U.S. Preventive Services Task Force Recommendations for Latent TB Infection in Adults
On September 6, 2016, JAMA published new recommendations by the US Preventive Services Task Force (USPSTF) for screening asymptomatic adults at increased risk for latent TB infection (LTBI). USPSTF recommends screening adults at increased risk for infection, including those who were born in or lived in countries with increased TB prevalence and persons who have lived in high-risk congregate settings (e.g., homeless shelters or correctional facilities).
TB and LTBI Patient Fact Sheets/Brochures
Santa Clara County: English; Spanish; Vietnamese; Chinese
Centers for Disease Control and Prevention (CDC): English; Spanish; Vietnamese; Tagalog
Tuberculosis (TB) Risk Assessments
Treatment Regimens for Latent Tuberculosis Infection (LTBI)
Short-course regimens (12-dose weekly isoniazid/rifapentine and rifampin daily for four months) are preferred (except in persons for whom there is a contraindication, such as a drug interaction or contact to a person with drug-resistant TB) due to similar efficacy and higher treatment completion rates as compared with 9 months of daily isoniazid.
12-dose Weekly Isoniazid/Rifapentine (3HP) Regimen (3HP CDPH Fact Sheet)
This regimen is not recommended for pregnant women, children <2 years-old, HIV-positive patients on antiretroviral medications, or those exposed to a person with INH or RIF-resistant TB.
2-11 years old: 25 mg/kg rounded up to nearest 50 or 100 mg (max. 900 mg)
≥ 12 years old: 15 mg/kg rounded up to nearest 50 or 100 mg (max. 900 mg)
10.0-14.0 kg: 300 mg
14.1-25.0 kg: 450 mg
25.1-32.0 kg: 600 mg
32.1-50.0 kg: 750 mg
>50 kg: 900 mg
50 mg (also given weekly) for patients with other conditions associated with neuropathy
(e.g., diabetes, HIV, renal failure, alcoholism)
- Rifampin [adults: 600 mg; children: 15 - 20 mg/kg (max. 600 mg)] daily for 4 months. (Rifampin CDPH Fact Sheet)
- Isoniazid [adults: 300 mg; children: 10 mg/kg (range, 10-15 mg/kg; max. 300 mg)] daily for 9 months. Daily vitamin B6 supplementation (e.g., 50 mg) recommended for patients with other conditions associated with neuropathy (e.g., diabetes, HIV, chronic renal failure, alcoholism) or who are pregnant or breast-feeding. For children receiving pyridoxine, recommended pyridoxine dosage is 6.25 mg for infants, 12.5 mg for toddlers, and 25 mg for school-aged children (or 1-2 mg/kg/day). (Isoniazid CDPH Fact Sheet)
Reporting Cases of Suspected or Confirmed Tuberculosis
Why Do You Report?
Reporting cases of suspected or confirmed tuberculosis is vital to protect public health as it allows the Health Department to intervene in order to interrupt disease transmission.
The Santa Clara County Public Health Department Tuberculosis (TB) Prevention & Control Program investigates all reports of persons with suspected or confirmed TB disease. A Public Health Nurse Case Manager is assigned to every patient during their treatment to provide individualized case management, providing education and support, helping to ensure that TB is not spread further, addressing barriers to treatment adherence, monitoring clinical progress and symptoms of possible medication side effects, and ensuring treatment completion. The TB Program also investigates close contacts to patients with infectious TB to identify any other individuals with TB infection and refer for appropriate treatment.
Reporting of all patients with confirmed or suspected TB is legally required by California Code of Regulations, Title 17, Section 2500; reports must be submitted within one working day of identification of the case or suspected case.
GOTCH Law for Inpatients at Health Care or Correctional Facilities
Prior to the discharge or transfer of patients with confirmed or suspected TB, California Health and Safety Code Section 121361 requires all health care facilities (e.g., hospitals, skilled nursing facilities, and nursing homes) and correctional facilities to obtain written approval of the treatment plan by the Health Officer (i.e., Tuberculosis Controller) of the county in which the facility is located (this does not apply when there is an immediate need to transfer for a higher level of care, nor to transfer from a health care facility to a correctional institution).
The GOTCH form should be faxed to the TB Prevention & Control Program at (408) 885-2331. Please call (408) 885-2440 to verify receipt. The TB Program has 24 hours to review the GOTCH form. To make a request after-hours, you must contact the Health Officer On-Call via County Communications: 408-998-3438. To expedite approval, please submit an initial GOTCH form along with pertinent medical records as soon as a patient is suspected to have TB. When a GOTCH form is received, a Public Health Nurse Case Manager is assigned and begins the evaluation of the household to ensure a safe transition home for patients and their families.
