Duration of Effective Tuberculosis Treatment, Not Acid-Fast Bacilli (AFB) Smear Status, as the Determinant for De-isolation in Community Settings

For decades, multiple public health and clinical tools have been used to prevent tuberculosis (TB) transmission.Two of these tools are directly discussed in the document by the National Tuberculosis Coalition of America (NTCA) in this issue of Clinical Infectious Diseases:(1) prompt and effective TB disease treatment and (2) isolation, or separating persons with TB disease from others until noninfectious.Use of nucleic acid amplification tests can facilitate rapid TB diagnosis, rapid detection of drug resistance, and early effective treatment [1, 2]; prompt TB treatment initiation is beneficial to both the person with TB and the community.The risk-benefit equation for isolation of persons with TB after treatment initiation, however, is not as straightforward; in this situation, persons with TB bear the burden of isolation, with potential benefit from preventing transmission accruing to the community.While the US Centers for Disease Control and Prevention (CDC) has issued guidelines for discontinuation of TB isolation in healthcare settings [3] and congregate settings such as correctional facilities [4], there are currently no parallel national guidelines for community settings, such as the home where a person with TB on treatment is awaiting clearance for return to work or school.Recognizing that state TB programs and TB medical directors have the most familiarity with local TB epidemiology, public health resources, and healthcare systems, as well as other state or local priorities, CDC defers to state and local authorities to make and enforce policies regarding TB isolation within their jurisdictional boundaries.