Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Liver disease ...................................................... 6.34 Renal insufficiency and end-stage renal disease..................................... 6.34 Tuberculosis associated with tumor necrosis factor-alpha antagonists..................................... 6.35 Culture-negative pulmonary tuberculosis ........... 6.35 Figure 4: Treatment Algorithm for Active, Culture-negative Tuberculosis and Inactive Tuberculosis ....................................................... 6.37 Extrapulmonary tuberculosis .............................. 6.38 Pregnancy and breastfeeding ............................ 6.39 Resources and References ................. 6.40 Quick Guide to Important Tuberculosis Treatment Resources Table 3: Four Treatment Regimens For Drug-susceptible Tuberculosis ................. 6.8 Table 4: Doses of First-line Antituberculosis Drugs for Adults and Children ........................ 6.10 Figure 1: Treatment Algorithm for Drug- Susceptible Tuberculosis in Adults ............... 6.12 Figure 2: Treatment Algorithm for Active, Culture-negative Tuberculosis and Inactive Tuberculosis ..................................................... 6.24 Figure 3: Management of Treatment Interruptions ..................................................... 6.32 Figure 4: Restarting Anti-TB Medications in Patients with Drug-induced Hepatitis ............ 6.37 DIAGNOSIS OF LATENT TUBERCULOSIS INFECTION Introduction ............................................. 7.2 Purpose................................................................ 7.2 Policy ................................................................... 7.2 Forms ................................................................... 7.3 Tuberculosis Classification System ..... 7.4 High-Risk Groups ................................... 7.5 Diagnosis of Latent Tuberculosis Infection ........................... 7.7 Mantoux tuberculin skin testing .......................... 7.7 Candidates for Mantoux tuberculin skin testing .......................................................... 7.8 Administration of the tuberculin skin test ........... 7.11 Measurement of the tuberculin skin test .......... 7.12 Interpretation of the tuberculin skin test ............ 7.13 Human immunodeficiency virus screening ........ 7.15 Follow-up activities ............................................ 7.15 Interferon gamma release assays ..................... 7.16 Chest radiography ............................................. 7.17 Chest X-ray interpretation and treatment .......... 7.18 Work and school clearance ............................... 7.20 Resources and References .................. 7.21 TREATMENT OF LATENT TUBERCULOSIS INFECTION Introduction ............................................. 8.2 Purpose ............................................................... 8.2 Policy ................................................................... 8.3 Forms .................................................................. 8.3 Whom to Treat ......................................... 8.4 Window period prophylaxis for susceptible and vulnerable contacts ............................................. 8.4 Tuberculin skin test results of 5 mm or more ...... 8.5 Tuberculin skin test results of 10 mm or more .... 8.5 Treatment Regimens and Dosages ....... 8.6 Regimens ............................................................ 8.7 New 12-week Isoniazid-Rifapentine regimen ...... 8.8 Dosages .............................................................. 8.9 Pyridoxine (Vitamin B6) ....................................... 8.8 Side Effects and Adverse Reactions................................ 8.10 Basic monitoring steps ...................................... 8.10 Reporting reactions ........................................... 8.11 Monitoring for side effects and adverse reactions by antituberculosis drug ..................... 8.12 Adherence ............................................. 8.15 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 Table of Contents III Revised November 2012
Monthly assessment of adherence .................... 8.15 Directly observed therapy .................................. 8.15 Completion of Therapy ........................ 8.17 Treatment in Special Situations .......... 8.19 Human immunodeficiency virus and latent tuberculosis infection ................................ 8.19 Alcoholism .......................................................... 8.20 Pregnancy and breastfeeding ............................ 8.22 Resources and References ................. 8.23 DIAGNOSIS AND TREATMENT OF LATENT TUBERCULOSIS INFECTION (LTBI) AND TUBERCULOSIS DISEASE IN CHILDREN (UNDER 16 YEARS OF AGE) Introduction ............................................. 9.2 Purpose................................................................ 9.2 Background .......................................................... 9.3 Pathogenesis of TB.............................................. 9.3 Latent Tuberculosis Infection (LTBI) .... 9.5 Diagnosis of latent TB infection ........................... 9.5 Mantoux Tuberculin skin testing (TST) ................ 9.5 Candidates for Mantoux TST ............................... 9.5 TST recommendations for infants, children, and adolescents .......................................................... 9.6 Administration and Interpretation of the TST ....... 9.6 Interferon-Gamma release assays ....................... 9.8 BCG Vaccine ....................................................... 9.9 Management of Children with a Positive TST .... 9.12 Treatment of Latent TB Infection (LTBI) ..................................... 9.13 LTBI Treatment regimens .................................. 9.14 Dosages for LTBI treatment regimens ............... 9.15 Monitoring .......................................................... 9.17 Side Effects and Adverse Reactions .................. 9.17 Pyridoxine (Vitamin B6)…………………….…….9.18 Window Period Prophylaxis ............................... 9.18 Tuberculosis Disease ........................... 9.20 Diagnosis of Tuberculosis ................................. 9.20 Medical History .................................................. 9.20 Physical Examination ........................................ 9.20 Radiology .......................................................... 9.21 Bacteriologic Testing ......................................... 9.22 Gastric Aspirates ............................................... 9.22 Sputum Collection ............................................. 9.22 Bronchoscopy.................................................... 9.22 Treatment of Tuberculosis ................... 9.23 Basic principles ................................................. 9.23 Treatment regimens and dosages..................... 9.23 Regimens .......................................................... 9.23 Duration of treatment......................................... 9.24 First-line TB Drugs ............................................ 9.26 Pharmacology and Adverse Reactions ............. 9.28 Monitoring Response to Treatment ................... 9.29 Completion of treatment .................................... 9.30 Special Issues ....................................... 9.30 Isolation of Children with TB disease ................ 9.30 Child care and Schools ..................................... 9.31 Source case Investigations ............................... 9.31 Drug Delivery Options .......................... 9.32 Resources and References .................. 9.34 CASE MANAGEMENT Introduction ........................................... 10.2 Purpose ............................................................. 10.2 Policy ................................................................. 10.3 Forms ................................................................ 10.4 TB Case Management Timeline ........................ 10.5 Initial Assessment ................................ 10.6 Cultural sensitivity and language issues ........... 10.6 Patient’s medical records .................................. 10.7 Assessment site ................................................ 10.7 Discharge planning............................................ 10.8 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 Table of Contents IV Revised November 2012
Page 1 and 2: Alaska Tuberculosis Program Manual
Page 3: Purpose............................
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: Introduction Purpose Use this secti
Page 51 and 52: child or a person acting on behalf
Page 53 and 54: 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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Introduction Purpose Use this secti
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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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Resources and References Resources
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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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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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