Question: I recently applied for a job at a bar and grill, and one of the requirements was to have a TB clearance or test. My girlfriend and I went to Lanakila Health Center and filled out the forms to get tested. I took mine to a clerk behind the window, and she told me I didn't need one since my last test was in 1995. She gave me my TB clearance certificate (card) and said I'm still good and didn't need to take another one ever. My girlfriend went to a different window and was told the same thing. We were told that if you got a TB test after a certain year, then you wouldn't ever need another one. Is this true? If I didn't ever need one, how would I ever know I've contracted TB? What if I somehow I got TB after I got tested? No one would know since a TB test is not needed? If this is true there could be quite a bit of people serving food who actually have TB.

Answer: It is true that you might not need to be tested again in Hawaii unless, of course, you show signs of having tuberculosis.

It's not really what year you were last tested, but that you tested negative.

Each state sets its own requirements and procedures for testing.

Risk is the major factor in determining who should be tested and how frequently, according to state Department of Health officials.

“;The idea is to test people at high risk,”; which is the foreign-born, said Health Department spokeswoman Janice Okubo. The risk of TB for people born in the United States is “;relatively low.”;

According to Dr. Glenn Wasserman, chief of the Health Department's Communicable Disease Division, the one-time requirement for screening food handlers in Hawaii has been effective in identifying people who have active TB.

That's even though TB is not transmitted via food.

“;It turns out that most of the individuals who test positive are foreign-born,”; results that were not picked up through immigration testing or other programs, he said.

“;Additional testing for TB is not necessary unless someone has close contact with a person who has active TB or (has) occupational (e.g., hospital workers) or medical conditions that place them at higher risk for developing tuberculosis,”; Wasserman said.

Health care, nursing home and adult day care workers and clients, for example, are tested annually because of the nature of their jobs/situation.

The Health Department's Sanitation Branch for its part does not require TB testing because TB is not transmissible through food. So, TB is “;of minimal concern to (the branch's) restaurant inspection program.”;

That said, the Honolulu Liquor Commission has its own rules, which require TB clearance for employees who have Liquor Commission-issued work cards.

In addition to workers in food-handling establishments and schools, the one-time testing requirement—valid for an “;indefinite”; period, not necessarily “;forever”;—also pertains to students who are tested “;post high school.”;

Hawaii has the nation's highest incidence of TB per 100,000 people among the states, according to the Centers for Disease Control and Prevention.

That can be attributed to the many foreign-born residents and individuals with latent TB here who “;do not have symptoms, are not contagious and may decide not to undergo treatment,”; Okubo said. These people might develop active TB later in life, at which time they “;are picked up in the health care system for treatment.”;

Okubo says it's the reactivation of latent TB that “;contributes greatly to Hawaii's higher rates.”;

Screening and testing procedures should theoretically lower rates and reduce the spread of TB, she said, although the number of people with latent TB, i.e., the foreign-born, “;counterbalance this effort.”;

The intent of testing is “;catching those individuals who may have been born elsewhere, who may have been exposed to TB at some time in their lives,”; Okubo said.

But, with limited resources, the fact is that “;we can't be testing every single person all of the time.”;

The current requirements have “;been working fairly well for us in our ability to pick up (TB) cases,”; Okubo said. “;It's hard for us to be more aggressive than that because we don't have the resources.”;