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Health Care Personnel TB Screening Guidance

At the 2020 Fall TB Controllers Meeting in November, we briefly presented California requirements for Health Care Personnel (HCP) TB Screening and COVID-19 emergency response changes to these requirements.

Licensing and Certification and CalOSHA require routine TB screening of Health Care Personnel in California. Both have temporarily relaxed routine TB testing requirements to minimize potential exposure to COVID-19 during the extended emergency response. Our Health Care Personnel TB Screening resource page, located under “Guidance” on ctca.org, links to these posted changes. Though temporary, we hope that we can move into agreement with national guidance here in CA. The data proves this is the way to progress TB elimination efforts and protect HCP, working on the frontlines. It may be counter intuitive, but data show, routine testing does not provide any protection for HCP. Assessing risk, testing those at risk and treating TB infection provides HCP protection.

Background:

The Centers for Disease Control recommends risk-based testing of HCPl, based on specific job duties and a facility risk. CTCA waited a decade to endorse this change, after looking at HCP TB data. CTCA now enthusiastically endorses and promotes:

  • TB testing at hire. IGRA for those with BCG history.
  • If positive TB test plus risk for TB, and TB disease is ruled out, recommend treating for latent TB infection to prevent the development of TB disease.

Health Care Personnel TB Screening Information:

Virtual 2020 Conference and Fall CTCA TB Controllers Meeting

Planning for the 2020 CTCA Conference began in Fall 2019. Volunteer Planning Committee members created a full-day agenda with including new information to share with the TB public health workforce in May 2020. As conference planning progressed and then wrapped, TB program leaders were preparing for the potential impact of COVID-19. With a nationwide stay-at-home order and social distancing guidelines put in place, the conference went from postponed to the Fall in Palm Springs to an abbreviated and completely virtual event.

Two of the three plenary sessions were presented to more than 150 TB Control staff over two hours on November 12th via Zoom. Dr. Jennifer Flood, Chief of the California Department of Public Health TB Control Branch presented the 2019 California TB data, highlighting epidemiologic changes and recommending areas of focus to address the disparate impact of TB in the year ahead.  And Dr. Jacek Skarbinski of Kaiser Permanente, Northern California, presented his Kaiser TB care cascade study and plan to increase IGRA testing and treatment of latent TB infection (LTBI) to prevent TB disease in their patient subpopulations at risk for developing TB disease.

We are grateful for our two presenters who gave our community the opportunity to focus on TB and the strides being made toward TB elimination in California, all during the extended COVID-19 response.

Less than a week later, more than 100 attendees gathered for the Fall 2020 TB Controllers Meeting, which was also held for two hours on Zoom. The meeting focused on COVID-19 innovations in public health and how to leverage these advancements for TB elimination efforts after the COVID-19 emergency response concludes.

Report on Tuberculosis in California, 2019

CTCA recruits TB Patient Peer Navigator to offer support to TB patients in California

TB Patient Peer Support Navigator, Jackie (she/her), will pilot a peer support outreach effort for CTCA in partnership with the San Diego County Tuberculosis Control and Refugee Health Program.  An expert in her own experience with TB and fluent in Spanish and English, Jackie is eager to offer support to TB patients.

Jackie joined the San Diego TB Survivor group in 2019 and was excited to see how she could get more involved. She was introduced to, and joined, We Are TB, a national volunteer membership organization made up of former and current TB patients and their family members, working together to offer peer support to TB patients and provide education to the general public and policy leaders about the ongoing impact of TB in the U.S.

Unfortunately, most Americans believe that tuberculosis (TB) is a disease of the past. Each year, approximately 2,000 Californians and 10,000 in the U.S. are diagnosed with TB. In California 2.5 million are estimated to be living with TB infection, the latent (inactive) form of TB.  At any point, TB infection can make a person sick and be contagious, a threat to family and friends. Educating medical providers and community members with risks for TB that TB is a dangerous threat in the U.S. is an ongoing challenge.

Jackie will provide peer support or connect those seeking support with We Are TB volunteers with similar TB experiences, if preferred. For example, parents of children diagnosed with TB or women diagnosed while pregnant, may prefer support from someone with a similar experience with TB.  In addition to offering peer support, she provides an important perspective to TB elimination planning and can educate the public about the impact and persistence of TB in California. 

Learn more from Jackie about her TB journey. Watch her video featured on our Peer Support page. 

2020 CTCA Conference, two free two-hour Zoom meetings, Nov. 12 and 17

The CTCA Executive Committee’s top priority this year is to provide the CA public health TB care and prevention community opportunities to come together to focus on TB and have an opportunity to connect with one another during this extended emergency COVID-19 response.

On November 12th (1-3 PM PST) we’ll share two hours from our planned 2020 Spring Conference opening plenary session: Our state TB epidemiology update, California, TB Elimination Landscape, presented by leaders from the California Department of Public Health TB Control Branch, followed by an innovative TB elimination strategy presented by Jacek Skarbinski, MD, at Kaiser Permanente, Northern California, Moving TB prevention cascade forward in a large primary care setting.

Two hours of CMEs/CEUs will be available for those who attend the full program on November 12th and complete the evaluation that will be emailed to those registered by 11/6/20. This evaluation must be completed by 11/27.

We are excited to come together and focus on TB during this ongoing COVID-19 response. We hope you will be able to join us. Again, there is no cost to attend either of these meetings, and all are welcome. You must pre-register. The deadline for registration is 11/6/20.

Presentations and recordings from previous CTCA conferences can be found on our Events Archives page linked here.

TB and COVID-19

Tuberculosis (TB) and COVID-19, a growing concern, July 28, 2020

While we focus on the new threat, an old one may be gaining strength. With medical providers focusing on COVID-19 and patients delaying care, infectious disease experts in California are concerned that TB is going undiagnosed. Concerns are growing that TB could be spreading among those with COVID-19, undetected. When HIV/AIDS emerged in the U.S., TB surged in those communities heavily impacted.

TB has been with us for over 9,000 years, and it is estimated that one third of the world’s population is living with latent TB infection (LTBI). Approximately 2.4 million Californians are currently living with LTBI. People can live with LTBI for years, even decades before developing TB disease.

LTBI is not contagious and is much easier to treat than TB disease. Treating LTBI before people get sick with TB disease and spread TB in their communities is a new focus of TB experts in the U.S.

Each year more than 2,000 people are diagnosed with TB disease in California. TB disease is both preventable and curable, and yet people still die with TB. Approximately 10% of people with TB disease in California, died with TB.

Dr. Robert Benjamin, longtime CTCA member and dedicated TB MD in California, suggested a new slogan for TB care and prevention staff in public health departments, now focusing on COVID-19: Not All Coughs Are COVID. We want to urge the medical community and the general public to remember that one third of the world’s population is infected with TB, and Not All Coughs Are COVID.

Know the risks for TB. If you have one, contact your medical provider to be tested. If you have a positive TB test, talk with your medical provider about taking a short course drug treatment to prevent TB disease. You are not just protecting yourself, you are protecting the future of your family and those around you.

We can’t forget about TB. It doesn’t forget about us.

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