Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Completion of Therapy A full course of therapy (completion of treatment) is determined more accurately if the total number of doses ingested is taken into account, as well as the duration of therapy. If there are no interruptions in drug administration, six months is usually the minimum duration of treatment and accurately indicates the amount of time in which drugs are given. However, in human immunodeficiency virus (HIV)-negative, culture-negative patients, treatment for four months may be adequate if there is clinical or radiographic improvement and no other etiology identified. 18 For consultation regarding the treatment of tuberculosis (TB) in a patient with negative cultures, contact the Alaska Tuberculosis Control Officer at 907-269-8000. In some cases, either because of drug toxicity or nonadherence to the treatment regimen, the specified number of doses cannot be administered within the targeted period. In such cases, the goal is to deliver the specified number of doses within a recommended maximum time. For example, for a six-month daily regimen, the total doses should be administered within nine months of beginning treatment. If treatment is not completed within this period, the patient should be assessed to determine the appropriate action to take, such as continuing treatment for a longer duration or restarting treatment from the beginning. Treating a patient for a defined duration, without accounting for the number of doses taken, can result in under treatment. Interruptions in treatment may have a significant effect on the duration of therapy. Reinstitution of treatment must take into account the extensiveness of the disease (e.g., cavitary versus noncavitary disease on chest radiograph, smears and cultures, immunologic status), the point in time when the interruption occurred, and the duration of the interruption. In general, the earlier in treatment and the longer the duration of the interruption, the more serious the effect and the greater the need to restart therapy from the beginning. See Figure 2: Management of Treatment Interruptions 19 for additional information. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment of Tuber culosis Disease 6.23 Revised November 2012
Figure 2: MANAGEMENT OF TREATMENT INTERRUPTIONS 20 Interruption in initial phase of TB treatment. Yes No Duration of interruption.
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Alaska Tuberculosis Program Manual
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Purpose............................
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Monthly assessment of adherence ...
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When to Expand a Contact Investigat
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Introduction CONTENTS About the Ala
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How to Use This Manual Portable Doc
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Printing To access the print dialog
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Abbreviations Refer to the list bel
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QFT QuantiFERON ® -TB test QFT-G Q
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Alaska Statutes and Regulations on
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National and State Program Objectiv
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Indicator 3 Thorough contact invest
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National Standards and Recommendati
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Roles and Responsibilities Contact
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Local Public Health Agencies Table
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Resources and References Resources
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Introduction Purpose Use this secti
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Contact investigation: Collecting,
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Reporting Tuberculosis Detecting an
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Prompt reporting (prior to culture
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Use the Infectious Disease Report F
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Data Collection Forms The following
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Genotyping Genotyping is a useful t
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References 1 ATS, CDC, IDSA. Contro
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child or a person acting on behalf
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When to Conduct Targeted Testing Al
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Alaska Program Standards for Health
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B Notifications CONTENTS Introducti
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Table 1: NUMBERS OF FOREIGN-BORN PE
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chest radiograph and if sputum AFB
Page 63 and 64: Follow-up of B1 and B2 Tuberculosis
Page 65 and 66: Evaluation of B1, B2, and B Tubercu
Page 67 and 68: Treatment Prescribe medications as
Page 69 and 70: 12 Centers for Disease Control and
Page 71 and 72: Introduction Purpose Use this secti
Page 73 and 74: Tuberculosis Classification System
Page 75 and 76: Table 2: PERSONS AT HIGH RISK FOR T
Page 77 and 78: Table 3: WHEN TO SUSPECT PULMONARY
Page 79 and 80: Diagnosis of Tuberculosis Disease T
Page 81 and 82: 1. Exposure to Infectious TB: Ask p
Page 83 and 84: Physical Examination A physical exa
Page 85 and 86: For more information on chest radio
Page 87 and 88: Laboratories should report positive
Page 89 and 90: Guidelines for preventing the trans
Page 91 and 92: 50 CDC. National plan for reliable
Page 93 and 94: Introduction Purpose The overall go
Page 95 and 96: Basic Treatment Principles Follow t
Page 97 and 98: Treatment Regimens and Dosages Use
Page 99 and 100: Table 3: FOUR TREATMENT REGIMENS FO
Page 101 and 102: † 4 Table 4: DOSES*OF FIRST-LINE
Page 103 and 104: Figure 1:TREATMENT ALGORITHM FOR DR
Page 105 and 106: a. In remote locations in Alaska, m
Page 107 and 108: Antituberculosis Drug Rifampin (RIF
Page 109 and 110: Antituberculosis Drug Rifapentine (
Page 111 and 112: Reporting Reactions The table below
Page 113: Response to Treatment For consultat
Page 117 and 118: Post-Treatment Evaluation Routine f
Page 119 and 120: Treatment in Special Situations Tre
Page 121 and 122: Resources For consultation regardin
Page 123 and 124: with an increase in overall complet
Page 125 and 126: Liver Disease Management of TB in p
Page 127 and 128: After the initial phase (first two
Page 129 and 130: Extrapulmonary Tuberculosis The bas
Page 131 and 132: Resources and References Resources
Page 133 and 134: Diagnosis of Latent Tuberculosis In
Page 135 and 136: Forms All required and recommended
Page 137 and 138: High-Risk Groups Certain factors id
Page 139 and 140: Diagnosis of Latent Tuberculosis In
