Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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For more information, contact ASPHL Lab at 907-334-2100. To request lab supplies, visit the website: http://www.hss.state.ak.us/dph/labs/publications/default.htm Use the Anchorage Public Health Laboratory Request Form to request tuberculosis laboratory services from the Alaska State Public Health Laboratory in Anchorage. It is available in the Forms section of the manual 18.1. To obtain specimen collection and transport supplies, see the topic on “Specimen Collection and Shipment Supplies” in the Supplies, Materials, and Services section 16.1. 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 Laborator y Services 12.13 Revised November 2012
Resources and References Resources for Laboratory Services Detailed descriptions of recommended laboratory tests; recommendations for their correct use; and methods for collecting, handling, and transporting specimens have been published. For more information on laboratory testing for tuberculosis (TB), see the following: ATS, CDC, IDSA. “Controlling Tuberculosis in the United States: Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America” (MMWR 2005;54[No. RR-12]). Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5412.pdf . ATS, CDC, IDSA. “Diagnostic Standards and Classification of Tuberculosis in Adults and Children” (Am J Respir Crit Care Med 2000;161[4 Pt 1]). Available at: http://ajrccm.atsjournals.org/cgi/reprint/161/4/1376 National Committee for Clinical Laboratory Standards. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes; Approved Standard [Document no. M24-A] (Wayne, PA; 2003). Resources for Specimen Collection and Shipment CDC. “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-care Settings, 2005” (MMWR 2005;54[No. RR-17]). Available at: http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf . CDC. Public Health Mycobacteriology: A Guide for the Level III Laboratory (Atlanta, GA; 1985). Francis J. Curry National Tuberculosis Center. Pediatric TB: A Guide to the Gastric Aspirate (GA) Procedure (Francis J. Curry National Tuberculosis Center Web site). Available at: http://www.nationaltbcenter.edu/products/product_details.cfm?productID=ONL-06 . International Air Transport Association (IATA). IATA Web site. Available at: http://www.iata.org/index.htm . National Jewish Medical and Research Center. How to Mail Specimens and Cultures to the National Jewish Mycobacteriology Laboratory (Denver, CO: March 2005). National Jewish Medical and Research Center. Instructions (for Patients) for Collecting and Mailing Sputum Specimens (Denver, CO: March 2005). National Tuberculosis Controllers Association—National Tuberculosis Nurse Consultant Coalition. Tuberculosis Nursing: A Comprehensive Guide to Patient Care (Atlanta, GA; 1997):39–42. 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 Laborator y Services 12.14 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
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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
Page 279 and 280: Circumstances unique to Alaska may
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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 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
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: Specimen Shipment There are three m
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
Page 353 and 354: Follow-Up Type When to Initiate Not
Page 355 and 356: Action Transfers Within Alaska Tran
Page 357 and 358: Provide the patient with a. A copy
Page 359 and 360: References 1 CDC. International not
Page 361 and 362: Infection Control CONTENTS Introduc
Page 363 and 364: of TB infection control principles
Page 365 and 366: Administrative Activities 13 Key ac
Page 367 and 368: Personal Respiratory Protection Alt
Page 369 and 370: For regulations in your area, refer
Page 371 and 372: Employee Health All employees, phys
Page 373 and 374: Figure 1: TWO STEP TESTING AND FOLL
Page 375 and 376: Isolation To reduce disease transmi
Page 377 and 378: Table 4: CRITERIA FOR PATIENTS TO B
Page 379 and 380: 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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