Vaccination Details
Required TST (Tuberculin Skin Test)

University requirements:
Documentation of the two-step Mantoux test. This test involves placement of a purified protein derivative TST (Tuberculin Skin Test) to test for tuberculosis. It must be read 48-72 hours after placement, and the area of induration recorded. The AHC requires a second TST test to be performed two weeks after the first test. This two-step Mantoux test needs to be done once.

Why is a 2-step mantoux necessary?
Documentation of annual Mantoux test:
  • If you have had a two-step Mantoux more than one year ago you should have a standard Mantoux test. Annual Mantoux tests are required each year you are in your program.
  • A chest x-ray is required if you have had a positive Mantoux. This documentation must include the results of your follow-up chest x-ray. Once this documentation is submitted, yearly Mantoux testing is not required.

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Information about Tuberculosis (TB)
General signs and symptoms of TB:
Lethargy/weakness/fatigue
Fever
Weight loss
Persistent productive cough
Coughing up blood
Loss of appetite
Night sweats
Two-Step Mantoux Testing:

A mantoux test is a simple and safe test. A small amount of Tuberculin is injected just under the top layer of skin on a person’s arm using a small sterile needle and syringe. Two to 3 days later the skin reaction (lump) is measured and the result recorded.

  • Why is a 2-step Mantoux necessary?

Boosted reactions and skin testing:
The two-step test is important to establish the true baseline reaction when further tuberculin testing is required as part of contact tracing or monitoring of high risk groups.

The ‘booster effect’ represents bolstering of waned cellular immunity by an initial negative mantoux test such that a second test at any time from 1 week to 1 year later produces a greater, more accurate response. This effect will only be observed in individuals with prior cellular immunity to TST (whether from Mycobacterium tuberculosis, nontuberculous mycobacteria) and is more common in the elderly (age > 55 years). Because the proteins in TST are small in size, repeated skin testing with standard doses of tuberculin will not induce a positive skin test reaction in individuals who have no cellular immunity to the antigens in TST.

Two-step testing is used to avoid interpreting the effect of boosting as a new infection. If the first test is < 10mm (and no mantoux has been done in the previous 12 months), it is repeated 1-3 weeks later and the second test is interpreted as measuring the true degree of reactivity.
 

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Possible side effects:
Side effects are uncommon. However, a person who has been exposed to TB germs may occasionally have a sizeable reaction, which may cause some discomfort. This swelling should disappear in about 2 weeks.
 
Who needs testing?
People who have:
  • chronic renal insufficiency
  • people who have lowered immunity such as HIV infection or certain medical conditions
  • the elderly who are entering care facilities
  • Baseline two-step testing should be routinely offered for pre-employment testing of health care workers e.g. hospital and community health and staff of high risk workplaces (e.g. prisons, alcohol and drug rehab. centers and nursing homes)
  • people about to undergo organ donation.
What happens after the test is read?

If the test is negative, it is recommended that you undergo yearly or second yearly mantoux testing.
If the test is positive, a chest X-ray and physical examination will be needed to ensure there is no sign of active disease. If there are no signs of active TB the doctor will discuss the possibility of taking medication to prevent the development of TB disease. The benefits of taking the medication depend on the person’s age, health and underlying risk of TB disease.
What does a positive test mean?

It means that the person is infected by TB germs, but does not mean that he or she has TB disease. This person cannot pass TB onto anyone else unless they get active TB.
How can a person be infected and not have TB disease?

After TB germs enter the body, in most cases, body defenses control the germs by building a wall around them, the way a scab forms over a cut. The germs can stay alive inside these walls for years in an "inactive" state. While TB germs are inactive, they cannot harm the person and they cannot spread to other people. The person is infected but not sick and is unlikely to be aware that he or she is infected.

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How to become compliant:

The Student Immunization Record must be filled out completely with documentation from your provider attached if the form is not actually signed by your provider. If you have requested that your provider fax the information to Boynton Health Service, please document the name of your provider and the date of your request.

To make an appointment at Boynton Health Services to receive your vaccinations or titres, call: 612-625-3222.

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How to obtain the proper documentation of compliance:

You may have your health care provider complete the Student Immunization Record and you may submit it to Boynton Health Service (BHS) if you have received all the required immunizations. Your provider may fax documentation of your vaccination compliance to Boynton Health Services at 612-625-2925.  Please make your request specifically for only your immunization record.

If you have yet to receive all of the required immunizations, you may receive them from your own health care provider or at Boynton Health Service.

If you suspect you already received the required immunizations but cannot obtain the documentation, an antibody titre can be done by your health care provider or at BHS. Please keep a copy of all documentation sent to Boynton Health Service.

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Cost of services/ Student Services Fee Coverage:

Please note: Each immunization is accompanied by a $12.00 injection fee. After the first injection, the injection fee decreases to $8.00 per injection.
Also, all immunizations are available THIMEROSAL FREE.

Required TST (Tuberculin Skin Test) (2-step Mantoux):  $14.00 per injection. If you have paid for Student Services Fee during your enrollment at the University of Minnesota, the fees will cover this cost.

If you had a positive TST: 
Two-step Mantoux test, the required chest x-ray is covered by Student 
Service Fees. Also, if you choose to receive Isoniazid (INH) therapy, that 
is also covered by student service fees. 
Note: 
Student Service Fees do not cover immunization cost for AHC students from:

1. University of Minnesota-Duluth (Medical School and Pharmacy)
2. University of Minnesota-Twin Cities (Residents)

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