Tuberculosis
- Topics
- Basic TB Facts
- Treatment
- Testing & Diagnosis
- TB & HIV Coinfection
- Infection Control & Prevention
- Drug-Resistant TB
- TB in Specific Populations
- African-American Community
- Correctional Facilities
- Table of Contents
- Introduction
- Strengthen TB Information Systems and Program Assessment
- Strengthen TB Environmental Controls and Isolation Practices
- Provide More Comprehensive and Timely Screening and Diagnostic Evaluations
- Develop and Strengthen Contact Investigation Protocols
- Increase HIV Counseling and Testing
- Increase Staff Training
- Strengthen Collaboration Between Health Departments and Jails
- International Travelers
- Pregnancy
- Disaster Responders
- Children
- Vaccines & Immunizations
- Laboratory Information
- Drug Susceptibility Testing
- The Uses of Nucleic Acid Amplification Tests for the Diagnosis of TB
- Rapid Molecular Testing to Detect Drug-Resistant TB in the US
- Executive Summary
- Introduction
- Background on Tests for Molecular Detection of DR
- General Considerations and Principles for a Molecular DR Testing Service�
- Possible Scenarios and Scope of Testing for a Molecular DR Testing Service
- Research Needs
- General Recommendations of the Expert Panel
- Communication Plan for the Report
- Recommendations
- References
- Panel Members and CDC Participants
- Appendix 1
- Appendix 2
- Appendix 3
- Interim Laboratory Biosafety Guidance for XDR Mycobacterium tuberculosis strains
- Molecular Detection of Drug Resistance (MDDR)
- Research
- TB Epidemiologic Studies Consortium
- Background
- Infrastructure
- Research Projects
- Publications
- Meetings
- Directory
- TBESC Committee Members
- Translating Research into Practice (TRIP)
- Contact TBESC
- Prospective Evaluation of Immunogenetic and Immunologic Markers for Susceptibility to Tuberculosis Infection and Progression from M. Tuberculosisinfection to active TB
- Zero Tolerance for Pediatric TB
- Models for Incorporating HIV Counseling, Testing, and Referral into Tuberculosis Contact Investigations
- Prevalence of Latent TB Infection Among High Risk Populations in the United States
- Regional Capacity-Building in Low-Incidence Areas
- Use of Network Analysis Methods to Characterize M. tuberculosis Transmission Patterns Among Women and Other High-Risk Populations
- An Analysis of Molecular Epidemiology of Multi-Drug Resistant M. tuberculosisin the United States
- Missed Opportunities for TB Prevention in Foreign-Born Population in the United States and Canada
- New Model for Assessing TB Surveillance and Action Performance and Cost
- Addressing TB Among African Americans in the Southeast: Identifying and Overcoming Barriers to Treatment Adherence for Latent TB Infection and TB Disease
- Assessing the TB Knowledge, Attitudes, Beliefs, and Practices Among Private Providers Serving Foreign-born Populations at Risk for TB
- Factors Associated with Acceptance of, Adherence to and Toxicity From Treatment for Latent TB Infection and Pilot Study of Treatment for Latent TB Infection Effectiveness
- Culturally Appropriate TB Educational Materials for Leaders and Staff of Hispanic Service Organizations
- Enhancing TB Programs� Capacity for Self-Evaluation: Testing New Tools and Developing an Evaluation Toolkit
- African Refugee Women�s Health Improvement Project
- Evaluation of the TK Medium: A New Rapid Solid Culture System for Tuberculosis
- Evaluation of New Interferon-y Release Assays in the Diagnosis of Latent TB Infection in Health Care Workers
- Request for Proposal
- TB Trials Consortium
- Behavioral & Social Science Research
- TB Epidemiologic Studies Consortium
- Data & Statistics
- Education & Training
- Resources for TB Programs
- Publications & Products
- Fact Sheets
- General
- Fact sheets - Spanish
- TB - General Information
- The Difference Between Latent TB Infection and Active TB Disease
- Diferencia entre la infección de tuberculosis latente y enfermedad de tuberculosis activa
- A Global Perspective on TB
- Tuberculosis Information for Employers in Non-Healthcare Settings
