Table. Positive Purified Protein Derivative Results (Pediatrics In Review Apr 2008)

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Table. Positive Purified Protein Derivative Results (Pediatrics In Review Apr 2008)"

Transcription

1 PPD and TB Sreening COMPETENCY- The resident should know the risk factors for TB exposure, when to screen, and the appropriate criteria for recognizing a positive PPD in children of different age groups and exposure/infection to different risk factors. CASE- A mother and her 5 year old daughter, Mya present for an initial visit to your clinic for a well child check. The mother states that they have just moved from Chile and now reside in Chicago. She has never had a BCG vaccination. Mya seems to be doing well. You decide to screen for TB risk factors during this visit. QUESTIONS- 1. What is Tuberculosis and what is a PPD test? 2. How does Tuberculosis exposure/infection occur? 3. When is a PPD test considered positive in children? 4. When should children be screened for Tuberculosis? 5. What should be done if a patient s PPD test is positive, but the patient is asymptomatic? 6. What should be done if a patient s PPD test is negative but you highly suspect infection? 7. Can you place a PPD and give live viral vaccinations at the same time? References: Mayers, Marguerite M. Tuberculosis In Brief. Pediatrics in Review. Vol 29.No.4.April CDC.gov The Red Book Harriet Lane Book

2 1. What is Tuberculosis and what is a PPD test? Tuberculosis is a disease caused most commonly by Mycobacterium tuberculosis and Mycobacterium bovis that the World Heath Organization estimates to affect 2 billion people worldwilde, most with latent disease. Although less prominent in the United States, in 2005 there were 863 cases of active TB in children, with 480 of those children younger than 5 years of age and 383 in those between 5 and 15 years of age, for a rate of 1.4/100,000 children. Primary pulmonary disease is the most common presentation of active TB, although extrapulmonary infections are seen: lymphadenitis, meningitis, osteomyelitis, and peritoneal and renal TB. Symptoms usually are nonspecific and consist of fever, anorexia, and weight loss. Occasionally, a nonproductive cough, headache, and vague abdominal pain are seen. The intradermal Mantoux test is the most reliable TST (Tuberculin Skin Test) screen for TB. The test consists of 0.1mL of 5 tuberculin units of purified protein derivative (PPD) injected intradermally on the volar aspect of the forearm, forming a 6- to 10- mm wheal. The area is inspected at 48 to 72 hours; induration, not erythema, is measured transfersely to the long axis of the forearm and the results recorded in millimeters. The determination of a positive PPD depends on the clinical and epidemiologic circumstances of the child, and size does not differentiate between active or latent infection (see question 3). 2. How does Tuberculosis exposure/infection occur? All of the Mycobacterium organisms including atypicals are aerobic, nonmotile bacilli characterized by their ability to absorb a carbol-fuchsin stain (Ziehl-Neelsen) when heated and resist decolorization by acid alcohol, thus requiring the name acidfast bacilli (AFB). The air droplet nuclei containing the tubercle bacilli are inhaled, entering the respiratory tract and initiating infection in the lungs. Rarely there is GI or cutaneous acquisition. The infection spreads from there to regional lymph nodes and subsequently throughout the body via the systemic circulation, preferring the vascular areas. This is usually unrecognized and asymptomatic in all affected people. Once the affected individual mobilized cell-mediated immunity 6 to 10 weeks later, the progress of the infection is stopped, many of the bacilli are eliminated and those that remain enter a latent state. Ninety percent of those infected have latent TB infection (LTBI) and a lifetime risk of reactivation. The highest incidence of active disease is found in children younger than 4 years of age and in those recently infected. Symptomatic illness peaks within the first year or two after infection and decreases substantially after 5 years, although a small ongoing risk of reactivation exists for the lifetime of the individual. This risk increases if the individual acquires HIV infection, certain chronic disease, or is on immunosuppressive therapy.

3 3. When is a PPD test considered positive in children? Table. Positive Purified Protein Derivative Results (Pediatrics In Review Apr 2008) 5-mm Reaction Exposure to active tuberculosis (TB) Human immunodeficiency virus (HIV) infection or immunosuppression Chest radiograph or clinical presentation consistent with TB 10-mm Reaction High risk of disseminated TB (<4 y; lymphoma, diabetes, renal failure, malnutrition, or other predisposing condition) High risk of exposure to TB (birth in or frequent visits to a high prevalence area; exposure to adults who are infected with HIV, homeless, incarcerated, illicit drug users, residents of nursing homes or institutions, or migrant workers) 15-mm Reaction More than 4 years of age with no identifiable risk factor Of note, this community (Chicago, Illinois) should be considered a high prevalence area so a 10-mm reaction would be considered positive in a well child. 4. When should children be screened for Tuberculosis? Routine screening for TB no longer is recommended. However, children always should be tested if active disease is suspected, and in certain identifiable groups, the prevalence of disease is high enough that a TST is recommended. In fact the CDC recommends screening for Tuberculosis by asking about risk factors during Well Child Checkups. BCG vaccination is not a contraindication to TST nor does it change the interpretation of results. Immediate TST: -Contacts of people with confirmed or suspected contagious tuberculosis -Children with radiographic or clinical findings suggesting tuberculosis disease -Children immigrating from countries with endemic infection (eg Asia, Middle East, Africa, Latin America, countries of the former Soviet Union) including international adoptees

