BUMEDINST 6224.8B TB Control Program Flashcards
What is the TB Control Program instruction number?
BUMEDINST 6224.8B
Who is responsible for providing technical support as needed to all Navy and Marine Corps units in their AOR?
OICs of NAVENPVNTMEDUs
What is NAVMED 6224/7?
Initial TB Exposure Risk Assessment
What is NAVMED 6224/8?
TB exposure Risk Assessment
What is NAVMED 6224/9?
Monthly evaluation for PTs receiving treatment for Latent TB Infection.
What is NAVMED 6230/4?
Adult Imms Record
What is NAVMED 6230/5?
Child Imms Record
What is the complex bacteria that causes TB?
Mycobacterium Tuberculosis
What is LTBI?
Latent Tuberculosis Infection
True or False:
All Navy and Marine Corps accessions must be tested for LTBI unless there is documented or previous TB infections?
True
True or False:
All individuals beginning employment as Civilian Mariners for MSC must be tested for LTBI unless there is documented or previous TB infections?
True
All personnel must be screened for LTBI during their operations suitability screening after receipt of PCS orders to a commissioned vessel. Screening or testing documentation within how long prior to reporting aboard is acceptable?
6 months
When will all active duty and reserve personnel be screened for LTBI other then during accession?
during their PHA
During a member’s PHA, what form should be used to determine their TB exposure history and risk of acquiring TB?
NAVMED 6224/8
TB risk assessment
what are four examples of additional TB screening other than during a PHA or accession? (4)
- As directed by combatant commanders.
- As part of a contact or outbreak investigation.
- if clinically indicated
- as recommend by cognizant NAVENPVNTMEDUs
perform TB screening on all personnel prior to or within how long prior to arrival on a commissioned vessel?
6 months
Is TB testing required for personnel separating from naval service 6 months before separation or retirement?
no
What does PPD stand for?
Tuberculin, Purified Protein Derivative
What is the approved tuberculin skin test material?
Mantoux test:
Tween-80-stablized intermediate strength
What is the preferred product of tuberose?
from Sanofi Pasteur
What is an alternative tuberose product?
Aplisol from Parkedale Pharmaceuticals
Record PPD test on one of what two forms?
NAVMED 6230/4 or NAVMED 6230/5
The TST reaction must be read between what time after PPD administration?
48 to 72 hours
If a person returns more that 72 hours after TST placement what do you do?
record “not Read” in the record, and apply a TST on the opposite forearm.
what must you record as the results for a TST?
mm of induration
If there is no induction after the administration of a TST what do you record in the record?
0mm or zero mm
What is available as a as a diagnostic aid for M. Tuberculosis infection?
BAMT
Blood Assay for M. Tuberculosis
or a TST
What type of BAMT does the Navy use?
QuantiFERON-TB Gold (QFT-G)
True or False:
QFT-G is designed for use in place of, not in addition to, a TST
True
Based on historical TST results associated with routine screening, the rate of newly-identified LTBI converters is normally no more that __ to __ percent of personnel tested per year in most Navy and MC settings.
1-2 percent
What is a BCG immunization?
Bacillus Calmette Guérin
TSTs can be administered to persons who have previously received BCG immunizations however, a positive TST reaction should be regarded how?
as indicative of a TB infection and they must be evaluated for active TB prior to receiving treatment for LTBI
A TST may be placed on the same day as parenteral live-attenuated virus vaccines or given at least how long later?
4 weeks
Are TSTs safe during pregnancy?
yes
they are both safe and reliable throughout pregnancy and should be administered as appropriate
Can you use the two-step procedure for recruit or officer accession screening or other active duty screening programs?
no
Can members with a positive TST deploy?
not until evaluations are completed and all results have been reported
evaluate all individuals with a TST induration greater than or equal to __mm to determine if their test is positive.
5 mm
What are three factors that would place a member into the “high risk” for acquiring TB?
- Recent close contact of active TB disease PTs
- Persons with fibrotic or other changes on chest X-rays with prior TB
- PT suspected of having active TB
What are three factors that would place a member into the “medium risk” for acquiring TB?
- Recent immigration (i.e. within the last 5 years) from hight TB prevalence countries.
- Mycobacteriology laboratory personnel
- persons with clinical conditions that place them at increased risk
A high risk PT with a __mm TST reaction is considered to be positive.
5mm
A medium risk PT with a __mm TST reaction is considered to be positive
10mm
A low risk PT with a __mm TST reaction is considered to be positive.
15mm
Chest X-rays should be examined for what changes consistent with old TB?
fibrotic
A person with suspected active disease should be masked and ____ed immediately and then referred to an appropriate provider at a MTF.
isolated
If active TB is ruled out and the individual meets the criterion for LTBI, ___ treatment shall be initiated unless medically contraindicated.
Isoniazid (INH)
what is the preferred INH treatment regimen?
5mg/kg (300mg max)
daily
for 9 months to accomplish 270 daily doses within 12 months
What is the alternate INH treatment regimen?
INH 15mg/kg (900mg max)
Twice weekly
for 9 months
only in combination with directly observed therapy
Are baseline laboratory testing routinely indicated for PTs at the start of LTBI TX?
no
Routine laboratory monitoring is necessary for what individuals?
individuals whose baseline liver function tests are abnormal
how frequently must individuals receiving therapy for LTBI follow up ?
monthly until tx is completed
what form is used to document monthly follow ups?
NAVMED 6224/9
Monthly Evaluation of PTs receiving Therapy for LTBI
If a person gives an undocumented history of positive BAMT or TST without documentation of an adequate course of treatment for LTBI or active TB what do you do?
perform a BAMT or TST
Where do you document patient education and counseling?
SF 600
Upon successful completion of appropriate LTBi tx regimen , additional LTBI testing or chest x-rays need to be done?
no
Do not restart the 9 month daily INH regimen if at least how many doses of INH can be administered within a 12 month period.
270
What happens if INH treatment has been interrupted for more that two months?
PT must be examined to exclude active TB disease
