contact investigation of tuberculosis

1. 0
Announcements
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Introduction to the TB CIR Module

2. 1
Introduction to the DRSi Tuberculosis Contact
Investigation Reports Module
Courtney Rudiger
29 August 2017

3. 2
Objectives
1. Describe DRSi Tuberculosis Contact Investigation Report module
capabilities.
2. Understand how standardized investigation data assist in program
and policy planning.
3. Describe current trends in tuberculosis in the military and the
importance of data collection to tracking those trends.
Introduction to the TB CIR Module

4. 3
What’s new in DRSi for tuberculosis?
 Tuberculosis MER screen expanded with additional questions.
– Examples
 New Module: Tuberculosis Contact Investigation Reports (TB CIR)
contains CIRs filled out by reporters for investigations conducted in
response to a tuberculosis case.
Introduction to the TB CIR Module

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Why do we have a TB CIR module?
 Fulfills reporting requirements
– Navy: Per BUMEDINST 6224.8B (Tuberculosis Control Program),
completed TB investigation reports should be provided to NMCPHC.
– Air Force: Available for use; however, ensure all cases are
investigated/reported IAW AFI48-105, Attachment 3.
– Army: Available for use.
Introduction to the TB CIR Module

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Who should use the TB CIR module?
 When reporting a case of TB, all reporters should fill out as much
information as possible when submitting the MER.
 MTFs should fill out a CIR if a contact investigation is conducted.
 NEPMUs should fill out a CIR if they support or conduct a contact
investigation in operational units.
 A CIR should be filled out whenever a contact investigation takes place,
regardless of whether a TB MER has also been submitted.
– Example:
• Investigation of a contractor not diagnosed by a DoD MTF, but where active
duty were exposed
Introduction to the TB CIR Module

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Accessing the TB CIR Module
 The TB CIR module is accessed from the DRSi home page, in the
Medical Event Reports tab.
– You can view and edit your TB CIRs from here.
Introduction to the TB CIR Module

8. 7
Filling Out a TB MER
Introduction to the TB CIR Module
1. In a new MER, select “Tuberculosis” as the diagnosis.
2. Laboratory Criteria and Event
Related Questions will appear based
on the selected diagnosis. One new
question for tuberculosis is:
Is an active TB case contact
investigation being conducted?
Selecting “Yes” will cause additional
questions to appear:

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Introduction to the TB CIR Module
3. These new questions include items that will be relevant to a contact investigation, such as:
• Laboratory testing: collection/result date, additional result options, susceptibility testing
• Clinical details: chest radiography and infectious period
• Risk factors: immunosuppression, TB vaccine history, case identification, LTBI history,
country of birth

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Introduction to the TB CIR Module
4. After clicking “Submit” on the TB MER, the following pop-up window will
appear. To initiate a new contact investigation report (CIR), click “Report New
TB CIR”. The CIR module will appear.

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Introduction to the TB CIR Module
5. If the CIR was created via a MER,
Index Case Information will be pre-
populated from the corresponding fields
within the MER for the patient. To
update this information, return to the
MER, make necessary corrections, and
re-submit. Then return to the CIR and
click:

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Introduction to the TB CIR Module
6. The Contact Investigation Summary section allows entry of:
Reporting Unit
Location of the investigation
Lead agency/agencies of the investigation
Date the investigation was initiated
Setting of tuberculosis exposure

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Introduction to the TB CIR Module
7. The Contact Investigation
Summary also allows for entry about
the contacts that were screened and
tested as part of the investigation.
Note that the fields below “Number
of Contacts” are greyed out. You
will not be able to enter anything in
these fields until a value is entered
for “Number of Contacts.”
Numbers entered here do not have
to be final. Reporters can update
these numbers as the investigation
continues.

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Additional Features
 Linking TB MERs to a CIR
– When creating a CIR from a TB MER, that MER is “linked” to the CIR.
– If other TB MERs are associated with the same contact investigation, they
can also be linked to the CIR.
 Uploading associated files
– CIRs are standardized so that all reports include the same information, but
it is a limited amount of information.
– The upload function allows reporters to upload briefs, powerpoints, formal
reports, and other documents to provide additional details.
– Provides context for future planning and NEPMU support.
Introduction to the TB CIR Module

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Using the TB CIR Module
 Example: Case of TB in a Sailor on a ship
 What would need to be put in DRSi?
– TB MER for the active duty case
– TB CIR for the subsequent contact investigation
– Additional TB MERs (if necessary) for cases identified during the
contact investigation
• These would then be linked to the original CIR
Introduction to the TB CIR Module

