Download March 2003: Volume 31, Number 2 (PDF: 102KB/8 pages)

MINNESOTA
DEPARTMENT
OF HEALTH
D ISEASE C ONTROL N EWSLETTER
Volume 31, Number 2 (pages 13-20)
March/April 2003
Recommended Childhood and Adult Immunization
Schedules - Minnesota, 2003
In 2003, for the first time in several
years, there are no significant changes
or modifications to the Minnesota
Department of Health (MDH)’s recom­
mended schedule for childhood
immunizations. The schedule, now
called the Recommended Childhood
and Adolescent Immunization Schedule, includes several minor enhance­
ments to make it easier to use and
understand (pages 14-15). The
addition of “Adolescents” in the title
reflects the entire population (birth
through 18 years of age) covered by
the schedule. A companion piece to
the childhood and adolescent immuni­
zation schedule, the Recommended
Adult Immunization Schedule, provides
comparable guidelines for persons 19
years of age or older (pages 16-17).
This schedule was modified slightly in
the fall of 2002 following the withdrawal
of the Lyme disease vaccine.
less frequently and is updated as
needed.
MDH has attempted to consolidate and
summarize the recommendations of the
various advisory bodies as clearly and
succinctly as possible in the Minnesota
immunization schedules. Providers
also should consult the national
recommendations and subsequently
published supplemental recommenda­
tions as needed. In particular, please
be aware of the following points:
• The charts and guidelines in
each schedule must be read
together.
• Refer to the complete ACIP
statement for specific circum­
stances beyond the guidance
offered in the MDH schedules.
Other resources include the following:
The childhood and adult immunization
schedules reflect recommendations of
national advisory bodies such as the
Advisory Committee on Immunization
Practices (ACIP), the American
Academy of Pediatrics (AAP), the
American Academy of Family Physi­
cians, and the American College of
Physicians. The MDH Immunization
Practices Task Force reviews the
schedules and suggests modifications,
which are incorporated as appropriate
for Minnesota’s populations. The
childhood schedule is issued annually
to incorporate changes as new vac­
cines are licensed, products change,
and recommendations for their use are
modified. The adult schedule changes
• American Academy of
Pediatrics. Pickering LK, ed.
2000 Red Book: Report of the
Committee on Infectious
Diseases. 25th ed.
Elk Grove Village, IL: American
Academy of Pediatrics; 2000.
• The Minnesota Immunization
Hotline (M-F, 9:00 A.M. – 12:00
P.M. and 1:00 P.M. – 3:00 P.M.),
at 612-676-5100 or 1-800-6573970.
• The Centers for Disease Control
and Prevention (CDC) hotline at
1-800-232-0233.
and,
• Vaccine manufacturers’
help-lines and package inserts.
Both the childhood and adult immuniza­
tion schedules are available on the
MDH website at http://
www.health.state.mn.us/immunize;
scroll down to “Schedules and Recom­
mendations.” Color copies of both
schedules are being printed, and MDH
will distribute these to all clinics,
hospitals, public health agencies, and
health plans when they become
available in mid- to late April. Additional
copies can be ordered by calling the
Minnesota Immunization Hotline at 612676-5100 or 1-800-657-3970, or by
e-mailing MDH at
[email protected].
• Department of Health and
Human Services, Centers for
Disease Control and Prevention.
Atkinson W, Wolfe C, eds.
Epidemiology and Prevention of
Vaccine-Preventable Diseases.
7th ed. Washington, DC: Public
Health Foundation; 2002.
Inside:
Newly Approved Blood Test for
Diagnosing Latent Tuberculosis
Infection: Guidelines for Use of
QuantiFERON®-TB .................. 18
DCN Readership Alert
and Survey .............................. 19
Recommended Childhood and Adolescent Immunization Schedule - Minnesota, 2003
Chart 12345678901234567890123456789012123
must be used with guidelines below
12345678901234567890123456789012123
12345678901234567890123456789012123
Catch-up vaccination
12345678901234567890123456789012123
Range of recommended ages
?
Age?