4 Children who should have annual TST: -Children infected with HIV -Incarcerated adolescents Children at increased risk of progression of LTBI to active disease: Children with Diabetes mellitus, chronic renal failure, malnutrition, and congenital or acquired immunodeficiencies need special consideration. In addition, a TST should be performed in all children who will begin immunosuppressive therapy. A positive TST result in a child or adolescent should be regarded as a marker for active disease within that community and should serve as a call to investigate contacts and to find and treat cases of latent TB infection. 5. What should be a done if a patient s PPD test is positive, but the patient is asymptomatic? Prompt clinical and radiographic evaluation of all children and adolescents with a positive TST reaction is recommended. Latent tuberculosis infection (LTBI) is defined as M tuberculosis or M bovis infection in a person who has a positive TST result, no physical findings of disease, and chest radiograph findings that are normal or reveal evidence of healed infection (eg granuloma or calcification in the lung, hilar lymph nodes, or both). Isoniazid given to adults who have LTBI (no clinical or radiographic evidence to suggest active disease) provides a substantial protection (54-88%) against development of tuberculosis disease for at least 20 years. Among children, efficacy approaches 100% with appropriate adherence to therapy. All infants, children, and adolescents who have a positive TST result but no evidence of active disease and who never have received antituberculosis therapy should receive isoniazid unless resistance to isoniazid is suspected (known exposure to a person with isoniazidresistant TB) or a specific contraindication exists. Radiograph should be done once prior to treatment and if the individual remains asymptomatic after treatment is completed it should not be repeated. For infants, children and adolescents the recommended duration of isoniazid therapy is 9 months. Isoniazid is given daily in a single dose. When adherence with daily therapy with isoniazid cannot be ensured, twce-a-weel DPT cam be considered. 6. What should be done if a patient s PPD test is negative but you highly suspect infection? Approximately 10% to 15% of immunocompetent children with culture-documented disease do not react initially to a TST. Host factors, such as a young age, poor nutrition, immunosuppression, other viral infections, recent tuberculosis infection, and disseminated tuberculosis disease can decrease TST reactivity. Many children and adults coinfected with HIV and M tuberculosis do not react to a TST. Control skin test to assess cutaneous anergy are not recommended routinely. A child who is suspected of having active TB should be hospitalized to obtain an organism for culture and sensitivity. Chest radiography can show an infiltrate and hilar lymph adenopathy (a Ghon complex), a disseminated or millet seed pulmonary appearance, a pleural effusion (a progressive primary infection), or apical abnormalities

5 or a cavity in the adolescent who has reactivated disease. In small children, the highest yield for positive AFB smears and culture is from an early morning gastric aspirate when the volume collected exceeds 50 ml of fluid. In the adolescent who has a productive cough, sputum should be obtained by expectoration or saline induction. Bronchoscopy can be useful in obtaining a specimen. If tuberculous meningitis is suspected, the cerebrospinal fluid (CSF) examination can show a pleocytosis with a lymphocytic predominance, a low glucose concentration, and a high protein concentration. The CSF should be centrifuged and the resultant pellicle examined for AFB. Biopsies of the lymph nodes, bone marrow, and liver can be evaluated by the pathologist for caseating granulomas and sent for culture. 7. Can you place a PPD and give live viral vaccinations at the same time? The measles vaccine (part of MMR) can temporarily suppress tuberculin reactivity. If necessary, you can place the PPD on the same day as giving the MMR vaccine but it is not recommended to place a PPD within 4-6 weeks after receiving an MMR vaccination. There is no official evidence regarding other live attenuated vaccines, but it is recommended that you follow the guidelines for MMR. Additional information: Since risk of active disease is higher in children age 4 or younger, pediatricians are often conservative regarding beginning treatment (prophylaxis) for these patients who have risk factors and have LTBI. Please see references for additional information on treatment of active tuberculosis disease. Alanna Nzoma M.D. Reviewed by Kyran Quinlan M.D.

LEARNING OUTCOMES. Identify children at risk of developing TB disease. Correctly manage and refer children suspected of TB. Manage child contacts

LEARNING OUTCOMES. Identify children at risk of developing TB disease. Correctly manage and refer children suspected of TB. Manage child contacts TB in Children 1a TB IN CHILDREN 2 LEARNING OUTCOMES Identify children at risk of developing TB disease Correctly manage and refer children suspected of TB Manage child contacts 3 TB Infection and Disease

More information

Pediatric Latent TB Diagnosis and Treatment

Pediatric Latent TB Diagnosis and Treatment Date Updated: April 2015 Guidelines Reviewed: 1. CDC Latent TB Guidelines 2. Harborview Pediatric Clinic Latent TB Management, 2010 3. Pediatric Associates Latent TB Guidelines, 2013 4. Seattle Children

More information

Massachusetts Department of Public Health Division of Global Populations and Infectious Disease Prevention

Massachusetts Department of Public Health Division of Global Populations and Infectious Disease Prevention Massachusetts Department of Public Health Division of Global Populations and Infectious Disease Prevention Screening Infants and Children for Tuberculosis in Massachusetts Executive Summary In Massachusetts,

More information

2011 NTP Paediatric guidelines update- final draft

2011 NTP Paediatric guidelines update- final draft Childhood TB Investigation and management of children suspected to have tuberculosis (TB) or who are close contacts of a TB case (sputum smear positive or negative) Key facts Children who are close contacts

More information

Tuberculosis in Children and Adolescents

Tuberculosis in Children and Adolescents Tuberculosis in Children and Adolescents Ritu Banerjee, MD, Ph.D TB Clinical Intensive April 8, 2015 2014 MFMER slide-1 Disclosures None 2014 MFMER slide-2 Objectives Describe the epidemiology of pediatric

More information

X-Plain Pediatric Tuberculosis Reference Summary

X-Plain Pediatric Tuberculosis Reference Summary X-Plain Pediatric Tuberculosis Reference Summary Introduction Tuberculosis, or TB, is a bacterial infection that causes more deaths in the world than any other infectious disease. When a child gets TB,

More information

Chapter 3 Testing for Tuberculosis Infection and Disease

Chapter 3 Testing for Tuberculosis Infection and Disease Chapter 3 Testing for Tuberculosis Infection and Disease Table of Contents Chapter Objectives.... 45 Introduction.... 47 Identifying High-Risk Groups for M. tuberculosis Testing... 47 Testing Methods for

