Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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eaction size on a later test, which can be confused with a conversion or a recent M. tuberculosis infection. Two-step testing is used to distinguish new infections from boosted reactions in infection-control surveillance programs, but this method is not recommended for testing contacts. bronchoscopy: A procedure for examining the lower respiratory tract in which the end of the endoscopic instrument is inserted through the mouth or nose (or tracheostomy) and into the respiratory tree. Bronchoscopy can be used to obtain diagnostic specimens. Bronchoscopy also creates a high risk for M. tuberculosis transmission to healthcare workers (HCWs) if it is performed on an untreated patient who has TB disease (even if the patient has negative acid-fast bacilli smear results) because it is a cough-inducing procedure. case: A particular instance of a disease (e.g., TB), referring only to the disease, not to the person with the disease. A case is detected, documented, and reported. cavity (pulmonary): A hole in the lung parenchyma, usually not involving the pleural space. Although a lung cavity can develop from multiple causes and its appearance is similar regardless of its cause, in pulmonary TB disease cavitation results from the destruction of pulmonary tissue by direct bacterial invasion and an immune interaction triggered by M. tuberculosis. A TB cavity substantial enough to see with a normal chest radiograph predicts infectiousness. chest x-ray: See radiography. clinical examination: A physical evaluation of the clinical status of a patient by a physician or equivalent practitioner. cluster (TB): A group of patients with latent TB infection or TB disease that are linked by epidemiologic, location, or genotyping data. Two or more tuberculin skin test conversions within a short period can be a cluster of TB and might suggest transmission within the setting. A genotyping cluster is 2 or more cases with isolates that have an identical genotyping pattern. confirmed TB: A diagnosis of TB disease based on positive cultures for M. tuberculosis. However, TB may also be diagnosed on the basis of clinical signs and symptoms in the absence of a positive culture. Positive cultures for M. tuberculosis confirm the diagnosis of TB; however, TB may also be diagnosed on the basis of clinical signs and symptoms in the absence of a positive culture. Culture examinations should be done on all specimens, regardless of acid-fast bacilli smear results. contact: A person who has been exposed to M. tuberculosis infection by sharing air space with a person with infectious TB. 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 Glossary 20. 3 Revised November 2012
contact investigation: Procedures that occur when a case of infectious TB is identified, including finding persons (contacts) exposed to the case, testing and evaluation of contacts to identify latent TB infection or TB disease, and treatment of these persons, as indicated. contagious: See infectious. conversion: A change in the result of a test for M. tuberculosis infection that is interpreted to indicate a change from being uninfected to infected. With the tuberculin skin test, an increase of more than 10 mm in induration size during a maximum of 2 years is defined as a conversion. If blood assay for M. tuberculosis (BAMT) is used for testing, a conversion is a change from a negative to a positive BAMT result over a 2-year period. A conversion is presumptive evidence of new M. tuberculosis infection and poses an increased risk for progression to TB disease. The term is applied to contacts only when previous test results are available. A change in tuberculin status during the window period is not necessarily consistent with this definition. conversion rate: The percentage of a population with a converted test result (tuberculin skin test or blood assay for M. tuberculosis) for M. tuberculosis within a specified period. This is calculated by dividing the number of conversions among eligible healthcare workers (HCWs) in the setting in a specified period (numerator) by the number of HCWs who received tests in the setting over the same period (denominator) multiplied by 100. culture: Growth of microorganisms in the laboratory performed for detection and identification in sputum or other body fluids and tissues. This test usually takes 2 to 4 weeks for mycobacteria to grow (2 to 4 days for most other bacteria). delayed-type hypersensitivity (DTH): Cell-mediated inflammatory reaction to an antigen, which is recognized by the immune system usually because of previous exposure to the same antigen or similar ones. Cell-mediated reactions are contrasted with an antibody (or humoral) response. DTH typically peaks at 48–72 hours after exposure to the antigen. deoxyribonucleic acid (DNA) genotyping: A clinical laboratory technique used to distinguish between different strains of M. tuberculosis and to help assess the likelihood of TB transmission. directly observed therapy (DOT): An adherence-enhancing strategy in which a healthcare worker or other trained person watches a patient swallow each dose of medication and is accountable to the public health system. DOT is the standard of care for all patients with TB disease and is a preferred option for patients treated for latent TB infection. 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 Glossary 20. 4 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
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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
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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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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
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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 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
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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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