Birth
Vaccine
HBV - 1
Hepatitis B1
1
mo
2
mos
4
mos
6
mos
DTaP
DTaP
DTaP
Hib
Hib
Hib3
IPV
IPV
DTaP2
Varicella
PCV
PCV
4-6
yrs
PCV
11-12
yrs
13 -18
yrs
1234567890123456789012345678
1234567890123456789012345678
1234567890123456789012345678
HBV1 series
12345678
12345678
12345678
2
DTaP
Td
12345678
Hib3
MMR - 1
6
Pneumococcal7
24
mos
IPV
IPV
Measles, Mumps,
Rubella5
Varicella
18
mos
HBV - 3
Haemophilus influenzae
type b3
Polio4
15
mos
only if mother is HBsAg(-)
HBV - 2
Diphtheria, Tetanus,
Pertussis2
12
mos
Preadolescent assessment
PCV
12345678901234
12345678901234
MMR-25 12345678901234
MMR-25
1234567890123456789012345678
1234567890123456789012345678
1234567890123456789012345678
Varicella
12345678901
12345678901
12345678901
PCV
12345678901
PPV
Vaccines below line are for selected populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
Guidelines: This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of January 1, 2003,
for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit, when indicated and feasible.
123456
123456 : Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and
recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the
vaccine’s other components are not contraindicated. Consult the manufacturers’ package inserts for detailed recommendations.
1. Hepatitis B vaccine (HBV): All infants should receive HBV-1 soon after birth
and before hospital discharge; the 1st dose also may be given by age 2 mos if
the infant’s mother is HBsAg-negative. Give HBV-2 >4 wks after HBV-1 and
HBV-3 >8 wks after HBV-2 (provided it is >4 mos since HBV-1 and infant is no
younger than 6 mos of age).
Infants born to HBsAg-positive mothers should receive 0.5 mL hepatitis B
immune globulin (HBIG) within 12 hrs of birth and HBV-1 at a separate site. HBV­
2 is recommended at 1-2 mos of age and HBV-3 at 6 mos of age.
Infants born to mothers whose HBsAg status is unknown should receive
HBV-1 within 12 hrs of birth. Maternal blood should be drawn at the time of
delivery to determine the mother’s HBsAg status. If the HBsAg test is positive,
the infant should receive 0.5 mL of HBIG as soon as possible (no later than 1 wk
of age). HBV-2 is recommended at 1 mo of age and HBV-3 at 6 mos of age.
Children and adolescents who have not previously received all 3 doses of
HBV should complete the series, with minimum intervals of 4 wks between HBV1 and HBV-2, and 8 wks between HBV-2 and HBV-3 (and 4 mos between HBV-1
and HBV-3). Refer to package insert for alternate 2-dose schedules for
adolescents.
2. Diphtheria, tetanus, and acellular pertussis (DTaP): DTaP-4 may be given as
early as 12 mos of age, if at least 6 mos have passed since DTaP-3 and the child
is considered unlikely to return at 15-18 mos of age. Td (tetanus and diphtheria
toxoids, adsorbed, for adult use) is recommended at 11-12 yrs of age, if at least
5 yrs have passed since the last dose of tetanus and diphtheria-containing vaccine.
Subsequent routine Td boosters are recommended every 10 yrs.
3. Haemophilus influenzae type b (Hib): Three Hib conjugate vaccines are
licensed for infants. If PRP-OMP (PedvaxHIB or Comvax) is given at 2 and 4
mos of age, a dose at 6 mos is not required. Do not use DTaP/Hib combination
products for the first 3 doses (primary series). Use any Hib conjugate vaccine as
a booster.
4.
Polio: Inactivated polio vaccine (IPV) is the only vaccine available in the United
States.
5.
Measles, mumps, rubella (MMR): MMR-2 is recommended at 4-6 yrs but may
be given during any visit, provided >4 wks have elapsed since MMR-1 and both
doses are given at >12 mos of age.
6.
Varicella (chickenpox): Varicella vaccine is recommended at any visit at or
after age 12 mos for susceptible children - i.e., those who lack a reliable history of
chickenpox. Susceptible persons age >13 yrs should receive 2 doses given at
least 4 wks apart.
7.
