Reporting
TB Disease is a rapidly reportable condition in Virginia as reflected in the Virginia Reportable Disease List. Providers must report all suspected and confirmed cases of TB Disease immediately to their local health department.
- Tuberculosis Disease and Latent Tuberculosis Infection Reporting Guidance in Virginia - (UPDATED 12/28/2022)
View contact information for your local health department at this link.
For Local Health Districts:
- Report all new presumptive and confirmed TB cases to VDH TB Program via the electronic portal within three days of learning about the new case.
- Contact a VDH TB nurse consultant as needed and/or if you anticipate media attention surrounding a contact investigation.
- Contact a VDH TB Program consultant if you need assistance with an environmental assessment associated with a contact investigation.
- 2009 Report of Verified Case of Tuberculosis (RVCT) Resources (2009-2022 cases):
- 2020 Report of Verified Case of Tuberculosis (RVCT) Resources (2023 on later cases):
Testing
There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin test (TST) and TB blood tests. A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria. It does not tell whether the person has latent TB infection (LTBI) or has progressed to TB disease. Other tests, such as a chest x-ray and a sample of sputum (if symptomatic), are needed to see whether the person has TB disease. -CDC, 2018
Treatment/Management
When TB bacteria become active (multiplying in the body) and the immune system can’t stop the bacteria from growing, this is called TB disease. TB disease will make a person sick. People with TB disease may spread the bacteria to people with whom they spend many hours.
It is very important that people who have TB disease are treated, finish the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.
TB disease can be treated by taking several drugs for 6 to 9 months. There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens are: isoniazid (INH), rifampin (RIF), ethambutol (EMB), pyrazinamide (PZA). -CDC, 2018
- Needed Communication between Local Health Departments and the TB and Newcomer Health Programs - December 2022
- Nursing Directives and Guidelines
- Alternative Housing and Incentive Program Manual - March 2022
- Discontinuing Regimens that Do Not Contain a Rifamycin
- Documentation in the Medical Record
- Recommendations for Determination of Completion of Treatment (UPDATED)
- Recommendations for TB Record and Form Use
- Guidance for Evaluating Individuals with Class B TB Conditions (UPDATED)
- Recommended Sputum Sample Collection Schedule - January 2021
- Recommendations and Procedures for the Use of Therapeutic Drug Monitoring (TDM) 2022 (UPDATED)
- Serum Drug Level Collection, Shipping, and Handling Instructions - August 2022
- Diagnosis of Tuberculosis in Adults and Children: Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines (2017)
- Treatment of Drug-Susceptible Tuberculosis: Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines (2016)
- Drug-Resistant Tuberculosis – A Survival Guide for Clinicians, 3rd Edition
- Nursing Guide for Managing Side Effects to Drug-resistant TB Treatment
- Hepatotoxicity of Antituberculosis Therapy: An Official ATS Statement
- Diagnostic Standards and Classification of Tuberculosis in Adults and Children
- Treatment of Tuberculosis (MMWR, 2003)
- Controlling Tuberculosis in the United States (MMWR, 2005)
- Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005
- Essential Components of a Public Health Tuberculosis Prevention, Control, and Elimination Program: Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association (2020) and Supplementary Appendices
Drug Resistance
Drug-resistant tuberculosis (TB) is a deadly communicable disease that poses a serious global health threat. It impacts not only individual patients and their families, but also imposes tremendous burdens on overextended public health systems that may lack the resources to contain it.
- Multidrug-resistant (MDR) refers to TB caused by Mycobacterium tuberculosis that is resistant to at least isoniazid (INH) and rifampin (RIF).
- Pre-extensively drug-resistant (Pre-XDR) refers to MDR-TB that is also resistant to either a fluoroquinolone or a second-line injectable anti-TB drug, but not both.
- Extensively drug-resistant (XDR) refers to MDR-TB that is also resistant to both a fluoroquinolone and a second-line injectable anti-TB drug.
-Curry International Tuberculosis Center, 2016
- Treatment of Drug Resistant Tuberculosis (2019) - ATS/CDC/ERS/IDSA
- Drug-Resistant Tuberculosis: A Survival Guide for Clinicians, 3rd edition (Curry International Tuberculosis Center)
- Nursing Guide for Managing Side Effects to Drug-resistant TB Treatment (Curry International Tuberculosis Center) also check out the guide in mobile app form called: Nursing DR-TB Guide (Apple, Google Play).
- Provisional CDC Guidance for the Use of Pretomanid as part of a Regimen [Bedaquiline, Pretomanid, and Linezolid (BPaL)] to Treat Drug-Resistant Tuberculosis Disease (May 5, 2023)
Contact Investigation
Conducting contact investigations (CIs) is one of the highest priorities for TB programs in the United States; second in importance only to detection and treatment of TB disease.
Contact investigations are complicated undertakings that typically require hundreds of interdependent decisions, the majority of which are made on the basis of incomplete data, and dozens of time-consuming interventions. Making successful decisions during a contact investigation requires use of a complex, multi-factor matrix rather than simple decision trees. -CDC, 2005
- Nursing Directives and Guidelines
- Determining the Need for a Contact Investigation and Prioritizing Public Health Response
- Guidelines for Estimating the Start of the Infectious Period
- TB Transmission - Effect of Index Patient Characteristics and Behaviors
- Reporting a Contact Investigation: Contact Investigation Documentation Instructions
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