PRESENT: TB Controller EC: Louise McNitt (CC), Julie Vaishampayan (San Joaquin), Susan Strong (San Bernardino), Jenny Flood (CDPH), Connie Caldwell (Mendocino), Laura Romo (NAHPF), Mike Carson (Extra), Wen Lin (Sec/T), Maxine Liggins (L.A. Rep);Controllers/Reps: Andy Miller (Butte), Hava Phillips (Humboldt), Barbara Cole (Riverside), Chris Keh (San Francisco), Julie Low (Orange), Miguel Zamora (Imperial), Tara Perti (Santa Clara), Lisa Gooze (San Mateo), Amit Chitnis (Alameda), Julie Higashi (L.A.), Bob Benjamin (City of Berkeley), Thomas Bertsch (Sacramento), Michael Stacey (Solano), Bryan Wheeler (Mono),Davithia Perry(Monterey), Tom Cole (Madera and Merced), Anissa Davis (City of Long Beach),Katie Kelsch (Yolo), (Phone: Rita Kerr Amador )
OTHERS PRESENT: Rocio Agraz-Lara, Erika Alex, Janet Andrea, Pennan Barry, Paige Batson, Anne Cass, Shua Chai, Alicia Chang, Lisa Chen, Charlie Crane, Felix Crespin, Laurie Crider, Melissa Ehman, Jeannie Fong, Sandra Gibson, Erika Gist-Siever, Beth Grant, Jason Green, Carol Greene, VarshaHampole, Jenny Hernandez, Cheyenne Humphrey, Nancy Jaggers, John Jereb, Michael Joseph, Saul Kanowitz, Masae Kawamura, April King-Todd, Phil Lowenthal, Barbara Materna, Matthew Middleton, Tessa Mochizuki, Kelly Musoke, Thomas Navin, Gail Newel, Mark Norman, Javier Ortiz, Christy Pak, Lisa Pascopella, Christine Perez, Jose Perez, Wendy Pernal, Davithia Perry, Hava Phillips, ShameerPoonja, Eva Reeder, Susan Sawley, James Sederberg, Sebastian Seiguer, Teri Serna, Neha Shah, Purvi Shah, Tambi Shaw, Benjamin Silk, Janie Soito, Stephanie Spencer, Susan Spieldenner, OluTeiko, Sally Watt, Donna Wegener, Kristen Wendorf, Janice Westenhouse, Karen White, DeLellis York, David Yost, Jan Young
Item / Discussion
I. / Housekeeping, Review of Agenda, and Introductions
II. / TB Control Branch (TBCB), California Department of Public Health (CDPH)
- California Pediatric TB Network Update,Kristen Wendorf(20 min)
New Study, >2500 healthy SAfrican Infants, followed for QFT conversion and disease, most important findings for this group is the results of negative predictive values of 99%, and highly predictive of disease with a quantitative value of 4.
- Commercial Laboratory Reporting and Toolbox, Christy Pak (~10 min)
Electronic Laboratory Reporting and use of the California IZ Registry (CAIR)-Janice Westinhouse (min32.5) Q and A:Are labs reporting IGRA negatives?We only know of Orange County Lab including all IGRA results, including negative. We are not sure what all of the labs are doing. Q. If it is an IGRA result we want related to a TB5, will we have to go in and look for it or will it automatically make that connection? IF the names are the same, they will automatically link. Q. Adding treatment information to CAIR was not allowed. A. The law has not changed. We will have discussions about interpretations about existing regulations. Q. Will CAIR link to CalREADIE? A. No. Q. Are you working with other registries to get IGRA information in there? A. We would like to. We aren’t there yet. Q. QFT only, right, in the ELR? A. We have not worked on TSPOT. The ELR currently allows for quantitative results from TSPOT. The five components from TSPOT should be coming in to the ELR.
- NTCA LTBI Reporting Workgroup Update, Lisa Pascopella- (min42)
- Recent transmission estimates being adopted by the CDC, Benjamin Silk (min52) Atthe program level, San Joaquin, 4 outbreaksin eight years: 2006-2014. This study came out. Asked for clarity, compared to everyone else, how challenged was San Joaquin by recent transmission. The number was 24% of cases were recent transmission in San Joaquin compared to 12% statewide. Local administration presentation resulted in 7 new positions requested to improve all Communicable Disease activities (TB, CD, and STD). Additionally CDC approved Technical Assistance to CDPH for improving CI at San Joaquin County. in 2016, cases due to recent transmission were dramatically reduced due to all these efforts.