Pneumococcal: The heptavalent pneumococcal conjugate vaccine (PCV) is
recommended for all children age 2-23 mos and for certain children age 24-59
mos. Pneumococcal polysaccharide vaccine (PPV) is recommended, in
addition to PCV, for certain high-risk groups. See MMWR 2000;49(RR-9);1-35.
8.
Hepatitis A: Give hepatitis A vaccine to children and adolescents who are at
increased risk of infection, as defined by ACIP*, and consider it for all others >2
yrs of age who wish to obtain immunity. Give a booster >6 mos after the initial
dose.
9.
Influenza: Influenza vaccine is recommended annually for children age >6 mos
with certain risk factors (including, but not limited to asthma, cardiac disease,
sickle cell disease, HIV, and diabetes) [see MMWR 2002;51(RR-3);1-31]. It can
also be administered to all others wishing to obtain immunity. In addition, healthy
children age 6-23 mos are encouraged to receive influenza vaccine, if feasible,
because they are at substantially increased risk for influenza-related
hospitalizations. Children age <12 yrs should receive a dosage appropriate for
their age (0.25 mL, if age 6-35 mos or 0.5 mL, if age >3 yrs). Children aged <8
yrs who are receiving influenza vaccine for the first time should receive 2 doses
separated by at least 4 wks.
Based on recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and
the American Academy of Family Physicians (AAFP) and endorsed by the Immunization Practices Task Force of the Minnesota Department of Health (MDH).
*Questions or need current ACIP recommendations?
Call the Minnesota Immunization Hotline at 612-676-5100 or (toll-free) 1-800-657-3970.
Web site: www.health.state.mn.us/immunize
Minnesota Department of Health, March 2003, IC# 141-0188
14
For Children and Adolescents Who Start Late or Who Are >1 Month Behind
For any vaccine given in a series, it is not necessary to start over. Refer to the tables below for the recommended “catch-up” schedule
and minimum intervals between doses. Determine the number of previous doses of each vaccine received, find that number in the first
column, and read across to the appropriate column for the next dose(s) and minimum interval(s).
Table 1. Catch-up schedule for children 4 months through 6 years of age - must be used with guidelines below.
Doses to be given and minimum intervals from previous dose
Number of
previous doses
First dose
DTaP
IPV
HBV
MMR2
Varicella3
Hib1
PCV1,4
None
Third dose
Second dose
DTaP:
IPV:
HBV:
MMR2:
Hib:
One
4 weeks
4 weeks
4 weeks
4 weeks
4 weeks - if 1st dose given at <12
mos of age
8 weeks (as final dose) - if 1st
dose given at 12-14 mos of age
No further doses needed - if 1st
dose given at >15 mos of age
PCV4: 4 weeks - if 1st dose given
at <12 mos of age and child is <24
mos of age
8 weeks (as final dose) - if 1st
dose given at >12 mos of age or
child is now 24-59 mos of age
Two
DTaP: 4 weeks
IPV:
4 weeks
HBV: 8 weeks and 16 weeks after
first dose
Hib:
4 weeks6 - if current age <12
mos
8 weeks (as final dose)6 - if
current age >12 mos and
2nd dose given at age <15
mos
No further doses needed if previous dose given at age
>15 mos
PCV4: 4 weeks - if child is <12 mos
of age
8 weeks (as final dose) - if
child is >12 mos of age
Fourth dose
DTaP: 6 months
IPV5: 4 weeks
Hib6:
Fifth dose
DTaP7: 6 months
8 weeks (as final
dose) - this dose
necessary only for
children age 12
mos - 5 yrs who
received 3 doses
before age 12 mos
PCV4: 8 weeks (as final
dose) - if 3rd dose
given at <12 mos of
age
Three
Four
Table 2. Catch-up schedule for children 7 through 18 years of age - must be used with guidelines below.
