Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Otherwise, ethambutol is always included in the initial treatment regimen until drug sensitivities are known, to minimize the emergence of drug-resistant strains. If the child is doing well after two weeks of daily treatment, consideration may be given to changing to twice weekly treatment, also by DOT. The Curry International TB Center has a brochure of helpful tips on administration of TB medications to infants and children. These are listed in Appendix A and are available online at: http://currytbcenter.ucsf.edu/pediatric_tb/resources.cfm Antituberculosis drug doses should be adjusted in accordance with the weight of the child. Monthly monitoring of body weight is therefore especially important in pediatric cases with adjustment of doses as children gain weight. Duration of Treatment: Drug-sensitive pulmonary disease and hilar adenopathy disease: After treatment for two months with three or four drugs (ethambutol may be discontinued when it becomes known that the child or source case has a fully sensitive TB isolate), treatment is continued with isoniazid and rifampin for a minimum of four additional months. The minimum duration of treatment for fully-sensitive pulmonary TB disease is six months. If the chest radiograph shows a cavitary lesion or lesions and sputum or gastric aspirate specimens remains culture positive after two months of therapy, the duration of therapy should be extended to nine months. Drug-sensitive extra-pulmonary TB: Extrapulmonary TB in children is treated with the same regimens as pulmonary disease, with the exception of CNS TB, disseminated/miliary TB, and bone and joint TB, for which the recommended minimum duration of treatment is nine to twelve months. Drug-Resistant Tuberculosis or HIV Co-infection: For the treatment of children proven to have or suspected of having drug-resistant TB or HIV coinfection, consultation with a pediatric TB specialist experienced in the management of drug-resistant TB should be obtained. An excellent resource for pediatric TB expertise is the Francis J. Curry National TB Center Warmline; telephone: 415-502-4700 or 877-390-NOTB(6682) The Curry International Tuberculosis Center and California Department of Health Services have an excellent reference on drug resistant TB: Drug- Resistant Tuberculosis: A Survival Guide for Clinicians, 2 nd edition. Available online at http://currytbcenter.ucsf.edu/products/product_details.cfm?productID=WPT- 11CD 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 Diagnosis and Treatment of LTBI and TB Disease in Children 9.24 R e v i s e d N o v e m b e r 2 0 1 2
Regime n 1 2 3 ❺ Table 10: FOUR TREATMENT REGIMENS FOR DRUG-SUSCEPTIBLE TUBERCULOSIS Initiation Phase Continuation Phase Total Doses Rating ❶ Drugs Interval & Duration I, R, P, E I, R, P, E I, R, P, E Daily for 8 wks ➌ Daily x 2 wks ➌ , then twice wkly x 6 wks Three times wkly x 8 wks 4 I, R, E Daily for 8 wks ➌ Regime n Drugs Interval & Duration❷ 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 Diagnosis and Treatment of LTBI and TB Disease in Children 9.25 R e v i s e d N o v e m b e r 2 0 1 2 1a 1b 1c ➍ 2a 2b ➍ I, R I, R I, RPT I, R I, RPT Daily for 18 wks Twice wkly for 18 wks Once wkly for 18 wks. Twice wkly for 18 wks Once wkly for 18 wks 3a I, R Three times wkly for 18 wks 4a 4b I, R I, R Daily for 31 wks Twice wkly for 31 wks Definition of abbreviations: I=isoniazid, R=rifampin, RPT=rifapentine, P=pyrazinamide, E=ethambutol ❶ Definitions of ratings: Strength of recommendation A. Preferred; should generally be offered B. Alternative; acceptable to offer C. Offer when preferred or alternative regimens cannot be given D. Should generally not be offered E. Should never be offered Minimum duration❷ 182 –130 (26 wks) 92-76 (26 wks) 74-58 (26 wks) 62-58 (26 wks) 44-40 (26 wks) 78 (26 wks) 273-195 (39 wks) 118-102 (39 wks) A (I) A (I) B (I) A (II) B (I) HIV- HIV+ A (II) A (II) E (I) B (II) E (I) B (I) B (II) C (I) C (I) Quality of evidence supporting recommendation I. At least one properly randomized trial with clinical end points II. Clinical trials that either were not randomized or were conducted in other populations III. Expert opinion ❷ Patients with cavitation on initial CXR and positive cultures at completion of 2 mo. of therapy should receive a 7-month (31 weeks) continuation phase for a total of 9 months (39 wks) of treatment. ➌ When DOT is used, daily dosing may be given 5 days a week (rating A III). DOT is the standard of care for all persons with pulmonary tuberculosis in Alaska. ➍ Options 1c and 2b should only be used in HIV-negative patients who have negative sputum smears after 2 mo. of therapy and who do not have cavitation on initial CXR; however, if these patients have positive cultures after 2 months of therapy, the continuation phase should be extended to 31 weeks. ❺ Regimen 3 is not approved for children. C (II) C (II)
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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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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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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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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
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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
Page 185 and 186: All children suspected or diagnosed
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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: Treatment of Tuberculosis Basic pri
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
Page 223 and 224: Alaska TB Program: Timeline for the
Page 225 and 226: For assistance with language issues
Page 227 and 228: Ascertain the extent of TB illness
Page 229 and 230: medical/health problem. The date of
Page 231 and 232: necessary to teach people how to ta
Page 233 and 234: Treatment Plan Components Recommend
Page 235 and 236: Implementation Activities To begin
Page 237 and 238: o Indicate the number of doses prov
Page 239 and 240: Review the status of the contact in
Page 241 and 242: For more information, see the “Di
Page 243 and 244: importance of continued treatment a
Page 245 and 246: 5. Review information with the prov
Page 247 and 248: Completion of Therapy The case mana
Page 249 and 250: Case Closures Other than Completion
Page 251 and 252: Conduct a case management meeting o
Page 253 and 254: Biweekly (BIW) doses of TB medicati
Page 255 and 256: 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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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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