III. / LTBI Reporting System,Thomas Navin Q. Have you purchased private insurance company data? A. CDC DTBE has purchased data in the past from private insurance companies. They do not know if they will purchase in the future. Reporting pilots are being done in states doing electronic reporting of LTBI. Q. Should have results by the end of 2017. Will you publish B not data in 2018? A. It is the plan. The ARPE data will be an update. You will be able to look back at data. The old data and new will be connected. Q. What is the CDC doing to get country of birth added to the electronic medical records? Is there a role for meaningful use to get this to happen? A. EPIC developers in Denver are eager to work with CDC DTBE. It is harder than he thought. Country of birth was added. Where on the screen will it be visible is a harder issue? It was made optional because it was “made up”by providers when it was made mandatory.Will keep you apprised of the progress.
IV. / Civil Surgeon Update,Alicia Chang (3:56:-4:37:) Q. Are there unintended consequences of improving the connection between the TB Control Program and Civil Surgeons? A. One call from a civil surgeon about a suspected case. Not there yet with improved direct communication/collaboration relationships. Not yet. Comment: this training was recorded and is available through the CITC website along with supporting materials. Q. Were some categories of providers more likely to respond to the survey. A. No, but we did get a better sense of who the providers were that did respond. We can target materials and information to those providers and their communities. Q. How do the Technical Instructions help/hinder reporting? A. Abnormal chest x-ray must report to the health department. With other results, the language of reporting makes it more of an option. This doesn’t help with reporting. Comment: Find out who will take ownership of the patients with LTBI? In each setting this will take a different champion for TB prevention in these populations.
V. / TB Controller Aerosol Transmissible Disease Standard Update,Barbara Materna and Deborah Gold: (4:37:-5:19:) Q. Any changes in the last 7 years since the last revision? A. What respirators can be used was changed recently. No plans for more changes at this time. Q. Does criteria have to occur to trigger the Health Officer order? A. Evidence would need to be provided by the CalOSHA worker or supplied by the local TB program. If there is potential transmission threat to that employee setting. That is sufficient.Q. CalOSHA protections for operating room potential transmission, regarding a sterile field and PAPRs? A. They have concluded research in a lab environment about different protections. They will publish this soon. It was a very small study. It was a pilot to get methods for a larger study to confirm what they found in the pilot. Q. What is CalOSHA’s current recommendation? A. Issue of infection control is a part of the success of the procedure. Where there is a sterile field, then you would have to use a surgical N95. Q. Exposures in non health care work settings. Nurses go out to the corporation impacted. We tell them who needs to get tested. The corporation blocks progress. It takes a long time to resolve. Occ Health Branch will work with you to resolve the issue. If it doesn’t resolve quickly, call CalOSHA to enforce. They should be called too in some instances. Comment: Barbara Cole told a resistant employer that a CalOSHA was being contacted to help with this situation, and the employer immediately complied.(5:29:02) Q. There is a movement to replace the mandated universal TB testing with a risk assessment to test those at risk. What do you see as the role of risk assessments? A. personal response from former CalOsha Director: The basis for decision making in an employee setting is not the same as a primary care setting. The employer doesn’t have a right to medical information. We need to separate out what we are doing for public health purposes, which is a kind of a risk reduction thing; what we are doing for personal health purposes, which involves individual risk assessments, and what we are doing foroccupationalsurveillance and detection ofoccupational infection purposes.What works for one purpose doesn’t necessarily work for another.Comment: Employer refused to cooperate. Labor code had more power than health and safety code. Q. Which providers are notincluded by the standard? A. The providers with greatest risk for exposures are the priorities. Certain medical specialty offices, like psychiatry, don’t have increased occupational risk than other groups. They have screening procedures and train the employees in the screening procedures, so they don’t treat them. If they don’t have those screening procedures, then they become employers under the standard. Anyone providing care in a hospital is included in the standard. Q. Oncology practice settings think they are not included in the standard. Any practice acting like a primary provider is covered. The burden of proof is on the provider to prove they are not included in the standard.
VI. / Discussion and Voting Items
- LTBI Private Provider Outreach and Treatment Toolbox and Guidelines, Louise McNitt and Julie Vaishampayan – Toolkit in progress. Gathering tools exist already, filling in some gaps, and creating a dear colleague letter. C: Add a tracking sheet to show what is being moitored and followed during treatment. C: Let Anne Cass know if you want a student to create for LTBI materials like m bovis. Guideline revision. Focus on user friendly, fact sheet structure, customizable for programs.