Doses to be given and minimum intervals from previous dose
Number of
previous doses
None
First dose
Td
IPV
Second dose
Td:
IPV :
4 weeks
HBV
HBV:
4 weeks
5
MMR:
Varicella
3
Td:
4 weeks
5
MMR
Third dose
6 months
IPV5: 4 weeks
HBV: 8 weeks and 4 months
after 1st dose
4 weeks
Varicella : 4 weeks
3
One
Two
Three
Booster dose
Td: If 7-10 yrs of age:
• 6 mos, if 1st dose given at <1 yr of
age
• 5 yrs (but no sooner than age 11
yrs), if 1st dose given at >1 yr of
age
If 11-18 yrs of age:
• 5 yrs, if 3rd dose given at <7 yrs of
age
• 10 years, if 3rd dose given at >7 yrs
of age
IPV5
Guidelines for Catch-up
1. Hib and/or PCV: Vaccine generally is not recommended for children >5 years of age.
2. MMR: Do not administer MMR vaccine before 12 months of age. Administer 2nd dose of MMR routinely at 4-6 years of age or earlier, if desired.
3. Varicella: Do not administer varicella vaccine before 12 months of age. Give 2-dose series to all susceptible adolescents >13 years of age.
4. PCV: Use Table 1 to determine catch-up scheduling of children at high risk of infection, as well as healthy children <60 months of age who have begun, but not
completed, a schedule of PCV. Unvaccinated children 24-59 months of age and at moderate risk of infection need only 1 dose [see MMWR 2000;49(RR-9);135]. Consider giving 1 dose to unvaccinated children 36-59 months of age who are not at moderate or high risk of infection, yet wish to obtain immunity.
5. Polio: The 4th dose is not necessary in an all-IPV or all-OPV schedule, if the 3rd dose was given after the 4th birthday. If both OPV and IPV were given as part
of the series, a total of 4 doses should be given, regardless of the child’s current age. Vaccine generally is not recommended for persons >18 years of age.
6. Hib: If PRP-OMP (PedvaxHIB or Comvax) was given for the first 2 doses, no more than 3 doses are needed, with the final dose given at 12-15 months of age
and at least 8 weeks after the previous dose. If a 3rd dose of HbOC (HibTiter) or PRP-T (ActHib) is given at >12 months of age, a 4th dose is not needed.
7. DTaP: The 5th dose is not necessary if the 4th dose was given after the 4th birthday.
Reporting Adverse Reactions
Disease Reporting
Report adverse reactions to vaccines through the federal Vaccine Adverse Event Reporting System.
For information on reporting reactions following vaccines administered by private clinics, call the 24hour national toll-free information line at 1-800-822-7967. Report reactions to vaccine administered in
public clinics to the Minnesota Department of Health at 612-676-5414 or (toll-free) 1-877-676-5414.
Report suspected cases of vaccine-preventable diseases to the local
health department or to the Minnesota Department of Health, P.O. Box
9441, Minneapolis, MN 55440, 612-676-5414 or (toll-free) 1-877-6765414.
15
Recommended Adult Immunization Schedule
**Chart must be used with guidelines below**
Age ?
?
z
Vaccine
45 - 49 years
19 - 44 years
Tetanus, Diphtheria1
50 - 64 years
65+ years
Booster every 10 years
Measles, Mumps, Rubella2 1-2 doses, if born after 1956
Vaccines below line are for selected populations
Influenza3
Pneumococcal4
Hepatitis A5
Annually, if at risk or wishing to obtain immunity
1-2 doses for those with risk factors
Varicella8
1-2 doses
2 doses for those at increased risk of HAV infection and others wishing to obtain immunity
3 doses for those with risk factors
Hepatitis B6
Meningococcal7
Annually
1 or more doses for those with risk factors
2-dose series for selected groups
1. Tetanus and Diphtheria (Td): All previously unvaccinated adults should
complete a 3-dose primary series of diphtheria and tetanus toxoids. All
adults for whom 10 years have elapsed since their primary series or
since their last booster dose should receive a Td booster.
2. Measles, Mumps, Rubella: Adults born before 1957 are considered
naturally immune. Adults born in 1957 or later should receive 1 dose of
MMR vaccine. Some adults, such as college students, those working in
health care facilities, and international travelers may need 2 doses given
not less than 4 weeks apart.
3. Influenza: Administer influenza vaccine annually to all adults >50 years
of age; residents of nursing homes and other long-term care facilities;
younger adults with chronic cardiopulmonary disorders, chronic metabolic
diseases (including diabetes), renal dysfunction, hemoglobinopathies,
or immunosuppression, as well as to the household members, caregivers,
and health care workers of the above. Other adults who wish to reduce
their likelihood of becoming ill with influenza also may be vaccinated.
