CHAPTER 2: YUKON COMMUNICABLE DISEASE CONTROL TB CONTROL

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1 CHAPTER 2: YUKON COMMUNICABLE DISEASE CONTROL TB CONTROL 2.1 Case Definitins and Reprting Requirements Labratry-Cnfirmed Cases Suspect Cases Rles and Respnsibilities Chief Medical Officer f Health (CMOH) YCDC TB Cntrl Nurses Yukn Hspital Crpratin Nurses Physicians Cntact Infrmatin.9 1

2 CHAPTER 2: YUKON COMMUNICABLE DISEASE CONTROL TB CONTROL The mandate f Yukn Cmmunicable Disease Cntrl TB Cntrl (YCDC TB Cntrl) is t prvide central crdinatin f management and cntrl measures fr cases, cntacts, and thers at risk fr TB in Yukn. This includes: Crdinatin and supervisin f treatment fr latent TB infectin (LTBI) and active TB disease. Crdinatin f cntact investigatins and surce case investigatins. Maintenance f the Territrial TB surveillance database (TB iphis). Liaisn with Federal/Prvincial/Territrial cmmittees and wrking grups n matters related t TB. Reprting f all labratry- r clinically cnfirmed cases f active TB disease diagnsed in YT t the Centre fr Cmmunicable Diseases and Infectin Cntrl (CCDIC), Public Health Agency f Canada (PHAC). YCDC TB Cntrl is led by the Chief Medical Officer f Health (CMOH), the Manager f YCDC, and tw YCDC TB Cntrl Nurses. Specific rles and respnsibilities fr persnnel f YCDC TB Cntrl are utlined in Sectin 2.2. Currently, the British Clumbia Centre fr Disease Cntrl (BCCDC) TB Services is cntracted t prvide YCDC TB Cntrl with clinical cnsultatin services frm a TB physician specialist. Thrugh this specialist, directin is given t the YCDC TB Cntrl Nurses and t Yukn physicians and nurses in the care f clients invlved with YCDC TB Cntrl. BCCDC TB Services als prvides YCDC TB Cntrl with prescriptins and anti-tb medicatins, labratry examinatins f specimens cllected fr TB testing, and IPHIS (TB nline mdule) supprt. Figure 2-1 describes hw YCDC, YCDC TB Cntrl, and cntracted services frm BCCDC TB Services align with Cmmunity Health Prgrams in Yukn. 2

3 Figure 2-1, Yukn Cmmunicable Disease Cntrl Organizatinal Chart 2.1 Case Definitins and Reprting Requirements In Yukn, TB is a reprtable disease under the Public Health and Safety Act. Cnfirmed r suspect cases f active TB disease must be reprted t the CMOH and/r YCDC TB Cntrl as sn as they are identified. NOTE: Initiate cntrl measures immediately upn the identificatin f a cnfirmed r suspect case. Initiatin f cntrl measures must nt await labratry cnfirmatin (see Chapter 11) Labratry-Cnfirmed Cases The BC Public Health Reference Micrbilgy Labratry (BCPHRML) advises YCDC TB Cntrl and BCCDC TB Services simultaneusly f labratry-cnfirmed cases f active TB disease in Yukn. Whitehrse 3

4 General Hspital is included in simultaneus reprting frm BCPHRML when specimens riginated frm inpatients f that facility Suspect Cases Health care prviders knwing f, r in attendance n, suspect cases f active TB disease are required t reprt these case t the CMOH and/r YCDC TB Cntrl as sn as they are identified. The administratr f each health facility, clinic, r ther setting where mre than ne health care prvider may knw f a suspect case f active TB disease within the facility is respnsible fr administrative prcedures t assure that reprts are made t the CMOH and/r YCDC TB Cntrl. Fr reprting purpses, a suspect case f TB means 1 : A persn whm a health care prvider believes, after weighing signs, symptms, and/r labratry evidence, t prbably have active TB disease; OR A persn wh is cnsidered a prbable case r an epidemilgically linked case 1 r wh has supprtive labratry findings 2 under the mst recent surveillance case definitin established by the Centre fr Cmmunicable Diseases and Infectin Cntrl (CCDIC), Public Health Agency f Canada (PHAC). 1 epidemilgically linked case means a case in which a patient has/had cntact with ne r mre persns wh have/had the disease, and transmissin f the agent by the usual mdes f transmissin is plausible. 2 labratry findings means the results f a labratry examinatin f any specimen derived frm the human bdy which yields micrscpical, cultural r ther evidence suggestive f (TB). 4

