infection?

Treatment for TB infection should be considered in all persons to prevent the progression to TB disease. This decision should be made between the HCP and their health care provider.

When facilities screen for TB, DSHS recommends that an annual educational activity component is included in the screening plan. Education can include information on signs and symptoms of TB, the difference betwixt TB infection and illness, TB hazard factors, and the risks for developing TB disease if not treated.

Take the updated 2019 guidelines for screening HCP for TB changed the need for a facility take a chance assessment?

No, facility risk assessments are however recommended. The results of the cess are no longer used to make up one's mind frequency of TB screening but are useful in documenting infection control in facilities. Refer to the CDC website for more details on the use of the risk assessment and updates to the 2019 guidelines.

Does DSHS accept a sample class that health care facilities may use to document TB screening, testing, and educational activity?

Yes. DSHS has adult the post-obit forms that facilities may use or alter to fit their need.

Baseline Tuberculosis Assessment for Health Care Personnel (PDF). Information technology is intended for use in health care facilities when assessing employees for TB upon hire.
Afterwards Rent Tuberculosis Assessment for Health Care Personnel (PDF). It is intended for utilise in wellness care facilities when assessing employees for TB any time after baseline screening.
Tuberculosis Screening Results and Work Clearance for Wellness Care Personnel (PDF). It allows facilities to document results of baseline and after hire screening including the recommended annual educational activity.

These forms are not required by DSHS but may exist used to guide and document facility screening practices, as they align with DSHS and CDC recommendations.

Where can I detect more information regarding screening health care personnel for TB?

Refer to the Centers for Illness Command and Prevention (CDC) website for more information.

TB and COVID-19

Do COVID-19 and TB share similar symptoms?

Yeah, TB and COVID-nineteen have some similar symptoms such as a cough or a fever. But a licensed healthcare provider can decide the cause of symptoms and further testing may exist needed. For healthcare providers, information technology is important to "Call back TB" when symptoms and adventure factors for TB are present. Come across Tuberculosis and COVID-19 Know the Difference (PDF) for details.

Are at that place recommendations to delay TB screening in persons recently vaccinated against COVID-xix?

No, TB screening should non be delayed for people with hazard factors for TB who have been vaccinated against COVID-19. The Centers for Disease Control and Prevention (CDC) has information most TB screening practices and the COVID-xix vaccine.

It is recommended that those in charge of TB screening visit the CDC website periodically for whatsoever updates regarding TB screening practices. When considering the impact of TB in your area, please consult with your regional or local health department (R/LHD). Study suspected and confirmed TB infections to your R/LHD.

Full general Reporting Requirements

How practise I report tuberculosis screening results?

Both TB infection and TB illness are Notifiable Conditions reportable to the local or regional wellness department TB Programs. Reporting details can be establish on the DSHS website, which include reporting forms.

Tuberculosis Infection- Reportable inside one (1) week to the local or regional health department. A diagnosis of a latent TB infection is NOT complete until the following criteria take been met:

Positive pare exam with results written in millimeters and appointment read, or positive IGRA blood test results; and
Documentation that patient has no current signs or symptoms of active tuberculosis illness; and
CXR results that are read as normal, or non consistent with TB; and
There is no suspicion of Agile TB affliction

TB Disease or Suspicion of TB Illness- Reportable within i (one) working day.

Recommendations for TB Screening of Adults and Children in Various Settings

Are there general recommendations about which adults should and should non be screened for TB in Texas, and how to screen them?

Yes, the DSHS TB Unit has recommendations for TB screening of adults in Texas, depending on identified TB risk factors. Please refer to data in Tuberculosis Screening Recommendations for Adults in Various Settings (TB-1002) (PDF).

Are at that place general recommendations about which children should and should not exist screened for TB in Texas, and how to screen them?

Aye, the DSHS TB Unit has recommendations for TB screening of children in Texas, depending on identified TB run a risk factors. Please refer to information in Tuberculosis Screening Recommendations for Children in Diverse Settings (TB-1003) (PDF).

What are the screening requirements for TB testing in facilities that provide care to children?

Facilities with a permit or license from Texas Health and Human Services (HHS) to provide intendance to children volition abide past the chapters that apply to each type of facility in the Texas Authoritative Code (TAC) Title 26, Part ane.

The Minimum Standards page on the HHS website contains links to the standards related to daycare facilities, 24-hour residential care, and kid-placing agencies. These links are located at the bottom of the page.

Any facilities that provide care to children and are non listed in a higher place should beginning review the Texas Authoritative Code for whatsoever statutory requirements or check with their licensing or credentialing agency. Collaboration with a local or regional TB plan may aid in developing screening, testing, and handling plans.

