Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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settings, 2005. MMWR 2005;54(No. RR-17):11; and CDC. “Medical evaluation.” In: Chapter 5: diagnosis of TB. Core Curriculum on Tuberculosis (2000). Updated November 2001. 31 CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR-17):11; and ATS, CDC, IDSA. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161:1378. 32 CDC.”The medical history” In: Module 3: targeted testing and the diagnosis of latent tuberculosis infection and tuberculosis disease Self-Study Modules on Tuberculosis [Division of Tuberculosis Elimination Web site]. 2008. Available at: http://www.cdc.gov/tb/education/ssmodules/pdfs/Module3.pdf. Accessed November 16, 2010; and CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR-17):11. 33 CDC.”The medical history” In: Module 3: targeted testing and the diagnosis of latent tuberculosis infection and tuberculosis disease Self-Study Modules on Tuberculosis [Division of Tuberculosis Elimination Web site]. 2008. Available at: http://www.cdc.gov/tb/education/ssmodules/pdfs/Module3.pdf. Accessed November 16, 2010. 34 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):51. 35 CDC. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. MMWR 2006;55(No. RR-14):1–17. 36 CDC. Medical evaluation. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf. Accessed June 20, 2012; and Colorado Department of Public Health and Environment. Tuberculosis Manual [Colorado Department of Public Health and Environment Web site]. (2004):3-1. Available at: http://www.cdphe.state.co.us/dc/TB/tbman.html Accessed November 16, 2010. 37 ® CDC. Guidelines for using the QuantiFERON -TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR 2005;54(No. RR-15):52 and CDC. Updates Guidelines for Using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection, United States 2010. MMWR 2010;59 (No. RR-5);1-25. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5905a1.htm?s_cid=rr5905a1_e 38 ® CDC. Guidelines for using the QuantiFERON -TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR 2005;54(No. RR-15):52 and CDC. Updates Guidelines for Using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection, United States 2010. MMWR 2010;59 (No. RR-5);1-25. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5905a1.htm?s_cid=rr5905a1_e 39 ® CDC. Guidelines for using the QuantiFERON -TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR 2005;54(No. RR-15):52 and CDC. Updates Guidelines for Using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection, United States 2010. MMWR 2010;59 (No. RR-5);1-25. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5905a1.htm?s_cid=rr5905a1_e 40 CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR-6):25. 41 CDC. Medical evaluation. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2004) [Division of Tuberculosis Elimination Web site]. Updated October 2004. Available at: http://www.cdc.gov/tb/webcourses/CoreCurr/index.htm Accessed November 16, 2010. 42 CDC. Medical evaluation. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf. Accessed June 20, 2012. 43 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):19; and Tenover, R., et al. The resurgence of tuberculosis: is your laboratory ready? Journal of Clinical Microbiology 1993:767–770. 44 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):19; and Tenover, R., et al. The resurgence of tuberculosis: is your laboratory ready? Journal of Clinical Microbiology 1993:767–770. 45 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):19. 46 ATS, CDC, IDSA. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161:1384. 47 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):19; and Tenover, R., et al. The resurgence of tuberculosis: is your laboratory ready? Journal of Clinical Microbiology 1993:767–770. 48 CDC. National plan for reliable tuberculosis laboratory services using a systems approach–recommendations from CDC and the Association of Public Health Laboratories Task Force on Tuberculosis Laboratory Services. MMWR 2005;54(No. RR-6):3. 49 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):19; and Tenover, R., et al. The resurgence of tuberculosis: is your laboratory ready? Journal of Clinical Microbiology 1993:767–770. 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 Diagnosis of Tuber culosis Disease 5.21 R e v i s e d N o v e m b e r 2 0 1 2
50 CDC. National plan for reliable tuberculosis laboratory services using a systems approach–recommendations from CDC and the Association of Public Health Laboratories Task Force on Tuberculosis Laboratory Services. MMWR 2005;54(No. RR-6):2. 51 Tenover, R., et al. The resurgence of tuberculosis: is your laboratory ready? Journal of Clinical Microbiology 1993:769; and ATS,CDC, IDSA. Treatment of tuberculosis. MMWR 2003;52(No. RR-11):38. 52 ATS, CDC, IDSA. Treatment of tuberculosis. MMWR 2003;52(No. RR-11):12. 53 CDC. Diagnostic microbiology. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf. Accessed June 20, 2012. 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 Diagnosis of Tuber culosis Disease 5.22 R e v i s e d N o v e m b e r 2 0 1 2
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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
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
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: Guidelines for preventing the trans
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: Resources and References Resources
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
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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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