More information

Maria Dalbey RN. BSN, MA, MBA March 17 th, 2015

Maria Dalbey RN. BSN, MA, MBA March 17 th, 2015 Maria Dalbey RN. BSN, MA, MBA March 17 th, 2015 2 Objectives Participants will be able to : Understand the Pathogenesis of Tuberculosis (TB) Identify the Goals of Public Health for TB Identify Hierarchy

More information

Paediatrica Indonesiana. Limitations of the Indonesian Pediatric Tuberculosis Scoring System in the context of child contact investigation

Paediatrica Indonesiana. Limitations of the Indonesian Pediatric Tuberculosis Scoring System in the context of child contact investigation Paediatrica Indonesiana VOLUME 51 November NUMBER 6 Original Article Limitations of the Indonesian Pediatric Tuberculosis Scoring System in the context of child contact investigation Rina Triasih 1,2,

More information

Primary Care Management of Latent Tuberculosis Infection in the Foreign-Born

Primary Care Management of Latent Tuberculosis Infection in the Foreign-Born Primary Care Management of Latent Tuberculosis Infection in the Foreign-Born Investigators Carey Jackson MD, MPH University of Washington Jenny Pang MD, MPH, Seattle-King County Department of Public Health

More information

Long-term Care - TB Risk Assessment

Long-term Care - TB Risk Assessment Montana DPHHS Tuberculosis Program Long-term Care - TB Risk Assessment Long-term Care, Residential Treatment, ESRD (outpatient), Hospice (inpatient) Today s Date Facility Address Phone County Completed

More information

Self-Study Modules on Tuberculosis

Self-Study Modules on Tuberculosis Self-Study Modules on Tuberculosis Treatment of Latent Tuberculosis Infection and Tube rc ulos is Disease U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National

More information

Tuberculosis (TB) Screening Guidelines for Substance Use Disorder Treatment Programs in California

Tuberculosis (TB) Screening Guidelines for Substance Use Disorder Treatment Programs in California Tuberculosis (TB) Screening Guidelines for Substance Use Disorder Treatment Programs in California 1 of 7 Table of Contents Preface 2 TB Symptoms and TB History 2 Initial Screening 2 Follow-Up Screening

More information

CDC TB Testing Guidelines and Recent Literature Update

CDC TB Testing Guidelines and Recent Literature Update Pocket Guide QuantiFERON -TB Gold CDC TB Testing Guidelines and Recent Literature Update Using IGRAs for TB screening in your patients June 2010 A full copy of the US Centers for Disease Control and Prevention

More information

TUBERCULOSIS (TB) SCREENING GUIDELINES FOR RESIDENTIAL FACILITIES AND DRUG

TUBERCULOSIS (TB) SCREENING GUIDELINES FOR RESIDENTIAL FACILITIES AND DRUG TUBERCULOSIS (TB) SCREENING GUIDELINES FOR RESIDENTIAL FACILITIES AND DRUG Tx CENTERS Tuberculosis Control Program Health and Human Services Agency San Diego County INTRODUCTION Reducing TB disease requires

More information

Tuberculosis Surveillance and Screening for Long Term Care Facilities in Colorado

Tuberculosis Surveillance and Screening for Long Term Care Facilities in Colorado Tuberculosis Surveillance and Screening for Long Term Care Facilities in Colorado Developed by the Colorado Medical Directors Association and The Colorado Department of Public Health and Environment Introduction:

More information

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention Division of Tuberculosis Elimination Public

More information

Challenges in Pediatric Tuberculosis. Mimi Emig, MD Spectrum Health Kent County Health Department

Challenges in Pediatric Tuberculosis. Mimi Emig, MD Spectrum Health Kent County Health Department Challenges in Pediatric Tuberculosis Mimi Emig, MD Spectrum Health Kent County Health Department Pediatric Tuberculosis: A Missed Public Health Opportunity Mimi Emig, MD Spectrum Health Kent County Health

More information

Childhood Tuberculosis: Diagnosis, Treatment and Prevention of TB in HIV-infected Children

Childhood Tuberculosis: Diagnosis, Treatment and Prevention of TB in HIV-infected Children Childhood Tuberculosis: Diagnosis, Treatment and Prevention of TB in HIV-infected Children Celia DC Christie-Samuels Professor of Paediatrics (Infectious Diseases, Epidemiology and Public Health) University

More information

Diagnosis of Tuberculosis Infection

Diagnosis of Tuberculosis Infection Diagnosis of Tuberculosis Infection CONTENTS Introduction... 7.2 Purpose... 7.2 Policy... 7.2 High-Risk Groups... 7.3 Diagnosis of Tuberculosis Infection... 7.4 Interferon gamma release assays... 7.4 Mantoux

More information

PEOSH Model Tuberculosis Infection Control Program

PEOSH Model Tuberculosis Infection Control Program PEOSH Model Tuberculosis Infection Control Program Revised November, 2004 NOTE: The information in this document is not considered to be a substitute for any provision of the PEOSH Act or for any standards

More information

Latent Tuberculosis Infection: A Guide for Primary Health Care Providers

Latent Tuberculosis Infection: A Guide for Primary Health Care Providers Latent Tuberculosis Infection: A Guide for Primary Health Care Providers A B Latent Tuberculosis Infection: A Guide for Primary Health Care Providers U.S. Department of Health and Human Services Centers

More information

Questions and Answers About Tuberculosis

Questions and Answers About Tuberculosis Questions and Answers About Tuberculosis 2014 Questions and Answers About Tuberculosis 2014 Questions and Answers About Tuberculosis ( TB) was written to provide information on the diagnosis and treatment

More information

THE PREVALENCE OF TB INFECTION AND DISEASE AMONG CHILDREN WITH ACUTE LEUKEMIA

THE PREVALENCE OF TB INFECTION AND DISEASE AMONG CHILDREN WITH ACUTE LEUKEMIA PIDSP Journal 2009 Vol 10 No.1 Copyright 2009 THE PREVALENCE OF TB INFECTION AND DISEASE AMONG CHILDREN WITH ACUTE LEUKEMIA Ma. Ysabel Lesaca-Medina, MD* and Cecilia Maramba-Lazarte, MD* ABSTRACT Objective:

More information

New York City Department of Health Protocols for Latent TB Infection Treatment

New York City Department of Health Protocols for Latent TB Infection Treatment New York City Department of Health Protocols for Latent TB Infection Treatment CONTENT A. Medical evaluation for latent TB infection (LTBI) treatment 1. Medical history and physical examination 2. Chest

More information

New Jersey Department of Health and Senior Services. Standards of Care for Tuberculosis Disease and Latent TB Infection

New Jersey Department of Health and Senior Services. Standards of Care for Tuberculosis Disease and Latent TB Infection New Jersey Department of Health and Senior Services Standards of Care for Tuberculosis Disease and Latent TB Infection Tuberculosis Medical Advisory Board March 2007 Table of Contents Standard # 1: Diagnosis

More information

Daniel Chemtob MD MPH DEA 1,2, Daniel Weiler-Ravell MD 1,2, Alex Leventhal MD MPH MPA 2 and Haim Bibi MD 3. Patients and Methods Case studies

Daniel Chemtob MD MPH DEA 1,2, Daniel Weiler-Ravell MD 1,2, Alex Leventhal MD MPH MPA 2 and Haim Bibi MD 3. Patients and Methods Case studies Epidemiologic Characteristics of Pediatric Active Tuberculosis Among Immigrants from High to Low Tuberculosis-Endemic Countries: the Israeli Experience* Daniel Chemtob MD MPH DEA 1,2, Daniel Weiler-Ravell

More information

BASIC INFORMATION ABOUT HIV, HEPATITIS B and C, and TUBERCULOSIS Adapted from the CDC

BASIC INFORMATION ABOUT HIV, HEPATITIS B and C, and TUBERCULOSIS Adapted from the CDC BASIC INFORMATION ABOUT HIV, HEPATITIS B and C, and TUBERCULOSIS Adapted from the CDC HIV What are HIV and AIDS? HIV stands for Human Immunodeficiency Virus. This is the virus that causes AIDS. HIV is

More information

Childhood Tuberculosis Some Basic Issues. Jeffrey R. Starke, M.D. Baylor College of Medicine

Childhood Tuberculosis Some Basic Issues. Jeffrey R. Starke, M.D. Baylor College of Medicine Childhood Tuberculosis Some Basic Issues Jeffrey R. Starke, M.D. Baylor College of Medicine TUBERCULOSIS IS A SOCIAL DISEASE WITH MEDICAL IMPLICATIONS THE GREAT PARADOX OF TUBERCULOSIS A CAUTIONARY TALE

More information

GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN

GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN 2013 health Department: Health REPUBLIC OF SOUTH AFRICA GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN 2013 Published by the Department

More information

TB preventive therapy in children. Introduction

TB preventive therapy in children. Introduction TB preventive therapy in children H S Schaaf Department of Paediatrics and Child Health, and Desmond Tutu TB Centre Stellenbosch University, and Tygerberg Children s Hospital Introduction Children are

More information

Targeted Testing and Treatment of Latent Tuberculosis Infection in Adults and Children

Targeted Testing and Treatment of Latent Tuberculosis Infection in Adults and Children C D H S / C T C A J O I N T G U I D E L I N E S Targeted Testing and Treatment of Latent Tuberculosis Infection in Adults and Children Targeted Skin Testing and Treatment of Latent Tuberculosis Infection

More information

Pediatric TB. Pediatric TB. Acknowledgements & Conflict of Interest

Pediatric TB. Pediatric TB. Acknowledgements & Conflict of Interest Pediatric TB Paul K. Nolan, FAAP Pediatric Pulmonologist, BC Amarillo Children s Clinic #17 Care Circle Amarillo, TX 79124 TB Updates for the Community: Partnering to Eliminate TB July 23, 2009 (806) 468-6277

More information

Pediatric Tuberculosis

Pediatric Tuberculosis Pediatric Tuberculosis Ana M. Alvarez, M.D. Division of Pediatric Infectious Diseases and Immunology University of Florida College of Medicine/Jacksonville Children are not small adults! Objectives At

More information

TB CARE EARLY DETECTION AND PREVENTION OF TUBERCULOSIS (TB) IN CHILDREN. Risk factors in children acquiring TB:

TB CARE EARLY DETECTION AND PREVENTION OF TUBERCULOSIS (TB) IN CHILDREN. Risk factors in children acquiring TB: EARLY DETECTION AND PREVENTION OF TUBERCULOSIS (TB) IN CHILDREN Risk factors in children acquiring TB: Children living in the same household as a lung TB patient (especially children under 5) Children

More information

Policy Directive: compliance is mandatory

Policy Directive: compliance is mandatory Policy Directive: compliance is mandatory Policy for Control of Tuberculosis in South Australian Health Services Policy developed by: Public Health and Clinical Coordination Approved at Portfolio Executive

More information

Tuberculosis handbook for school nurses

Tuberculosis handbook for school nurses Tuberculosis handbook for school nurses cov1 Tuberculosis handbook for school nurses The New Jersey Medical School Global Tuberculosis Institute is designated and funded by the Centers for Disease Control

More information

Pediatric Tuberculosis: Pearls, Pitfalls and Progress. Amina Ahmed, MD Levine Children s Hospital June 25, 2013

Pediatric Tuberculosis: Pearls, Pitfalls and Progress. Amina Ahmed, MD Levine Children s Hospital June 25, 2013 Pediatric Tuberculosis: Pearls, Pitfalls and Progress Amina Ahmed, MD Levine Children s Hospital June 25, 2013 Disclosures I have no relationships with commercial interests related to this presentation

