Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Confidential Infectious Disease Report Form State of Alaska, Section of Epidemiology Health care providers may use this form for making infectious disease reports. Please use the STD/HIV Disease Report Form for reporting of Sexually Transmitted Diseases (STD) and HIV. Forms may be found at http://www.epi.alaska.gov/pubs/conditions/crForms.htm. Immediately report any suspected or confirmed public health emergency to 907-269-8000 (during business hours) or 1-800-478-0084 (afterhours). Diseases classified as public health emergencies are listed in bold on page 5 of the Disease Reporting Manual (http://www.epi.alaska.gov/pubs/conditions/ConditionsReportable.pdf). Patient Information Last Name _____________________________________ First Name______________________________ MI _______ Date of birth ____/____/______ Sex: Female Pregnant: No Yes EDC ___/___/____ Unknown (mm/dd/yyyy) Male Transgender Race: White Asian Ethnicity: Hispanic Black Unknown Non-Hispanic Alaska Native/American Indian Other __________ Unknown Native Hawaiian/Pacific Islander Physical Address __________________________________________________ PO Box ___________________ City ______________________________________ State_______ Zip Code ___________________ Phones (home) _______________________ (cell) _____________________ (work) ___________________ Disease Information Name of Disease_________________________________________________ Was the diagnosis laboratory confirmed? Yes No Specimen collection date: ____/____/______ Type of Specimen: Stool Serum CSF Blood Other___________________________________ Name of Medical Facility ______________________________________________ Phone ___________________________ Attending health care provider _______________________ Laboratory Name (if known) _______________________________ Reported by: ____________________________________________________ Date Reported: ____/____/_____ Fax reports to (907) 561-4239 – please verify fax has been transmitted. If line is busy, please fax again or call the RTR to make a report. Rapid Telephonic Reporting System (RTR): (907) 561-4234 or outside Anchorage (800) 478-1700 This form is also available online at http://www.epi.alaska.gov/pubs/conditions/crForms.htm.
Interjurisdictional Tuberculosis Notification Referring Jurisdiction city county state Date sent / / Contact person Phone ( ) FAX ( ) Verified case State reporting to CDC: RVCT# (attach RVCT) Not reported Suspect case Close contact Reactor (LTBI) Convertor (LTBI) Source case investigation A/B Classified Immigrant Patient name Sex M F Last First Middle AKA Date of birth / / Interpreter needed? No Yes, specify language New address Hispanic No Yes Number/Street/Apt. Race White Black Asian Am.Indian/Nat.Alaskan. City/State/ZipCode Other: New telephone ( ) Date of expected arrival / / New health provider Unknown Known (name, address, phone) Emergency contact: Name Phone ( ) Relationship Clinical information for this referred case/suspect index case for this contact not applicable Date of Collection Specimen type Smear Culture Susceptibility Chest X-ray Other Site(s) of disease: Pulmonary Other(s) specify all Date 1 st negative smear / / Not yet Date 1 st negative culture / / Not yet TB skin test #1:Date / / Result mm TB skin test #2: Date / / Result mm Contact/LTBI Information TB Skin test Not Done TST #1 Date / / Result mm TST#2 Date / / Result mm CXR Not Done Date / / Normal Other: Last known exposure to index case / / Place/intensity of exposure: Medications this referred case/suspect this referred contact/LTBI Planned completion date / / Drug Dose Start date Stop date DOT No Yes: start date / / Comments For non-Class 3/5 referrals indicate if: Follow-up requested No follow-up requested NTCA 3-2002 Daily 1x W 2x W 3x W Last DOT Date / / Adherence problems/significant drug side effects: Patient given ________ days of medication
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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
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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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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
Page 361 and 362: Infection Control CONTENTS Introduc
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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
Page 381 and 382: Confirmed Tuberculosis Disease A pa
Page 383 and 384: Multidrug-Resistant Tuberculosis Di
Page 385 and 386: Environmental Controls in the Patie
Page 387 and 388: Return to Work, School, or Other So
Page 389 and 390: Tuberculosis Infection Control in P
Page 391 and 392: Transportation Vehicles To prevent
Page 393 and 394: 7 CDC. Guidelines for preventing th
Page 395 and 396: Forms: Alaska State Public Health L
Page 397 and 398: ALASKA STATE PUBLIC HEALTH LABORATO
Page 399 and 400: Anchorage Alaska State Public Healt
Page 401 and 402: INDEX CASE INFORMATION Name: DOB: /
Page 403 and 404: CONTACT Name: Tuberculosis Contact
Page 405 and 406: Directly Observed Therapy (DOT) Cal
Page 407 and 408: B. Documents patient care activitie
Page 409 and 410: Alaska TB Program Section of Epidem
Page 411: Treatment Summary for Active TB Nam
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Page 421 and 422: Latent Tuberculosis Infection (LTBI
Page 423 and 424: Alaska Tuberculosis Program 9210 Va
Page 425 and 426: Instructions for Collecting Sputum
Page 427 and 428: TB Case Management Information Requ
Page 429 and 430: Table 1: First-line anti-tuberculos
Page 431 and 432: Return the fax to the Drug Room (90
Page 433 and 434: Stock Orders: A small supply of
Page 435 and 436: TB/LTBI Medication Return Form Reas
Page 437 and 438: TB/LTBI Stock Medication Request FA
Page 439 and 440: TB Medication Dose Monitoring Regim
Page 441 and 442: TB Medication Dose Monitoring Regim
Page 443 and 444: ALASKA DEPARTMENT OF HEALTH AND SOC
Page 445: Tuberculosis Discharge Planning Che
Page 448 and 449: PART 2: 8. Have you ever been told
Page 450 and 451: Tuberculosis Treatment Contract Dep
Page 452 and 453: Statutes and Regulations Contents I
Page 454 and 455: Regulations Infection Control 7 AAC
Page 456 and 457: place of work is remote from patien
Page 458 and 459: (2) the child or a person acting on
Page 460 and 461: 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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