Questions and Answers about AB 2132
General
Is tuberculosis (TB) a problem in California?
Despite being preventable, TB disease continues to cause significant suffering and death in the state of California. The incidence of TB disease in California is nearly twice the national incidence. There was a substantial increase in TB in California in 2023; the number of reported TB cases increased by 15% from 2022 to 2023. Medical and societal costs of TB reached $265 million in California in 2023. In addition, the percentage of people with TB who die has been increasing.
TB disease is preventable for people of all ages if treated when still in the latent phase. An estimated 2 million Californians (6% of the population) have latent TB infection (LTBI), and most are unaware and untreated. Those born outside of the U.S., as well as racial and ethnic minorities, experience disproportionately high rates of TB disease. Most TB disease in California occurs in people who progress from latent infection, who are usually unaware of their infection and do not seek testing or treatment. Because there is no effective TB vaccine in use in the U.S., the most promising tool in the fight against TB is diagnosing and treating LTBI. Testing and treating for LTBI is recommended by California Department of Public Health (CDPH), Centers for Disease Control and Prevention (CDC), and the U.S. Preventive Services Task Force (USPSTF).
More information about the impact of TB in California can be found here:
TB Disease Data
Costs & Consequences of TB in California
What does the bill say? Where can I read the text of the bill?
AB2132 describes a new requirement for tuberculosis screening (assessment for risk factors) in primary care in California. It specifies when and which patients should be offered screening and follow-up health care.
Under AB2132, TB screening and appropriate follow-up should be offered to all adult patients in California receiving primary care services. If risk factors are identified and if the patient’s health insurance covers it, TB testing is required. For those who test positive for TB, further follow-up or referral for latent TB infection treatment is then required.
Unless their health care provider determines that they should still be screened, the requirements of AB2132 do not apply to patients who:
- Are being treated for a life-threatening emergency
- Have been screened previously and have no new risk factors
- Have a documented previous positive Interferon-Gamma Release Assay (IGRA) test or other USDA-licensed test for LTBI.
If there is no documented follow-up care, follow-up is required.
- Lack capacity to consent to screening and consent cannot be obtained from a person legally authorized to make medical decisions on the patient’s behalf.
The full text of the bill can be read here:
California Legislative Information, AB-2132 Health Care Services: Tuberculosis
Are there legal consequences for medical providers who do not comply with AB 2132?
HSC Section 121560(f) states: “A health care provider that fails to comply with the requirements of this section shall not be subject to any disciplinary actions related to their licensure or certification, or to any civil or criminal liability, because of the health care provider’s failure to comply with the requirements of this section.”
For Medical Providers
Is testing and treating for latent TB infection evidence-based?
Yes. Testing and treating for LTBI is recommended by the California Department of Public Health (CDPH), CDC, and the U.S. Preventive Services Task Force. Evidence-based clinical guidance on latent TB infection can be found here:
Can the California Department of Public Health (CDPH) provide TB testing or treatment for my patient?
No, CDPH is not a clinical site and cannot provide TB testing or treatment.
Who is at risk of TB infection?
CDPH recommends TB testing for people with any/all of these TB risk factors:
Those who were born, lived in, traveled for over 1 month, or frequently cross the border into a country with higher TB prevalence
Those with immunosuppression, current or planned (HIV infection, organ transplant recipient, treated with biologic agents including TNF-alpha antagonist (e.g., infliximab, adalimumab, etanercept, others), steroids (equivalent of prednisone ≥15 mg/day for ≥1 month) or other immunosuppressive medication)
How should people be tested for TB infection?
There are two types of TB tests: a blood test (IGRA) or a skin test (TST). Testing with an IGRA is recommended for all patients, and especially for those who were born outside of the U.S. The IGRA only requires one visit and results take about 24 hours; prior vaccination with BCG should
not impact this test result. The TST requires two separate visits, 24–48 hours apart; prior vaccination with BCG can cause false positives. Reach out to your local TB program for questions about TB testing.
Do patients need to be tested for TB if they received a TB vaccine, also called BCG? Doesn’t the BCG protect them from infection?
The BCG vaccine is given to people in some countries at an early age to protect against TB. Over time the vaccine stops providing protection, meaning most teenagers and adults are not protected by the vaccine. Even if a person receives BCG as a child, they may develop latent TB infection or TB disease later in life. Learn more about BCG at:
CDC Bacille Calmette-Guerin (BCG) Vaccine for Tuberculosis
Having a BCG vaccine can cause a false positive with the TB skin test (TST) but does
not cause a false positive blood test (also called IGRA). If a person’s TB blood test is positive, then the person most likely has TB infection.
