Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Field Investigation A field investigation includes visiting the patient's home or shelter, workplace (if any), and the other places where the patient said he or she spent time while infectious. The field investigation is important and should be done even if the patient interview has already been conducted. The purpose of the field investigation is to identify contacts and evaluate the environmental characteristics of the place in which exposure occurred. The field investigation may provide additional information for the risk assessment and identify additional contacts. 39 During field visits, the healthcare worker should do the following: Observe environmental characteristics, such as room size, crowding, and ventilation, to estimate the risk of tuberculosis (TB) transmission: air volume, exhaust rate, and circulation predict the likelihood of transmission in an enclosed space. In large indoor settings, the degree of proximity between contacts and the index patient can influence the likelihood of transmission. The most practical system for grading exposure settings is to categorize them by size (e.g., “1” being the size of a vehicle or car, “2” the size of a bedroom, “3” the size of a house, and “4” a size larger than a house). The volume of air shared between an infectious TB patient and contacts dilutes the infectious particles. Local circulation and overall room ventilation also dilute infectious particles, but both factors have to be considered because they can redirect exposure into spaces that were not visited by the index patient. 40 Identify additional contacts (especially children) and their locating information, such as phone numbers and addresses. Look for evidence of other contacts who may not be present at the time of the visit (for example, pictures of others who may live in or visit the house, shoes of others who may live in the house, or toys left by children). Interview, screen and skin test high- and medium-priority contacts who are present and arrange for reading of the results. For contacts who are (+) TST, symptom screening and collection of 3 sputa are advised. Educate the contacts about the purpose of a contact investigation, the basics of transmission, the risk of transmitting Mycobacterium tuberculosis to others, and the importance of testing, treatment, and follow-up for TB infection and disease. Refer contacts who have TB symptoms for a medical evaluation, including sputum collection. 41 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 Contact Investigation 11.25 Revised November 2012
Healthcare workers should remember to follow infection control precautions while visiting a potentially infectious TB patient at home or in any other location. These precautions may include wearing a personal respirator. 42 For more information on infection control, see the Infection Control section 17.1. Another critical consideration during field investigations is safety. Healthcare workers should become familiar with policies and recommendations of local law enforcement agencies and health department administration regarding personal safety. Current information on local high-risk areas for crime can be very valuable in planning and conducting safe field visits. General safety precautions that are recommended for the healthcare worker include the following: Wearing an identity badge with a current photo Working in pairs when visiting a potentially dangerous area Informing someone of your itinerary and expected time of return, especially if you anticipate problems 43 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 Contact Investigation 11.26 Revised November 2012
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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
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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
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
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: General Guidelines for Interviewing
Page 293 and 294: Index Patient with Positive Acid-Fa
Page 295 and 296: Index Patient with Negative Acid-Fa
Page 297 and 298: Contact Evaluation, Treatment, and
Page 299 and 300: Definition of abbreviations: HIV =
Page 301 and 302: Note: An IGRA may be used in place
Page 303 and 304: When to Expand a Contact Investigat
Page 305 and 306: Figure 7: EVALUATION, TREATMENT, AN
Page 307 and 308: CDC’s “Framework of Program Eva
Page 309 and 310: Definitions of abbreviations: AIDS
Page 311 and 312: elease assay; LTBI = latent tubercu
Page 313 and 314: officials to distinguish between di
Page 315 and 316: References 1 ATS, CDC, IDSA. Contro
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Page 319 and 320: Introduction Purpose Use this secti
Page 321 and 322: Available Laboratory Tests Table 2:
Page 323 and 324: Table 3: PCR Testing Algorithm and
Page 325 and 326: Table 4: SPECIMEN COLLECTION METHOD
Page 327 and 328: 5. If possible, send the specimen o
Page 329 and 330: Specimen Shipment There are three m
Page 331 and 332: Resources and References Resources
Page 333 and 334: Patient Education CONTENTS Introduc
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Page 337 and 338: Education Topics During the initial
Page 339 and 340: 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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