Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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ALASKA DHSS, DPH, TB PROGRAM TB/LTBI Prescription and Medication Request Fax Completed Form to: 907/563-7868 Date Needed at Facility in month/day/year format:____/____/20___. (Overnight shipping requires Epi approval) Pt Last Name (printed)_______________________________Pt First Name (printed):________________________________ Weight:________kg. HR # _________________ D.O.B. __________________Allergies: _____________________________ New Medication Request Modification of Existing Medication Order AutoFill: YES or NO Male Female/Pregnant: yes no /Breastfeeding: yes no Dispense in: Bottles or Dose Packs (NOT CHILD PROOF) Doses given from Stock: _______ Send English Medication Info Sheet or other: ______________________ Drug Dose Route Frequency ___ Doses Requested to Complete Therapy INH ________mg ____ 7X wk 5X wk 2X wk Wkly Other:_______________ x _____Doses RIF ________mg ____ 7X wk 5X wk 2X wk Wkly Other:_______________ x _____Doses PZA ________mg ____ 7X wk 5X wk 2X wk Wkly Other:_______________ x _____Doses EMB _______mg ___ 7X wk 5X wk 2X wk Wkly Other:_______________ x _____Doses B-6 _______mg ___ Daily Twice Weekly Other:_________________________ x _____Doses RPT ______mg ___ Weekly Other:______________________________________x _____Doses Moxifloxacin ____mg ___ Daily Other:________________________________________x _____Doses ______________ ______mg ____ ______________________________________________x_____Doses Notation:____________________________________________________________________________________ Provider Signature:___________________________________Date: ______________________________ Provider Printed Name:________________________________Provider City: ____________________________ Provider Phone: ____________________________Provider Fax: ______________________________________ EMB=Ethambutol, INH=Isoniazid, PZA=Pyrazinamide, RIF=Rifampin, RPT=Rifapentine EMB=Ethambutol RPT=Rifapentine Provider Prescription Pt Name :_______________________________________________Address:___________________________________ Mail to: ______________________________ PHN Requesting Med: ______________________________ Address: ____________________________ City: _______________________Phone: _______________ City: ______________St ____Zip________ Date Requested:__________________________________ AK TB Program Reviewed by:__________Date:_________ Overnight Shipping Approved by:_________ Faxed to Drug Room by:_____________ Date:____ _____ Processed by:_____ Checked by:________ Rev 11-28-2012
Table 1: First-line anti-tuberculosis drugs and dosing for adults and children* Drug Preparation Adult/Child Daily 1 x wkly Dosage (maximum) 2 x wkly 3 x wkly Isoniazid Rifampin Tablets (100, 300 mg); Elixir (50 mg/5 ml); Aqueous IV/IM solution (100 mg/ml) Capsule (150, 300 mg); suspend powder for PO; Aqueous IV solution Rifapentine Tablet (150 mg) Pyrazinamide Tablet (500 mg) Ethambutol Tablet (100 and 400 mg) Adults 5 mg/kg (300 mg) 15 mg/kg (900 mg) 15 mg/kg (900 mg) 15 mg/kg (900 mg) Children 10-15 mg/kg (300 mg) ---- 20-30 mg/kg (900 mg) ---- Adults ❶ 10 mg/kg (600 mg) ---- 10 mg/kg (600 mg) 10 mg/kg (600 mg) Children 10-20 mg/kg (600 mg) ---- 10-20 mg/kg (600 mg) ---- Adults ---- 10 mg/kg (600 mg); continuation phase only --- --- Children Not approved Not approved Not approved Not approved Adults 40-55 kg 1,000 mg 56-75 kg 1,500 mg 76-90 kg 2,000 mg ---- 40-55 kg 2,000 mg 56-75 kg 3,000 mg 76-90 kg 4,000 mg Children 15-30 mg/kg (2,000 mg) ---- 50 mg/kg (2,000 mg) ---- Adults 40-55 kg 800 mg 56-75 kg 1,200 mg 76-90 kg 1,600 mg ---- 40-55 kg 2000 mg 56-75 kg 2,800 mg 76-90 kg 4,000 mg Children 15-20 mg/kg (1000 mg) ---- 50 mg/kg (2.5 gm) ---- Dosage for a combination regimen of Isoniazid and Rifapentine in 12 once-weekly doses by DOT for treatment of LTBI ❷ Isoniazid Rifapentine Tablets (100mg, 300mg) Tablet (150mg) >12 years of age ---- >12 years of age ---- * Children weighing more than 40 kg (88 lbs) should be dosed as adults ❶ Dose may need to be adjusted when there is concomitant treatment for HIV/AIDS 15mg/kg (900mg) Rounded up to nearest 50 or 100mg 10.0-14.0 kg 300mg 14.1-25.0 kg 450mg 25.1-32.0kg 600mg 32.1-49.9kg 750mg > 50kg 900mg (900mg) ❷ CDC. (2011). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent tuberculosis infection. MMWR, 60(48). 1650-1653 ---- ---- ---- ---- 40-55 kg 1,500 mg 56-75 kg 2,500 mg 76-90 kg 3,000 mg 40-55 kg 1,200 mg 56-75 kg 2,000 mg 76-90 kg 2,400 mg
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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
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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
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 and 412: Treatment Summary for Active TB Nam
Page 413 and 414: Interjurisdictional Tuberculosis No
Page 415 and 416: ! !"#$%&'%()*(+#(,"-./0'1$%+'.,)()/
Page 417 and 418: ! B!9:(78;7)3702D!! ! 3"#$%&%''98#5
Page 419 and 420: ! ?"#51)09/02!H0/.!9:(78;7)37028!/'
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: TB Case Management Information Requ
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
Page 462 and 463: eaction size on a later test, which
Page 464 and 465: disseminated TB: See miliary TB. dr
Page 466 and 467: immunocompromised and immunosuppres
Page 468 and 469: include medical history and TB symp
Page 470 and 471: thousands to millions of copies of
Page 472 and 473: secondary (TB) case: A new case of
Page 474: eproducing TB organisms from respir
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Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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