Santa Clara County GOTCH (Tuberculosis Report/Readmission/Transfer/Discharge Plan) Form
If a patient being treated for TB is readmitted to the hospital, do I still need to submit a GOTCH?
YES. Submission of the GOTCH form is required any time a patient with confirmed or suspected TB is discharged or transferred from a health care or correctional facility, including when patients being treated for TB are readmitted to the hospital. Notification of rehospitalization is helpful to alert the assigned Public Health Nurse and DOT worker; verify TB medication dosages; help assess whether there are issues related to TB or TB medications, including any new significant drug interactions; and to resume DOT after the patient is discharged.
To whom do I report a patient who is hospitalized in Santa Clara County but resides in a different county?
Initial and discharge GOTCH forms should be submitted to the Santa Clara County Public Health Department who will, in turn, notify and update the Health Department for the county in which the patient resides. When discharge is requested, Santa Clara County will inform the other county and ensure they are in agreement before signing the GOTCH form. Given the more involved process, we recommend submitting the discharge GOTCH at least 2 days before the anticipated discharge date.
Who Must Report?
All health care providers knowing of or in attendance on a patient suspected or confirmed to have tuberculosis disease must report within 1 working day from the time of identification (California Code of Regulations, Title 17, Section 2500).
The director or designee of any clinical laboratory must report laboratory evidence suggestive of tuberculosis to the Local Health Department for the jurisdiction of the health care provider within 1 working day of notification of the ordering provider or referring laboratory (California Code of Regulations, Title 17, Section 2505).
Which Patients Must be Reported?
All patients with suspected or confirmed TB must be reported within 1 working day from time of identification, that is:
- When the following conditions are present (Do not wait for laboratory results to confirm the diagnosis prior to reporting):
- Symptoms/signs of tuberculosis, and/or
- Radiologic findings consistent with tuberculosis, or
- The patient is placed on two or more anti-TB drugs due to clinical suspicion of TB
- AFB smear or culture demonstrate acid-fast bacilli, or
- Molecular diagnostic testing (e.g. Xpert MTB/RIF or other PCR) is positive for Mycobacterium tuberculosis complex, or
- Positive culture for M. tuberculosis complex (i.e., M. tuberculosis, M. bovis, M. africanum, M. microti, M. canetii, M. caprae, and M. pinnipedii), or
- Pathology report is consistent with tuberculosis (i.e., granulomas or positive AFB stain).
Latent TB Infection is only reportable for persons with:
- TST/IGRA conversion who live or work in a health care setting
- Children less than 2 years old
How Do You Report?
The Confidential Morbidity Report (CMR) should be used for outpatients. The GOTCH form is used for inpatients. The same GOTCH form used to make the initial report can be updated to later request discharge approval.
- Report a tuberculosis case by FAX: (408) 885-2331
- Report a tuberculosis case by PHONE: (408) 885-2440
- After-hours, to report a patient, please leave the following information on voicemail:
- Your name
- Your phone or pager number
- Patient’s name
- Patient's date of birth
- Patient's medical record number
- For discharge approval requests after-hours, you must contact the Health Officer On-Call via County Communications: (408) 998-3438
The following documentation is routinely requested prior to GOTCH approval. Please provide as soon as possible to facilitate discharge:
- Physician notes (including any Infectious Diseases or Pulmonary consultation)
- Medication list, including TB medication dosages and non-TB medications
- Documented current weight
- Radiology reports
- Diagnostic testing for TB [e.g. AFB smears/cultures, molecular diagnostic tests, pathology and cytology reports, body fluid (pleural/ peritoneal/ pericardial/CSF) chemistries and cell counts]
- TST/IGRA results (these tests cannot exclude active TB disease, but are utilized for Public Health Reporting to CDC)
- HIV test results (testing recommended for all patients with suspected TB before treatment initiation); for patients with risk factors, results of chronic Hepatitis B/C screening
- Baseline laboratory tests: CBC, Chem 7, LFTs
- For patients suspected to have TB (i.e., without laboratory confirmation), any other diagnostic evaluation performed (e.g., fungal serologies, cultures, etc.)
Clinical Consultation for Tuberculosis Disease or Latent TB Infection
During business hours, please call the TB Provider line at (408) 885-2440.
After business hours, please call Santa Clara County Communications and ask for the Health Officer On-Call at (408) 998-3438.
Thank you for helping us protect the health of residents in Santa Clara County!
Tuberculosis (TB) Prevention and Control Program
Santa Clara County Public Health Department
976 Lenzen Avenue, Suite 1700
San Jose, CA 95126
Phone: (408) 792-1381
Fax: (408) 885-2331