Hawaii has temporarily stopped preventing food handlers and others who have not been cleared for tuberculosis from working because of a nationwide shortage of testing solutions. State health officials from across the nation are trying to cope with the shortage. South Carolina’s state health alert network says both TUBEROL®, made by Sanofi Pasteur Limited, and APLISOL®, made by JHP Pharmaceuticals, LLC, are in short supply and not expected to be more readily available until at least the end of May. Both products are immunological methods for testing Mycobacterium tuberculosis infection, including tuberculin skin tests (TSTs) and interferson-y release assay (IGRA) blood tests. Hawaii’s requirements that food handlers, school personnel and students, health care workers, and residential and daycare staff all be cleared for TB before going to work or school were suspended April 11 because of the testing solution shortages. TB clearance is an important public health tool because people can be infected without showing any symptoms. And TB bacteria is spread whenever anyone carrying the mycobacteria in their lungs or throat coughs, sneezes, speaks or sings. Anyone nearby is then in danger of breathing in the TB bacteria and becoming infected. “With limited supplies of testing solution available due to nationwide production delays that began late last year we anticipate people may have some difficulty getting tested for TB at this time,” said Dr. Richard Brostrom, chief of Hawaii’s TB Control Branch. In addition to suspending its requirements for TB clearance, Hawaii also limiting its own TB testing to high-risk groups. Those include: high-risk immigrants, people with immunodeficiency, individuals awaiting medical treatment, anyone exposed to an infectious case and anyone showing symptoms. In a typical year, Hawaii conducts about 50,000 tuberculosis skin tests and treats 120 people found to be carrying the bacteria. The state anticipates suspensions of TB clearances to last for 120 days. The South Carolina alert says the state has been told by the federal Centers for Disease Control in Atlanta that more expensive blood tests might be substituted for the shortage of the skin test method.