Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Completion of Therapy Determine whether and when therapy is completed based on the total number of doses administered, not on the duration of therapy. When patients have had lapses in therapy but are still able to complete the recommended number of doses in the allotted time period, encourage them to complete therapy. Assess patients who will not complete appropriate therapy within the time frame specified to determine whether or not to restart treatment. If the decision is made to retreat the patient, then restart the entire regimen and follow the recommended treatment plan of therapy. Specific factors to consider when determining whether to restart treatment include the following: Total number of doses of latent tuberculosis infection (LTBI) treatment administered Time elapsed since the last dose of treatment for LTBI Patient adherence issues (previous attempts at completion, willingness to continue, etc.) Give nonadherent patients at very high risk of developing TB disease every opportunity to complete treatment for LTBI. Consider these patients for intermittent therapy with directly observed therapy (DOT), and evaluate the use of incentives and enablers. 34 Treatment of LTBI in contacts is considered a priority in TB control activities. Make every effort to assure completion of treatment in contacts. All contacts who are being treated for infection should be seen face-to-face by a healthcare provider at least every month or more often. When available, incentives and enablers are recommended as aids to adherence, and the healthcare provider should educate the patient about TB, its treatment, and the signs of adverse drug effects at each patient encounter. 35 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 Latent Tuberculosis Infection Revised November 2012 8.18
Table 7 describes the duration of therapy and the number of doses that patients are required to take to complete therapy and the time frame within which the total number of doses must be administered for completion of therapy. Please report completion of treatment to the Alaska TB Program. Table 7: RECOMMENDED REGIMENS FOR COMPLETION OF THERAPY 36 Regimen Age Duration of Therapy INH daily Adult and child 9 months Number of Doses 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 Latent Tuberculosis Infection Revised November 2012 270 Must be Administered Within 12 months INH daily Adult 6 months 180 9 months INH twice weekly INH twice weekly Adult and child RIF daily Adult INH/RPT once weekly 9 months 76 12 months Adult 6 months 52 9 months Child ≥ 12 years of age 4 months 6 months 120 180 6 months 9 months 12 weeks 12 16 weeks Definitions of abbreviations: INH = isoniazid; RIF = rifampin, RPT= Rifapentine. Sources: CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR-6):26–27; CDC. Regimens. In: Chapter 5: treatment of LTB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/webcourses/CoreCurr/index.htm. and New England Journal of Medicine. “Three Months of Rifapentine and Isoniazid for Latent TB Infection”. 12/8/2011; (vol365)23.p 2155-2165. Make every effort to encourage patients to adhere to the LTBI treatment regimen. However, if a patient has failed three attempts to complete treatment, no further effort may be merited. The healthcare provider should contact patients who interrupt therapy and are at high risk of developing TB disease (for example, contacts of patients with infectious TB, or human immunodeficiency virus (HIV)-infected patients for reevaluation. 37 For consultation regarding completion of therapy and considerations to examine when restarting treatment in noncompliant patients, contact the Alaska TB Control Program at 907-269-8000. Use the Latent Tuberculosis Infection (LTBI) Treatment Completion Form to report LTBI treatment Completion. It is available in the Forms section 18.1. 8.19
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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
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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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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
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: DOT is strongly encouraged for thos
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
Page 185 and 186: All children suspected or diagnosed
Page 187 and 188: Latent Tuberculosis Infection (LTBI
Page 189 and 190: History of BCG vaccination is not a
Page 191 and 192: Because of their higher specificity
Page 193 and 194: Table 3: COUNTRIES AND AREAS WITH A
Page 195 and 196: Treatment of Latent TB Infection (L
Page 197 and 198: For consultation regarding the trea
Page 199 and 200: Monitoring DOT is mandatory for INH
Page 201 and 202: For young infants, some experts rec
Page 203 and 204: TABLE 8: SIGNS AND SYMPTOMS OF PULM
Page 205 and 206: Treatment of Tuberculosis Basic pri
Page 207 and 208: Regime n 1 2 3 ❺ Table 10: FOUR T
Page 209 and 210: † 35 Table 11: DOSES*OF FIRST-LIN
Page 211 and 212: Monitoring Response to Treatment Ch
Page 213 and 214: Child Care and Schools: Children wi
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Page 217 and 218: 10 Centers for Disease Control and
Page 219 and 220: Case Management CONTENTS Introducti
Page 221 and 222: 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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