More information

QUICK REFERENCE FOR HEALTHCARE PROVIDERS

QUICK REFERENCE FOR HEALTHCARE PROVIDERS QUICK REFERENCE FOR HEALTHCARE PROVIDERS Ministry of Health Malaysia Academy of Medicine Malaysia Malaysian Thoracic Society KEY MESSAGES 1. Tuberculosis (TB) is a notifiable infectious disease. Timely

More information

Ottawa Public Health Tuberculosis Screening and Contact Management Guidelines 2012

Ottawa Public Health Tuberculosis Screening and Contact Management Guidelines 2012 Ottawa Public Health Tuberculosis Screening and Contact Management Guidelines 2012 ottawa.ca/health ottawa.ca/sante 613-580-6744 TTY/ATS : 613-580-9656 Tuberculosis Screening and Contact Management Guidelines

More information

Screening and preventive therapy for MDR/XDR-TB exposed/infected children (and adults)

Screening and preventive therapy for MDR/XDR-TB exposed/infected children (and adults) Screening and preventive therapy for MDR/XDR-TB exposed/infected children (and adults) H S Schaaf Department of Paediatrics and Child Health, and Desmond Tutu TB Centre Stellenbosch University, and Tygerberg

More information

PEDIATRIC TUBERCULOSIS. Hot topics / Unresolved issues in Clinical Practice

PEDIATRIC TUBERCULOSIS. Hot topics / Unresolved issues in Clinical Practice PEDIATRIC TUBERCULOSIS Hot topics / Unresolved issues in Clinical Practice Ann M. Loeffler, M.D. Legacy Emanuel Children s Hospital Portland, OR Faculty Consultant Francis J. Curry National TB Center February

More information

MANAGEMENT OF LATENT TUBERCULOSIS INFECTION IN CHILDREN AND ADOLESCENTS A GUIDE FOR THE PRIMARY CARE PROVIDER

MANAGEMENT OF LATENT TUBERCULOSIS INFECTION IN CHILDREN AND ADOLESCENTS A GUIDE FOR THE PRIMARY CARE PROVIDER New Jersey Medical School Global Tuberculosis Institute P.O. Box 1709, 225 Warren Street Newark, NJ 07101-1709 1 800-4TB-DOCS www.umdnj.edu/ntbcweb A Founding Component of the International Center for

More information

Core Curriculum on Tuberculosis: What the Clinician Should Know Sixth Edition 2013

Core Curriculum on Tuberculosis: What the Clinician Should Know Sixth Edition 2013 Core Curriculum on Tuberculosis: What the Clinician Should Know Sixth Edition 2013 CS234269 To View or Order the Core Curriculum on Tuberculosis To view or download the Core Curriculum, please visit: www.cdc.gov/tb.

More information

MIOSHA s Tuberculosis Guidelines For Worker Protection from Mycobacterium (Occupational Health Program Directive No. 96-9)

MIOSHA s Tuberculosis Guidelines For Worker Protection from Mycobacterium (Occupational Health Program Directive No. 96-9) MIOSHA s Tuberculosis Guidelines For Worker Protection from Mycobacterium (Occupational Health Program Directive No. 96-9) In recent years, the incidence of Mycobaterium Tuberculosis (M. tuberculosis)

More information

12 Points of Tuberculosis (TB) Patient Education

12 Points of Tuberculosis (TB) Patient Education 12 Points of Tuberculosis (TB) Patient Education Transmission of TB TB is a disease caused by the TB germ. The disease is mainly in the lungs (pulmonary TB), but the germ can travel to other parts of the

More information

Abstract. 1. Basic underlying view

Abstract. 1. Basic underlying view _ Abstract 1. Basic underlying view Mycobacterium tuberculosis Table 1 2. LTBI treatment subjects 1. Basic view 2. TB development risk factors and infection diagnosis i. HIV/AIDS ii. Hemodialysis for

More information

Frequently Asked Questions

Frequently Asked Questions Frequently Asked Questions QuantiFERON -TB Gold Health Professionals www.quantiferon.com 2 FAQ - Health Professionals Table of contents About TB 6 What is latent TB? And how is it different from active

More information

Introduction to TB Nurse Case Management Online February 4, 11, 18 and 25, 2015

Introduction to TB Nurse Case Management Online February 4, 11, 18 and 25, 2015 Introduction to TB Nurse Case Management Online February 4, 11, 18 and 25, 2015 Completion of Treatment: Case Studies or A Little Bit of Everything Presented by Cherie Fulk February 25, 2015 Cherie Fulk

More information

Clinical Scenarios In Childhood TB. Josefina Cadorna Carlos M.D., FPPS, FPIDSP, FSMID Associate Professor of Pediatrics U E R M M M C

Clinical Scenarios In Childhood TB. Josefina Cadorna Carlos M.D., FPPS, FPIDSP, FSMID Associate Professor of Pediatrics U E R M M M C Clinical Scenarios In Childhood TB Josefina Cadorna Carlos M.D., FPPS, FPIDSP, FSMID Associate Professor of Pediatrics U E R M M M C Objectives: To present different commonly encountered clinical scenarios

More information

MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol)

MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol) MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol) 1. Hepatotoxicity: In Active TB Disease a. Background: 1. Among the 4 standard anti-tb drugs,

More information

Section IV. Evaluation and Treatment of Extrapulmonary Tuberculosis

Section IV. Evaluation and Treatment of Extrapulmonary Tuberculosis Section IV. Evaluation and of Extrapulmonary Tuberculosis Tuberculosis Section IV. Evaluation and of Extrapulmonary Tuberculosis The basic principles that underlie the treatment of pulmonary tuberculosis

More information

Tuberculosis. Clinical diagnosis and management of tuberculosis, and measures for its prevention and control

Tuberculosis. Clinical diagnosis and management of tuberculosis, and measures for its prevention and control Issue date: March 2011 Tuberculosis Clinical diagnosis and management of tuberculosis, and measures for its prevention and control This updates and replaces NICE clinical guideline 33 NICE clinical guideline

More information

American Thoracic Society Documents

American Thoracic Society Documents American Thoracic Society Documents American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States This Official