Page 141 and 142: continually exposed to populations
Page 143 and 144: Administration of the Tuberculin Sk
Page 145 and 146: See “Two-Step Tuberculin Skin Tes
Page 147 and 148: See “Live-Virus Vaccines” under
Page 149 and 150: For more information on IGRAs and t
Page 151 and 152: Table 5: TARGETED TESTING FOR LATEN
Page 153 and 154: Resources and References Resources
Page 155 and 156: Treatment of Latent Tuberculosis In
Page 157 and 158: Policy Detailed information on the
Page 159 and 160: Window period prophylaxis is treatm
Page 161 and 162: Regimens Identify an appropriate re
Page 163 and 164: Dosages Once the appropriate regime
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Side Effects and Adverse Reactions
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If a patient reports to a healthcar
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Antituberculosis Drug Rifampin (RIF
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DOT is strongly encouraged for thos
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Table 7 describes the duration of t
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Alcoholism Alcohol-Related Treatmen
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Medication Administration and Pharm
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National Tuberculosis Controllers A
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24 CDC . “Recommendations for Use
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Diagnosis and Treatment of Latent T
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All children suspected or diagnosed
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Latent Tuberculosis Infection (LTBI
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History of BCG vaccination is not a
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Because of their higher specificity
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Table 3: COUNTRIES AND AREAS WITH A
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Treatment of Latent TB Infection (L
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For consultation regarding the trea
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Monitoring DOT is mandatory for INH
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For young infants, some experts rec
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TABLE 8: SIGNS AND SYMPTOMS OF PULM
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Treatment of Tuberculosis Basic pri
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Regime n 1 2 3 ❺ Table 10: FOUR T
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† 35 Table 11: DOSES*OF FIRST-LIN
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Monitoring Response to Treatment Ch
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Child Care and Schools: Children wi
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Other TB medications are not commer
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10 Centers for Disease Control and
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Case Management CONTENTS Introducti
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patient-centered approach to case m
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Alaska TB Program: Timeline for the
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For assistance with language issues
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Ascertain the extent of TB illness
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medical/health problem. The date of
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necessary to teach people how to ta
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Treatment Plan Components Recommend
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Implementation Activities To begin
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o Indicate the number of doses prov
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Review the status of the contact in
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For more information, see the “Di
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importance of continued treatment a
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5. Review information with the prov
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Completion of Therapy The case mana
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Case Closures Other than Completion
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Conduct a case management meeting o
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Biweekly (BIW) doses of TB medicati
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Use DOT with other measures such as
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It is important not to send a mixed
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Medical Orders Progressive Interven
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CDC. Module 9: “Patient Adherence
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36 New Jersey Medical School Nation
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75 CDC. Module 9: patient adherence
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Introduction Purpose A contact inve
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For roles and responsibilities, ref
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Decision to Initiate a Contact Inve
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chest radiographic findings that ar
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In general, a contact investigation
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Time Frames for Contact Investigati
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Circumstances unique to Alaska may
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Circumstances unique to Alaska may
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Activity Purpose Maximum Time Inter
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Infectious Period Determine the inf
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In general, for the purposes of con
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General Guidelines for Interviewing
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Healthcare workers should remember
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Index Patient with Positive Acid-Fa
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Index Patient with Negative Acid-Fa
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Contact Evaluation, Treatment, and
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Definition of abbreviations: HIV =
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Note: An IGRA may be used in place
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When to Expand a Contact Investigat
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Figure 7: EVALUATION, TREATMENT, AN
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CDC’s “Framework of Program Eva
