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Chest X-ray if the person has not had one recently – unless younger than 11 or possibly pregnant. ● Clinical assessment for anyone with an abnormal chest X-ray. ● Risk assessment for HIV – take into account for Mantoux testing and BCG vaccination. ● Mantoux test if recent chest X-ray is normal and person is: – younger than 16, or – aged 16–35 and from sub-Saharan Africa or a country with a TB incidence greater than 500 per 100,000. ● Mantoux test for children younger than 11 years and pregnant women. ● Interferon-gamma test (if available) if Mantoux test is positive (unvaccinated person) or strongly positive (vaccinated person). ● Assessment for active TB if interferon-gamma test is positive; interpret chest X-ray first if it is not contraindicated. ● Treatment for latent TB infection in people aged 35 or younger after excluding active TB, if person has positive Mantoux test inconsistent with their BCG history, and positive interferongamma test, and is: – younger than 16, or – aged 16–35, from sub-Saharan Africa or a country with a TB incidence greater than 500 per 100,000. ● Consideration of BCG if unvaccinated and Mantoux negative. ● ‘Inform and advise’ if not being offered treatment or vaccination.
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