The National PPD Skin Test Shortage: What’s Causing it and How to Get Around it

By Alana Smart / August 26, 2019 / Blog ,

The National PPD Skin Test Shortage: What’s Causing it and How to Get Around it

What's the Cause of the PPD Shortage?

Back in June 2019, the Center of Disease Control (CDC) released a nationwide health alert that there is a shortage of Aplisol, a product of Par Pharmaceuticals. Aplisol is one of the two purified-protein derivatives (PPD) tuberculin antigens, which is licensed by the food and drug administration (FDA) for the administration of TB (tuberculosis) skin tests.

The projected rate of this shortage is expected to be between 3-10 months in length. The first shortage of Apisol 5 mL (50 tests) began in June 2019, and another shortage of Apisol 1ML (10 tests) is predicted to begin in November 2019. The shortage length is subject to change due to the demands of these tests throughout the nation.


Alternative Options for the PPD Skin Test

Due to this national shortage of PPD skin tests, there has been both disruption and frustration throughout the healthcare industry. Many employers, third party administrators, hospitals, and healthcare facilities need the PPD skin test to be administered for pre-employment, and / or vendor credentialing exam purposes. When the PPD test is not available, it is important to note what your other options are

According to the CDC, these alternative options are recommended for when the PPD skin test is not available…

    1. Substitute with interferon-gamma release assay (IGRA) blood test. This test is more commonly referred to as QuantiFERON-TB Gold (QFT-GIT). The cost is higher than a PPD Skin Test, but results can be interpreted without a second visit by the patient and there is a lower chance of a false positive.


  1. Substitute with the T-SPOT, TB test. The T-Spot test substitutes with Tubersol, the other FDA approved PPD, TB antigen.


If you’d like to learn the differences between IGRA and PPD testing as well as the benefits of each, an article can be found here.


Our Staff's Experiences with the PPD Shortage

At NMS Health, our staff on the vendor credentialing team are facing the complications of this PPD shortage daily. Many of our clients require PPD skin testing for their employees for pre-employment or part of an annual requirement. This requirement is to ensure their staff members can either access or service hospitals as a necessity of their job functions.

Here is some insight shared from our Medical Administration and Client Service teams over at NMS Health.

Alana Smart

“Many clinics are not informing us upon scheduling that they are currently out of stock of the PPD test. Therefore, when we call for the medical records, we are informed that the test was not performed. The employee then needs to either visit a new clinic that does have PPD in stock, or, we then ask their employer if they would allow for the employee to receive the QuantiFERON-TB Gold (QFT) test instead. It is interesting to see how some clinics are even running low, or are out of the QFT test, due to it being the main replacement for the PPD test.”

Denise Marcus

“I had a few instances this week where the shortage of PPD was an issue. A clinic I was scheduling a TB skin test for a client’s employee in Lancaster, CA was out of PPD. Fortunately, I was able to order the QuantiFERON test instead for this specific employee. I also came across some issues when scheduling another test in South Dakota."


Minimizing the Need for PPD Tests During the Shortage

At this point in time, it is important for companies to prioritize their employees who are in definite need of the PPD test, and those who are not. The use of “symptom screening,” can be administered to decided if this PPD test is necessary for your employee at this point in time.

If an employee can provide valid documentation of a recent negative TB test can usually negate the requirement for another PPD skin test.


In Summary

The PPD Skin Test shortage is affecting healthcare facilities throughout the entire country. This shortage is impacting scheduling, medical result turnaround times and costs for both employers and administrators of all different industry types. As long as the shortage is an issue, the best course of action is to turn to IGRA based TB testing, like the QuantiFERON Gold test. IGRAs are not impacted by the shortage and will ensure a quicker turnaround time for your employees.

If you require TB testing for your staff for pre-employment purposes, NMS Health can help you get started and administer testing anywhere in the country. If you’d like to learn more about how we help our clients save time on pre-employment medical testing while providing a national test solution, check out an overview of our services.


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