Guidelines on the Prevention and Control of Tuberculosis in Ireland

More documents

Recommendations

Info

<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCSputum smear positive TBThe revised WHO definition of a new sputum smear positive pulmonary TB case is based on the presenceof at least one acid fast bacillus (AFB+) in at least one sputum sample in countries with a well functioningexternal quality assurance (EQA) system in their laboratories. 24Sputum smear negative TBA sputum smear negative patient has:• At least three negative sputum smears (including at least one early morning specimen)• Chest X-ray findings consistent with TB and• Lack of response to a trial of broad-spectrum antimicrobial agents (Note: because thefluoroquinolones are active against M. tuberculosis complex and thus may cause transientimprovement in persons with TB, they should be avoided). 25It should be noted that in making a diagnosis of sputum smear negative TB based on the above threecriteria, a clinician who decides to treat with a full course of anti-TB chemotherapy should report thisas a case of sputum smear negative pulmonary TB to the MOH. Although the results of culture maynot be available until after a decision to begin treatment has to be made, treatment should be stoppedsubsequently if cultures are negative, the patient has not responded clinically and the clinician has soughtother evidence in pursuing the differential diagnosis. 25TB outbreaksThe following are examples of situations to report:1. An unexpected increase (significantly above baseline) of newly identified confirmed or suspectedcases in any setting2. Two or more TB cases on treatment from a congregate (e.g. school or prison) or high risk settinge.g. HIV positive individuals occurring within a relatively short space of time3. Three or more TB cases on treatment in a household4. Three or more cases on treatment from a community setting (outside a household) occurring withina relatively short period of time who may be related5. Two or more cases of MDR-TB or XDR-TB that may be related and occur outside a household.When assessing whether a cluster of TB cases represents an outbreak, indicators to look for include:• Epidemiological links between cases• Similar unique characteristics among cases• Matching drug resistance patterns of isolates• Matching DNA fingerprint patterns of isolates.Outbreaks of particular concern are MDR-TB or XDR-TB outbreaks, outbreaks among immunocompromisedpopulations, children or other vulnerable groups.1.5 Notification ProceduresOnce a diagnosis of TB is either laboratory confirmed or strongly suspected on clinical grounds, the MOHshould be notified by the clinical director of a diagnostic laboratory and/or clinician as soon as possibleand ideally at the time of diagnosis (appendix 2). Infection prevention and control staff or other laboratorymedical or scientific staff to whom the function of providing notification of infectious diseases has beendelegated by the clinician/clinical director of the laboratory may notify the case (s) also if authorised to doso by the clinician. Notification should be made using the infectious disease notification form available at:www.hpsc.ie/hpsc/NotifiableDiseases/NotificationForms/.-7-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCOnce notified, the MOH or designated medical officer, usually a Consultant in Public Health Medicine(CPHM) shall inform the designated members of the contact tracing team of cases of new and re-treatmentTB as they occur. Immediate notification enables prompt contact tracing and facilitates successful contactinvestigation. The practitioner notifying presumed cases of TB is also required to inform the MOH ordesignated medical officer if the diagnosis subsequently proves not to be TB. If the case of TB is fromanother HSE area, the MOH or designated medical officer should notify his/her opposite number in therelevant HSE area. The responsible MOH is required to report possible, probable and confirmed cases ofTB to the Health Protection Surveillance Centre (HPSC).Recommendation:Once a diagnosis of TB is either laboratory confirmed or strongly suspected on clinicalgrounds, the MOH should be notified by the clinical director of the laboratory and/or clinicianas soon as possible and ideally at the time of diagnosis.In the case of unusual incidences or clusters of TB cases, they should be notified by the MOH ordesignated medical officer to the HPSC as they occur. 