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Definitions of abbreviations: AIDS
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elease assay; LTBI = latent tubercu
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officials to distinguish between di
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References 1 ATS, CDC, IDSA. Contro
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44 CDC, NTCA. Guidelines for the in
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Available Laboratory Tests Table 2:
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Table 3: PCR Testing Algorithm and
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Table 4: SPECIMEN COLLECTION METHOD
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5. If possible, send the specimen o
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Specimen Shipment There are three m
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Resources and References Resources
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Patient Education CONTENTS Introduc
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treatment, common side-effects of m
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Education Topics During the initial
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10. Explain the signs and symptoms
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Patient Education Materials Get th
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References 1 CDC. Module 4: treatme
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National Guidelines The following g
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Transfer Notifications CONTENTS Int
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For roles and responsibilities, ref
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Follow-Up Type When to Initiate Not
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Action Transfers Within Alaska Tran
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Provide the patient with a. A copy
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References 1 CDC. International not
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Infection Control CONTENTS Introduc
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of TB infection control principles
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Administrative Activities 13 Key ac
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Personal Respiratory Protection Alt
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For regulations in your area, refer
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Employee Health All employees, phys
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Figure 1: TWO STEP TESTING AND FOLL
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Isolation To reduce disease transmi
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Table 4: CRITERIA FOR PATIENTS TO B
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When to Initiate Airborne Infection
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Confirmed Tuberculosis Disease A pa
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Multidrug-Resistant Tuberculosis Di
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Environmental Controls in the Patie
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Return to Work, School, or Other So
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Tuberculosis Infection Control in P
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Transportation Vehicles To prevent
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7 CDC. Guidelines for preventing th
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Forms: Alaska State Public Health L
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ALASKA STATE PUBLIC HEALTH LABORATO
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Anchorage Alaska State Public Healt
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INDEX CASE INFORMATION Name: DOB: /
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CONTACT Name: Tuberculosis Contact
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Directly Observed Therapy (DOT) Cal
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B. Documents patient care activitie
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Alaska TB Program Section of Epidem
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Treatment Summary for Active TB Nam
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Interjurisdictional Tuberculosis No
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Latent Tuberculosis Infection (LTBI
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Alaska Tuberculosis Program 9210 Va
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Instructions for Collecting Sputum
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TB Case Management Information Requ
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Table 1: First-line anti-tuberculos
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Return the fax to the Drug Room (90
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Stock Orders: A small supply of
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TB/LTBI Medication Return Form Reas
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TB/LTBI Stock Medication Request FA
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TB Medication Dose Monitoring Regim
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TB Medication Dose Monitoring Regim
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ALASKA DEPARTMENT OF HEALTH AND SOC
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Tuberculosis Discharge Planning Che
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PART 2: 8. Have you ever been told
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Tuberculosis Treatment Contract Dep
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Statutes and Regulations Contents I
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Regulations Infection Control 7 AAC
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place of work is remote from patien
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(2) the child or a person acting on
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Glossary acid-fast bacilli (AFB): M
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eaction size on a later test, which
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disseminated TB: See miliary TB. dr
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immunocompromised and immunosuppres
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include medical history and TB symp
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thousands to millions of copies of
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secondary (TB) case: A new case of
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eproducing TB organisms from respir
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Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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