4. Pneumococcal: Give pneumococcal polysaccharide vaccine (PPV) to
all adults >65 years of age and those <65 years of age with chronic
cardiovascular disease, chronic pulmonary disease, diabetes mellitus,
alcoholism, cirrhosis, CSF leaks, functional or anatomic asplenia, HIV
infection, leukemia, lymphoma, Hodgkins disease, multiple myeloma,
generalized malignancy, chronic renal failure, nephrotic syndrome, or if
receiving immunosuppressive chemotherapy. Routine revaccination of
immunocompetent persons previously vaccinated with 23-valent PPV
is not recommended; however, revaccination is recommended if a person
was vaccinated >5 years previously and either (1) was <65 years of age
when first vaccinated and is now >65 years of age or (2) is at highest
risk for serious pneumococcal infection, as defined by ACIP, or (3) is
likely to have a rapid decline in pneumococcal antibody levels.
5. Hepatitis A: Give 2 doses of hepatitis A vaccine, 6-12 mos apart, to
persons who are at increased risk for infection with hepatitis A virus
(HAV), as well as to food-handlers and others wishing to obtain immunity.
Populations at increased risk include: persons traveling to or working in
countries with high rates of HAV, men who have sex with men, persons
who use street drugs, persons with chronic liver disease, persons who
work with HAV-infected primates or with HAV in a research setting, and
persons with clotting factor disorders.
6. Hepatitis B: Adults at risk for HBV infection include: persons who may
be exposed to blood or blood products in their work, clients and staff of
institutions for the developmentally disabled, hemodialysis patients,
recipients of factor VIII or IX concentrates, household or sexual contacts
of persons identified as HBsAg-positive, persons who plan to travel or
live in parts of the world where HBV infection is common, injecting drug
users, sexually active homosexual or bisexual males, sexually active
heterosexual persons with multiple partners or recent episode of an STD,
inmates of long-term correctional facilities, and persons of Pacific Islander
ethnicity or first-generation immigrants/refugees from countries where
HBV infection is of high/intermediate endemicity. Give a 3-dose series
on a schedule of 0, 1, and 6 months.
7. Meningococcal: Give quadrivalent polysaccharide meningococcal
vaccine (A/C/Y/W-135) to adults with terminal complement component
deficiencies, those with anatomic or functional asplenia, and travelers
to countries where meningococcal disease is epidemic (e.g., the
“meningitis belt” of sub-Saharan Africa) or to Mecca, Saudi Arabia.
Consider revaccination within 3-5 years for persons who continue to be
at high risk of infection (e.g., persons remaining in areas where disease
is epidemic). Providers may consider vaccination of college freshman
who live in dormitories to reduce their slightly increased risk of disease.
8. Varicella: Administer varicella vaccine to susceptible persons who will
have close contact with persons at high risk for serious complications
(e.g., health care workers and family contacts of immunocompromised
persons). Consider vaccinating susceptible persons who are at high
risk of exposure, such as those with occupational risk (e.g., teachers of
young children, day care workers, and residents and staff in institutional
settings), college students, inmates and staff of correctional institutions,
military personnel, non-pregnant women of childbearing age, and
international travelers. Vaccination for adults consists of 2 doses given
4-8 weeks apart.
Based on recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American College of Physicians
and endorsed by the Immunization Practices Task Force of the Minnesota Department of Health (MDH).
*Questions or need current ACIP recommendations?
Call the Minnesota Immunization Hotline at 612-676-5100 or (toll-free) 1-800- 657-3970.
Web site: www.health.state.mn.us/immunize
Minnesota Department of Health, 2002, IC# 141-0316
16
Catch-Up Schedule and Minimum Intervals for Adults
For any vaccine given in a series, it is not necesary to start over. Refer to the table below for the recommended “catch-up”
schedule and minimum intervals between doses. Determine the number of previous doses of each vaccine received, find
that number in the first column, and read across to the appropriate column for the next dose(s) and minimum interval(s).
