Tuberculosis Risk Questionnaire
1. To the best of your knowledge have you ever had close contact with anyone who was sick with tuberculosis (TB)?
2. Were you born in one of the countries listed below*?
3. Have you traveled or lived for more than one month in one or more of the countries listed below*?
If the answer to any of the above questions is YES, the Massachusetts Department of Public Health strongly recommends that you have a tuberculin skin test to check for latent TB infection.
If the answer to all of the above questions is NO, a tuberculin skin test should not be done.
*Please note: If you have had a positive tuberculin skin test in the past, you do not need another test. If you had the BCG vaccine in the past, a simple blood test may be more appropriate for you.
Please contact UHCS if you would like to schedule a tuberculin skin test or the TB blood test.
COUNTRIES WITH HIGH RATES OF TUBERCULOSIS (TB) (alphabetical listing)*
- A: Afghanistan, Angola, Armenia, Azerbaijan
- B: Bahamas, Bahrain, Bangladesh, Belarus, Benin, Bhutan, Bolivia, Bosnia & Herzegovina, Botswana, Brazil, Brunei/Darussalam, Burkina Faso, Burundi
- C: Colombia, Comoros, Cote d'Ivoire, Croatia, Cambodia, Cameroon, Cape Verde, Central African Rep., Chad, China
- D: DR Congo, Djibouti, Dominican Rep., DPK
- E: Ecuador, El Salvador, Equatorial Guinea, Eritrea, Estonia, Ethiopia
- G: Gabon, Gambia, Georgia, Ghana, Guam, Guatemala, Guinea, Guinea-Bissau, Guyana
- H: Haiti, Honduras, Hong Kong (PRC)
- I: India, Indonesia, Iraq, Iran
- K: Kazakhstan, Kenya, Kiribati, Korea, Kyrgyzstan
- L: Lao, Latvia, Lesotho, Liberia, Lithuania
- M: Moldova, Mongolia, Mozambique, Morocco, Myanmar, Macedonia, Madagascar, Malawi,
Malaysia, Maldives, Mali, Macao (PRC), Marshall Islands, Mauritania, Mauritius, Micronesia
- N: Namibia, Nepal, Nicaragua, New Caledonia, Niger, Nigeria, Northern Mariana Islands, Niue
- P: Pakistan, PDR, Palau, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Portugal
- R: Romania, Russian Federation, Rwanda
- S: Rep. Senegal Solomon Islands, Sierra Leone, Somalia, South Africa, Sudan, Sri Lanka, Suriname, Swaziland, Syrian Arab Rep., South Africa, Sao Tome & Principe
- T: Tajikistan, Tanzania, Thailand, Togo, Tokelau, Turkmenistan
- U: Uganda, Ukraine, Uzbekistan
- V: Vanuatu, Vietnam
- Y: Yemen
- Z: Zambia, Zimbabwe
* World Health Organization. Global tuberculosis control. WHO report 2002.