Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Whom to Treat Determine whom to treat for latent tuberculosis infection (LTBI). Certain groups are at high risk of developing tuberculosis (TB) disease once infected, so make every effort to begin appropriate treatment and to ensure those persons complete the entire course of treatment for LTBI. 6 For a list of high-risk groups see Table 2: Persons at High Risk for Tuberculosis Infection and Progression to Tuberculosis Disease in the Diagnosis of LTBI section 7.6. High-risk contacts (under 5 years of age or immunocompromised) should be started promptly on treatment for LTBI regardless of TST results. For more information on time frames, see the “Time Frames for Contact Investigation” topic in the Contact Investigation section 11.12. Detailed information on the diagnosis and treatment of LTBI in children can be found in the Diagnosis and Treatment of Latent Tuberculosis Infection (LTBI) and Tuberculosis Disease in Children section 9.1. Several treatment regimens are available for the treatment of LTBI, and providers should 7 8 discuss treatment options with their patients. For consultation regarding the treatment of LTBI, call the Alaska TB Program at 907-269-8000. Window Period Prophylaxis for Susceptible and Vulnerable Contacts A contact is someone who has been exposed to M. tuberculosis infection by sharing air space with a person with infectious TB. 9 Susceptible contacts are those who are more likely to become ill with TB disease if they are infected, and vulnerable contacts are those who could suffer severe morbidity if they had TB disease. 10 Persons who are susceptible and/or vulnerable to TB disease are candidates for window period treatment. 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 Tr eatment of Latent Tuberculosis Infection Revised November 2012 8.4
Window period prophylaxis is treatment for presumptive TB infection during the interval between infection and detectable skin test reactivity. The National Tuberculosis Controllers Association (NTCA) and the CDC recommend that the window period be estimated at 8 to 10 weeks. 11 The following contacts with initially negative TST results should receive treatment for LTBI after TB disease has been ruled out by clinical examination and chest radiograph: 1. contacts younger than 5 years of age (with highest priority given to those under 3 years) 2. contacts with human immunodeficiency virus (HIV) infection or who are otherwise immunocompromised If the second skin test result is negative at 8 – 10 weeks post exposure and the contact is immunocompetent (including immunocompetent young children) and no longer exposed to infectious TB, treatment for LTBI may be discontinued, and further follow-up is unnecessary. Persons known to be or suspected of being immunocompromised, such as HIV-infected persons, should be given treatment for LTBI regardless of the TST reaction. 12 Tuberculin Skin Test Results of 5 mm or More Persons in the following high-risk groups are candidates for treatment of LTBI if their skin test result is 5 mm or more: Persons with HIV infection Recent contacts of persons with newly diagnosed infectious TB Persons with fibrotic changes consistent with old TB on their chest radiograph Persons with organ transplants and other immunosuppressed patients (receiving the equivalent of 15 mg or more/day of prednisone for at least one month) 13 Tuberculin Skin Test Results of 10 mm or More In Alaska, all persons with skin test results of 10 mm or more are candidates for treatment of LTBI. 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 Tr eatment of Latent Tuberculosis Infection Revised November 2012 8.5
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Window period prophylaxis is treatment for presumptive TB infection during the<br />
interval between infection and detectable skin test reactivity. The National <strong>Tuberculosis</strong><br />
Controllers Association (NTCA) and the CDC recommend that the window period be<br />
estimated at 8 to 10 weeks. 11<br />
The following contacts with initially negative TST results should receive treatment for<br />
LTBI after TB disease has been ruled out by clinical examination and chest radiograph:<br />
1. contacts younger than 5 years <strong>of</strong> age (with highest priority given to those under 3<br />
years)<br />
2. contacts with human immunodeficiency virus (HIV) infection or who are otherwise<br />
immunocompromised<br />
If the second skin test result is negative at 8 – 10 weeks post exposure and the contact<br />
is immunocompetent (including immunocompetent young children) and no longer<br />
exposed to infectious TB, treatment for LTBI may be discontinued, and further follow-up<br />
is unnecessary.<br />
Persons known to be or suspected <strong>of</strong> being immunocompromised, such as<br />
HIV-infected persons, should be given treatment for LTBI regardless <strong>of</strong> the<br />
TST reaction. 12<br />
Tuberculin Skin Test Results <strong>of</strong> 5 mm or More<br />
Persons in the following high-risk groups are candidates for treatment <strong>of</strong> LTBI if their<br />
skin test result is 5 mm or more:<br />
Persons with HIV infection<br />
Recent contacts <strong>of</strong> persons with newly diagnosed infectious TB<br />
Persons with fibrotic changes consistent with old TB on their chest radiograph<br />
Persons with organ transplants and other immunosuppressed patients (receiving<br />
the equivalent <strong>of</strong> 15 mg or more/day <strong>of</strong> prednisone for at least one month) 13<br />
Tuberculin Skin Test Results <strong>of</strong> 10 mm or More<br />
In <strong>Alaska</strong>, all persons with skin test results <strong>of</strong> 10 mm or more are<br />
candidates for treatment <strong>of</strong> LTBI.<br />
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 Tr eatment <strong>of</strong> Latent <strong>Tuberculosis</strong> Infection<br />
Revised November 2012<br />
8.5
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