5 Examples f suspect TB cases that must be reprted t the CMOH and/r YCDC TB Cntrl include: Any persn in whm a smear r preliminary culture result frm any bdy fluid r tissue is psitive fr acid fast bacilli (AFB smear- psitive); Any persns in whm a smear r preliminary culture result frm any bdy fluid r tissue is psitive fr MTB with nuclei acid amplificatin testing (NAAT), e.g., TB PCR, Gen-Prbe TM Accuprbe; Any persn with pathlgic findings cnsistent with active TB, unless ther clinical evidence makes a TB diagnsis unlikely; Any persn with clinical, radigraphic, r labratry evidence cnsistent with active TB disease, even if the diagnstic evaluatin is incmplete r culture results are pending, in whm the level f clinical suspicin f active TB disease is high enugh t warrant the initiatin f anti-tb therapy, whether r nt such therapy has actually been started; Any persn with knwn r suspected HIV infectin wh: Has a new finding n chest radigraph cnsistent with active TB disease, regardless f symptms, AFB smear results, and whether anti-tb therapy has been initiated; AND Resides in, r may reside in, a cngregate setting where ther immuncmprmised persns may be expsed, such as a crrectinal, hmeless, r residential facility. 5

6 2.2 Rles and Respnsibilities Chief Medical Officer f Health (CMOH) In Yukn, the respnsibility fr the cntrl f cmmunicable diseases, including TB, lies with the CMOH YCDC TB Cntrl Nurses YCDC TB Cntrl Nurses serve as the liaisn between BCCDC TB Services and health care agencies and prviders in Yukn. In this rle, the YCDC TB Cntrl Nurses cllabrate clsely with a variety f health care agencies in Whitehrse and surrunding cmmunities, including: Health centres Physician ffices Hspitals Lng term care facilities Whitehrse Crrectinal Centre Alchl and drug services Any issues pertaining t TB that require the assistance f BCCDC TB Services shuld be brught t the attentin f the YCDC TB Cntrl Nurses, wh will then liaise with persnnel at BCCDC TB Services. Specific respnsibilities f the YCDC TB Cntrl Nurses include: Maintaining all crrespndence with BCCDC TB Services and the TB physician specialist. Crdinatin and direct client care services fr: Clients with active TB disease; Cntact investigatins fr infectius cases; Surce case investigatins fr cases less than 5 years f age; Clients with latent TB infectin (LTBI); Clients referred fr pst-landing medical surveillance by Citizenship and Immigratin Canada. 6

7 Mnitring and facilitating TB medicatins fr treatment f LTBI and active TB disease. Overseeing data entry f TB infrmatin int iphis (TB Mdule). Prviding TB educatin t the public and practitiners. Fr clients residing in Whitehrse, the YCDC TB Cntrl Nurses prvide direct client care services fr TB screening, cntact investigatin, and treatment fr LTBI and active TB disease Yukn Hspital Crpratin Yukn Hspital Crpratin is respnsible fr the care and management f all inpatient TB cases and fr reprting f cnfirmed r suspect TB cases t the CMOH and/r YCDC TB Cntrl (refer t Sectin 2.1). The clinical care f inpatient cnfirmed r suspect TB cases is the respnsibility f cases primary physicians, usually in cnsultatin with YCDC TB Cntrl and BCCDC TB Services specialist physician Nurses (e.g., Primary Health Care Nurses, Cmmunity Health Nurses, RNs) Nurses play a central rle in the delivery f TB preventin, care and cntrl services in the Territry. Nurses emplyed by Cmmunity Nursing and Kwanlin Dunn Health Centre, in cllabratin with the YCDC TB Cntrl nurses, prvide direct client care services fr TB screening. In additin t this care, Rural Yukn nurses and Kwanlin Dunn Health Centre nurses wrk in cllabratin with YCDC TB Cntrl nurses t prvide direct client care services fr cntact investigatin, and treatment fr LTBI and active TB disease in their cmmunities. Nurses wh prvide TB preventin, care, and cntrl services in cmmunity are respnsible fr cllecting and relaying infrmatin n treatment adherence and mnitring (e.g., bld wrk mnitring), and TB screening utcmes t YCDC TB Cntrl. 7

8 As health care prviders, nurses are respnsible fr reprting f cnfirmed r suspect TB cases t the CMOH and/r YCDC TB Cntrl (refer t Sectin 2.1) Physicians Physicians play a key rle in the detectin f peple with LTBI and active TB disease, and prvide medical clearance fr thse recmmended fr LTBI treatment by the BCCDC TB Services specialist physician. As health care prviders, physicians are respnsible fr reprting f cnfirmed r suspect TB cases t the CMOH and/r YCDC TB Cntrl (refer t Sectin 2.1). 8

9 2.3 Cntact Infrmatin Yukn Cmmunicable Disease Cntrl TB Cntrl #4 Hspital Rd Whitehrse, YT Y1A 3H8 Phne: (867) Tll-Free within Yukn: , ext Fax: (867) Chief Medical Officer f Health Dr. Brendan Hanley Phne: (867) Clinical Manager, YCDC Lri Strudwick RN MN Phne: (867) YCDC TB Cntrl Nurses: Beth Rberts RN, BScN Phne: (867) Melanie Stangeland, RN Phne: (867)

10 REFERENCES 1. Adapted frm CDPA-CTCA Jint Guidelines, Guidelines fr Reprting Tuberculsis Suspects and Cases in Califrnia (Feb 2011) accessed March 8.14 frm: 10

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