Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

More documents

Recommendations

Info

place of work is remote from patient or residential care areas and who does not come in contact with clinical specimens; (B) an employee who has previously had a positive tuberculin skin test result, or an employee whose tuberculin skin test obtained under (A) of this paragraph has a positive result, (i) shall have a health evaluation by a health care provider to identify symptoms suggesting that tuberculosis disease is present; the health evaluation must also include evaluation for the presence of any of the following risk factors: evidence of inadequately treated past tuberculosis disease, history of close exposure to a case of communicable pulmonary tuberculosis within the previous two years, history of a negative tuberculin test within the previous two years, diabetes mellitus (severe or poorly controlled), diseases associated with severe immunologic deficiencies, immunosuppressive therapy, silicosis, gastrectomy, excessive alcohol intake, or human immunodeficiency virus infection; if symptoms suggesting tuberculosis disease are present, or if any of the risk factors is present, a chest x-ray shall be obtained as part of the health evaluation and the health care provider shall report the case to the section of epidemiology, division of public health; and (ii) if the employee has previously received appropriate antituberculosis chemotherapy and has no symptoms suggesting that tuberculosis is present, the employee need not have further annual tuberculosis evaluation under this paragraph; and (2) requires evidence of immunization against rubella by (A) a valid immunization certificate signed by a physician listing the date of rubella vaccination; (B) a copy of a record from a clinic or health center showing the date of vaccination; or (C) the result of a serologic test approved by the department showing the employee is immune. (b) The requirement of (a)(2) of this section does not apply to home health agencies, nursing homes, or ambulatory surgical facilities, and, for employees of other facilities, may be waived if a physician signs a certificate that there are medical reasons which dictate that an employee should not be vaccinated against rubella. History: Eff. 11/19/83, Register 88; am 7/17/87, Register 103 Authority: AS 18.05.040 AS 18.20.010 AS 18.20.060 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 STATUTES AND REGULAT IONS 19.5 Revised November 2012
School Screening 7 AAC 27.213. Tuberculosis skin test (a) Each public school district and non-public school offering pre-elementary education through the 12th grade, or a combination of these grades, shall administer an intradermal purified protein derivative (PPD) skin test for tuberculosis within 90 days of enrollment to each child who enrolls in (1) grades kindergarten and seven; or (2) the district in grades kindergarten or higher for the first time. (b) The division may require a district or a non-public school to administer PPD skin tests to enrolled children in addition to those tests required under (a) of this section. The division shall issue a notice to a district or a non-public school requiring enrolled children in additional grade levels, including potentially all grade levels, to be PPD skin tested if the division makes a determination that there is evidence of increased risk of spread of tuberculosis in the community or communities where the district or the non-public school is located. The division shall use the following criteria to determine the need for additional required testing required under this subsection: (1) evidence that the results of prior PPD skin testing of school children in the local community or communities demonstrate tuberculosis transmission; (2) evidence that tuberculosis disease is recognized to be occurring in the local community or communities; (3) evidence that the local community or communities have a history of high rates of tuberculosis when compared to rates of tuberculosis for the nation or this state; or (4) evidence that children from populations having a high risk of tuberculosis are enrolled in the district or the non-public school; in this paragraph, "populations having a high risk" include groups that historically have been medically underserved, homeless persons, foreign-born persons from countries with high rates of tuberculosis, and persons with immune deficiency conditions. (c) If the result of a PPD skin test is positive, including a test result provided under (f)(1) of this section, the district or non-public school shall refer the child to a health care provider and notify the division at its office in Anchorage. (d) The district or non-public school shall record the result of a PPD skin test administered under this section in the permanent health record of the child. (e) The district or school shall suspend a child under AS 14.30.045 (4) if (1) the child fails to submit to a PPD skin test required under this section; or 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 STATUTES AND REGULAT IONS 19.6 Revised November 2012
Page 1 and 2:
Alaska Tuberculosis Program Manual
Page 3 and 4:
Purpose............................
Page 5 and 6:
Monthly assessment of adherence ...
Page 7 and 8:
When to Expand a Contact Investigat
Page 9 and 10:
Introduction CONTENTS About the Ala
Page 11 and 12:
How to Use This Manual Portable Doc
Page 13 and 14:
Printing To access the print dialog
Page 15 and 16:
Abbreviations Refer to the list bel
Page 17 and 18:
QFT QuantiFERON ® -TB test QFT-G Q
Page 19 and 20:
Alaska Statutes and Regulations on
Page 21 and 22:
National and State Program Objectiv
Page 23 and 24:
Indicator 3 Thorough contact invest
Page 25 and 26:
National Standards and Recommendati
Page 27 and 28:
Roles and Responsibilities Contact
Page 29 and 30:
Local Public Health Agencies Table
