REVIEW OF THE NEW TB RISK ASSESSMENT

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REVIEW OF THE NEW TB RISK ASSESSMENT

• Kristin Rounds
• South Dakota Department of Health
• May 7, 2007

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Presentation Outline

• I. South Dakota Statistical Review
• II. TB Risk Assessment Worksheet
• III. Whats New in TB Control

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South Dakota TB Statistical Review
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TB in South Dakota1962-2006
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Number of TB Cases 1997-2006
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of Foreign-born TB Cases in SD 1997-2006
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of TB Latent Infections 1997-2006
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TB Risk Assessment Review
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TB Risk Assessment Review

• The TB risk assessment is an ongoing
• evaluation of the facility that determines the
• relative risk for transmission of TB.
• Includes a review of the following
• -- community rate of TB
• -- of TB patients encountered in facility
• -- speed at which TB patients are identified,
• isolated evaluated (inpatient only)
• Determines frequency of TB skin testing
• other infection control recommendations.

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TB Risk Assessment Review cont.

• Original TB risk assessment guidelines
• published in 1994 by CDC.
• 1994 guidelines included 5 risk categories
• -- Minimal Risk
• -- Very Low Risk
• -- Low Risk
• -- Intermediate Risk
• -- High Risk
• Document targeted mostly to inpatient and
• hospital-based facilities.

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TB Risk Assessment Review cont.

• CDC guidelines updated in December 2005.
• New 2005 risk categories
• -- Low Risk
• -- Medium Risk
• -- Potential Ongoing Transmission
• Revised guidelines are broader referencing
• health care setting versus health care
• facility. Includes nontraditional facility-
• based settings including EMS, correctional
• health, home-based health-care, long-term
• care, homeless shelters.

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Steps in a TB Risk Assessment

• 1. Assign responsibility to a specific person.
• 2. Determine time period to be assessed (usually
  previous calendar year).
• 3. Determine the counties to be included in
  assessment.
• (The recommendation is to include the counties
  of residence for clients and employees during
  the time period assessed. Do not include
  out-of-state
• county information unless the facility receives
  clients or staff from those locations on a
  consistent basis).

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Steps in a TB Risk Assessment

• 4. Calculate the of TB cases reported in the
  counties included in the assessment.
• 5. Calculate the of TB cases encountered in
  the health care setting.
• 6. Determine type of health care setting
• -- Inpatient lt200 beds
• -- Inpatient gt200 beds
• -- Outpatient/non-traditional setting

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Steps in a TB Risk Assessment

• 7. Determine TB risk category
• Low Risk
• Inpatient lt 200 beds lt 3 TB cases
• Inpatient gt 200 beds lt 6 TB cases
• Outpatient/nontraditional lt 3 TB cases
• Medium Risk
• Inpatient lt 200 beds ? 3 TB cases
• Inpatient gt 200 beds ? 6 TB cases
• Outpatient/non-traditional ? 3 TB cases
• Potential Ongoing Transmission
• Evidence of ongoing transmission of TB
• regardless of setting.

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TB Screening Recommendations

• Low Risk
• Baseline TB screening for new staff/clients upon
• hire/admission (TB skin test or blood test)
• No annual testing recommended
• If TB skin test, require chest X-ray to rule
  out active TB
• Medium Risk
• Baseline TB screening for new staff/clients upon
• hire/admission (TB skin test or blood test)
• Annual TB screening
• If TB skin test, require chest X-ray to rule
  out active TB
• Potential Ongoing Transmission
• TB screening every 8-10 weeks until no evidence
  of
• ongoing transmission. This is a temporary
  classification.

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

• CDC webpage www.cdc.gov/tb
• Download PDF file
• Click on TB guidelines (left)
• Click on Listed by Category
• Click on Infection Control
• Receive by mail
• Click on Order Publications (left)
• Currently being reprinted and not available!

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Whats New in TB Control
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Whats New in TB Control?QuantiFERON Gold
Overview

• QuantiFERON-TB Gold Test (2nd generation test).
• Approved by FDA in 2005.
• Blood test for LTBI which could can be used in
  all circumstances that the TB skin test is used.
• Measures the release of IFN-gamma released from
  white blood cells in infected persons.
• Not currently available in South Dakota. Test
  currently requires 12 hour window from collection
  to inoculation in laboratory which is not
  possible in SD even with a courier service.

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Whats New in TB Control? XDR-TB

• First reported in November 2005.
• TB cases resistant to the following meds
• INH, Rifampin, any fluoroquinolone and
• at least one second-line injectable drug
• (amikacin, capreomycin, kanamycin)
• Requires treatment for 24 months or longer
• Reported primarily in California New York
• During 1993-1999, 19 patients reported
• During 2000-2006, 10 patients reported

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For additional questions, please contact
Kristin Rounds TB Control
Program SD Department of Health 615 East
4th Street Pierre, SD 57501 (605)
773-3737 1-800-592-1861 kristin.rounds
_at_state.sd.us DOH Website ww.state.sd.us/doh/t
b