Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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FDA U.S. Food and Drug Administration HAART highly active antiretroviral therapy HCW healthcare worker HEPA high-efficiency particulate air HIPAA Health Insurance Portability and Accountability Act HIV human immunodeficiency virus IDSA Infectious Diseases Society of America IGRA interferon gamma release assay INH isoniazid LTBI latent tuberculosis infection M. tuberculosis Mycobacterium tuberculosis MDR-TB multidrug-resistant tuberculosis MIRU mycobacterial interspersed repetitive units MOTT mycobacterium other than tuberculosis NAA nucleic acid amplification NIOSH National Institute for Occupational Safety and Health NNRTI nonnucleoside reverse transcriptase inhibitors NTCA National Tuberculosis Controllers Association NTM nontuberculous mycobacteria NTNC National Tuberculosis Nurse Coalition OSHA Occupational Safety and Health Administration PAPR powered air-purifying respirator PCR polymerase chain reaction PI protease inhibitor PPD purified protein derivative PZA pyrazinamide QA quality assurance 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 Introduction 1.8 Revised November 2012
QFT QuantiFERON ® -TB test QFT-G QuantiFERON ® -TB Gold test RFB rifabutin RFLP restriction fragment length polymorphism RIF rifampin RNA ribonucleic acid RPT rifapentine RVCT Report of Verified Case of Tuberculosis RZ rifampin and pyrazinamide TB tuberculosis TIMS Tuberculosis Information Management System TNF-α tumor necrosis factor-alpha TST tuberculin skin test TU tuberculin units USCIS U.S. Citizenship and Immigration Services UVGI ultraviolet germicidal irradiation XDR-TB extremely drug-resistant tuberculosis 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 Introduction 1.9 Revised November 2012
Page 1 and 2: Alaska Tuberculosis Program Manual
Page 3 and 4: Purpose............................
Page 5 and 6: Monthly assessment of adherence ...
Page 7 and 8: When to Expand a Contact Investigat
Page 9 and 10: Introduction CONTENTS About the Ala
Page 11 and 12: How to Use This Manual Portable Doc
Page 13 and 14: Printing To access the print dialog
Page 15: Abbreviations Refer to the list bel
Page 19 and 20: Alaska Statutes and Regulations on
Page 21 and 22: National and State Program Objectiv
Page 23 and 24: Indicator 3 Thorough contact invest
Page 25 and 26: National Standards and Recommendati
Page 27 and 28: Roles and Responsibilities Contact
Page 29 and 30: Local Public Health Agencies Table
Page 31 and 32: Resources and References Resources
Page 33 and 34: Introduction Purpose Use this secti
Page 35 and 36: Contact investigation: Collecting,
Page 37 and 38: Reporting Tuberculosis Detecting an
Page 39 and 40: Prompt reporting (prior to culture
Page 41 and 42: Use the Infectious Disease Report F
Page 43 and 44: Data Collection Forms The following
Page 45 and 46: Genotyping Genotyping is a useful t
Page 47 and 48: References 1 ATS, CDC, IDSA. Contro
Page 49 and 50: Introduction Purpose Use this secti
Page 51 and 52: child or a person acting on behalf
Page 53 and 54: When to Conduct Targeted Testing Al
Page 55 and 56: Alaska Program Standards for Health
Page 57 and 58: B Notifications CONTENTS Introducti
Page 59 and 60: Table 1: NUMBERS OF FOREIGN-BORN PE
Page 61 and 62: 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
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12 Centers for Disease Control and
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Introduction Purpose Use this secti
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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
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Physical Examination A physical exa
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For more information on chest radio
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Laboratories should report positive
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Guidelines for preventing the trans
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50 CDC. National plan for reliable
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Introduction Purpose The overall go
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Basic Treatment Principles Follow t
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Treatment Regimens and Dosages Use
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Table 3: FOUR TREATMENT REGIMENS FO
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† 4 Table 4: DOSES*OF FIRST-LINE
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Figure 1:TREATMENT ALGORITHM FOR DR
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a. In remote locations in Alaska, m
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Antituberculosis Drug Rifampin (RIF
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Antituberculosis Drug Rifapentine (
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Reporting Reactions The table below
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Response to Treatment For consultat
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Figure 2: MANAGEMENT OF TREATMENT I
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Post-Treatment Evaluation Routine f
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Treatment in Special Situations Tre
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Resources For consultation regardin
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with an increase in overall complet
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Liver Disease Management of TB in p
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After the initial phase (first two
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Extrapulmonary Tuberculosis The bas
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Resources and References Resources
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Diagnosis of Latent Tuberculosis In
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Forms All required and recommended
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High-Risk Groups Certain factors id
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Diagnosis of Latent Tuberculosis In
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continually exposed to populations
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Administration of the Tuberculin Sk
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See “Two-Step Tuberculin Skin Tes
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See “Live-Virus Vaccines” under
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For more information on IGRAs and t
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Table 5: TARGETED TESTING FOR LATEN
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Treatment of Latent Tuberculosis In
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Policy Detailed information on the
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Window period prophylaxis is treatm
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Regimens Identify an appropriate re
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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
Page 267 and 268:
Introduction Purpose A contact inve
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For roles and responsibilities, ref
Page 271 and 272:
Decision to Initiate a Contact Inve
Page 273 and 274:
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 =
Page 301 and 302:
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
Page 307 and 308:
CDC’s “Framework of Program Eva
Page 309 and 310:
Definitions of abbreviations: AIDS
Page 311 and 312:
elease assay; LTBI = latent tubercu
Page 313 and 314:
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
Page 319 and 320:
Page 321 and 322:
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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Page 333 and 334:
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
Page 341 and 342:
Patient Education Materials Get th
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References 1 CDC. Module 4: treatme
Page 345 and 346:
Page 347 and 348:
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
Page 359 and 360:
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
Page 367 and 368:
Personal Respiratory Protection Alt
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For regulations in your area, refer
Page 371 and 372:
Employee Health All employees, phys
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Figure 1: TWO STEP TESTING AND FOLL
Page 375 and 376:
Isolation To reduce disease transmi
Page 377 and 378:
Table 4: CRITERIA FOR PATIENTS TO B
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When to Initiate Airborne Infection
Page 381 and 382:
Confirmed Tuberculosis Disease A pa
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Multidrug-Resistant Tuberculosis Di
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Environmental Controls in the Patie
Page 387 and 388:
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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Page 419 and 420:
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Page 421 and 422:
Latent Tuberculosis Infection (LTBI
Page 423 and 424:
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
Page 470 and 471:
thousands to millions of copies of
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secondary (TB) case: A new case of
Page 474:
eproducing TB organisms from respir
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