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HomeMy WebLinkAboutcivil-surgeon-letter-new-tb-technical-instructions-ada Aneeka Chaudhry Interim AC Health Director Page 1 of 3 Kimi Watkins-Tartt ACPHD Director Dr. Nick Moss Health Dr. Amit Chitnis Controller December 17, 2018 Dear Alameda County Civil Surgeon, As of October 1, 2018, the Centers for Disease Control and Prevention have released new Tuberculosis (TB) Technical Instructions for Civil Surgeons. A summary of the pertinent TB screening recommendations; reporting requirements; and Civil Surgeon responsibilities are provided below. Summary of Pertinent TB Screening Recommendations for Civil Surgeons • All applicants 2 years of age or older are required to have an interferon-gamma release assay (IGRA) The United States Food and Drug Administration has approved two IGRAs: • QuantiFERON-TB • Gold Plus (QFT-Plus) and the T-SPOT.TB blood test • All applicants less than 2 years of age must have a history and physical exam provided by a parent or responsible adult • Anyone with signs of symptoms suggestive of TB disease or known human immunodeficiency virus (HIV) infection must have a TST; PA and lateral chest radiograph (CXR); and must be reported to the health department • A CXR is required if an applicant has any of the following findings: • Positive IGRA • Known HIV infection • Signs or symptoms of TB disease • All lGRAs, TSTs, and CXRs must be ordered by civil surgeons and must be performed independently of the health department • Do not refer applicants to the health department for an IGRA, TST, or CXR Page 2 of 3 Health.AlamedaCountyCA.gov/ACPHD Reporting Requirements • The table below provides a summary of applicants who must be reported to the health department Category of Applicant Definition • and all • Normal CXR • No known HIV • No sign or symptom of active TB disease • Active TB Disease • or • Positive or negative IGRA • For persons less than 2 years of age, a TST must be used • There are two options for reporting applicants to the health department • Electronically via the CalREDIE Provider Portal • Fax a Confidential Morbidity Report (CMR) to Alameda County TB Control at (510) 273-3916  If a CMR is faxed, then indicate in the remarks section that you are a civil surgeon • For applicants with suspected or confirmed active TB disease, the law mandates that reports be submitted within one business day to TB Control by either calling (510)667-3096, or sending a fax to (510) 273-3916. • Please note the Alameda County Public Health Department does not have a TB clinic where patients can be seen and evaluated. The Alameda County TB Control Program can help coordinate and link patients to care who have suspected or confirmed active TB disease Page 3 of 3 Health.AlamedaCountyCA.gov/ACPHD Civil Surgeon Responsibilities • It is the responsibility of the civil surgeon to complete the I-693 form. • For an applicant who is referred to the health department for TB disease (e.g., suspected or confirmed active TB), the civil surgeon cannot sign the form until the applicant returns from the local health department with documentation of the results of the TB evaluation We have compiled several resources that may be helpful to both you and your applicants: • TB and LTBI Fact Sheet from the Centers for Disease Control and Prevention • Alameda County Provider Guide to Diagnosis and Treatment of TB and LTBI • List of potential clinics where patient can receive LTBI treatment if they do not have a primary care physician or insurance • Referral Letter recommending LTBI treatment that can be sent to an applicant's primary care physician • Letter to patient summarizing resuIt of TB evaluation • LTBI • Referral to Health Department If you have any questions regarding civil surgeon instructions and reporting requirements or the diagnosis or treatment of TB or LTBI, please contact Alameda County TB Control Program. Sincerely, Amit Chitnis, MD, MPH TB Controller and Section Director