Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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For roles and responsibilities, refer to the “Roles, Responsibilities, and Contact Information” topic in the Introduction 1.18. State Laws and Regulations See the Statutes and Regulations section for more information on: 7 AAC 27.213. Tuberculosis skin test http://www.legis.state.ak.us/basis/folioproxy.asp?url=http://wwwjnu01.legis.state.ak.us/cgibin/folioisa.dll/aac/query=[group+!277+aac+27!2E213!27!3A]/doc/{@1}/hits_only 7 AAC 12.571. Employee health program http://www.legis.state.ak.us/basis/folioproxy.asp?url=http://wwwjnu01.legis.state.ak.us/cgibin/folioisa.dll/aac/query=[group+!277+aac+12!2E571!27!3A]/doc/{@1}/hits_only 7 AAC 12.650. Employee health program http://www.legis.state.ak.us/basis/folioproxy.asp?url=http://wwwjnu01.legis.state.ak.us/cgibin/folioisa.dll/aac/query=[group+!277+aac+12!2E650!27!3A]/doc/{@1}/hits_only Tuberculin Skin Testing of School Children: Program Standards Tuberculin skin testing of school children Alaska law requires that children who enroll in specific grade-levels – kindergarten and grade seven – or in the district in grades kindergarten or higher for the first time, are to be tuberculin skin tested within 90 days of enrollment in school. (27 AAC 27.213) In addition, the Tuberculosis Control Program requires that students in all grades be skin tested annually at schools in which the majority of students are Asian or Alaska Native (these groups have the highest risk of tuberculosis in Alaska) and at schools in which the prevalence rate of tuberculosis infection exceeds 1%. Schools required to test students in all grades are notified in writing by the Tuberculosis Control Program. Tuberculin skin testing of school children is done by public health nurses at schools which lack personnel capable of conducting the testing. The school district is responsible for obtaining a consent form signed by the child’s parent or guardian prior to administration of a tuberculin skin test to a child in the parent’s absence. All children with undocumented or previously negative tuberculin reactions should be skin tested. Prior BCG vaccination is not a contraindication to tuberculin skin testing. The only exception to testing is if a physician provides a written statement that the test “…would be injurious to the health and welfare of the child or members of the family or household ” (27 AAC 27.213). It is also the school district’s responsibility to 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 (2) the 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 Targeted Testing for Latent Tuber culosis Infection 3.3 R e v i s e d N o v e m b e r 2 0 1 2
child or a person acting on behalf of the child fails to provide the district or non-public school, within 30 days after referral under (c) of this section, a written and signed statement of a health care provider stating that the child is not infectious from tuberculosis to others.” (27 AAC 27.213). Schools are responsible for completing and sending the School Tuberculin Testing Report to the Alaska TB Program by the deadline. The results of screening should be provided to the school district by public health nurses or others who administer testing. See the Forms section of the manual 18.1. High-Risk Groups Certain factors identify persons at high risk for tuberculosis (TB) infection and/or for progression to TB disease. Persons in the high-risk groups listed in Table 1: Persons at High Risk for Tuberculosis Infection and Progression to Tuberculosis Disease are candidates for tuberculin skin testing or TB screening in Alaska Persons with risk factors from both columns may be at much higher risk than those with risk factors in only one column. For example, an individual born in a high-TB-prevalence country with HIV infection is at much higher risk of having active TB than a US-born individual with HIV 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 Targeted Testing for Latent Tuber culosis Infection 3.4 R e v i s e d N o v e m b e r 2 0 1 2
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: Introduction Purpose Use this secti
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: Introduction Purpose Use this secti
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
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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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Introduction Purpose Use this secti
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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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Introduction Purpose Use this secti
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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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