Preventive treatment of HCW with evidence of LTBI without evidence of recent exposure is no more recommended in Germany but can be considered in cases who had a documented contact with an index case, similar to contacts in the general population. National recommendations for TB contact tracing also VE-822 report that the risk of patients with silicosis to be 30 times elevated. In a study on 118 retired coal miners in Germany, almost 40% with silicosis, approximately 50% had a positive IGRA test result. None of the 90 individuals who were evaluated after 2 years in follow-up developed active tuberculosis in the absence of preventive chemotherapy. More than one third of close contacts of patients with contagious TB can be identified as having LTBI. In the absence of preventive chemotherapy the risk of close contacts with positive TST results to progress to active disease has been estimated around 2–6% during the first 2–3 years after exposure. However two studies report progression rates to active TB of 12–13% in close contacts with positive IGRA test results not receiving preventive chemotherapy. It is thus possible, that close contacts are the group with the highest risk for the progression to TB in Germany. Other studies also suggest that the risk in contacts of TB patients and particularly in household contacts is underestimated. Given the fact that LTBI testing of close TB contacts is mandatory in Germany according to the Infection Protection Act the low acceptance rate documented in this survey, confirming recent observations, is surprising. In order to improve TB prevention and to achieve the goal of TB elimination in countries of low TB incidence the indication for preventive chemotherapy should be made on a risk assessmentbased approach where the need to screen individuals is prioritised on the basis of the intensity of exposure and susceptibility of individuals for M. tuberculosis infection. Additionally, due to the low positive predictive value, LTBI-testing should not be directed at individuals with a low risk of active TB in whom the risks of preventive chemotherapy may outweigh its benefits. It has been suggested that over 95% of individuals with a positive IGRA or TST do not develop active TB during follow-up further supporting targeted testing. Rather surprisingly we found that physicians in Germany did not rank migrants among the groups with a high risk for TB, although it is recognized that individuals coming from high TB prevalence countries who are latently infected might have an increased risk of active TB of more than 13-fold in comparison with migrants without LTBI. Other studies also report insufficient testing coverage of migrants for LTBI. Even though preventive therapy is highly effective in selected populations, acceptance and adherence to a prolonged treatment are less than optimal and adverse effects, although rare, can occur in a small proportion of individuals. Mistrust against preventive strategies might explain the suboptimal acceptance rates for preventive therapy among both patients and prescribing physicians with even lower acceptance rates being recorded among HCW.