Doses to be given and minimum intervals from previous dose for adults >19 years of age
Number of
previous doses
None
First dose
Second dose
Td
Td: 4 weeks after 1st dose
MMR
MMR: 4 weeks after 1st dose
Pneumococcal
(PPV)
PPV: 5 years after 1st dose for those who
received 1st dose at <65 years of age or who
are at highest risk for pneumococcal infection
Hepatitis A (HAV)
HAV: 6 months after 1st dose
Hepatitis B (HBV)
HBV: 4 weeks after 1st dose
Varicella
Varicella: 4 weeks after 1st dose
Third dose
Booster dose
Td: 6 months after 2nd dose
Td: 10 years after
completion of the primary
series or since last
booster dose
HBV: 8 weeks after 2nd dose
and 4 months after 1st dose
One
Two
Three
Guidelines for Patients with an Incomplete or Non-existent Vaccine History
• For adult patients who are refugees or immigrants, provide vac­
cinations as you would for any other adult patient. Translations of
foreign vaccine terms and vaccine products can be found in the
Minnesota Department of Health (MDH) Provider’s Guide to Im­
munizations or on the MDH web site: www.health.state.mn.us/immunize.
• Patients 18 years of age or older, including foreign-born adults,
do not need polio vaccination, unless they are traveling to a coun­
try where wild poliovirus still exists. (See MDH Recommended
Immunizations for International Travel.)
• A Mantoux tuberculin skin test can be administered simulta­
neously with any live or inactivated vaccine. If the patient already
received MMR, the Mantoux test must be delayed for at least 4
weeks after the MMR; if the Mantoux was applied first, MMR or
any other vaccine can be given at any time.
• Count only vaccinations that are well documented (i.e., includ­
ing month, year, and, preferably, day of vaccination). If no docu­
mentation exists, assume the patient is unvaccinated. It is always
better to vaccinate when in doubt, rather than miss an opportunity
to provide protection.
• This catch-up schedule must be used together with the guide­
lines on page 16.
• Use all opportunities to assess the vaccination status of adult
patients. At age 50 years, give a Td (unless a dose has been
given in the previous 10 years) and evaluate for risk factors for
pneumococcal and other vaccine-preventable diseases.
• If patient has started a series (e.g., HBV) but not completed it,
continue where he/she left off. Never restart a series of any
vaccine (exception: oral typhoid vaccine, in some situations).
• MMR and varicella vaccines can be given at the same visit. If
not given simultaneously, they must be separated by at least 4
weeks.
• Patients do not need measles, mumps, and/or rubella vaccine
if they were born before 1957, have lab evidence of immunity, or
(for measles/mumps only) have a physician-diagnosed disease
history. Consider vaccinating women born before 1957 who may
become pregnant and do not have lab evidence of immunity or
physician-diagnosed disease.
Reporting Adverse Reactions
Disease Reporting
Report adverse reactions to vaccines through the federal Vaccine Adverse
Event Reporting System. For information on reporting reactions following
vaccines administered by private clinics, call the 24-hour national (toll-free)
information line at 1-800-822-7967. Report reactions to vaccines
administered in public clinics to the Minnesota Department of Health at
612-676-5414 or (toll-free) 1-877-676-5414.
Report suspected cases of vaccine-preventable diseases
to the local health department or to the Minnesota
Department of Health, P.O. Box 9441, Minneapolis,
Minnesota 55440, 612-676-5414 or (toll-free) 1-877-6765414.
17
Newly Approved Blood Test for Diagnosing Latent
Tuberculosis Infection: Guidelines for Use of
QuantiFERON®-TB
Until recently, the only test available to
diagnose latent tuberculosis infection
(LTBI) was the tuberculin skin test
(TST). In late 2001, the Food and Drug
®
Administration approved QuantiFERON
-TB (QFT), a new diagnostic test for
LTBI. Due to limited clinical experience
regarding the use of QFT and the
absence of a “gold standard” to confirm
LTBI, data to assess the accuracy and
beneficial applications of QFT currently
are limited. In January 2003, the
Centers for Disease Control and
Prevention (CDC) issued interim
guidelines for the use of QFT.1 These
guidelines are intended to provide
guidance on the use and interpretation
of QFT for public health professionals,
health care providers, and laboratorians
involved in TB prevention and control
activities in the United States. Those
recommendations are summarized
here.
and limited clinical and laboratory
experience with the test. Also, due to
insufficient data on the predictive
accuracy of QFT in some populations,
the CDC guidelines do not support the
use of QFT in certain situations in
which the TST commonly is employed
(e.g., TB contact investigations or
evaluation of patients with suspected
TB disease). CDC also recommends
confirming a positive QFT result with a
TST before starting treatment for LTBI,
particularly in certain low-risk patients.
