Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
The recommended dose is 6.25 mg (1/4 of a 25 mg tablet) for infants), 12.5 mg (1/2 of a 25 mg tablet) for toddlers, and 25 mg (1 tablet) for school age children. For infants and small children, the tablet portions can be crushed and placed in an agreeable liquid or soft food for administration 43 . Response to Treatment: In most children, response to treatment is assessed primarily clinically and by x-ray. In children, weight loss or, more commonly, failure to gain weight adequately is of particular concern and is often one of the first (or only) signs of treatment failure. For children able to produce sputum, follow-up sputum cultures are helpful, especially if there is a concern of treatment failure. Similarly, follow-up gastric aspirates may be of benefit in infants and young children, especially for those with severe or drug resistant TB disease. Completion of Treatment The date of completion of treatment is determined by the total doses administered by DOT. If therapy has been interrupted, the date of completion should be extended. Decisions about the completion of treatment should be made in consultation with the Alaska TB Program. See the Treatment of Tuberculosis section of this manual for more information about determining completion of treatment 6.23. Special Issues Isolation of Children with TB Disease Most children with tuberculosis disease are not infectious and do not require airborne isolation and negative pressure rooms in the hospital, although hospital infection control policies may require otherwise. Airborne precautions with isolation in a negative pressure room are indicated for (1) children with cavitary pulmonary tuberculosis; (2) children with positive sputum AFB smears; (3) children with laryngeal involvement; (4) children with extensive pulmonary infection; and (5) children with congenital tuberculosis undergoing procedures that involve the oropharyngeal airway (e.g., endotracheal intubation); until effective therapy has been initiated, sputum smears demonstrate a diminishing number of organisms, and cough is abating. 44 The major concern in hospital infection control relates to adult household members and contacts who may be the source case to a child with TB. Household members and other contacts should be managed with tuberculosis precautions when visiting until they are demonstrated not to have infectious tuberculosis. Nonadherent household contacts should be excluded from hospital visitation until their evaluation is complete and tuberculosis disease is excluded or treatment has rendered source cases noninfectious. 45 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 9.30 R e v i s e d N o v e m b e r 2 0 1 2
Child Care and Schools: Children with tuberculosis disease can attend school or child care if they are receiving therapy. They can return to regular activities as soon as effective therapy has been instituted, adherence to therapy has been documented, and clinical symptoms have diminished substantially. 46 Source Case Investigations A diagnosis of LTBI or tuberculosis disease in a young child is a sentinel event representing recent transmission of M tuberculosis in the community. Health care providers should assist state and local health department personnel in the search for a source case and others infected by the source case. Members of the household, such as relatives, babysitters, au pairs, boarders, domestic workers, and frequent visitors or other adults, such as child care providers and teachers with whom the child has frequent contact, potentially are source cases. See the Contact Investigation section of this manual for more information about source case investigations 11.11. 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 9.31 R e v i s e d N o v e m b e r 2 0 1 2
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Child Care and Schools:<br />
Children with tuberculosis disease can attend school or child care if they are receiving therapy.<br />
They can return to regular activities as soon as effective therapy has been instituted, adherence<br />
to therapy has been documented, and clinical symptoms have diminished substantially. 46<br />
Source Case Investigations<br />
A diagnosis <strong>of</strong> LTBI or tuberculosis disease in a young child is a sentinel event representing<br />
recent transmission <strong>of</strong> M tuberculosis in the community. Health care providers should assist<br />
state and local health department personnel in the search for a source case and others infected<br />
by the source case. Members <strong>of</strong> the household, such as relatives, babysitters, au pairs,<br />
boarders, domestic workers, and frequent visitors or other adults, such as child care providers<br />
and teachers with whom the child has frequent contact, potentially are source cases.<br />
See the Contact Investigation section <strong>of</strong> this manual for more information<br />
about source case investigations 11.11.<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 Diagnosis and Treatment <strong>of</strong> LTBI and TB Disease in Children 9.31<br />
R e v i s e d N o v e m b e r 2 0 1 2
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