Tuberculosis (TB) Control Program - Information for Providers

San Mateo County’s Tuberculosis (TB) Control program provides priority TB prevention and control activities to help those with TB disease, and protect the health of the public.

San Mateo County’s TB Control Program:

  • Provides evaluation, treatment and case management services for County residents with active tuberculosis or latent tuberculosis infection
  • Identifies, notifies and ensures follow up of individuals determined to have been contacts of a case of active tuberculosis disease
  • Investigates outbreaks of tuberculosis
  • Collects and analyzes data on tuberculosis cases in the county
  • Provides consultation to medical providers regarding the diagnosis and treatment of tuberculosis cases
  • Provides tuberculosis education to the public
Tuberculosis is a reportable disease. Providers are required by law to report any suspect or confirmed cases of tuberculosis as mandated by Title 17 California Code of Regulations (CCR): Please use this Confidential Morbidity Report - TB (CMR-TB). For more information, view the reporting tab below.

Do you have questions? 

We are available for consultation: (650) 573-2346

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TB Provider Info

Tuberculosis is a reportable disease, as mandated by Title 17 California Code of Regulations (CCR)

Active Tuberculosis Disease

All confirmed or suspected cases of active TB disease must be reported by phone and/or fax within 1 working day to TB Control

Phone:    (650) 573-2346
Fax:        (650) 573-2919

Do not wait for lab results to confirm the diagnosis prior to reporting

For faxed reports use the Confidential Morbidity Report - TB (CMR-TB).  Please fill out the entire CMR-TB (completely as possible).

Latent Tuberculosis Infection

Report by fax or mail within 1 week to TB Control

Fax:    (650) 573-2919

Mail:    San Mateo County Health System
           TB Control Program
           225 37th Avenue
           San Mateo, CA 94403

Which cases of LTBI need to be reported?

  • Recent TST converters (patients with tuberculin skin test indurations increasing 10 mm or more in 2 years).
  • Recent TB blood test converters (patients with a TB blood test that converts from negative to positive within 2 years).
  • All children up to 5 years of age who test positive on the tuberculin skin test or TB blood test.
  • New cases of LTBI identified as part of a contact investigation.
Report after the chest x-ray results are known using the Confidential Morbidity Report - TB (CMR-TB)

NOTE: Report to the Public Health Department in the county where the patient lives.
 

Who, Why, How and Where


Who should be screened?

San Mateo County’s tuberculosis (TB) prevention and control program follows testing recommendations set forth by the Centers for Disease Control (CDC), which include the use of a targeted testing strategy.  This strategy entails finding and treating persons with latent tuberculosis infection (LTBI) who are at the highest risk for developing TB disease, and thus would benefit from treatment.

Generally, persons at risk for developing TB disease fall into two broad categories: those who have an increased likelihood of exposure to persons with TB disease and those with clinical conditions or other factors associated with an increased risk of progression from LTBI to TB disease.

Persons at risk for exposure to persons with TB disease Conditions and other factors associated with progression from LTBI to TB disease
 
  • Known close contacts of a person with infectious TB disease
  • Persons who have immigrated from TB-endemic regions of the world
  • Persons who work or reside in facilities or institutions with people who are at high risk for TB, such as hospitals that care for TB patients, homeless shelters, correctional facilities, nursing homes, or residential facilities for patients with AIDS.
  • HIV infection, or AIDS
  • Injection drug use
  • Radiographic evidence of prior healed TB
  • Low body weight (10% below ideal)
  • Other medical conditions, such as:
    • silicosis
    • diabetes mellitus
    • chronic renal failure or on hemodialysis
    • gastrectomy
    • jejunoileal bypass
    • solid organ transplant
    • head and neck cancer
    • conditions that require prolonged use of corticosteroids or other immunosuppressive agents such as TNF-antagonists
  • Recent tuberculin skin test (TST) or interferon gamma release assay (IGRA) converters
    • TST converters are persons with baseline testing results whom have an increase of 10 mm or more in the size of the TST reaction within a 2-year period.
    • IGRA converters are persons with negative baseline testing whom have a new positive result within a 2-year period.

The risk of progression to active TB disease is greatest in the first 1 or 2 years after infection

  • Infants and children under the age of five years who have a positive TB test result

Why should these individuals be screened?

Screening of these high-risk individuals allows for identification and treatment of new LTBI cases, while providing the public health benefit of decreasing the reservoir of infection in the community, reducing the number of future TB cases.