- Bovine Tuberculosis in Humans
- Tuberculosis Information for International Travelers
- TB Can Be Treated
- Exposure to TB
- TB and HIV/AIDS
- You Can Prevent TB
- Testing for TB
- Tuberculosis: informaci�n general
- Diferencia entre la infecci�n de tuberculosis latente y enfermedad de tuberculosis activa
- Informaci�n sobre la tuberculosis para los viajeros internacionales
- Exposición a la tuberculosis
- Usted puede prevenir la tuberculosis
- La tuberculosis puede ser tratada
- Tuberculosis y VIH/SIDA
- Usted puede prevenir la tuberculosis
- Pruebas para detectar la tuberculosis
- Data & Statistics
- A Global Perspective on TB
- Trends in Tuberculosis – United States
- The Revised Report of Verified Case of Tuberculosis
- The National Tuberculosis Indicators Project (NTIP)
- National Tuberculosis Indicators Project (NTIP): Frequently Asked Questions
- TB Genotyping
- TB Genotyping Information Management System (TB GIMS)
- Drug-Resistant TB
- Multidrug-Resistant Tuberculosis (MDR TB)
- Extensively Drug-Resistant Tuberculosis (XDR TB)
- CDC’s Role in Preventing Extensively Drug-Resistant Tuberculosis (XDR TB)
- Tuberculosis multirresistente (MDR)
- Tuberculosis extremadamente resistente (XDR)
- El papel de los CDC en la prevenci�n de la tuberculosis extremadamente resistente (XDR)
- Infection Control & Prevention
- TB in Specific Populations
- Tuberculosis Information for Employers in Non-Healthcare Settings
- Tuberculosis in Minorities
- Tuberculosis Information for International Travelers
- TB and HIV/AIDS
- Recommendations for Human Immunodeficiency Virus (HIV) Screening in Tuberculosis (TB) Clinics
- Treatment of Drug-Susceptible Tuberculosis Disease in HIV-Infected Persons
- Tuberculosis in Blacks
- Tuberculosis and Pregnancy
- Tuberculosis y embarazo
- Treatment
- TB Can Be Treated
- Treatment of Latent TB Infection
- Treatment of Latent Tuberculosis Infection: Maximizing Adherence
- Treatment Options for Latent Tuberculosis Infection
- Treatment of Drug-Resistant Tuberculosis
- Treatment of Drug-Susceptible Tuberculosis Disease in Persons Not Infected with HIV
- Treatment of Drug-Susceptible Tuberculosis Disease in HIV-Infected Persons
- Tratamiento de la infecci�n de tuberculosis latente
- Testing & Diagnosis
- TB Can Be Treated
- Testing for TB
- Recommendations for Human Immunodeficiency Virus (HIV) Screening in Tuberculosis (TB) Clinics
- Interferon-Gamma Release Assays (IGRAs)
- Tuberculin Skin Testing
- Diagnosis of Tuberculosis Disease
- Targeted Tuberculin Testing and Interpreting Tuberculin Skin Test Results
- Prueba cutánea de la tuberculina
- Diagnóstico de la tuberculosis activa
- Vaccines & Immunizations
- General
- Guidelines
- Guides & Toolkits
- Core Curriculum
- Self-Study Modules
- Report of Verified Case of Tuberculosis (RVCT)
- Forging Partnerships to Eliminate TB
- Understanding the TB Cohort Review Process
- Latent Tuberculosis Infection: A Guide for Primary Health Care Providers
- Effective TB Interviewing for Contact Investigation
- Mantoux Tuberculin Skin Testing Products
- Ethnographic Guides
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- Posters
- Mantoux Tuberculin Skin Test Wall Chart
- World TB Day
- Afiches
- 2011 Poster (English)
- 2011 Poster (Spanish)
- 2010 Poster (English)
- 2010 Poster (Spanish)
- 2008 Poster (English)
- 2008 Poster (Spanish)
- 2006 Poster (English)
- 2004 Poster (English)
- 2004 Poster (Spanish)
- 2003 Poster (English)
- 2003 Poster (Spanish)
- 2003 Now is the Time Poster (English)
- 2003 Now is the Time Poster (Spanish)
- Think TB
- Stop TB
- Reports & Articles
- Morbidity and Mortality Weekly Reports (MMWRs)
- Contact Investigations
- Control and Elimination
- Data & Statistics
- Drug-Resistant Tuberculosis
- Infection Control & Prevention
- Laboratory
- TB in Specific Populations
- Foreign-Born
- High-Risk Settings
- Homeless
- International
- Occupational Groups
- Travel
- TB & HIV
- Testing & Diagnosis
- Treatment
- LTBI Updates
- Vaccines & Immunizations
- World TB Day
- DTBE Authored Journal Articles
- Tuberculosis Laboratory Aggregate Reports
