Tuberculosis (TB) Risk Assessment and Management

This document is  a comprehensive resource for identifying and managing TB on college and university campuses.

It covers the steps necessary for a college or university to develop a TB risk assessment program to minimize the risk of TB on campus, including TB screening and targeted testing. It also includes information about case management in the event there are cases of inactive TB infection or active TB disease on campus. TB case management includes clinical evaluation, treatment management, public health response, and patient education.

See also: FAQs on Tuberculosis Risk Assessment and Management

Summary of Changes for 2026

The Tuberculosis (TB) Workgroup made a limited number of updates to the Tuberculosis Guidelines and associated Frequently Asked Questions (FAQ) in In 2026, following the major revision completed in 2025. A total of 41 comments were received from 12 ACHA members, including 29 comments from a major urban public health department, 10 comments from a range of institutions, and two comments submitted via ACHA Connect. Many of these comments were incorporated into the current revision, while several others have been flagged for consideration in the 2027 update of the TB Guidelines. See the submitted comments and notes from the workgroup.

The 2026 updates include:

• Updated the Introduction to align with and reference the Immunization Guidelines, reinforcing our shared goal of protecting the nation’s 19 million college students and the communities in which they live and learn.

• Updated Appendix A—(Tuberculosis Screening Tool), Question 3:  “Have you resided in or traveled to one or more of the countries or territories listed above for a cumulative period of at least one month …” (previously “one to three months or more”). Note: Institutions may need to update this question in their electronic health record templates.

• Updated Appendix B—High‑Incidence Country List, with the following changes:
  • • Added: French Polynesia, Latvia, Syrian Arab Republic, and Trinidad and Tobago (incidence rose above the threshold).
    • Removed: Anguilla and Belarus (incidence fell below the threshold).

Note: Institutions may need to update this question in their electronic health record templates. 

Download the TB Incidence Data by Country List (Excel)

• Added Appendix D—Inactive TB Infection (LTBI) Risk Assessment Matrix, customized for college student populations.

• Made minor editorial updates, including verification and adjustment of references throughout the TB Guidelines and the FAQ.