Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Introduction Purpose Use this section to understand and follow national and Alaska TB Program guidelines to classify patients with latent TB infection (LTBI) diagnose LTBI One of the recommended strategies to achieve the goal of reduction of TB morbidity and mortality is the identification of persons with LTBI at risk for progression to TB disease, and treatment of those persons with an effective drug regimen. 1 Policy Evaluation and follow-up of contacts are covered in more depth in the Contact Investigation section 11.1. For information on treatment, refer to the Treatment of Latent Tuberculosis Infection section 8.1. For detailed information on the diagnosis and treatment of latent tuberculosis infection in children, refer to the Diagnosis and Treatment of Latent Tuberculosis Infection (LTBI) and Tuberculosis Disease in Children (under 16 years of age) section 9.1. In Alaska, TB skin testing should be provided for: Persons with risk factors for LTBI. Persons with a greater risk to progress to active TB once infected with M. tuberculosis (i.e. those infected with HIV) School children, as directed by state regulation. See Statutes and Regulations section 19.6. Persons who are contacts to an active TB case, as described in the Contact Investigation section 11.1. For roles and responsibilities, refer to the “Roles, Responsibilities, and Contact Information” topic in the Introduction 1.18. A L A S K A T U B E R C U L O S I S C O N T R O L P R O G R A M M A N U A L Diagnosis of Latent Tuber culosis Infection R e v i s e d N o v e m b e r 2 0 1 2 7 . 2
Forms All required and recommended forms are available in the Forms section of this manual 18.1. A L A S K A T U B E R C U L O S I S C O N T R O L P R O G R A M M A N U A L Diagnosis of Latent Tuber culosis Infection R e v i s e d N o v e m b e r 2 0 1 2 7 . 3
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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
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Follow-up of B1 and B2 Tuberculosis
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Evaluation of B1, B2, and B Tubercu
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Treatment Prescribe medications as
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12 Centers for Disease Control and
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Tuberculosis Classification System
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Table 2: PERSONS AT HIGH RISK FOR T
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Table 3: WHEN TO SUSPECT PULMONARY
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Diagnosis of Tuberculosis Disease T
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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 and 114: Response to Treatment For consultat
Page 115 and 116: Figure 2: MANAGEMENT OF TREATMENT I
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: Diagnosis of Latent Tuberculosis In
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
Page 165 and 166: Side Effects and Adverse Reactions
Page 167 and 168: If a patient reports to a healthcar
Page 169 and 170: Antituberculosis Drug Rifampin (RIF
Page 171 and 172: DOT is strongly encouraged for thos
Page 173 and 174: Table 7 describes the duration of t
Page 175 and 176: Alcoholism Alcohol-Related Treatmen
Page 177 and 178: Medication Administration and Pharm
Page 179 and 180: National Tuberculosis Controllers A
Page 181 and 182: 24 CDC . “Recommendations for Use
Page 183 and 184: 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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