Tuberculosis

Tuberculosis 1. Class 1A case report required. 2. Human Infections: The local health officer shall determine and prescribe for individual cases and contacts the isolation, quarantine restrictions and/or treatment necessary for their protection and that of other people. Should any patient fail to observe the isolation methods prescribed by the local health officer, said health officer shall quarantine the patient in writing and prescribe therein the procedures to be carried out by said patient. Should the patient break his/her quarantine restrictions, the local health officer may apply by letter outlining the circumstances to the Executive Secretary of the Mississippi State Board of Health and request approval of proceedings to commit the patient to a hospital. Upon approval by the Executive Secretary of the Mississippi State Board of Health, the local health officer may initiate proceedings as provided by law for the forcible commitment of the patient. (Sections 41-33-5, 41-33-7, Mississippi Code of 1972 as amended.) 3. Control in Animals: Bovine tuberculosis may be transmitted to man by infected cattle through close contact or the consumption of raw milk. Milk shall be from dairy herds that comply with tuberculosis requirements set forth in the current Mississippi State Board of Health Regulations, and the Mississippi State Department of Health Regulations Governing the Production and Sale of Milk and Milk Products. 4. Tuberculosis Management in Correctional Institution: The following regulations govern all Mississippi state correctional facilities, city and county facilities housing state prisoners, and privately operated correctional facilities in the state. a. “Correctional Institutions” and/or “correctional facility” shall be construed to mean any of the state-operated penitentiaries, privately operated correctional facilities, community work centers, community pre-release centers, restitution centers, county or regional correctional facilities, and/or administrative offices as is applicable to each respective policy. b. All inmates shall be medically screened for communicable diseases (including Mycobacterium tuberculosis [TB], syphilis, and Human Immunodeficiency Virus [HIV]) to prevent the spread of these diseases within the correctional institutions and to the public. Employees (i.e. full and part-time employees, contract staff and volunteers) shall be screened for tuberculosis infection and disease. c. The correctional institution shall establish schedules, protocols, and responsibilities for the testing of inmates and employees to ensure compliance with all relevant Mississippi State Department of Health (MSDH) guidelines. The correctional institution shall appoint a liaison to ensure that all necessary screening is provided to each inmate and employee under its jurisdiction regardless of the individual’s physical location. d. The director of the correctional institution, in consultation with the correctional institution’s medical director, shall issue procedures to ensure that inmates, prior to being transferred into the correctional institution from another correctional institution, a non-state facility, or out-of-state jurisdiction have been properly tested/screened for communicable disease within the previous thirty (30) days. If such testing and screening has not been accomplished, the director shall ensure that these procedures are completed prior to the transfer or upon the receipt of the inmate. e. Screening shall include a Rapid Plasma Reagin (RPR) for syphilis, HIV serology, and TB testing, including, TB signs and symptoms assessment, exposure history, two-step Mantoux tuberculin skin test or blood assay for mycobacterium tuberculosis (BAMT) and chest x-ray if indicated. All HIV-Positive inmates and employees shall have an x-ray as part of the medical screening. No inmate shall be placed in the general population until the medical assessment is completed. Any symptomatic inmate shall remain in respiratory isolation until TB test results are known and active tuberculosis disease has been ruled out. Documentation of these screening tests shall be maintained for all inmates in a correctional institution. Test results shall be reported to the MSDH. f. Screening, latent therapy, active treatment and treatment follow-up of inmates and employees for tuberculosis shall follow the policies and procedures included in the latest revision of the Tuberculosis Manual of the MSDH. All latent and active TB treatment of the inmates shall be directly observed by a health care provider. g. The correctional institution’s medical director, in order to contain communicable disease and/or enforce screening schedules, with the approval of the correctional institutional superintendent and/or classification director shall have the authority to: i. Place inmates in quarantine ii. Suspend employees iii. Move inmates between approved housing locations or to approved medical facilities iv. Issue procedures for the care and treatment of inmates and employees with communicable diseases h. Each correctional institution or correctional facility shall provide a complete, legible and accurate Tuberculin Testing Summary (MSDH Form 181) summarizing the correctional facility’s tuberculin testing activity and containing a roster of all inmates and employees that were first identified as having a significant Mantoux tuberculin skin test reaction* or positive BAMT within the reporting period. This roster shall include comments and conclusions concerning the individual follow-up of each person listed. The Tuberculin Testing Summary, with appropriate notations, shall be logged in the Office of the State Tuberculosis Program on or before March 15th of each year for the twelve (12) months preceding January 31st of that year. 5. Summary of TB screening and procedures: a. All inmates shall have a two-step Mantoux tuberculin skin test or BAMT. Each Mantoux tuberculin skin test shall be administered using five tuberculin units (5 t.u.) of purified