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Download No Slide Title - New England TB Consortium
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Transcript
TB Prevention and Control in Correctional and Detention Facilities Mark Lobato, MD Division of TB Elimination Centers for Disease Control and Prevention Corrections Connections Forming Partnerships to Stop TB April 26-27 and May 11, 2007 What’s New? (1) • Broadens definition of corrections to include detention facilities • Uses a risk assessment approach • Recommends all inmates receive symptom screening • Suggests testing by TST or QFT-Gold What’s New? (2) • Highlights importance of collaboration, education, and evaluation • Emphasizes case management • Expands environmental controls section and adds a section on respiratory protection • Recognizes the role of ICE in screening the foreign born in the U.S. TB Testing • TST should be done within 7 days • If TST positive, CXR done within 72 hours • HIV-infected persons require a CXR Facility Risk Assessment Minimum Risk Facility • Zero TB cases in last year • Not a “high-risk” population (HIV, IDU) • Not large numbers of foreign born • Employees not otherwise at risk for TB • All other facilities are non-minimal risk Individual Risk Assessment Minimum Risk Facility • Inmates with TB symptoms require immediate isolation in an AII room • Individuals in minimum-risk facilities require further evaluation if • clinical condition or risk factor for TB • HIV • require CXR Non-Minimum Risk Facility • Review symptoms at entry • immediately place symptomatic in a AII room • TB test (TST, QFT-G, CXR) within 7 days • CXR for HIV infected or immunosuppressed • Consider therapy for positive test results TB Screening: > Minimal Risk Facility Entry Screen for symptoms TB Symptoms Present? Yes Isolate and evaluate No Obtain medical History Previous TST + documented? No Yes If treatment not completed, CXR and evaluate TB Screening: > Minimal Risk Facility No previous TST+ documented TST* or QFT-G TST+ or QFT-G? Yes CXR and evaluate Yes CXR and evaluate No HIV+ or at risk for HIV but status unknown? No Retest periodically In long-term facilities *2-step testing recommended for Initial testing in facilities that perform periodic TST testing Recommendations • Report suspect cases by all entities including federal facilities to local or state HD • Screen all incoming inmates at entry with at least a TB symptom review • Perform risk assessment • Isolate TB suspects immediately • Plan for discharge early • Provides a special section on ICE detainees New and Renewed Emphasis • Summarizes treatment for TB and latent TB infection • Expands on collaboration between health departments and medical staff • Emphasizes contact investigations • Provides details for evaluation of TB control activities • Offers guidance on training and education Airborne Infection Isolation (AII) • Initiate TB AII precautions for any patient who • Has signs and symptoms of TB disease • Has not completed treatment • Has not previously been determined noninfectious When to Discontinue AII • Discontinue AII when infectious TB is unlikely • Another diagnosis is made • Patient has 3 negative AFB sputum smears • If patient has 3 negative AFB smear results • Release after starting 4 anti-TB drugs • Patient improving clinically LTBI - Treatment • Prioritize patients • Preferred treatment 9 months INH • Daily or biweekly (DOT) • Other regimens • 4 months rifampin • NOT 2 months of pyrazidamide and rifampin • Drug resistance Collaboration • Requires formal mechanisms • Designated liaisons • Regular meetings • Written agreements • Case management • Discharge planning • Contact investigations Case Management • Care should be individualized • Management should be coordinated with health department • Most inmates released before treatment is completed • Evaluate outcomes Jails – A Community Institution Shelter Soup Kitchen Homeless Clinic Hospital Clinic Jail Detention -Center Discharge Planning • Requires coordination between corrections and public health • Begin as soon as possible • Interview by health department should occur before release Contact Investigations • Goal is to interrupt TB transmission • Collaboration with public health essential • Scope of investigation depends on • Site of TB disease (pulmonary, laryngeal) • AFB smear status (smear positive) • “Index of suspicion”
