Tuberculosis (TB) Control

The Healthy People 2010 Goal was to reduce the tuberculosis case rate in New York to no more than 1.0 per 100,000 by the year 2013. Chronic Disease reports from 2003-2005 revealed a Baseline of 7.2 per 100,000.

Visit the Tuberculosis information page on the NY State Department of Health website.

The website outlines the evidence base for effective interventions. This includes:

Case Detection.
New cases of infectious TB should be diagnosed and reported as early as possible in the course of illness so appropriate treatment can be initiated, transmission interrupted, and public health responses promptly initiated.

Case Management.
TB case management includes assignment of primary responsibility for TB patients to public health staff, systematic regular review of patient progress, and development of plans to address barriers to patient adherence to therapy. An important component of TB case management is directly observed therapy.

Contact Investigation.
In contact investigation, persons exposed to someone with infectious TB disease are identified and evaluated for TB disease and latent TB infection. Contacts are at high risk for infection, and if infected recently, are also at high risk for developing TB disease. Contacts can be given treatment to reduce their risk of developing active TB.

Directly Observed Therapy (DOT).
Trained health care workers observe TB patients take every dose of the prescribed drugs. DOT is the most effective strategy for ensuring patients take all of their medicine and complete full courses of appropriate therapy. DOT is the standard of care for all TB patients in New York State.

Laboratory Services.
Mycobacteriology laboratories confirm the diagnosis in persons with active TB disease and aid in assessing patients' infectiousness and response to TB therapy.

Targeted Testing and Treatment of Latent TB Infection.
Targeted testing identifies those at highest risk for progression from latent infection to active TB who may benefit most from treatment. Priorities include persons at risk due to certain medical conditions, as well as those who live in settings or communities, or have immigrated from countries where TB is more prevalent.

Prevention of TB transmission in Healthcare Settings
Comprehensive infection control includes administrative controls (procedures for detecting and managing persons with possible active tuberculosis disease and for education and screening of health care workers), environmental controls (appropriate use and maintenance of airborne infection and isolation rooms and other ventilation measures), and respiratory-protection controls (appropriate use of respirators in settings with increased risk for TB exposure).

The New York City Department of Health and Mental Hygiene requires healthcare providers to submit the attached form when referring a patient for direct observation for tuberculosis. http://www.nyc.gov/html/doh/downloads/pdf/tb/tb316.pdf

The following publication explain all you need to know about DOT: http://www.health.ny.gov/publications/3705.pdf

The World Health Organization (WHO) recommends that DOT be performed for at least the first two months of treatment. They call this DOTS (directly observed treatment, short-course).

The WHO tuberculosis control strategy that combines the following five components:

  • Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)
  • Case detection by sputum smear microscopy
  • Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months
  • A regular drug supply
  • A standardized recording and reporting system that allows assessment of treatment results
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