Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Resources and References Resources Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR-6) http://www.cdc.gov/mmwr/PDF/rr/rr4906.pdf Centers for Disease Control and Prevention. Treatment of Tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR 2003;52(No. RR-11) http://www.cdc.gov/mmwR/PDF/rr/rr5211.pdf Curry International Tuberculosis Center and California Department of Public Health, 2008: Drug-Resistant Tuberculosis: A Survival Guide for Clinicians, Second Edition http://currytbcenter.ucsf.edu/products/product_details.cfm?productID=WPT-11CD American Academy of Pediatrics. Tuberculosis. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006 American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. In Pickering LK, 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. Pediatric Tuberculosis Collaborative Group, Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents Pediatrics 2004 114: 1175-1201 References 1 Marais BJ Tuberculosis in Children. Pediatr Pulmonol. 2008; 43:322–329. 2 Marais BJ, Gie RP, Schaaf HS, Hesseling AC, et al. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era.Int J Tuberc Lung Dis. 2004 Apr;8(4):392-402. 3 Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds. 10 th edition. Washington, DC: Public Health Foundation, 2007 4 American Academy of Pediatrics , Tuberculosis. In Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases, 28 th ed. Elk Grove Village, Il.: American Academy of Pediatrics,; 2009, 686-7. 5 Centers for Disease Control and Prevention. Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection — United States, 2010. MMWR 2010;59(No. RR-5). http://www.cdc.gov/mmwr/PDF/rr/rr5905.pdf 6 Centers for Disease Control and Prevention. Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection — United States, 2010. MMWR 2010;59(No. RR-5). http://www.cdc.gov/mmwr/PDF/rr/rr5905.pdf 7 Centers for Disease Control and Prevention. Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection — United States, 2010. MMWR 2010;59(No. RR-5). http://www.cdc.gov/mmwr/PDF/rr/rr5905.pdf 8 Centers for Disease Control and Prevention. Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection — United States, 2010. MMWR 2010;59(No. RR-5). http://www.cdc.gov/mmwr/PDF/rr/rr5905.pdf 9 American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases.Pickering LK, ed. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 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 9.34 R e v i s e d N o v e m b e r 2 0 1 2
10 Centers for Disease Control and Prevention. Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection — United States, 2010. MMWR 2010;59(No. RR-5). http://www.cdc.gov/mmwr/PDF/rr/rr5905.pdf 11 World Health Organization: Baccille Calmette Guérin vaccine, Reported estimates of BCG coverage http://www.who.int/immunization_monitoring/en/globalsummary/timeseries/tscoveragebcg.htm 12 Pediatric Tuberculosis Collaborative Group Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents Pediatrics, 2004; 114(4)October 2004, pp. 1175-1201 13 CDC Division of Tuberculosis Elimination Fact Sheet: BCG http://www.cdc.gov/tb/publications/factsheets/vaccine/BCG.pdf?s_cid=cs_476 14 Lockman S, Tappero J, Kenyon T. et al. Tuberculin reactivity in a pediatric population with high BCG vaccination coverage. , Volume 3, Number 1, January 1999 , pp. 23-30(8) 15 Pediatric Tuberculosis Collaborative Group Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents Pediatrics, 2004; 114(4)October 2004, pp. 1175-1201 16 Pediatric Tuberculosis Collaborative Group Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents Pediatrics, 2004; 114(4)October 2004, pp. 1175-1201 17 Pediatric Tuberculosis Collaborative Group Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents Pediatrics, 2004; 114(4)October 2004, pp. 1175-1201 18 Adapted from Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene. Clinical Policies and Protocols New York City Department of Health and Mental Hygiene. 4 th ed. March 2008; page 175, Table X-2. http://www.nyc.gov/html/doh/downloads/pdf/tb/tb-protocol.pdf 19 CDC . “Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection. MMWR 2011; 60(48); 1650-1653. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6048a3.htm?s_cid=mm6048a3_w 20 CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR-6):31, 36. 21 CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR-6):36. 22 CDC . “Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection. MMWR 2011; 60(48); 1650-1653. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6048a3.htm?s_cid=mm6048a3_w 23 ATS, CDC, IDSA. Treatment of tuberculosis. MMWR 2003;52(No. RR-11):4. 24 CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR-6):28–29. 25 CDC . “Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection. MMWR 2011; 60(48); 1650-1653. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6048a3.htm?s_cid=mm6048a3_w 26 Curry International Tuberculosis Center. Pediatric Tuberculosis: An Online Presentation [Curry International Tuberculosis Center Web site]. San Francisco, CA; 2007: Slides 59–60. Available at: http://currytbcenter.ucsf.edu/pediatric_tb/presentation.cfm Accessed October 28, 2011. 27 American Academy of Pediatrics. [Tuberculosis]. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:[685] 28 Curry International Tuberculosis Center. Pediatric Tuberculosis: An Online Presentation [Curry International Tuberculosis Center Web site]. San Francisco, CA; 2007: Slides 51. Available at: http://currytbcenter.ucsf.edu/pediatric_tb/presentation.cfm . Accessed October 28, 2011. 29 CDC, NTCA. Guidelines for the investigation of contacts of persons with infectious tuberculosis: recommendations from the National Tuberculosis Controllers Association and CDC. MMWR 2005;54(No. RR-15):13. 30 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):38. 31 CDC. Chapter 5: Treatment of LTBI. Core Curriculum on Tuberculosis (2004) [Division of Tuberculosis Elimination Web site]. Updated November 2001. Available at: http://www.cdc.gov/tb/webcourses/CoreCurr/index.htm . Accessed May 7, 2011. 32 Adapted from slides in a presentation on Pediatric Tuberculosis by Dr. Ann Loeffler, Francis Curry National TB Center, http://currytbcenter.ucsf.edu/pediatric_tb/presentation.cfm 33 Adapted from slides in a presentation on Pediatric Tuberculosis by Dr. Ann Loeffler, Francis Curry National TB Center, http://currytbcenter.ucsf.edu/pediatric_tb/presentation.cfm 34 Pediatric Tuberculosis Collaborative Group Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents Pediatrics, 2004; 114(4)October 2004, pp. 1175-1201 35 ATS, CDC, IDSA. Treatment of tuberculosis. MMWR 2003;52(No. RR-11):4. 36 American Academy of Pediatrics. [Tuberculosis]. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:[685] 37 Curry International Tuberculosis Center. Pediatric Tuberculosis: An Online Presentation [Curry International Tuberculosis Center Web site]. San Francisco, CA; 2007: Slides 51. Available at: http://currytbcenter.ucsf.edu/pediatric_tb/presentation.cfm Accessed October 28, 2011. 38 American Academy of Pediatrics. [Tuberculosis]. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:[685] 39 American Academy of Pediatrics. [Tuberculosis]. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:[685] 40 American Academy of Pediatrics. [Tuberculosis]. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:[685] 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 9.35 R e v i s e d N o v e m b e r 2 0 1 2
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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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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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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
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Page 179 and 180: National Tuberculosis Controllers A
Page 181 and 182: 24 CDC . “Recommendations for Use
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Page 191 and 192: Because of their higher specificity
Page 193 and 194: Table 3: COUNTRIES AND AREAS WITH A
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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
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Page 211 and 212: Monitoring Response to Treatment Ch
Page 213 and 214: Child Care and Schools: Children wi
Page 215: Other TB medications are not commer
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
Page 257 and 258: It is important not to send a mixed
Page 259 and 260: Medical Orders Progressive Interven
Page 261 and 262: CDC. Module 9: “Patient Adherence
Page 263 and 264: 36 New Jersey Medical School Nation
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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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