What are the screening requirements for TB testing in adult care centers such as assisted living facilities?

Screening requirements for adults working in these facilities are outlined in the Long-Term Care Regulatory Provider Letter of the alphabet (PDF) :

Assisted Living Facility
Twenty-four hours Activity and Health Services Facility
Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions
Dwelling and Customs Back up Services Bureau
Nursing Facility, and
Prescribed Pediatric Extended Care Center

Facilities licensed by HHS for adult care in Type A and Type B Assisted Living Facilities will abide past Texas Administrative Code (TAC) Title 26 Part i Affiliate 553 Subchapter E Rule §553.261B. TB requirements are summarized below; however, each facility should review the TAC for specific details:

Facilities must develop written policies for the control of communicable diseases in employees and clients, including TB screening and the provision of a safe and sanitary environment for clients and their families.
Screen employees for TB inside two weeks of employment.
Subsequently rent, facilities must follow CDC guidance in Tuberculosis Screening, Testing, and Treatment of U.Southward. Wellness Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. See FAQs for Health Care Professionals.
Facilities must screen residents for TB upon access and later exposure to TB.
Whatever facilities that provide care to adults and are not listed in a higher place review the Texas Administrative Code for any statutory requirements or check with their licensing or credentialing agency. Collaboration with a local or regional TB plan may help in developing screening, testing, and treatment plans.

For Schools

Practice all employees in Texas schools yet need a tuberculin skin test?

There is no statewide requirement for teachers or other school employees to have a tuberculin skin test or TB claret examination. The Centers for Disease Control and Prevention (CDC) and DSHS discourage the use of the tuberculin pare testing or IGRA blood examination for persons who accept no risk factors for TB exposure.

However, anyone with signs or symptoms of TB should be considered for medical evaluation.

Specifications for employee or volunteer TB screening may be required by a licensing, credentialing, or insurance policy, or past the school district's regulations and requirements. Each school should defer to their own policy.

Do all new students in Texas schools still need a tuberculin pare test?

No. A tuberculosis questionnaire has been developed past Texas Department of State Health Services to identify children at high hazard for TB infection. Refer to the list of counties with a high incidence of TB (PDF) where apply of the questionnaire is recommended prior to entering school. As resources let, school districts in other counties may use the TB questionnaire to identify children who should receive a TB skin examination prior to school entry.

Children who have a positive reaction to the TB pare test merely no symptoms of TB disease should Non be kept out of school while they are beingness evaluated for treatment of TB infection.

The American Academy of Pediatrics (AAP) recommends that physicians routinely assess a child's risk of TB exposure with a questionnaire and offer tuberculin skin testing just to at-risk children. The AAP does not recommend routine tuberculin peel testing of children with no TB risk factors for school entry, twenty-four hours intendance attendance, WIC eligibility, or camp attendance.

A tuberculin skin exam may be applied on the same day every bit routine immunizations. The pare test will need to be read 48-72 hours after. If a skin exam is non placed on or earlier the day of a live virus immunization such as measles-mumps-rubella (MMR), then the skin test should be postponed at least 6 weeks.

For more information almost TB screening for children in schoolhouse settings visit the following links:

Recommendations for TB Screening of School Aged Children (PDF)
Tuberculosis Questionnaire in English (DOC)
Tuberculosis Questionnaire (en Español) (DOC)

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

The law (Chapter 89 of the Texas Health & Safety Code) in Texas requires county correctional facilities that encounter any ane of three criteria to screen all inmates for TB past the seventh day of incarceration and annually thereafter, and to screen all employees and volunteers both pre-employment and annually thereafter.

The 3 criteria are as follows:

a capacity of 100 or more than beds,
housing inmates transferred from a county that has a jail with a capacity of 100 or more beds, or
housing inmates from another state.

The police also requires all correctional facilities in the land, including youth detention facilities, regardless of whether they meet the criteria stated higher up, to report to the Texas Department of State Health Services, Communicable diseases Intervention and Control Branch, the release of inmates being treated for TB and so that the Department can adjust for continuity of care.

Other Resources

What are other recommended sites where I can find information about tuberculosis?

Centers for Disease Control and Prevention:

Basic TB Facts
Tuberculosis Fact Canvass
Tuberculosis Fact Canvas (PDF) Courtesy of the CDC

HIPAA:

Frequently asked questions about HIPAA Privacy Rule

Medical Consultation:

TB Medical Consultation Procedure

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Source: https://www.dshs.texas.gov/disease/tb/faq.shtm