- Morbidity and Mortality Weekly Reports (MMWRs)
- Slide Sets
- Core Curriculum
- Self-Study Modules
- Prevention and Control of Tuberculosis in Correctional and Detention Facilities
- Guidelines for Preventing the Transmission of M. TB in Health care Settings
- Investigation of Contacts of Persons with Infectious TB
- Text-Only version
- Introduction
- Decisions to Initiate a Contact Investigation
- Investigating the Index Patient and Sites of Transmission
- Assigning Priorities to Contacts
- Diagnostic and Public Health Evaluation of Contacts
- Medical Treatment for Contacts with LTBI
- When to Expand a Contact Investigation
- Communicating Through the News Media
- Data Management and Evaluation of Contact Investigations
- Confidentiality and Consent in Contact Investigations
- Staff Training for Contact Investigations
- Contact Investigations in Special Circumstances
- Source-Case Investigations
- Cultural Competency and Social Network Analysis
- Resources
- Epidemiology of Pediatric Tuberculosis in the United States
- Text-Only version
- Introduction
- Pediatric TB Cases by Age and Race
- Pediatric TB Cases by Origin of Birth
- Pediatric Cases, Percentages and Rates by States
- Pediatric TB Cases by Case Verification Criterion and Site of Disease
- Pediatric TB Cases in Specific Groups
- Pediatric TB Cases Case Completion
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- Slide 3
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- Slide 5
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- Slide 7
- Slide 8
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- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
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- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Treatment of TB
- Targeted Tuberculosis Testing and Treatment of Latent Tuberculosis Infection
- CD Roms
- Electronic Tools & Resources
- Web-Based Courses & Webinars
- Fact Sheets
- Global TB
- Events
- Links
- About Us
- Mission Statement and Activities
- Organization Chart
- Advisory Groups
- Federal TB Task Force
- Table of Contents
- Executive Summary
- Introduction
- Chronology in the Development of This Report
- Strategies for Maintaining Control of TB
- Strategies for Accelerating the Decline of TB
- Activities for Developing New Tools
- Global U.S. Actions
- Assessing the Impact of Actions Taken
- Federal TB Task Force Members and Others Involved in the Development of This Report
- Glossary
- References
- Federal TB Task Force Roster
- Table of Contents
- Executive Summary
- Introduction
- How to Eliminate TB? – The IOM Report
- Why Eliminate TB? – Rationale for Elimination
- Who Will Lead? – CDC's Response
- Goal I: Maintain control of TB
- Goal II: Accelerate the decline
- Goal III: Create new tools
- Goal IV: Reduce the global burden of TB
- Goal V: Summon and sustain support
- Goal VI: Track progress
- References
- Federal TB Task Force
- Funding
Report of an Expert Consultation on the Uses of Nucleic Acid Amplification Tests for the Diagnosis of Tuberculosis
General Recommendations of the Expert Panel:
- All U.S. clinicians and public health TB programs should have access to molecular tests to aid in the diagnosis of TB. NAA testing for TB should become standard practice for TB suspects.
- NAA testing should be performed on a respiratory specimen from each patient with signs and symptoms of active pulmonary TB disease for whom a diagnosis of TB is being considered (i.e., TB suspect), but has not been established.
- NAA testing does not replace the need for AFB smear and culture. All current guidelines and recommendations for culture-based testing should remain in effect, especially recommended turn around times for culture and DST.
- A single positive NAA test result can support the diagnosis of TB in a patient for whom there is a reasonable index of suspicion. This result should trigger reporting to public health officials, initiation of treatment if not already started, and intensified efforts to obtain an isolate for drug susceptibility testing.