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Using the TB CIR Module
 Example: Case of TB in a civilian contractor who has exposed active
duty service members in the workplace. The case does not receive
any medical care from within the MHS.
 What would need to be put in DRSi?
– No MER would be expected for this case, as they are not diagnosed
by a DoD MTF.
– A TB CIR would be expected, as a contact investigation would be
conducted examining the exposure to those active duty members.
– If additional TB cases are identified among those active duty service
members, then TB MERs would be submitted for those cases.
• These would then be linked to the original CIR
Introduction to the TB CIR Module

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Investigation Data and TB Policy
 During a contact investigation, many of the same questions will come
up surrounding the case and the subsequent investigation.
– Was the case identified during routine screening?
– Was the case a prior converter?
– Was the case in a high-risk environment? (e.g., ship or training
center)
– Did the investigation go beyond close family and into workplace
contacts?
– Was the case a contractor? What were the circumstances
surrounding their TB screening?
Introduction to the TB CIR Module

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Investigation Data and TB Policy
 Many of these questions were added to either the TB MER itself or the
TB CIR form.
 Standardizing these questions helps to ensure they are asked for every
TB case and every TB contact investigation.
 Works towards standardizing TB case and investigation-related data,
which contributes to policy reviews and potential changes.
 Could identify trends that would necessitate a change in the policy.
Introduction to the TB CIR Module

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Current Tuberculosis Trends
Introduction to the TB CIR Module
0
2
4
6
8
10
12
14
16
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Number
of
Cases
Year
Marine Corps Navy
Number of Tuberculosis Cases by Year and Service, DON Beneficiaries, 2005-2015

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Current Tuberculosis Trends
Introduction to the TB CIR Module
Rates of Tuberculosis by Service, DON Active Duty, 2005-2015
0.0
0.2
0.4
0.6
0.8
1.0
1.2
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate
per
100,000
service
members
Year
Marine Corps Navy

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Current Tuberculosis Trends
Introduction to the TB CIR Module
Asia
50.0%
United States
30.0%
Mexico/Caribbean
10.0%
South America 5.0%
Unknown 5.0%
Tuberculosis Cases by Region of Birth, DON Active Duty, 2005-2015

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Current Tuberculosis Trends
 For the Navy, active pulmonary tuberculosis is uncommon, particularly
among active duty service members.
 The majority of cases in Sailors and Marines occur in foreign-born
individuals (70% of active duty cases and 80% of recruit cases)
Introduction to the TB CIR Module

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Current Tuberculosis Trends
 The trends described in the previous slides come from many data
sources, including medical event reports and contact investigation
reports.
 It is important to monitor TB regularly to be aware of any changes in
trends that could influence effectiveness of preventive measures.
 These data are vital to the overall knowledge of TB in the military
population as well to informing program and policy decisions related to
force health protection.
Introduction to the TB CIR Module

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Contact Information
Introduction to the TB CIR Module
 Navy: NMCPHC Preventive Medicine Programs and Policy Support Department
– COMM: (757) 953-0700; DSN: (312) 377-0700
– Email: usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-threatassess@mail.mil
 Navy Environmental and Preventive Medicine Units (NEPMU)
• NEPMU2
– COMM: (757) 953-6600; DSN: (312) 377-6600
– Email: usn.hampton-roads.navhospporsva.list.nepmu2norfolk-threatassess@mail.mil
• NEPMU5
– COMM: (619) 556-7070; DSN (312) 526-7070
– Email: usn.san-diego.navenpvntmedufive.list.nepmu5-health-surveillance@mail.mil
• NEPMU6
– COMM: (808) 471-0237; DSN: (315) 471-0237
– Email: usn.jbphh.navenpvntmedusixhi.list.nepmu6@mail.mil
• NEPMU7
– COMM (international): 011-34-956-82-2230 (local: 727-2230); DSN: 94-314-727-2230
– Email: NEPMU7@eu.navy.mil

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Contact Information
 Army: APHC – Disease Epidemiology Division
Aberdeen Proving Ground, MD
COMM: 410-436-7506 DSN: 584-7605
usarmy.apg.medcom-aphc.mbx.disease-epidemiologyprogram13@mail.mil
 Air Force: Contact your MAJCOM PH or USAFSAM/PHR
USAFSAM / PHR / Epidemiology Consult Service
Wright-Patterson AFB, Ohio
COMM: 937-938-3207DSN: 798-3207
usafsam.phrepiservic@us.af.mil
Introduction to the TB CIR Module

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Questions?
Introduction to the TB CIR Module