Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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een documented from different days. 57 Culture-Positive Pulmonary Tuberculosis For patients with culture-positive pulmonary TB, collect three sputa specimens every month for smears and cultures until persistently negative cultures are documented. 58 Continued Positive Sputum Smears or Positive Cultures If sputum smears or cultures are positive after two months of treatment, call the Alaska TB Program at 907-269-8000 to review the case. A patient with continued AFB sputum smear positive results or positive cultures should be evaluated for treatment failure if sputum specimen(s) remain bacteriologically positive (i.e., culture positive and/or AFB sputum smear positive) after three months of treatment or become bacteriologically positive after initially converting to negative. In consultation with the Alaska TB Program, the case manager should initiate the evaluation of the patient and do the following: 1. Review and confirm the patient’s medication compliance with the DOT aide. 2. Reconfirm the appropriateness of the medication regimen, based on drug susceptibility results and other considerations. 3. If additional antituberculosis drugs are added to the treatment regimen, ensure that at least two new drugs that the patient has not been treated with previously are used. 4. Consider serum drug levels. 5. Repeat cultures and repeat drug susceptibility testing. 59 Culture Negative or No Specimens If a patient is culture negative or no specimens were collected: 1. Review the medications that the patient was on at the time TB medications were started, particularly other antibiotics. 2. If applicable, obtain follow-up chest radiograph reports to determine improvement. 3. Review the patient’s symptoms for improvement, if applicable. 4. Review the patient’s tuberculin skin testing information (retesting may be appropriate if initially negative or if test not initially done), and discuss this with the patient’s provider. A L A S K A T B P R O G R A M M A N U A L Case Management 10. 26 R e v i s e d N o v e m b e r 2 0 1 2
5. Review information with the provider regarding his or her reasons for continuing TB medications. 6. Discuss the above findings with the Alaska TB Program at 907-269-8000 to determine if the patient is to be reported as a case. Verification of Isolate Drug Susceptibility Results The case manager should obtain and promptly document all positive cultures and respective drug susceptibility results. 1. If a patient’s TB organism is susceptible to all first-line anti-tuberculosis drugs: Follow the recommended treatment regimen. 2. If a patient’s TB organism is drug resistant: a. Consult with the patient’s health care provider and the Alaska TB Program at 907-269-8000. 3. If isoniazid-resistant or multidrug-resistant TB (MDR-TB) or extremely drug resistant TB (XDR-TB): a. Place contacts on appropriate latent TB infection (LTBI) treatment regimens. Treatment of LTBI caused by drug-resistant organisms should be provided by, or in close consultation with, an expert in the management of these difficult situations. For patients with MDR-TB, refer to the instructions on multidrugresistant tuberculosis provided below. Contact the Alaska TB Program at 907-269-8000 for consultation regarding the treatment of all drug-resistant tuberculosis and management of contacts. Multidrug-Resistant Tuberculosis Notify the Alaska TB Controller of all cases of suspected or confirmed MDR- TB or XDR-TB. Consultation regarding the treatment of all drug-resistant tuberculosis and management of contacts is available by calling 907-269- 8000. Clinical Response to Treatment The case manager should monitor/evaluate a patient’s clinical response to treatment. Some indicators are: 1. Lessening or resolution of TB symptoms 2. Weight gain A L A S K A T B P R O G R A M M A N U A L Case Management 10. 27 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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Side Effects and Adverse Reactions
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If a patient reports to a healthcar
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Antituberculosis Drug Rifampin (RIF
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DOT is strongly encouraged for thos
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Table 7 describes the duration of t
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Alcoholism Alcohol-Related Treatmen
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Medication Administration and Pharm
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National Tuberculosis Controllers A
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24 CDC . “Recommendations for Use
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Diagnosis and Treatment of Latent T
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All children suspected or diagnosed
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Latent Tuberculosis Infection (LTBI
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History of BCG vaccination is not a
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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
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: importance of continued treatment a
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
Page 273 and 274: chest radiographic findings that ar
Page 275 and 276: In general, a contact investigation
Page 277 and 278: Time Frames for Contact Investigati
Page 279 and 280: Circumstances unique to Alaska may
Page 281 and 282: Circumstances unique to Alaska may
Page 283 and 284: Activity Purpose Maximum Time Inter
Page 285 and 286: Infectious Period Determine the inf
Page 287 and 288: In general, for the purposes of con
Page 289 and 290: General Guidelines for Interviewing
Page 291 and 292: Healthcare workers should remember
Page 293 and 294: 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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