21Recommendation:Reporting of outbreaks of TB is a mandatory requirement.Following notification of a case of TB, the MOH or designated medical officer shall seek further clinicaldata on the case as an aid to contact tracing and detailed TB surveillance. The national TB notificationform is available at: http://www.hpsc.ie/hpsc/AZ/VaccinePreventable/TuberculosisTB/SurveillanceForms/(appendix 3).Enhanced surveillanceThe specific objectives of surveillance are to:• Support local management of identified cases, contacts and screening programmes• To monitor the incidence and distribution of TB disease at both local and national level• To identify risk factors to support interventions aimed at the prevention of TB• To monitor the process and outcome of disease control and screening programmes so thatimprovements can be introduced• To monitor antibiotic susceptibility to M. tuberculosis and M. bovis to guide appropriate use ofantibiotics.Notification of cases of TB forms the basis of surveillance and public health follow-up of cases and contacts.The early identification of cases of TB is essential to the effective management and control of the disease.National epidemiological data on TB have been collated by the HPSC, formerly the National DiseaseSurveillance Centre (NDSC) since 1998. Prior to the establishment of HPSC, limited epidemiologicaldata had been collated for TB in Ireland. An enhanced national TB surveillance system (NTBSS) becameoperational in 2000, following consultation with the eight health boards and the National TuberculosisAdvisory Committee. The NTBSS is based on the minimum dataset required to be reported by Ireland toEuroTB, 10 the European TB surveillance centre located at the European Centre for Disease Prevention andControl (ECDC), which collates national TB data within Europe and contributes epidemiological data to theWHO global TB control programme for Europe.-8-
Page 2 and 3: Guidelines on the
Page 54 and 55: BGuidelines on the
Page 70 and 71: 1♦Guidelines on
Page 76 and 77:
Guidelines on the
Page 78 and 79:
Guidelines on the
Page 80 and 81:
Guidelines on the
Page 82 and 83:
Guidelines on the
Page 84 and 85:
Guidelines on the
Page 86 and 87:
Guidelines on the
Page 88 and 89:
Guidelines on the
Page 90 and 91:
Guidelines on the
Page 92 and 93:
Guidelines on the
Page 94 and 95:
Guidelines on the
Page 96 and 97:
Guidelines on the
Page 98 and 99:
Figure 6.1Patient placement for Pul
Page 100 and 101:
Guidelines on the
Page 102 and 103:
Guidelines on the
Page 104 and 105:
Guidelines on the
Page 106 and 107:
Guidelines on the
Page 108 and 109:
Guidelines on the
Page 110 and 111:
Guidelines on the
Page 112 and 113:
Guidelines on the
Page 114 and 115:
Guidelines on the
Page 116 and 117:
Guidelines on the
Page 118 and 119:
Guidelines on the
Page 120 and 121:
Guidelines on the
Page 122 and 123:
Guidelines on the
Page 124 and 125:
Guidelines on the
Page 126 and 127:
Guidelines on the
Page 128 and 129:
Guidelines on the
Page 130 and 131:
Guidelines on the
Page 132 and 133:
Guidelines on the
Page 134 and 135:
Guidelines on the
Page 136 and 137:
Guidelines on the
Page 138 and 139:
Guidelines on the
Page 140 and 141:
Guidelines on the
Page 142 and 143:
Guidelines on the
Page 144 and 145:
Guidelines on the
Page 146 and 147:
Guidelines on the
Page 148 and 149:
Guidelines on the
Page 150 and 151:
Guidelines on the
Page 152 and 153:
Guidelines on the
Page 154 and 155:
Guidelines on the
Page 156 and 157:
Guidelines on the
Page 158 and 159:
Guidelines on the
Page 160 and 161:
Guidelines on the
Page 162 and 163:
Guidelines on the
Page 164 and 165:
Guidelines on the
Page 166 and 167:
Guidelines on the
Page 168 and 169:
Guidelines on the
Page 170 and 171:
Guidelines on the
Page 172 and 173:
Guidelines on the
Page 174 and 175:
Guidelines on the
Page 176 and 177:
Guidelines on the
Page 178 and 179:
Guidelines on the
Page 180 and 181:
Guidelines on the
Page 182 and 183:
Guidelines on the
Page 184 and 185:
Guidelines on the
Page 186 and 187:
Guidelines on the
Page 188 and 189:
Guidelines on the
Page 190 and 191:
Guidelines on the
Page 192 and 193:
Guidelines on the
Page 194 and 195:
Guidelines on the
Page 196 and 197:
Guidelines on the
Page 198 and 199:
Guidelines on the
Page 200 and 201:
Guidelines on the
Page 202 and 203:
Guidelines on the
Page 204 and 205:
Guidelines on the
Page 206 and 207:
Guidelines on the
Page 208 and 209:
Guidelines on the
Page 210 and 211:
Guidelines on the
Page 212 and 213:
Guidelines on the
Page 214 and 215:
Guidelines on the
Page 216 and 217:
Guidelines on the
Page 218:
25-27 Middle Gardiner Street Dublin
show all

Guidelines on the Prevention and Control of Tuberculosis in Ireland

Create successful ePaper yourself

Delete template?

Save as template?