Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Forms Required and recommended forms are available in the Forms section 18.1. Consent for Release of Medical Information Contact Investigation Form DOT Aide Job Description DOT Aide Memorandum of Agreement DOT Calendar DOT Monthly Invoice for Payment End of Treatment Letter and Summary Referral and Authorization for TB Screening and Follow-up Services TB and LTBI Prescription and Medication Request Form TB Case Management Form TB Case Management Information Request TB Medication Dose Monitoring Forms Tuberculosis Discharge Planning Checklist Tuberculosis Treatment Contract A L A S K A T B P R O G R A M M A N U A L Case Management 10. 4 R e v i s e d N o v e m b e r 2 0 1 2
Alaska TB Program: Timeline for the Case Management of Tuberculosis Treatment Weeks Months Activity 0 1 2 3 4 5 6 7 8 3 4 5 6 9 Clinical & lab evaluation History & Physical CBC, platelets, creatinine, AST, bilirubin, alk. phosph. Visual acuity, color vision X X X X X Dose daily (5 days/wk) for 10 doses (2 wks), then twice wkly Twice weekly for 36 doses (18 wks) 2.) INH, RIF, PZA, EMB for 12 doses (6 wks) When appropriate, consider INH + RPT Sputum collection X X X Collect sputa at least monthly until culture conversion occurs Optional Chest x-ray X (X) Optional Clinical assessment during treatment DOT & compliance evaluation Contact investigation Initial Treatment Phase Continuation Treatment Phase Drugs Isoniazid Refer to CDC. Treatment of Rifampin Tuberculosis. MMWR 203;52 Pyrazinamide (No. RR-11) Ethambutol Treatment options Administer all doses using directly observed therapy (DOT) 5 days/wk for 90 doses or twice wkly for 36 1.) INH, RIF, PZA, EMB Dose daily (5 days/wk) for 40 doses (8 wks) doses (18 wks) When appropriate, consider INH + RPT 3.) INH RIF, PZA, EMB 4.) INH, RIF, EMB Dose three times wkly for 24 doses (8 wks) Dose daily (5 days/wk) for 40 doses (8 wks) X X X X X X X X X X X X X X X X Screen priority contacts (TST or SX & sputa) Discontinue ethambutol if M. tuberculosis is sensitive to all first line anti-tuberculosis agents. INH = isoniazid; RIF = rifampin; PZA = pyrazinamide; EMB = ethambutol; RPT= rifapentine 5 days/wk for 155 doses (31 wks) or twice wkly for 62 doses (31 wks) 11/12/2012 End of treatment evaluation Not recommended Consider INH + rifapentine once weekly for 18 doses (18 wks) for HIV-negative patients without cavitation on initial chest x-ray and with negative sputum smears after 2 months of therapy. If sputums cultures taken at 2-months grow M. tuberculosis , extend INH + rifapentine for an additional 3 months. Patients with cavitation on initial CXR and (+) culture at completion of 2 months treatment should receive a 7-month continuation phase. Consult the Alaska TB program to verify count of DOT doses and determine end of treatment date. Three times wkly for 54 doses (18 wks) Repeat TSTs if initially negative Collect 3 sputa monthly until all 3 are culture negative. More frequent sputum evaluation is acceptable if clinically indicated. Repeat susceptibility testing if cultures positive after 3 mos of treatment. Confirm completion of contact investigation If the patient is culture-negative, a repeat CXR is indicated during treatment to demonstrate improvement. A repeat CXR may also be useful if sputum specimens remains culture positive > 3 mo. Perform monthly clinical assessments throughout treatment. Ask about nausea, vomiting, abdominal pain or swelling, jaundice, joint pain, vision changes, tingling extremities, or flu-like symptoms. When EMB is part of the regimen, test visual acuity and color vision. A L A S K A T B P R O G R A M M A N U A L R e v i s e d N o v e m b e r 2 0 1 2 Case Management 10. 5 Count doses delivered by DOT to assure treatment completion Repeat liver enzyme tests if signs of drug toxicity appear during treatment. Perform monthly liver enzyme tests if high risk for hepatic toxicity (e.g. pre-existing liver disease or with abnormal liver function that does not require discontinuation).
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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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Side Effects and Adverse Reactions
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If a patient reports to a healthcar
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Antituberculosis Drug Rifampin (RIF
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 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
Page 215 and 216: Other TB medications are not commer
Page 217 and 218: 10 Centers for Disease Control and
Page 219 and 220: Case Management CONTENTS Introducti
Page 221: patient-centered approach to case m
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
Page 265 and 266: 75 CDC. Module 9: patient adherence
Page 267 and 268: Introduction Purpose A contact inve
Page 269 and 270: For roles and responsibilities, ref
Page 271 and 272: 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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