Unfocused, population-based testing is not cost-effective or useful and leads to unnecessary treatment. TB testing activities should be conducted only among high-risk groups, with the intent to treat if LTBI is detected. A decision to test, is a decision to treat.  Once active TB disease has been excluded, treatment of LTBI should be offered to patients regardless of their age.


How to test for LTBI

San Mateo County encourages the use of one of two interferon gamma release assays (IGRAs), either the QuantiFERON-TB Gold In-Tube test or the T-Spot TB test.  The IGRA is a blood test that is specific to M. tuberculosis and does not have false positive results in persons with a history of BCG immunization.  These tests are approved for use in adults and children age 5 and up, and may sometimes be indicated in younger children.

In persons <5 and in situations where an IGRA cannot be obtained, a TST should be used.  Generally, it is not recommended to test a person with both a TST and an IGRA.

For more information, refer to the California Tuberculosis Controller’s Association (CTCA) IGRA Clinical Guidelines in California (2012) [PDF], adapted from the Center for Disease Control (CDC) Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection (2010).


For current tuberculosis diagnosis and treatment guidelines, please follow this link to the California Tuberculosis Controllers Association guidelines page.

List of local clinics offering TB skin tests [PDF]

San Mateo County outpatient clinics offering TB skin tests
Note: this information is subject to change. Please confirm in advance with the clinic!
Daly City Clinic
380 90th Street, Daly City
(650) 301-8600
TST & QFT: Mon & Wed 8:45-11AM
APPOINTMENT NEEDED.
$40 per test.
Daly City Youth Health Center
(ages 13-21 years only)
2780 Junipero Serra Boulevard, Daly City
(650) 985-7000
TST & QFT: Mon-Fri 9:30-11:30AM & 1-4PM, except Thurs mornings.
APPOINTMENT NEEDED.
Eligibility: Medi-Cal/HPSM, ACE, CHDP.
New patients require physical to establish care.
South San Francisco Clinic
306 Spruce Avenue, South San Francisco
(650) 877-7070
TST & QFT: Mon-Fri 9-11AM & 1-3:30PM
APPOINTMENT NEEDED FOR CHILDREN ONLY.
Eligibility: Medi-Cal/HPSM, ACE, CHDP.
Insurance screening available on site.
Fair Oaks Health Center
2710 Middlefield Road, Redwood City
(650) 364-6010
QFT only: Mon-Fri 8AM-5PM
APPOINTMENT NEEDED.
Eligibility: Registered patients only (subject to change). Call to inquire.
Sequoia Teen Wellness Center
(ages 12-21 years only)
200 James Avenue, Redwood City
(650) 366-2927
TST & QFT: Mon-Fri 8:30-10:30AM & 1-2:30PM
NO APPOINTMENT NEEDED FOR REGISTERED PATIENTS.
Eligibility: Medi-Cal/HPSM, ACE, CHDP.
If uninsured, call to screen for Gateway Program coverage.
$10 TST, $45 QFT.

San Mateo County Mobile Health Van
(Varies by day, time, and location)
Schedule: www.smchealth.org/mobileclinic
(650) 573-2786
TST & QFT: Mon-Wed
FIRST COME, FIRST SERVED UNTIL FULL.
(No TSTs on Thurs or Fri before Mon holiday.)
TST: $35 per test, $49 for two-step test
QFT: $110 per test ($75 + $35 consultation fee)

 

Managing Patients with Positive Tuberculin Skin Tests (TSTs) or Interferon Gamma Release Assays (IGRAs)

A chest x-ray must always be obtained when there is a positive TST or IGRA to rule out active disease.

If the chest x-ray is not suggestive of active TB, the patient is a candidate for latent TB treatment (this was previously called “prophylaxis”.)

There are four regimens that can be used to treat LTBI.

Drugs Duration Interval Minimum doses
* must use directly observed therapy
Isoniazid 9 months Daily 270
Twice weekly* 76
Isoniazid 6 months Daily 180
Twice weekly* 52
Isoniazid and Rifapentine 3 months Once weekly* 12
Rifampin 4 months Daily 120

San Mateo County follows treatment recommendations set forth by the California Tuberculosis Controller’s Association (CTCA) adapted from the Centers for Disease Control (CDC), At the present time, the CTCA LTBI guidelines (2006) are under revision.  Until such time at the guidelines are updated, the county recommends following the 2010 LTBI guidelines set forth by the CDC.