protein derivative (PPD) unless individually excluded by a licensed physician or nurse practitioner due to medical contraindications or exceptions noted herein. BAMT testing shall be collected and results interpreted by personnel trained and certified in the procedure BAMT results shall be given as EIA positive, Negative or Indeterminate. All Mantoux tuberculin skin test shall be administered and read by personnel trained and certified in the procedure and the results recorded in millimeters of induration. Exception to the tuberculin skin test requirements may be made if: i. The individual is currently receiving or can provide documentation of having successfully completed a course of therapy for latent tuberculosis approved by the State Tuberculosis Program. ii. The individual is currently receiving or can provide documentation of having successfully completed a course of multi-drug chemotherapy approved by the State Tuberculosis Program for active tuberculosis disease, or iii. The individual has a documented previous significant tuberculin skin test reaction* or positive BAMT. b. The tuberculin skin test status of all employees shall be documented in the individual’s personnel record. The BAMT or the first step of a two-step Mantoux tuberculin skin test shall be performed (i.e. administered and read) on all new employees (and rehires) within thirty (30) days prior to the first day of employment. The Mantoux tuberculin skin test or BAMT shall be administered and read by personnel trained and certified in the procedure. The results of the tuberculin skin test shall be recorded in millimeters of induration. The results of the BAMT shall be recorded as EIA positive, negative or indeterminate. An employee shall not have contact with inmates or be allowed to work in areas of the correctional institution to which inmates have routine access prior to the reading of the first-step of a two-step Mantoux tuberculin skin test or having a BAMT and completing an exposure history and symptom assessment. The results of both steps of the two-step Mantoux tuberculin skin test or BAMT shall be documented in the individual’s personnel record within fourteen (14) days of employment. Exception to the tuberculin skin test requirement may be if: i. The individual is currently receiving or can provide documentation of having successfully completed a course of therapy for latent tuberculosis infection approved by the State Tuberculosis Program, or ii. The individual is currently receiving or can provide documentation of having successfully completing a course of multi-drug chemotherapy approved by the State Tuberculosis Program for active tuberculosis disease, or iii. The individual has a documented previous significant tuberculin skin test reaction* or positive BAMT c. All inmates and employees with a previous significant Mantoux tuberculin skin test* or positive BAMT and/or symptoms suggesting TB (e.g. cough, sputum production, chest pain, anorexia, weight loss, fever, night sweats, especially if symptoms last three weeks or longer, regardless of the size of the skin test), shall receive a chest x-ray and be evaluated by a physician or nurse practitioner within 72 hours. Individuals found to have a significant Mantoux tuberculin skin test or positive BAMT, signs and symptoms of tuberculosis or a chest x-ray suggestive of active tuberculosis shall be placed in respiratory isolation according to MSDH policies, reported to MSDH and evaluated by physician or nurse practitioner for tuberculosis therapy. d. Individuals found to have a significant Mantoux tuberculin skin test or positive BAMT or with a history of a previous significant Mantoux tuberculin skin test or positive BAMT and a chest x-ray not suggestive of active tuberculosis, shall be evaluated by a physician or nurse practitioner for latent tuberculosis therapy. Individuals with significant Mantoux tuberculin skin tests or positive BAMT and no evidence of active TB disease should be reminded periodically about the symptoms of tuberculosis and the need for prompt evaluation of any pulmonary symptoms of tuberculosis. A tuberculosis symptom assessment shall be documented as part of the annual health screening. No additional follow-up for these individuals is indicated unless symptoms suggestive of active tuberculosis develop; specifically, routine annual chest x-rays are not indicated. e. Employees found to have a positive/significant reaction* to the skin test or a positive BAMT and no signs or symptoms of tuberculosis disease and have a negative chest x-ray shall, as a condition of employment, have thirty (30) days to report to the MSDH office in their county of residence to confirm appropriate follow-up testing has been completed and receive treatment, if indicated. The employees shall provide the director or designee with a written statement from the MSDH verifying compliance with the directives set forth by the correctional institution’s medical director and this regulation. Criteria for a significant tuberculin skin test Reaction >5 mm (greater than or equal to 5mm) High risk contact to an active tuberculosis case HIV-positive persons Fibrotic changes on chest radiograph consistent with prior TB Patients with organ transplants and other immunosuppressed patients (receiving the equivalent of >15 mg. of prednisone for 1 mo or more-risk of TB in patients treated with corticosteroids increases with higher doses and longer duration) Reaction >10 mm (greater than or equal to 10 mm) any other prisoner or employee of the prison f. All inmates and employees who do not have a significant Mantoux tuberculin skin test or positive BAMT shall be retested annually within thirty (30) days of the anniversary of their last Mantoux tuberculin skin test. Inmates and employees exposed to an active infectious case of TB between annual tuberculin skin test shall be treated as contacts and be managed appropriately. All contacts to an active tuberculosis case shall have HIV testing as part of the exposure management.