- Current Events and our Public Health TB Response, Louise McNitt (5:30:00)C: If data is deidentified then it would likely not get back to individuals. We need to inform/reassure our patients appropriately. C: We need to report complete data to not do a disservice to populations most affected. C: MediCAL sends a letter to all MediCAL Directors that says do not report immigration status. Stephanie Spencer has the letter. Any public assistance is public charge, and any medical care is not public charge. We need to be clear about this ourselves. C: We need to be educated and clear about any changes to give accurate information to our patients.MediCAL codes could potentially be used for proximations of immigration status.
- Rural and Small Health Jurisdiction Survey Summary, Connie Caldwell(6:04:15) – Q. Amore detailed report will be sent to CDPH TBCB and the CTCA Executive Committee for future priority and workplansetting.
VII. / Affiliate Reports/News
- California Conference of Local Health Officers(CCLHO), Julie Vaishampayan – (7:07:00) Funding for TB Elimination was approved by the CCLHO Board. Then the Governor let everyone know no budget increases would be issued. SB511, Sponsored by AssemblymemberArambula, MD, is an omnibus bill aiming to clean up mandatory TB testing to shift to mandatory risk assessments, testing only those at high risk for TB: temporary workers: certified nurse assistants and licensed nurses in long term care facilities, employees and volunteers at heritage schools, students at schools for the deaf and the blind, foster parents, employees at primary care clinics, volunteers in crisis nurseries and community care facilities, homecare aides, and park and recreation employees. We are waiting for a Health Committee hearing date. TB Elimination Plan for TB was endorsed. We are advocating for a facility risk based health care worker screening program in future in California. Annual testing would be based on TB case rate at the hospital. Entering the workplace at the facility would still require a new TB test. Q. How does this relate to the CalOSHAregulations. A. CalOSHAATD Standard is a regulation. This is talking about changing the laws. Comment: CTCA is going to have to take a look at this. Primary Care Clinic employees with direct patient contact are in the regulations. Comment: If our bill passes, it will not override the ATD Standard.
- Curry International TB Center (CITC), Kelly Musoke – (report given in the morning) Announcements about upcoming trainings available on their website. Counties are having to prioritize applicants due to demand exceeding seats in training.
- National TB Controllers Association (NTCA), Donna Wegener - April National Conference in Atlanta. Travel grants have been given to epidemiologists, young clinicians, and nurses: waiving the registration fee, and an $800 travel stipend per recipient, 3-5 from CA this year. TB Infection focused conference content. CSTE submission will be decided at the June meeting, so we won’t have those results yet. We will hear more about the surveillance definition submission. Keynote address will be given by Phil Lobue on the state of TB in the U.S. TB patient and clinician spokesperson will also open the conference. Massachusettes Department of Health and Linn Community Health Center, his health center will talk about their focused effort collaborating to identify and treat TB infection to help reach elimination.
2018 Joint Conference with CTCA is possible. We are working toward that collaboration.TB Survivors Hill Day planned for the week of World TB Day. Survivor Communicaitons Training will be held at the Confernece in April. Charlie Crane, NSTC: TB Infection Guidelines Companion Statement work stopped. Current question is whether to continue this work as a companion to nothing or work with the CDC on a guideline/both guideline and companion document, since ATS and IDSA withdrew their participation. - CDC Advisory Council for the Elimination of TB (ACET), Barbara Cole (7:17:00) Our goal for meeting with the Labor Health and Human Services Secretary will be to highlight plans for TB elimination and strides made recently. The ACET Charter was ammended to include a TB survivor or parent of a TB patient as one of the ten voting members. This will take effect as soon as a seat becomes available. Essential Components of a TB Prevention Control and Elimination Program received four pages of comments during the final review process. It will not be ready for the April 11 webinbar. Focus on absolute must haves in the final version. Workgroups: TB in Children, Drug Supply, Congregate Setting.
VIII. / Business
- Infectiousness Guideline VOTE(7:22:00) Walked through the final changes. Final changes: fix minor typos not caught by the formatter, Table 1 Rows 3 fixes: smear negative and NAAT positive, take out the 3rd “or” and say no smear 14 days, (Neha); Table 2 same issue; with these final changes unanimous approval
- New EC members for 2017- 2017 slate presented for VOTE;President Elect: Julie Higashi (L.A.), Secretary Treasurer: Susan Strong (San Bernardino), TB Controller At Large: Chris Keh (SF), Rural and Small Local Health Jurisdiction Rep: Katie Kelsch (Yolo) unanimous approval
- 2016 Fall TB Controller Meeting minutes VOTE; unanimous approval
IX. / Adjourn until we are reconnected for the California TB Elimination Coalition Meeting/ Webinar
CTCA 2017 Spring TB Controller Meeting Minutes
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