Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Roles and Responsibilities Contact Information Alaska Infectious Disease Control Program Nurse Manager Supervises TB Control Program Nurse Consultants Alaska TB Program Nurse Consultant(s) Provide statewide consultations to public health nurses (PHNs), physicians, other health care providers, hospitals, schools, long-term care facilities, homeless shelters, correctional systems and other agencies regarding TB program standards of care for case management, contact investigation, treatment of LTBI, and directly observed therapy. Provide oversight of PHN TB case management and participate in case management teleconferences with local PHNs. Conduct tuberculosis outbreak investigations and assist with large contact investigations. Conduct training for health care providers statewide. Provide phone consultations to the general public. Karen A Martinek, RN, MPH Section of Epidemiology 3601 C Street, Suite 540 Anchorage, AK 99503 Tel: 907-269-8000 Fax: 907-563-7868 E-mail: karenann.martinek@alaska.gov Ginger Provo, RNC, BSN Donna Fearey, RN, ANP, MS Barb Smith, BSN, RN Kim Spink, RN, BSN, CIC Section of Epidemiology 3601 C Street, Suite 540 Anchorage, AK 99503 Tel: 907-269-8000 Fax: 907-562-7802 E-mails: ginger.provo@alaska.gov donna.fearey@alaska.gov barbara.smith2@alaska.gov kimberly.spink@alaska.gov 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 Introduction 1.19 Revised November 2012
Local Public Health Agencies Table 3: LOCAL PUBLIC HEALTH AGENCIES’ ROLES, RESPONSIBILITIES, AND DIRECTORY Roles and Responsibilities Contact Information The Municipality of Anchorage Health and Human Services, Community Health Services, Disease Prevention and Control Provides tuberculosis screening, case management for persons with suspect or active TB, contact investigation, and immigrant and refugee screening. Private Medical Providers TB Control Program 825 L Street, 1 st Floor Anchorage, AK 99503 Tel: 907-343-4799 Fax: 907-343-7992 Information about TB services provided by the Municipality of Anchorage is available at: http://www.muni.org/Departments/health/community/Pages/Disease.aspx Table 4: PRIVATE MEDICAL PROVIDERS ROLES AND RESPONSIBILITIES Role and Responsibilities 1. Report all suspected or confirmed cases of tuberculosis to the Section of Epidemiology within 5 working days of evaluation. 2. Conduct initial patient evaluation and periodic follow-up with the patient. 3. Prescribe tuberculosis medications and send prescription to local public health nurse. Medications will be supplied free-of-charge from the state pharmacy. 4. Provide adequate and understandable instruction in disease control measures to each patient who has been diagnosed with active tuberculosis. 5. Maintain responsibility for deciding date of discharge for hospitalized tuberculosis patients and consult with the Alaska TB Program regarding plans for public health follow-up of the patient in the community. cal PHN 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 Introduction 1.21 Revised November 2012
Page 1 and 2: Alaska Tuberculosis Program Manual
Page 3 and 4: Purpose............................
Page 5 and 6: Monthly assessment of adherence ...
Page 7 and 8: When to Expand a Contact Investigat
Page 9 and 10: Introduction CONTENTS About the Ala
Page 11 and 12: How to Use This Manual Portable Doc
Page 13 and 14: Printing To access the print dialog
Page 15 and 16: Abbreviations Refer to the list bel
Page 17 and 18: QFT QuantiFERON ® -TB test QFT-G Q
Page 19 and 20: Alaska Statutes and Regulations on
Page 21 and 22: National and State Program Objectiv
Page 23 and 24: Indicator 3 Thorough contact invest
Page 25 and 26: National Standards and Recommendati
Page 27: Roles and Responsibilities Contact
Page 31 and 32: Resources and References Resources
Page 33 and 34: Introduction Purpose Use this secti
Page 35 and 36: Contact investigation: Collecting,
Page 37 and 38: Reporting Tuberculosis Detecting an
Page 39 and 40: Prompt reporting (prior to culture
Page 41 and 42: Use the Infectious Disease Report F
Page 43 and 44: Data Collection Forms The following
Page 45 and 46: Genotyping Genotyping is a useful t
Page 47 and 48: References 1 ATS, CDC, IDSA. Contro
Page 51 and 52: child or a person acting on behalf
Page 53 and 54: When to Conduct Targeted Testing Al
Page 55 and 56: Alaska Program Standards for Health
Page 57 and 58: B Notifications CONTENTS Introducti
Page 59 and 60: Table 1: NUMBERS OF FOREIGN-BORN PE
Page 61 and 62: chest radiograph and if sputum AFB
Page 63 and 64: Follow-up of B1 and B2 Tuberculosis
Page 65 and 66: Evaluation of B1, B2, and B Tubercu
Page 67 and 68: Treatment Prescribe medications as
Page 69 and 70: 12 Centers for Disease Control and
Page 73 and 74: Tuberculosis Classification System
Page 75 and 76: Table 2: PERSONS AT HIGH RISK FOR T
Page 77 and 78: 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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Resources and References Resources
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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
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Table 3: COUNTRIES AND AREAS WITH A
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Treatment of Latent TB Infection (L
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For consultation regarding the trea
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Monitoring DOT is mandatory for INH
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For young infants, some experts rec
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TABLE 8: SIGNS AND SYMPTOMS OF PULM
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Treatment of Tuberculosis Basic pri
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Regime n 1 2 3 ❺ Table 10: FOUR T
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† 35 Table 11: DOSES*OF FIRST-LIN
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Monitoring Response to Treatment Ch
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Child Care and Schools: Children wi
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Other TB medications are not commer
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10 Centers for Disease Control and
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Case Management CONTENTS Introducti
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patient-centered approach to case m
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Alaska TB Program: Timeline for the
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For assistance with language issues
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Ascertain the extent of TB illness
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medical/health problem. The date of
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necessary to teach people how to ta
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Treatment Plan Components Recommend
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Implementation Activities To begin
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o Indicate the number of doses prov
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Review the status of the contact in
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For more information, see the “Di
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importance of continued treatment a
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5. Review information with the prov
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Completion of Therapy The case mana
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Case Closures Other than Completion
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Conduct a case management meeting o
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Biweekly (BIW) doses of TB medicati
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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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Introduction Purpose Use this secti
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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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Introduction Purpose Use this secti
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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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