Introduction
The prevention and control of communicable diseases such as Tuberculosis (TB) is a key objective set out in the NWT Public Health Act and one of the primary roles of the Office of the Chief Public Health Officer (OCPHO). The Tuberculosis Manual is intended to serve as a resource guide to all health care providers who provide clinical support, treatment and/or management to patients with tuberculosis in the Northwest Territories.
The purpose of this manual is to ensure NWT health care providers and practitioners are familiar with the identification of and reporting requirements for TB that is legislated under the NWT Public Health Act. The goal is to provide guidance on public health management of cases and contacts, and to prevent the spread or outbreak of TB. This manual is not intended to provide individual clinical case management advice.
At this time, the Tuberculosis Manual is being revised to include current best practices in an electronic format, with each section searchable and downloadable as an individual PDF. Health care providers and practitioners must routinely refer to the online manual to ensure they are accessing the most current section.
Table of Contents
Section 1: Purpose and Introduction
Section 2: Description of TB
- Etiology
- Pathogenesis
- Primary TB (Early Disease Progression)
- Latent TB Infection (LTBI)
- Reinfection
- Reactivation (Late Disease Progression)
- Transmission
- Factors that Increase the Risk of Transmission
- Transmission Outcomes
- Risk Factors
Section 3: Bacillus Calmette-Guérin (BCG) Vaccination
- Description
- Indications for Use
- Infants in High Risk Communities
- Travellers
- Occupational Setting
- Booster Doses and Revaccination
- Administration Procedure
- Safety
- Contraindications
- Adverse Reactions
- Management of BCG Abscess
- Important Considerations
- BCG Vaccine Usage in Canada
Section 4: TB Screening
- Components of Screening
- The Tuberculin Skin Test (TST)
- TST Technique
- Special Considerations Using TST
- Two-Step TST: Distinguishing Between the Booster Phenomenon and Conversion
- Contraindications to TST
- Precautions with TST
- Interferon Gamma Release Assay (IGRA)
Section 5: TB Assessment
Section 6: Diagnosis of TB (Latent vs. Active Disease)
- Diagnosis of Latent Tuberculosis Infection (LTBI)
- Guidelines for Use: TST or IGRA
- Tuberculin Skin Test (TST)
- Chest Radiography
- Diagnosis of Active TB
- Respiratory TB
- Clinical Presentation
- Microbacteria Testing: AFB Smear and Culture
- Respiratory Specimen Collection
Section 7: Management of TB
- Management of Suspect TB
- Medical Transportation of a Confirmed or Suspected Case
- Infection Control Measures in the Management of TB
- Criteria for Discontinuing Airborne Precautions for TB
- Direct Observed Treatment (DOT)
- Discharge Planning
Section 8: Treatment for Tuberculosis
- Indications and Objectives for Treatment
- Treatment, Duration, and Adherence
- Special Considerations in the Treatment of LTBI
- Monitoring Treatment of LTBI
- Adverse Reactions/Treatment Induced Side Effects
- Follow-Up after LTBI Treatment and Management Following Re-Exposure
- Objectives of Treatment
- Principles of Treatment
- Special Considerations in the Treatment of Active TB Disease
- Anti-Tuberculosis Drugs
- Monitoring of Treatment of Active TB
- Adverse Reactions/Treatment Induced Side Effects
- Completion of Treatment
- Surveillance
- Drug-Resistant Tuberculosis
- Multidrug-Resistant (MDR-TB) and Extensively Drug-Resistant (XDR-TB) Tuberculosis
Section 9: Contact Tracing
- Contact Tracing Algorithms
- Contact Tracing and Contact Investigations
- Goals and Objectives of Contact Tracing
- Factors Contributing to Transmission
- Prioritization of Contact Follow-Up
- Steps in a Contact Investigation
- Evaluation of Contacts for the Presence of Active Disease and Evidence of Recent Infection
- Organizing an Investigation: Identification and Interview of Contacts
- Screening Contacts in a Contact Investigation
- INH Preventive Treatment for Contacts
- Evaluation of Contact Investigation
Section 10: Role of Public Health in TB Prevention and Control in the NWT
- Notification and Reporting of Suspect and Confirmed Cases of TB
- Directly Observed Treatment (DOT) and Directly Observed Preventive Treatment (DOPT)
- Surveillance
- Managing an Outbreak
Section 11: Pediatric TB
- Pediatric Population
- Transmission and Pathogenesis
- Management of Children with Close Contact to Smear (-), Culture (+) TB
- Management of Children Close Contact to Smear (+) TB
- Pediatric Active TB Disease Treatment
- Management and Treatment of Active Disease
- Monitoring and Follow-up
Section 12: Populations at Risk
- Overview of Screening Populations at Risk
- Immigrant Screening in the Northwest Territories
- Homeless Populations and Injection Drug Use
- Institutionalized Population – Correctional Facilities
- HIV and TB