My understanding is that TB doesn't spread while latent, it needs to develop into active TB to spread. The US healthcare system is tuned into TB cases and will

My understanding is that TB doesn't spread while latent, it needs to develop into active TB to spread. The US healthcare system is tuned into TB cases and will alert local health officials to do contact tracing, outreach, and follow up with confirmed cases when they pop up. Healthcare and childcare workers are routinely tested for TB in areas with recent spread. Doing screening on the general population doesn't seem necessary, given the low estimated % of people with latent infections and the low estimated % of latent infections that will develop into active infections. It may make sense to screen more people that have a higher risk if they develop active TB or are at a higher risk of exposure. Certainly, increased screening or vaccination would result in improved outcomes for people whose TB infection was averted. But those have to be weighed against the negative outcomes from side effects of screening/treatment and vaccination.