Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Figure 6: EVALUATION, TREATMENT, AND FOLLOW-UP OF CONTACTS WITH PRIOR POSITIVE TUBERCULIN SKIN TESTS 55 Definition of abbreviations: HIV = human immunodeficiency virus; LTBI = latent tuberculosis infection. * Before initiation of treatment, contacts should be evaluated fully for TB disease. A full course treatment is recommended for HIV-infected contacts in this category. Source: CDC. Guidelines for the investigation of contacts of persons with infectious tuberculosis; recommendations from the National Tuberculosis Controllers Association and CDC, and guidelines for using the QuantiFERON ® -TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR 2005;54(No. RR-15):19. 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 11.37 Revised November 2012
When to Expand a Contact Investigation Guidelines for Expanding an Investigation Determine when to expand a contact investigation using the following guidelines: 1. Do not include lower-priority contacts unless objectives for high- and medium-priority contacts are being met. 2. Consider the extent of recent transmission. 3. Consider expanding the scope (e.g., number of contacts) of an investigation if any one or more of the following criteria are met: a. Unexpectedly large rate of tuberculosis (TB) infection or disease in high-priority contacts: 20% or at least twice the rate of a similar population without recent exposure, whichever is greater Since the background prevalence of tuberculosis infection in adult foreign-born populations from high-incidence countries often exceeds 30%, it is important to stratify the infection rates by country of birth and/or length of residence and by age. For example, household contacts with a positive tuberculin skin test (TST) results are more likely to be infected recently (or as a result of exposure to the index patient) if the contacts are U.S.-born children rather than adults born in high-incidence countries. b. Evidence of second-generation transmission (i.e., from TB patients who were infected after exposure to the source patient) c. TB disease in any contacts who had been assigned low priority d. Infection in any contacts younger than 5 years old e. Contacts with change in TST status from negative to positive When results from an investigation indicate that it should be expanded, but resources are insufficient, seek assistance from the Alaska Tuberculosis Program. In general, without evidence of recent transmission, do not expand an investigation to lower-priority contacts. When program evaluation objectives have not been met, expand a contact investigation only in exceptional circumstances, generally involving highly infectious cases with high rates of infection among contacts or evidence for secondary cases and secondary transmission. Derive the strategy for expanding an investigation from the data obtained from the investigation to that point in time. Without data from the initial contact investigation to support evidence of transmission, there is little support to expand to lower-priority contacts. As in the initial investigation, review the incoming results of the expanded investigation at least weekly to reassess the strategy. 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 11.38 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
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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
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
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: Note: An IGRA may be used in place
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
Page 317 and 318: 44 CDC, NTCA. Guidelines for the in
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
Page 335 and 336: treatment, common side-effects of m
Page 337 and 338: Education Topics During the initial
Page 339 and 340: 10. Explain the signs and symptoms
Page 341 and 342: Patient Education Materials Get th
Page 343 and 344: References 1 CDC. Module 4: treatme
Page 345 and 346: Introduction Purpose Use this secti
Page 347 and 348: National Guidelines The following g
Page 349 and 350: Transfer Notifications CONTENTS Int
Page 351 and 352: 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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