TB Reporting Requirement

Health And Safety Code, Division 105, Part 1 California Code Of Regulations (CCR), Title 17

Case Reporting and Notification

California Code of Regulations, Title 17, Section 2500 requires that a health care provider make a case report to the TB Control Program within one (1) working day of identification of a TB case or suspected TB case (CCR Title 17, Section 2500). Similarly, Health and Safety Code 121362 requires that each health care provider, each person in charge of a health care facility, and each person in charge of a clinic providing outpatient care for active TB make a case report to the TB Control Program within one (1) working day of when there are reasonable grounds to believe that a person has active TB.

The initial disease notification report shall include an individual treatment plan, which includes:

Demographic:

• Patient name
• Patient address
• Date of birth, age
• Telephone number*
• Occupation*
• Ethnic group*
• Social Security number*
• Gender*

Clinical:

• Date of diagnosis
• Diagnostic status
• Tuberculin skin test findings
• Radiological findings: (results indicating normal or abnormal; if abnormal, cavitary or non-cavitary, impressions including stable, improving, worsening, or initial film)
• Bacteriologic findings: (AFB smear results, culture results, dates of collection, number of specimens, source of specimens, drug susceptibility results if available)
• Information regarding the risk of transmission of the disease to other persons
• Anti-tuberculosis medications administered to the patient, including doses and date started
• Date of onset*
• Date of death if appropriate*
• Any other information required by the TB Program such as:
  • Site(s) of disease
  • Adherence assessment and plan
  • Self administered or Directly Observed Therapy
  • Disposition (home, facility)

Other:

• Name, address and telephone number of person mailing the report* 

Contact Investigation

Health and Safety Code 121363 states that each health care provider who treats a person for active TB shall examine, or cause to be examined, all household contacts or shall refer them to the TB Program for examination. Each health care provider shall promptly notify the TB Program of the referral. When required by the TB Program, household contacts and non-household contacts not examined by a health care provider shall submit to examination by the TB Program or designee.

Ongoing Information Collecting/Subsequent Reporting

Health and Safety Code 121362 requires health care providers, health facilities, or clinics providing treatment for TB disease to promptly report to the TB Program when a TB patient ceases TB treatment including when the patient:

• Fails to keep an appointment
• Relocates without transferring care
• Discontinues care

In Orange County, subsequent reports shall be submitted to the Health Department once a month until treatment is completed, or more frequently as determined by the Health Officer. Reports shall include:

• Updated clinical status
• Date and finding of last chest radiograph including whether stable, improving or worsening
• Laboratory results (including all smear, culture, and drug susceptibility results obtained during the course of treatment)
• Assessment of treatment adherence
• Name of current care provider if patient transfers care
• Any other information required by the TB Program (including date of last examination and next appointment, current medications including doses, dates started and stopped, whether self administered or Directly Observed Therapy).

Directly Observed Therapy

Policy Statement

All treatment for active and suspect active tuberculosis disease should be administered by Directly Observed Therapy (“D.O.T.”). This policy applies to all residents of Orange County whether treated privately or by Public Health. Public Health provides staff and medications for D.O.T. administration of the physician’s prescribed treatment regimen. The Centers for Disease Control and Prevention (CDC) recommends that Directly Observed Therapy be considered for all patients because of the difficulty in predicting which patient will adhere to a prescribed treatment regimen.

Persons in the following categories must be on Directly Observed Therapy:

• Persons with drug resistant tuberculosis
• Persons with a history of previous tuberculosis treatment
• Persons demonstrating non-adherence with tuberculosis medications
• Persons with poor compliance during initial medical management
• Persons with slow sputum conversion or slow clinical improvement
• Persons with clinical deterioration while on tuberculosis treatment
• Persons with adverse reactions to tuberculosis medication
• Persons with major psychiatric disorder, memory disorder or cognitive disorder
• Persons under 18 years old
• Persons with a history of alcohol or drug abuse
• Persons who are homeless
• Persons with a history of incarceration
• Persons with poor or non-acceptance of their tuberculosis diagnosis
• Persons with poor confidence in the therapeutic regimen

Legal Authority

Legal authority to enforce compliance with Directly Observed Therapy is addressed in the California Health and Safety Code Section 121365. This section allows the Health Officer to issue an order requiring the person who has active tuberculosis, and who is unwilling or otherwise unable to follow a prescribed course of therapy, to complete an appropriate prescribed course of medication for tuberculosis through Directly Observed Therapy.