Health Advisory

November 27, 2018

Subject

The Virginia Department of Health (VDH) has added Tuberculosis (TB) Infection (Latent TB Infection [LTBI]), to the Regulations for Disease Reporting and Control List. Diagnoses of LTBI are now required to be reported in the Commonwealth of Virginia, which can be done online through the Fairfax County Health Department (FCHD) TB web page, https://www.fairfaxcounty.gov/health/tuberculosis/providers, by clicking on the reporting link.

Summary

• Latent TB Infection (LTBI), defined by a positive TB test — either a positive tuberculin skin test (TST) or positive interferon gamma release assay (IGRA) — and the absence of active TB disease, is now reportable among persons of any age in Virginia.
• The preferred method of reporting is online via the Fairfax County Health Department TB web page, where a direct link is provided to the VDH reporting portal.
• Immediate reporting of all suspected and confirmed active TB disease continues to be required under Virginia Code. Providers must report these cases to Fairfax County Health Department at 703-246-2433.

Suggested Actions

Reporting

• To complete the online LTBI report form, please have the following information available:
  1. Patient name, DOB, address, and phone number.
  2. Patient race and sex.
  3. Laboratory tests and results.
  4. Provider name, address, and phone number.

Clinical Considerations

• Diagnosing LTBI requires that active TB disease be ruled out. Rule out is completed by a full evaluation including a chest x-ray and a clinical screen for symptoms or signs of active TB disease (chronic cough, fever, weight loss, hemoptysis, night sweats, anorexia and malaise).
• LTBI (positive TB test with negative chest x-ray and no sign/symptoms of TB) can be treated to prevent the later occurrence of active disease. Three treatment options are available:
  1. 12-weeks Isoniazid-Rifapentine (3HP), once a week, for those two years of age and older. This regimen is usually given by directly observed therapy.
  2. Four months of daily Rifampin.
  3. Nine months of daily Isoniazid.
• Recently, approval for the 12-week 3HP regimen was broadened to include children as young as 2 years old. Guidance is provided in the VDH provider fact sheet, 12-dose Isoniazid (INH)/Rifapentine Regimen for Latent TB Infection Treatment.

Additional Information

• Health Department TB experts are available for consultation regarding evaluation, diagnosis and treatment of persons with suspect or confirmed TB disease, as well as for consultation regarding Fairfax County residents with LTBI. Contact the FCHD Intake/Referral line, 703-246-2433, to speak with the TB Physician Consultant for discussion of a case or any questions.
• The current Virginia reportable disease list, which includes TB infection, is posted at http://www.vdh.virginia.gov/content/uploads/sites/112/2018/11/Reportable_Disease_List.pdf.

Attachment:
Provider Guidance Fact Sheet: 12-dose Isoniazid (INH)/Rifapentine Regimen for Latent TB Infection Treatment