QFT, manufactured by Cellestis Limited
of Australia, measures immune
response to infection with Mycobacterium tuberculosis (Mtb) by quantifying
the release of interferon-gamma in
whole blood in response to stimulation
by purified protein derivative. As with
the TST, where cutoffs of 5, 10, or 15
millimeters of induration are used to
identify a positive TST result for high-,
moderate- and low-risk persons,
interpretation of QFT results also is
stratified by the patient’s estimated risk
for LTBI. QFT can aid in detecting LTBI
among certain populations, including
recent immigrants from areas of the
world where TB is common, injection
drug users, residents and employees of
correctional facilities, and health care
workers.
• initial and serial testing of persons
Advantages of QFT include the facts
that it is less subject to reader bias and
error than the TST; it is accomplished in
a single patient visit; it does not “boost”
immune response in persons with
remote LTBI; and, it differentiates
between infection with Mtb and Mycobacterium avium, a common
nontuberculous mycobacteria. Limita­
tions of QFT include the need to draw
blood, the need to process the blood
sample within 12 hours after collection,
CDC recommends that QFT can be
considered to screen for LTBI in the
following circumstances:
• initial and serial testing of certain
persons at an increased risk for LTBI
(e.g., recent immigrants, injection
drug users, residents and employ­
ees of correctional facilities);
who are, by history, at low risk for
LTBI but whose future activity might
place them at increased risk for
exposure, and others eligible for
LTBI surveillance programs (e.g.,
health care workers and military
personnel); and,
• testing of persons for whom screen­
ing may be required but who are not
considered to have an increased
risk for LTBI (e.g., entrance require­
ments for certain schools and
workplaces).
Due to a lack of sufficient data on which
to base recommendations, CDC
currently does NOT recommended QFT
for:
• evaluation of persons with sus­
pected TB disease;
• assessment of contacts of persons
• detection of LTBI after a suspected
exposure (e.g., laboratory spill of
Mtb) among persons who receive
serial testing for LTBI;
• confirmation of postitive TST results
(because injection of tuberculin in
tuberculin skin testing might affect
subsequent QFT results); or,
• diagnosis of M. avium complex
disease.
Consistent with current guidelines for
tuberculin skin testing, CDC discour­
ages screening for LTBI among
populations at low risk for TB, regard­
less of whether screening is performed
using the TST or QFT. Also, screening
for LTBI is recommended only if plans
are in place to provide necessary
follow-up, including medical evaluation
for persons with positive screening
results and treatment for persons
diagnosed with LTBI.
Before QFT testing is contemplated,
arrangements should be made with a
qualified laboratory to perform the test.
The Minnesota Department of Health
(MDH) TB Prevention and Control
Program is not aware of any facility or
laboratory in Minnesota that currently
uses or performs the QFT test. How­
ever, MDH is interested in determining
whether any facilities in Minnesota have
used QFT (or plan to do so) and in
learning from those experiences. If
your facility is conducting (or consider­
ing implementation of) QFT testing,
please contact the MDH TB Program’s
Nurse Consultant, Deb Sodt, at (612)
676-5421.
A fact sheet regarding QFT is available
on the CDC website at http://
www.cdc.gov/nchstp/tb/pubs/
tbfactsheets/250103.htm.
with infectious TB;
References:
• screening of children less than 17
years of age, pregnant women, or
persons with clinical conditions (e.g.,
HIV infection) that increase the risk
for progression of LTBI to TB
disease;
18
1. Centers for Disease Control and
Prevention. Guidelines for using the
QuantiFERON®-TB test for diagnosing
latent Mycobacterium tuberculosis
infection. MMWR 2003;52(No. RR-2):1518.
