TUBERCULOSIS SURVEILLANCE AND CONTROL PROGRAM Flashcards
BUMEDINST 6224.8 Series
Tuberculosis Surveillance and Control Program
What are the Elements of the TB Control Program
(1) Tuberculosis Screening
(2) Preventive Therapy
(3) Tuberculosis Case Identification
(4) Tuberculosis Patient Management
(5) Contact Investigation
What are the Elements of the TB Control Program
(1) Tuberculosis Screening
(2) Preventive Therapy
(3) Tuberculosis Case Identification
(4) Tuberculosis Patient Management
(5) Contact Investigation
What is the method for Tuberculin Skin Test
Mantoux Method
Approved materials for the tuberculin Purified Protein Derivative (PPD)
a) Tubersol – preferred product
b) Aplisol – alternate product
What type of syringe and needle is used for the PPD
Disposable 1 ml tuberculin syringe
Fitted with a ¼ to ½ inch, 27 gauge needle with a short bevel
What is Mycobacterium tuberculosis?
Bacteria that cause latent TB infection and active TB disease.
What term
An illness in which TB bacteria are multiplying and attacking a part of the body, usually the lungs.
Active TB disease.
What term
- A condition in which TB bacteria are alive but inactive in the body.
- People with latent TB infection have no symptoms, don’t feel sick, can’t spread TB to others, and usually have a positive skin test reaction.
Latent TB infection
What term
- A vaccine for TB named after the French scientists who developed it, Calmette and Guérin.
- is rarely used in the United States, but it is often given to infants and small children in other countries where TB is common.
BCG
Direct observed therapy (DOT)
(a) A way of helping patients take their medicine for TB.
(b) If you get DOT, you will meet with a health care worker every day or several times a week.
Latent Tuberculosis Infection (LTBI) Treatment
Isoniazid (INH) and Rifapentine (RPT) in an oral weekly dose of 15 mg/kg (900mg max) of INH and RPT based off weight for 3 months.
Initial screening (TB Testing) is done for?
- All personnel entering active duty.
- All individuals beginning employment as CIVMAR for the MSC
- When the person has past history of active disease, reaction to skin test, or a history of INH therapy
When the person has past history of active disease, reaction to skin test, or a history of INH therapy.
What documentation must they provide?
1) Clinical evaluations
2) Hospitalizations
3) Diagnosis
4) Treatments
Periodic screening (LTBI Screening) for active duty is done when and documented on what?
(a) Annual screening during Periodic Health Assessment (PHA).
(b) Document on NAVMED 6224/8
(LTBI Screening)
is documented on what form?
NAVMED 6224/8
Chest radiograph is done to rule out_____ or ____
If clinically indicated
active TB or fiberotic changes.
BCG stands for?
Bacillus Calmette Guerin
BCG stands for?
Bacillus Calmette Guerin
Can you still administer TST for someone who previously received BCG immunization
Yes
What risk type?
Induration of 5mm or greater is considered positive
-Recent close contacts of active TB disease patients.
-Persons with fibrotic or other changes on chest radiograph consistent with prior TB.
-Patients suspected of having active TB disease.
High Risk
TB risk category
Induration of 10mm or greater.
-Recent immigrants (within 5 years) from high TB prevalence countries.
Healthcare workers and others at risk of occupational exposure to TB.
-Persons with clinical conditions that place them at increased risk.
Medium
Risk factor
Induration of 15mm or greater
-Persons with no risk factors for TB
Low Risk
How much intermediate strength PPD do you use
0.1 mL
What is the angle of injection for PPD
5 to 15°
how big is the wheal supposed to be when injecting PPD
6 to 10mm
If the wheal is less than 6mm in diameter
he test should be administered
again
Record PPD result on
DD form 2766 or NAVMED 6230/4
what is the result NOT recorded as
1) Negative
2) Positive
If person does not return
Record the result as “not read”, recall the person and apply TST on opposite arm
When can you administer TST in relation to live attenuated vaccines
on the same day
At least four weeks after
Prior to therapy, the reactor must be evaluated by an
_____ active TB disease.
Provider
MO, NP, PA, or IDC
evaluation prior to INH
(a) Appropriate clinical history
(b) Physical exam
(c) Chest X-Ray
(d) Sputum Examination (only if radiographic shows signs of Active TB)
(e) Baseline liver function tests (SGOT/SGPT) and bilirubin. (on patients with elevated risk for liver disease)
what is INH
Isoniazid
what is RPT
Rifapentine
Monthly Evaluation for IHN includes
(1) Physical assessment to check for indication of active TB.
(2) Counseling on potential adverse drug reaction
(3) Discuss when to discontinue medication(s).
(4) Discuss when to report for prompt medical evaluation.
(5) Document on NAVMED 6224/9.
what are the liver enzymes
SGOT/SGPT
Upon discovery of a suspected or confirmed case of active TB, the responsible medical department representative must notify the cognizant ______ and the ______ as soon as possible
NEPMU and the local health department
Personnel who are enrolled in a contact investigation but are separating from the
service must be identified to the______ follow-up
testing.
e local public health department
Personnel separating from the service will have to follow up with the _____ for medications
VA
Treatment for active TB
- Chemotherapy is extremely effective and usually curative if the full course is taken.
- Antituberculous drugs are classified as bactericidal (Isoniazid, Rifampin, Pyrazinamide) and bacteriostatic (Ethambutol, Streptomycin)
To prevent development of resistance e, clinical TB must always be treated with ________
at least two drugs that act through different mechanisms.
alternate regimen is
Rifampin (RIF)
oral daily dose of 10 mg/kg (600mg max)
for 4 months
Consider withholding INH if patient’s transaminase levels exceed
- three times the upper limit of normal if associated with symptoms
- five times the upper limit of normal if patient is asymptomatic
When should the PPD be read
48 to 72 hours after the administration
Record PPD result on
NAVMED 6230/4 or
DD Form 2766 and
enter into AHLTA, MRRS or SAMS
active TB Intensive phase (INH, RIF, EMB)
7d/wk for 56 doses, or 5d/wk for 40 doses.
active TB Continuation phase (INH, RIF)
7d/wk for 126 doses or 5d/wk for 90 doses