More information

TB AND M/XDR-TB: FROM CLINICAL MANAGEMENT TO CONTROL AND ELIMINATION

TB AND M/XDR-TB: FROM CLINICAL MANAGEMENT TO CONTROL AND ELIMINATION ersnet.org/school TB AND M/XDR-TB: FROM CLINICAL MANAGEMENT TO CONTROL AND ELIMINATION 23-26 May 2012 - Bucharest, Romania SCHOOL COURSE 2012 Educational Material Thank you for viewing this document. We

More information

Regional Public Health or First Nations Inuit Health Branch (FNIHB):

Regional Public Health or First Nations Inuit Health Branch (FNIHB): Public Health and Primary Health Care Communicable Disease Control 4th Floor, 300 Carlton St, Winnipeg, MB R3B 3M9 T 204 788-6737 F 204 948-2040 www.manitoba.ca November, 2015 Re: Tuberculosis Reporting

More information

Guidelines on targeted tuberculin testing and treatment of latent tuberculosis infection

Guidelines on targeted tuberculin testing and treatment of latent tuberculosis infection Guidelines on targeted tuberculin testing and treatment of latent tuberculosis infection Tuberculosis and Chest Service (Last update on 31March 2015) Internal guidelines of the Tuberculosis & Chest Service

More information

Chapter 1 Overview of Tuberculosis Epidemiology in the United States

Chapter 1 Overview of Tuberculosis Epidemiology in the United States Chapter 1 Overview of Tuberculosis Epidemiology in the United States Table of Contents Chapter Objectives.... 1 Progress Toward TB Elimination in the United States.... 3 TB Disease Trends in the United

More information

April 22, 2015 Curry International Tuberculosis Center

April 22, 2015 Curry International Tuberculosis Center Tools for TB Elimination: Early Case Finding and Prevention Determining Your High-Risk Groups: Using the Universal Risk Assessment Tool Wednesday, d Sacramento, California Mike Carson, MS Program Manager

More information

National Guidelines on diagnosis and treatment of Pediatric Tuberculosis

National Guidelines on diagnosis and treatment of Pediatric Tuberculosis National Guidelines on diagnosis and treatment of Pediatric Tuberculosis The National guidelines on Pediatric TB diagnosis and management were updated based on the recent evidence and advances in pediatric

More information

American College Health Association (ACHA) TB Screening and Targeted Testing Recommendations Gregory Juckett, MD, MPH Professor of Family Medicine

American College Health Association (ACHA) TB Screening and Targeted Testing Recommendations Gregory Juckett, MD, MPH Professor of Family Medicine American College Health Association (ACHA) TB Screening and Targeted Testing Recommendations Gregory Juckett, MD, MPH Professor of Family Medicine West Virginia University gjuckett@hsc.wvu.edu Objectives

More information

Tuberculosis the disease, its treatment TBand prevention

Tuberculosis the disease, its treatment TBand prevention Tuberculosis the disease, its treatment TBand prevention TUBERCULOSIS TB (tuberculosis) is an infectious disease that usually affects the lungs, although it can affect almost any part of the body. About

More information

2 P age. Babies from Birth to Age 2

2 P age. Babies from Birth to Age 2 Contents Babies from Birth to Age 2... 2 Vaccines give parents the power... 2 Vaccines are recommended throughout our lives... 3 Talk to your doctor... 3 Vaccines are very safe... 3 Whooping Cough (Pertussis)...

More information

INITIATING ORAL AUBAGIO (teriflunomide) THERAPY

INITIATING ORAL AUBAGIO (teriflunomide) THERAPY FOR YOUR PATIENTS WITH RELAPSING FORMS OF MS INITIATING ORAL AUBAGIO (teriflunomide) THERAPY WARNING: HEPATOTOXICITY AND RISK OF TERATOGENICITY Severe liver injury including fatal liver failure has been

More information

Immunization Information for Blinn College Students

Immunization Information for Blinn College Students 1 Immunization Information for Blinn College Students *Important Information Regarding the Bacterial Meningitis Vaccine* The State passed Senate Bill 1107 in 2011 and recently Senate Bill 62 in 2013, which

More information

Tuberculosis. Mar yland TB Guidelines for. Maryland Department of Health and Mental Hygiene

Tuberculosis. Mar yland TB Guidelines for. Maryland Department of Health and Mental Hygiene Mar yland TB Guidelines for Pr evention and Tr eatment of Tuberculosis 2007 Maryland Department of Health and Mental Hygiene Martin O Malley, G o v e r nor Anthony G. Brown, L t. G o v er nor John M. Colmers,

More information

May 2015. Jennie Ho, M.D. Director, Student Health Services. 757 College Way, Claremont, CA 91711 (909) 621-8222 (909) 621-8472 F

May 2015. Jennie Ho, M.D. Director, Student Health Services. 757 College Way, Claremont, CA 91711 (909) 621-8222 (909) 621-8472 F May 2015 Dear Claremont Colleges Student: Congratulations and welcome to The Claremont Colleges (TCC) and your Student Health Services! Attached is your Entrance Personal Health History/Medical Examination

More information

Self-Study Modules on Tuberculosis

Self-Study Modules on Tuberculosis Self-Study Modules on Tuberculosis Epidemiology of Tuberculosis U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, STD,

More information

ALBERTA IMMUNIZATION POLICY GUIDELINES

ALBERTA IMMUNIZATION POLICY GUIDELINES ALBERTA IMMUNIZATION POLICY GUIDELINES Hepatitis Vaccines. Hepatitis A Vaccines Refer to the vaccine product monograph and the Canadian Immunization Guide for further Product monographs are available on

More information

A Tuberculosis Refresher Course for Physicians

A Tuberculosis Refresher Course for Physicians A Tuberculosis Refresher Course for Physicians A TUBERCULOSIS REFRESHER COURSE FOR PHYSICIANS The World Medical Association, with support from the Lilly MDR-TB Partnership and technical assistance from

More information

Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005

Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 Please note: This report has been corrected and replaces the electronic PDF version that was published on December 30, 2005. Morbidity and Mortality Weekly Report Recommendations and Reports December 30,

More information

COMMUNICABLE DISEASE

COMMUNICABLE DISEASE Public Health Activities & Services Inventory Technical Notes COMMUNICABLE DISEASE CLINICAL SERVICES, SURVEILLANCE AND CONTROL In 2014, decision was made to adopt number of national public health activities

More information

Immunization Forms. In lieu of these forms you may submit the following:

Immunization Forms. In lieu of these forms you may submit the following: Immunization Forms Welcome to Clemson University! We are glad you have chosen us to meet your higher education goals. The University requires a complete immunization record to be on file at for all students.