For contacts to a case of drug resistant tuberculosis, specific treatment recommendations may be made by San Mateo County’s TB program, depending on the susceptibility of the organism to which the contact was exposed.

Remember, we are available for consultation!
650-573-2346

San Mateo County follows treatment recommendations for active tuberculosis disease set forth by the California Tuberculosis Controller’s Association (CTCA) adapted from the Centers for Disease Control (CDC).  The recommendations by the CTCA differ slightly from the CDC’s guidelines.  An overview of the differences can be found on the CTCA Website

We have also highlighted below important matters for managing a patient with active TB disease in San Mateo County.

Treatment Monitoring

For patients with drug susceptible tuberculosis, San Mateo County follows a specific schedule of monitoring [PDF]. This allows for appropriate assessment of clinical improvement.  While all components of monitoring are essential, of particular importance to patient treatment is documented culture conversion after 8 weeks of treatment.

Directly Observed Therapy (DOT)

San Mateo County uses DOT as a tool to support patients through a lengthy course of treatment, improve tuberculosis treatment adherence, and minimize adverse outcomes.  All patients with pulmonary TB or drug resistant TB, as well as patients on intermittent regimens should be on DOT.  DOT is also strongly recommended for others at high risk for serious outcomes, or poor adherence.  To learn more, read the handout entitled Information for Physicians: Directly Observed Therapy [PDF].

HIV Testing

Since HIV co-infection is a significant risk factor for progression to active tuberculosis disease, and also alters medical management of tuberculosis, San Mateo County follow the California Department of Public Health (CDPH) and Centers for Disease Control (CDC) recommendation that all patients with suspected or confirmed tuberculosis be tested for HIV.  Additional information about who should be tested for HIV, and why can be found in the San Mateo County HIV Testing Memo [PDF].

Do you have questions?

We are available for consultation at 650-573-2346.

Hospital Discharge Guidelines

Providers must report patients with suspected or confirmed diagnosis of tuberculosis within one working day of identification (Title 17 California Code of Regulations §2500).

All patients with suspect or confirmed diagnosis of M. tuberculosis need approval by San Mateo County Health System prior to discharge or transfer to another facility to ensure that:

  • San Mateo County TB Control Program is aware of the patient at time of diagnosis and prepared to ensure continuity of treatment
  • Potentially infectious patients are not discharged to high risk environments where susceptible individuals may get exposed

The hospital shall notify Public Health of its discharge plans at least 24 hours prior to discharge.

Readiness for discharge is based on the following criteria:

  • Three consecutive sputa samples have been obtained for smear and culture
  • The patient is on appropriate multi-drug therapy
  • Home assessment by the Public Health Nurse has been completed
  • Arrangements have been made for continuation of care after discharge
Please complete the discharge planning summary form and fax it to the San Mateo County TB Control Program. The fax number is indicated on the form.

San Mateo County residents with private health insurance will need to complete the TB Immigration Clearance Process through their primary healthcare network.  Please fax the results of the follow-up and the completed TB Follow-Up Worksheet to (650) 573-2919.

Sputum Collection Instructions for Patients

The doctor has asked that you submit sputum specimens.  It’s important to collect the samples for three mornings in a row,  for example, on Monday, Tuesday, and Wednesday, or on Saturday, Sunday and Monday.

These instructions will help you collect the specimens in the right way.  

  1. Collect the specimen before breakfast.  The best time is as soon as you get up.
  2. Blow your nose first, to clear the nasal passages of any mucus.
  3. Rinse your mouth with water.  Do not brush your teeth or drink any liquids.
  4. Collect the specimen by coughing deeply to bring up the mucus and spit it into the plastic container that has been provided for you.  Please write the date and time on the container, and on the paper lab slip.
  5. After you’ve collected the specimen, please make sure to close the lid tightly.
  6. Please put the specimen container in the plastic lab bag, and put it in the refrigerator. Do not put the specimens in the freezer.
  7. Repeat the same procedure on each of the next two days.  Don’t forget to refrigerate the container.
  8. On the morning of your last specimen collection, please drop off the containers to the place told to you by your doctor.

Home Isolation Instructions for Patients

Patients required to be on home isolation should have the concept and it’s purpose explained to them, and be provided with home isolation instructions, available in English, Spanish and Tagalog.