DCN Readership Alert and Survey
The Minnesota Department of Health (MDH) Disease Control Newsletter (DCN) has been published for over 20 years.
The printed newsletter is mailed free of charge to every licensed physician in Minnesota and to other health care profes­
sionals who desire to receive it. We currently send each issue to over 17,000 individuals. Eight to 10 issues are pub­
lished annually, including a yearly issue devoted to an annual summary of communicable diseases reported in Minnesota.
Issues of the DCN are posted on the MDH website (http://www.health.state.mn.us/divs/dpc/ades/pub.htm).
Due to cutbacks in federal and state budgets that fund publication of the DCN, we are prompted to evaluate both the
content and format of the newsletter. To facilitate this assessment, please complete this brief survey. You may complete
this form and mail or fax it to MDH, or you may access and complete the survey online at http://www.health.state.mn.us/
divs/dpc/ades/dcn/rdr_survey.cfm. Your opinions are valuable to us. Thank you for completing the survey.
Name (optional):______________________________________________________
1. Do you receive the DCN directly by mail?
Yes___ No___
2. How much of a DCN issue do you typically read?
All ___ Most___ Some____ None___
3. Do you access the DCN on the MDH website?
Often ___ Sometimes ___ Never ____
4. On a scale of 1 to 5, with 1 being “NOT USEFUL” and 5 being “HIGHLY USEFUL”, how do you rate the DCN for
providing useful information?
1 2 3
4 5
5. If we were to stop printing and mailing the DCN, how often would you access DCN issues on the MDH website?
Often ____ Sometimes ______ Never ____
6. If we were to create an e-mail distribution list to disseminate electronic copies of the DCN, would you subscribe?
Yes ____ No ____
7. By what method would you prefer to receive the DCN (select one)?
Printed and mailed ___ E-mail distribution list ____ On-line at MDH website _____
8. What types of articles do you find particularly useful in the DCN? (select all that apply)
Annual summary of communicable diseases ___
Reprints/excerpts of recently released clinical/public health guidelines ____
Antibiogram ___
Summaries of recent state/local outbreak investigations ____
Non-communicable disease issues (e.g., cancer) _____
Other (specify): _____________________________________________
9. Your occupation: Physician___ Nurse ____ Public health professional ___ Laboratorian ____
Other (specify): ____________________________________
10. If you are a physician, what is your speciality?
Infectious Disease ___ Family Practice ___ Pediatrics ___ Internal Medicine ____ OB/GYN ____
Other (specify): _____________________________________
Please provide any additional comments regarding the DCN, its future, and/or about topics you would like to see ad­
dressed in the DCN:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Thank you. Please fax this page to MDH at: (612) 676-5743
OR
Mail to: Val Solovjovs
Acute Disease Investigation and Control
Minnesota Department of Health
717 SE Delaware St.
Minneapolis, MN 55414
OR You can access and complete this survey on our website at http://www.health.state.mn.us/divs/dpc/ades/dcn/
rdr_survey.cfm.
.
19
Please complete the survey on page 19.
To report a communicable disease
to the Minnesota Department of Health call 612-676-5414 or
(toll-free) 1-877-676-5414
Aggie Leitheiser, Acting Commissioner of Health
Division of Infectious Disease Epidemiology, Prevention and Control
Harry F. Hull, M.D. ........................... Division Director & State Epidemiologist
Richard N. Danila, Ph.D., M.P.H. ............................... ADIC Section Manager
Kirk Smith, D.V.M., Ph.D. ...................................................................... Editor
Wendy Mills, M.P.H. .............................................................. Assistant Editor
Valerie Solovjovs ................................................................. Production Editor
CHANGING YOUR ADDRESS?
Please correct the address
below and send it to:
DCN MAILING LIST
Minnesota Department of Health
717 Delaware Street SE
PO Box 9441
Minneapolis, MN 55440-9441
The Disease Control Newsletter is available on the MDH Acute Disease Investigation and Control
(ADIC) Section web site (http://www.health.state.mn.us/divs/dpc/ades/pub.htm).
The Disease Control Newsletter toll-free telephone number is 1-800-366-2597.