- In a patient with little suspicion of having active TB, a single positive NAA test result should be viewed with suspicion (i.e., a possible false-positive result) and interpreted in the same way as a single culture-positive result, i.e., by correlating the results with other diagnostic findings.
- A single negative NAA test result should never be used as a definitive test to exclude TB, especially in suspects with a moderate to high clinical suspicion of TB. Rather, the negative NAA test result should be used as additional information to aid in making clinical decisions to expedite a work-up for an alternative diagnosis or to prevent unnecessary use of TB treatment in suspects with a low clinical suspicion.
- Specimens may contain inhibitors. Testing for inhibitors should be considered for specimens that are AFB-smear positive and NAA test-negative. Each laboratory should establish the rate of inhibition to determine if routine testing for inhibitors is necessary. If inhibition testing is not performed on NAA test-negative specimens, it should be noted on the laboratory report.
- If the clinician is inexperienced with the diagnosis and treatment TB, consultation with a TB expert should be obtained with respect to the interpretation of NAA test results in the context of other diagnostic evidence.
- It is recommended that the appropriate work group
consider amending the guidelines for ‘Controlling the
Transmission of TB in Health Care Settings 2005’ section on
‘Suspected TB Disease’ to: ‘For patients placed under airborne
precautions because of suspected infectious TB disease of the
lungs, airway, or larynx, airborne precautions can be
discontinued when infectious TB disease is considered unlikely
and either 1) another diagnosis is made that explains the
clinical syndrome, 2) the patient has three negative AFB sputum
smear results,’ or 3) the patient has a sputum specimen that has
a negative NAA test result and two additional sputum specimens
that are AFB-smear negative. ‘Each of the three consecutive
sputum specimens should be collected in 8–24-hour intervals, and
at least one specimen should be an early morning specimen
because respiratory secretions pool overnight. Generally, this
method will allow patients with negative sputum smear results to
be released from airborne precautions in 2 days.’
Note: this recommendation does not apply to patients with a suspicion for TB that is high enough to start TB medication. For these patients, release from isolation requires clinical response to treatment, usually four to seven days of treatment in addition to three negative specimens by sputum AFB smears or NAA testing as outlined above. - NAA testing should be treated as a priority test.
- Health care providers should be provided with clear instructions for the collection of quality specimens and encouraged to collect an adequate volume (5-10ml).
- The processed diagnostic specimen must be suspended in sufficient volume to ensure adequate samples for NAA testing, AFB-smear microscopy, and culture.
- The interval from specimen collection to the time that the laboratory report is communicated to the treating clinician must be as brief as possible. Laboratories and programs should track this performance measure.
- Specimens must be delivered promptly to the laboratory that does the NAA testing.
- Specimens must be tested promptly in the laboratory, preferably on the day received (i.e., without introducing significant delays by batching specimens).
- The results of NAA tests should be available within 48 hours of specimen collection.
- Laboratorians should treat an initial positive NAA test result as a critical test value. They must immediately report NAA test results to the health care provider and be available for consultation as to appropriate test interpretation and possible need for follow-up testing.
- Laboratorians should immediately report initial positive NAA test results to public health authorities for earlier interventions and possibly earlier engagement of a TB expert in the management of the patient.
- For laboratories that do not have sufficient resources for NAA testing or sufficient test volume for NAA testing without adding delays from batching, specimens for NAA testing should be referred promptly to laboratories that have demonstrated proficiency in the test and can provide timely results (e.g., within 24–48hrs).
- Laboratories performing NAA testing should participate in a NAA proficiency testing program (e.g., WSLH PT [Wisconsin State Laboratory of Hygiene Proficiency Testing], CAP [College of American Pathologists], or other accredited program).
- The number and types of NAA tests, commercial sources, FDA-approved tests, and validated ASR tests should be increased.
- Research is needed to improve specimen processing, referral processes, testing algorithms, NAA test performance and ease-of-use, utility for diagnosing extrapulmonary and pediatric TB, and regulatory quality trials.
- The expert panel endorses the recommendations under consideration in the proposed revision of the ‘Diagnostic Standards and Classification of Tuberculosis in Adults and Children’ supporting the routine use of molecular methods for detection of drug resistance directly in AFB smear-positive sputum sediments for TB patients who are suspected of having drug-resistant disease or are from a region or population with a high prevalence of drug resistance.
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