In this issue...
TB Patients in Custody of the Immigration and Naturalization Service
DTC Offers Translated Educational Materials!
New Statement on the Treatment of Tuberculosis
Where Do All Those Encounters Go?
The January 2003 issue of the Blast neglected to credit the nurses of the Fairfax County Health Department Communicable Disease Committee for their work on the contact investigation chart. While the original document was edited to reflect DTC guidelines and recommendations, the impetus for the contact investigation chart came from their work, ideas and efforts; DTC sincerely acknowledges their contribution, and apologizes for the neglect.
The VDH Division of Tuberculosis Control (DTC) has received a request regarding possible INS detainees that may be held in local jails or state prisons. The U.S. Division of Immigration Health Services (DIHS) is requesting notification on all TB cases/suspects who are INS detainees that are followed by states and localities. This group includes individuals who are either placed in INS custody or are residents of a local jail or state prison and determined to be an INS detainee.
Background
Approximately 100-150 TB cases are identified annually among INS detainees
in the INS service processing centers (SPCs) and contract detention facilities. Approximately 30% of the TB cases in an INS detention center in FY 2001 and 2002 were released back into the U.S.
Approximately one third of INS detainees are held in facilities with on-site Division of Immigration Health Services (DIHS) health care staff. These facilities often make referrals to Cure TB or TB Net for post-detention continuity of care arrangements. The other two thirds of INS detainees are held in approximately 400 contract facilities. For patients in INS beds in local jails or prisons, there is not currently a system for notification of DIHS of TB cases or planned removals.
Procedure
If a district is following a patient who is either placed in INS custody or is identified as an INS detainee in a local jail or prison, please notify DTC of this individual. In addition to the patient's name and date of birth, please provide information on the country of birth, aliases, if applicable and the A#, a unique INS identifier. DTC will then make the appropriate notification to DIHS.
For questions regarding this procedure, contact Jane Moore or Wendy Heirendt at 804-786-6251
Several months ago, the Division of TB Control had announced its efforts to translate seven new tuberculosis patient education brochures developed by the Patient Education Committee of the VDH Nursing Council, in conjunction with DTC. For several months now, these brochures have been available (in English only) on the DTC website.The first of the promised TB brochure translations are now posted to the DTC web sites! You can now download TB patient education brochures in Chinese, Russian, Spanish and Tagalog! Click here to download these translated pamphlets! Additional translations will be posted as they become available.
In February 2003, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) jointly published the revised Statement on the Treatment of Tuberculosis - the first major revision of the guidelines since 1994. Click http://www.vdh.state.va.us/epi/tb/2003TBSt.htm for the full text of this document.
While it may take some time to digest all the changes recommended in the statement, here are a few highlights of the document:
1. The responsibility for the successful treatment of tuberculosis is placed on the health care provider and public health program, not the individual patient.
2. DOT is recommended as the preferred strategy for promoting adherence to therapy.
3. Treatment completion is now defined by the number of doses actually ingested as well as the duration of treatment.
4. Recommendations are made for sputum collection at the end of the initial phase of treatment in order to identify individuals at increased risk for relapse.
5. Extended treatment is recommended for individuals who have cavitation on x-ray and remain sputum culture positive at the end of the initial phase of treatment.
6. Streptomycin is no longer listed as a first line anti-TB drug due to increasing resistance worldwide to this agent.
7. More specific guidance is provided on the management of adverse reactions, lapses in treatment and drug interactions.
8. Treatment regimens for selected patients now offer the option of a once-a-week continuation phase with rifapentine.
9. Detailed guidance is provided for the management of TB in special populations such as HIV-infected, children, pregnancy, clinically defined cases of TB, hepatic disease, etc.
Future editions of the AcidFast Blast will provide more in-depth discussions of selected topics in the TB Treatment statement. In March and April 2003, DTC will sponsor and attend various activities across the state to celebrate World TB Day 2003. In these educational programs, DTC will provide training on the application of the new treatment guidelines in Virginia.
Do you ever wonder what happens to the information entered by local health departments into the VISION system? Some of the TB-related data were recently retrieved from the VISION data warehouse and analyzed for the impact of the 1999 Targeted Skin testing policy on the numbers of all the tuberculin skin tests done across the state, as well as the number that were positive. These data were used in the development of the article submitted to U.S. Department of Health and Human Services Best Practice Initiative. The article, "Risk-Based Targeted Tuberculosis Screening In Virginia" is this month's highlight on the Best Practice Initiative website! Click http://www.osophs.dhhs.gov/ophs/BestPractice/VA_tuberculosis.htm for the full text of the article.
DTC will continue to look at state and district numbers for TB skin tests, as well as chest x-rays and other TB program services. We will be exploring additional ways to use the data in the VISION system, so keep those encounters and data coming in!