My patient has a positive TB test, what follow up testing or treatment is needed?
A chest x-ray (CXR) and medical exam are necessary following a positive TB test in order to rule out active TB disease.
For most patients, LTBI treatment is recommended for those with a positive test result if TB disease is ruled out. If you are concerned that your patient has TB disease based on CXR or symptoms, please contact your local health department as described below.
My patient has an abnormal chest x-ray (CXR), who should I reach out to?
CXR findings suggestive of active TB disease include cavitary lesion, infiltrate or consolidation, multiple nodules or nodules with poorly defined margins, pleural effusion, hilar or mediastinal lymphadenopathy, and/or miliary nodular pattern. Persons with these CXR findings should be evaluated for active pulmonary tuberculosis with three sputums looking for acid-fast bacilli by smear, culture, and a nucleic acid amplification test (such as the Xpert MTB/RIF assay). For patients with highly suspected or confirmed TB disease, report to your local TB program.
If you have additional questions about chest x-ray findings for a specific patient, please reach out to a TB expert consultant (link below) or your local TB program.
If I suspect my patient has TB disease, or need help evaluating a specific patient, who should I reach out to?
How do I reach my local TB program/local public health department?
How should latent TB infection (LTBI) be treated, if work-up for active TB disease is complete and there is no evidence of TB disease?
For most patients, LTBI treatment is recommended for those with a positive test result if TB disease is ruled out. Most patients can be treated using 3–4 month rifamycin-based treatments. These have replaced 9 months of INH as the preferred therapy for most patients. To read more about drugs and dosages, please see link below.
What International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes help support LTBI testing and treatment?
- Z11.7: “Encounter for testing for latent tuberculosis infection,” may be used for TB testing
- Z11.1: “Encounter for screening for respiratory tuberculosis,” may be used for medical evaluation for TB disease
- Z22.7: “Latent tuberculosis,” which includes a previous positive test for TB infection without evidence of disease, may be used for medical evaluation or for treatment
Where does the California Department of Public Health maintain TB resources for medical providers, including the TB Risk Assessment, clinical and treatment guidance, and talking points for counseling patients about LTBI?
How can I receive additional clinical training about TB or latent TB?
If you have questions regarding future LTBI Prevention clinical trainings, please reach out to
TbFreeCAtraining@cdph.ca.gov. If you would like to join the TB Free CA Listserv, please inquire here as well.
For Patients and Communities
What is tuberculosis (TB) and latent TB infection (LTBI)?
Tuberculosis (TB) is an infectious disease caused by bacteria that is spread through the air. TB disease has serious symptoms that can include coughing (lasting for many weeks), weight loss, fever, night sweats and tiredness. TB disease can be treated using a combination of medications over several months.
A person with inactive or latent TB infection (LTBI) is infected with TB but does not feel sick and can’t spread it to others. LTBI can progress to active TB, but this can be prevented with LTBI treatment.
How do I access primary care if I need a TB test?
If you do not have a health care provider who can provide TB testing, please contact your local health department (Local Health Services/Offices) or a local Federally Qualified Health Center (health care clinic) (Health Resources and Services Administration: Find a Health Center) for more information about where to get tested for latent TB infection. If a patient needs additional help with insurance or getting an appointment, they may want to reach out to social service organizations. Using an internet search engine, type in the name of the county where they live and the words ‘social services.’ This should bring up a link to your county’s social services webpage, which includes information about healthcare access and how to apply for healthcare assistance programs like Medi-Cal.
I was told I have a positive TB test, what should I do now?
You will need a follow-up medical exam to determine if you have LTBI or active TB disease and which treatment is recommended. A California Department of Public Health website with detailed information for patients who test positive can be found here: TB Testing.
Will I be reported to immigration services if I have test positive?
No. All health records are confidential and don’t affect immigration status.
Am I protected because I got the Bacillus Calmette–Guérin (BCG) vaccine for TB?
No. The BCG vaccine does not provide life long protection against TB. Even if you’ve had the BCG vaccine you are still at risk of getting LTBI and developing active TB disease.
Where can I find more resources for patients and the community impacted by TB?