6.18 Tuberculosis Surveillance and Control Program Flashcards
Elements of TB Control Program
Tuberculosis screening Preventative therapy Tuberculosis case identification Tuberculosis patient management contact investigation
Approved Tuberculin Skin Test
Mantoux Method Purified Protein Derivative (PPD) - Tubersol (preferred) - Aplisol (alternative) 1/4in-1/2in needle 27 gauge
IGRA
Interferon Gamma Release Assays to detect TB
FDA approved
Quanti-Feron TB Gold
QFT
is designed for use in place of, not addition to a TST
Mycobacterium Tuberculosis
bacteria that cause latent TB infection and active TB disease
Active TB disease
illness with TB bacteria are multiplying and attacking the body
Latent TB infection
a condition that TB bacteria are alive but inactive in the body
cant spread to others, dont feel sick
TB Skin Test
a test used to find out if you have TB
TB Blood test
new test that uses blood to test for TB
BCG
TB Vaccine named after French scientist, Calmette and Guerin
RARELY used in US. often given to infants and small children in other countries where TB is common
Direct Observed Therapy
DOT
helping patient take their meds for TB
Latent Tuberculosis Infection LTBI Treatment
Isoniazid (INH) Rifapentine (RPT) Oral weekly dose 15mg/kg (900mg max) 10-14kg 300mg 14.1-25kg 450mg 25.1-32kg 600mg 32.1-49.9kg 750mg >50kg 900mg for three months
Rifampin (RIF)
10mg/kg 600mg max
4 months
When a person has a history of active TB they must provide documentation of:
clinical evaluations
hospitalizations
diagnosis
treatment
When do people get screened for TB?
PHA
What is the TB screening documented on?
NAVMED 6224/8
Chest radiograph requirements
if clinically indicated
to rule out active TB or fibrotic changes
High risk INH
induration of 5mm or greater
- recent close contacts
- fibrotic changes
- suspected of active TB
Medium Risk INH
induration of 10mm
- recent immigrants
healthcare workers
Low risk INH
15mm or greater induration
- no risk factors for TB
Mantoux Method
standard method for testing for TB
PPD Administration
0.1mL on the volar aspect of forearm
5-15degree angle
tense pale wheal that is 6-10mm
** if less than 6mm test should be administered again
When is the TST read?
48-72 hours
Not recorded as
Negative or positive
After 72 hours
result as not read - apply TST on opposite arm
Possible reasons for false negative TST results
immunosuppression due to TB infection
receipt of immunosuppressive meds
immune system compromising conditions
TST administered within a short period after live vaccine
When can a TST be placed in regards to live vaccines?
placed on same day - if given first
at least four weeks after live vaccine
Who can evaluate for TB?
MO, PA, NP or IDC
evaluations must include
appropriate clinical hx
physical exam
chest X ray
Sputum exam - only if chest x ray shows active TB
baseline liver function test and bilirubin
questions to address
is active disease present?
any contraindications to INH present?
should INH be prescribed and for what duration?
Monthly evaluations are documented on what form?
NAVMED 6224/9
Noncompliance of INH
consult with NEPMU
DOT
- twice weekly
- difficulty with treatment adherence
Serum Glutamic Oxaloacetic Transaminase (SGOT)
consider withholding INH therapy if transaminase levels exceed 3 times the upper limit - w/ sx
OR
5 times the upper limit - w/o sx
Who does the MDR notify when someone is dx with TB?
NEPMU
Personnel who are seperating from service but enrolled in contact investigation
can get their meds from local public health or VA
What is the MDR responsible for in regards to reporting TB?
ensuring the contact investigation is initiated rapidly
Reports of TB contact investigation
provided by cognizant NEPMU to:
members of command
cognizant FLEET/TYCOM surgeon
Navy and Marine Corps Public Health Center
How fast are MERs submitted?
within 24 hours
Anti tuberculous drugs are classified as
Bactericidal
Bacteriostatic
Different meds for TB
Isonizaed
Rifampin
Pyrzinamide
Ethambutol
Complications to active TB
Extrapulmonary TB infection
INH associated hepatitis