Page 31 and 32:
Resources and References Resources
Page 33 and 34:
Introduction Purpose Use this secti
Page 35 and 36:
Contact investigation: Collecting,
Page 37 and 38:
Reporting Tuberculosis Detecting an
Page 39 and 40:
Prompt reporting (prior to culture
Page 41 and 42:
Use the Infectious Disease Report F
Page 43 and 44:
Data Collection Forms The following
Page 45 and 46:
Genotyping Genotyping is a useful t
Page 47 and 48:
References 1 ATS, CDC, IDSA. Contro
Page 49 and 50:
Page 51 and 52:
child or a person acting on behalf
Page 53 and 54:
When to Conduct Targeted Testing Al
Page 55 and 56:
Alaska Program Standards for Health
Page 57 and 58:
B Notifications CONTENTS Introducti
Page 59 and 60:
Table 1: NUMBERS OF FOREIGN-BORN PE
Page 61 and 62:
chest radiograph and if sputum AFB
Page 63 and 64:
Follow-up of B1 and B2 Tuberculosis
Page 65 and 66:
Evaluation of B1, B2, and B Tubercu
Page 67 and 68:
Treatment Prescribe medications as
Page 69 and 70:
12 Centers for Disease Control and
Page 71 and 72:
Page 73 and 74:
Tuberculosis Classification System
Page 75 and 76:
Table 2: PERSONS AT HIGH RISK FOR T
Page 77 and 78:
Table 3: WHEN TO SUSPECT PULMONARY
Page 79 and 80:
Diagnosis of Tuberculosis Disease T
Page 81 and 82:
1. Exposure to Infectious TB: Ask p
Page 83 and 84:
Physical Examination A physical exa
Page 85 and 86:
For more information on chest radio
Page 87 and 88:
Laboratories should report positive
Page 89 and 90:
Guidelines for preventing the trans
Page 91 and 92:
50 CDC. National plan for reliable
Page 93 and 94:
Introduction Purpose The overall go
Page 95 and 96:
Basic Treatment Principles Follow t
Page 97 and 98:
Treatment Regimens and Dosages Use
Page 99 and 100:
Table 3: FOUR TREATMENT REGIMENS FO
Page 101 and 102:
† 4 Table 4: DOSES*OF FIRST-LINE
Page 103 and 104:
Figure 1:TREATMENT ALGORITHM FOR DR
Page 105 and 106:
a. In remote locations in Alaska, m
Page 107 and 108:
Antituberculosis Drug Rifampin (RIF
Page 109 and 110:
Antituberculosis Drug Rifapentine (
Page 111 and 112:
Reporting Reactions The table below
Page 113 and 114:
Response to Treatment For consultat
Page 115 and 116:
Figure 2: MANAGEMENT OF TREATMENT I
Page 117 and 118:
Post-Treatment Evaluation Routine f
Page 119 and 120:
Treatment in Special Situations Tre
Page 121 and 122:
Resources For consultation regardin
Page 123 and 124:
with an increase in overall complet
Page 125 and 126:
Liver Disease Management of TB in p
Page 127 and 128:
After the initial phase (first two
Page 129 and 130:
Extrapulmonary Tuberculosis The bas
Page 131 and 132:
Page 133 and 134:
Diagnosis of Latent Tuberculosis In
Page 135 and 136:
Forms All required and recommended
Page 137 and 138:
High-Risk Groups Certain factors id
Page 139 and 140:
Diagnosis of Latent Tuberculosis In
Page 141 and 142:
continually exposed to populations
Page 143 and 144:
Administration of the Tuberculin Sk
Page 145 and 146:
See “Two-Step Tuberculin Skin Tes
Page 147 and 148:
See “Live-Virus Vaccines” under
Page 149 and 150:
For more information on IGRAs and t
Page 151 and 152:
Table 5: TARGETED TESTING FOR LATEN
Page 153 and 154:
Page 155 and 156:
Treatment of Latent Tuberculosis In
Page 157 and 158:
Policy Detailed information on the
Page 159 and 160:
Window period prophylaxis is treatm
Page 161 and 162:
Regimens Identify an appropriate re
Page 163 and 164:
Dosages Once the appropriate regime
Page 165 and 166:
Side Effects and Adverse Reactions
Page 167 and 168:
If a patient reports to a healthcar
Page 169 and 170:
Antituberculosis Drug Rifampin (RIF
Page 171 and 172:
DOT is strongly encouraged for thos
Page 173 and 174:
Table 7 describes the duration of t
Page 175 and 176:
Alcoholism Alcohol-Related Treatmen
Page 177 and 178:
Medication Administration and Pharm
Page 179 and 180:
National Tuberculosis Controllers A
Page 181 and 182:
24 CDC . “Recommendations for Use
Page 183 and 184:
Diagnosis and Treatment of Latent T
Page 185 and 186:
All children suspected or diagnosed
Page 187 and 188:
Latent Tuberculosis Infection (LTBI
Page 189 and 190:
History of BCG vaccination is not a
Page 191 and 192:
Because of their higher specificity
Page 193 and 194:
Table 3: COUNTRIES AND AREAS WITH A
Page 195 and 196:
Treatment of Latent TB Infection (L
Page 197 and 198:
For consultation regarding the trea
Page 199 and 200:
Monitoring DOT is mandatory for INH
Page 201 and 202:
For young infants, some experts rec
Page 203 and 204:
TABLE 8: SIGNS AND SYMPTOMS OF PULM
Page 205 and 206:
Treatment of Tuberculosis Basic pri
Page 207 and 208:
Regime n 1 2 3 ❺ Table 10: FOUR T
Page 209 and 210:
† 35 Table 11: DOSES*OF FIRST-LIN
Page 211 and 212:
Monitoring Response to Treatment Ch
Page 213 and 214:
Child Care and Schools: Children wi
Page 215 and 216:
Other TB medications are not commer
Page 217 and 218:
10 Centers for Disease Control and
Page 219 and 220:
Case Management CONTENTS Introducti
Page 221 and 222:
patient-centered approach to case m
Page 223 and 224:
Alaska TB Program: Timeline for the
Page 225 and 226:
For assistance with language issues
Page 227 and 228:
Ascertain the extent of TB illness
Page 229 and 230:
medical/health problem. The date of
Page 231 and 232:
necessary to teach people how to ta
Page 233 and 234:
Treatment Plan Components Recommend
Page 235 and 236:
Implementation Activities To begin
Page 237 and 238:
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 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:
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:
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:
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
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 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 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
show all

Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

Create successful ePaper yourself

Delete template?

Save as template?