More information

Tuberculosis and You A Guide to Tuberculosis Treatment and Services

Tuberculosis and You A Guide to Tuberculosis Treatment and Services Tuberculosis and You A Guide to Tuberculosis Treatment and Services Tuberculosis (TB) is a serious disease that can damage the lungs or other parts of the body like the brain, kidneys or spine. There are

More information

Age In London TB is more common in younger adults aged 15-44 years and peaks in the 25-34 age group (3).

Age In London TB is more common in younger adults aged 15-44 years and peaks in the 25-34 age group (3). 4. TUBERCULOSIS INTRODUCTION Tuberculosis (TB) is an infectious, notifiable disease (meaning there is a requirement by law to report it to government authorities) caused by the bacterium Mycobacterium

More information

Chapter 6 Treatment of Tuberculosis Disease

Chapter 6 Treatment of Tuberculosis Disease Chapter 6 Treatment of Tuberculosis Disease Table of Contents Chapter Objectives.... 139 Introduction.... 141 Treatment and Monitoring Plan.... 143 Adherence Strategies... 143 TB Disease Treatment Regimens....

More information

PRODUCT MONOGRAPH TUBERSOL. Tuberculin Purified Protein Derivative (Mantoux) Solution for injection

PRODUCT MONOGRAPH TUBERSOL. Tuberculin Purified Protein Derivative (Mantoux) Solution for injection PRODUCT MONOGRAPH TUBERSOL Tuberculin Purified Protein Derivative (Mantoux) Solution for injection Diagnostic Antigen to aid in the detection of infection with Mycobacterium tuberculosis ATC Code: V04CF01

More information

Tuberculosis. TB the disease, its treatment and prevention

Tuberculosis. TB the disease, its treatment and prevention Tuberculosis TB the disease, its treatment and prevention Tuberculosis TB (tuberculosis) is an infectious disease that usually affects the lungs, although it can affect any part of the body. About 150

More information

Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection

Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection Recommendations and Reports June 09, 2000 / 49(RR06);1-54 Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection ATS/CDC Statement Committee on Latent Tuberculosis Infection Membership

More information

Commonly Asked Questions About Chronic Hepatitis C

Commonly Asked Questions About Chronic Hepatitis C Commonly Asked Questions About Chronic Hepatitis C From the American College of Gastroenterology 1. How common is the hepatitis C virus? The hepatitis C virus is the most common cause of chronic viral

More information

Tuberculosis Contact Investigation in a Renal Dialysis Center: Blood Vs. Skin test

Tuberculosis Contact Investigation in a Renal Dialysis Center: Blood Vs. Skin test Tuberculosis Contact Investigation in a Renal Dialysis Center: Blood Vs. Skin test Kevin L. Winthrop M.D., M.P.H. Assistant Professor of Medicine Divisions of Infectious Diseases and Public Health and

More information

Facts About Chickenpox and Shingles for Adults

Facts About Chickenpox and Shingles for Adults Facts About Chickenpox and Shingles for Adults What is chickenpox? Chickenpox, also known as varicella, is a very contagious disease caused by the varicella-zoster virus. It is spread easily through the

More information

SECTION SEVEN INSTITUTIONAL POLICIES RELATIVE TO GME PROGRAMS POLICY NO: 7. 6 SUBJECT: EMPLOYEE HEALTH SERVICE PROCEDURES AND GUIDELINES

SECTION SEVEN INSTITUTIONAL POLICIES RELATIVE TO GME PROGRAMS POLICY NO: 7. 6 SUBJECT: EMPLOYEE HEALTH SERVICE PROCEDURES AND GUIDELINES SECTION SEVEN INSTITUTIONAL POLICIES RELATIVE TO GME PROGRAMS POLICY NO: 7. 6 SUBJECT: EMPLOYEE HEALTH SERVICE PROCEDURES AND GUIDELINES l. PURPOSE To provide management guidelines for Infection Control

More information

Haley Blake, BA Senior Disease Investigation and Intervention Specialist Southern Nevada Health District

Haley Blake, BA Senior Disease Investigation and Intervention Specialist Southern Nevada Health District Haley Blake, BA Senior Disease Investigation and Intervention Specialist Southern Nevada Health District Course Objectives Identify causes of and route of transmission of tuberculosis (TB) Explain the

More information

DISCLAIMER. www.health.gov.fj

DISCLAIMER. www.health.gov.fj DISCLAIMER The authors do not warrant the accuracy of the information contained in the TB Technical Guideline and do not take responsibility for any death, loss, damage or injury caused by using the information

More information

Beth Israel Deaconess Medical Center Employee Occupational Health Service Manual

Beth Israel Deaconess Medical Center Employee Occupational Health Service Manual Beth Israel Deaconess Medical Center Employee Occupational Health Service Manual Title: PRE-PLACEMENT SCREENING OF EMPLOYEES, MEDICAL STAFF, VOLUNTEERS, AND CONTRACT PERSONNEL Policy #: PM-19 Purpose:

More information

CNA Certified Nurse Assistant Program

CNA Certified Nurse Assistant Program Health Center Signature/Stamp *1 st floor of Student Services Building HEALTH SCIENCES PROGRAM HEALTH REQUIREMENTS To be filled out by Health Care Provider (HCP) CNA Certified Nurse Assistant Program Student

More information

CHILDHOOD TUBERCULOSIS CASE MANAGEMENT IN PAKISTAN: ADDRESSING A PRIORITY

CHILDHOOD TUBERCULOSIS CASE MANAGEMENT IN PAKISTAN: ADDRESSING A PRIORITY CHILDHOOD TUBERCULOSIS CASE MANAGEMENT IN PAKISTAN: ADDRESSING A PRIORITY Nauman Safdar Dissertation for the degree of Philosophiae Doctor (PhD) University of Bergen, Norway 2011 Centre for International

More information

Disease/Illness GUIDE TO ASBESTOS LUNG CANCER. What Is Asbestos Lung Cancer? www.simpsonmillar.co.uk Telephone 0844 858 3200

Disease/Illness GUIDE TO ASBESTOS LUNG CANCER. What Is Asbestos Lung Cancer? www.simpsonmillar.co.uk Telephone 0844 858 3200 GUIDE TO ASBESTOS LUNG CANCER What Is Asbestos Lung Cancer? Like tobacco smoking, exposure to asbestos can result in the development of lung cancer. Similarly, the risk of developing asbestos induced lung

More information

Childhood tuberculosis guidelines of the Southern African Society for Paediatric Infectious Diseases

Childhood tuberculosis guidelines of the Southern African Society for Paediatric Infectious Diseases Childhood tuberculosis guidelines of the Southern African Society for Paediatric Infectious Diseases DP Moore, HS Schaaf, J Nuttall, BJ Marais David P Moore, Department of Paediatrics and Child Health,

More information

Maryland County Health Department Tuberculosis Infection Control Plan

Maryland County Health Department Tuberculosis Infection Control Plan Maryland County Health Department Tuberculosis Infection Control Plan Introduction In 1998, the Division of TB Control developed a Tuberculosis (TB) Prevention Plan template for use by the local health

More information

GREENFIELD COMMUNITY COLLEGE H e a l t h Records Room N408 One College Drive, Greenfield, Massachusetts 01301 TEL: (413) 775-1431 FAX: 775-1434

GREENFIELD COMMUNITY COLLEGE H e a l t h Records Room N408 One College Drive, Greenfield, Massachusetts 01301 TEL: (413) 775-1431 FAX: 775-1434 GREENFIELD COMMUNITY COLLEGE H e a l t h Records Room N408 One College Drive, Greenfield, Massachusetts 01301 TEL: (413) 775-1431 FAX: 775-1434 HEALTH REQUIREMENTS M e d i c a l Assistant Certificate (

More information

09/27/2006 Centers for Disease Control and Prevention Division of Tuberculosis Elimination

09/27/2006 Centers for Disease Control and Prevention Division of Tuberculosis Elimination Appendix B. Tuberculosis (TB) risk assessment worksheet This model worksheet should be considered for use in performing TB risk assessments for healthcare facilities and nontraditional facility-based settings.

More information

Patient Education CONTENTS. Introduction... 12.2

Patient Education CONTENTS. Introduction... 12.2 CONTENTS Introduction... 12.2 Purpose... 12.2 General Guidelines... 12.3 Language and Comprehension Barriers... 12.4 Education Topics... 12.5 Medical Diagnosis... 12.5 Contact Investigation... 12.6 Isolation...

More information

LTBI Program Implementation in a Substance Abuse Treatment Facility

LTBI Program Implementation in a Substance Abuse Treatment Facility LTBI Program Implementation in a Substance Abuse Treatment Facility (A Case Study) Acknowledgments The New Jersey Medical School (NJMS) National Tuberculosis Center wishes to acknowledge the following

More information

Synopses Diagnosis of Tuberculosis in Children: Increased Need for Better Methods Ejaz A. Khan, M.D., and Jeffrey R. Starke, M.D.

Synopses Diagnosis of Tuberculosis in Children: Increased Need for Better Methods Ejaz A. Khan, M.D., and Jeffrey R. Starke, M.D. Diagnosis of Tuberculosis in Children: Increased Need for Better Methods Ejaz A. Khan, M.D., and Jeffrey R. Starke, M.D. Baylor College of Medicine, Houston, Texas, USA In the last decade tuberculosis

More information

Ambulance Service Patient Care and Transportation Standards

Ambulance Service Patient Care and Transportation Standards Ambulance Service Patient Care and Transportation Standards Patient Care A. General Each operator and each emergency medical attendant and paramedic employed by the operator, shall: (a) Ensure that each

More information

DIVISION of SUBSTANCE ABUSE SERVICES. Tuberculosis Control Guidelines for Alcohol and Drug Abuse Treatment Programs

DIVISION of SUBSTANCE ABUSE SERVICES. Tuberculosis Control Guidelines for Alcohol and Drug Abuse Treatment Programs DIVISION of SUBSTANCE ABUSE SERVICES Tuberculosis Control Guidelines for Alcohol and Drug Abuse Treatment Programs 1. Purpose: This policy provides guidance and instruction to identify and prevent tuberculosis

More information

FOR IMMEDIATE RELEASE Release #2014-04

FOR IMMEDIATE RELEASE Release #2014-04 FOR IMMEDIATE RELEASE Release #2014-04 CONTACT for this Release: Krista Dommer Office Phone: (209) 468-3571 Email: kdommer@sjcphs.org Alvaro Garza, MD, MPH. Public Health Officer MEASLES OUTBREAKS PROMPT

More information

DIRECTLY OBSERVED TREATMENT SHORT-COURSE (DOTS)

DIRECTLY OBSERVED TREATMENT SHORT-COURSE (DOTS) DIRECTLY OBSERVED TREATMENT SHORT-COURSE (DOTS) Protocol for Tuberculosis Demonstration Projects in Russia U.S. Centers for Disease Control and Prevention and U.S. Agency for International Development

More information