Tuberculosis Reporting Made Simple

Wis. Admin. Code ch. DHS 145, Appendix A, divides the reportable communicable diseases into three categories. Tuberculosis is included with Category I diseases of urgent public health importance that “shall be reported IMMEDIATELY to the patient’s local health officer upon identification of a case or suspected case.” In addition to the immediate report (by phone or fax), the health care provider is required to complete and mail or fax an Acute and Communicable Diseases Case Report (F-44151) within 24 hours. Health care providers report to the local health department; health departments report to the state TB Program/epidemiologist. One complete, accurate F-44151 is all that is needed.

Nontuberculosis mycobacterial disease is included in Category II, diseases that “shall be reported to the local health officer on an Acute and Communicable Disease Case Report (F-44151) or by other means within 72 hours of the identification of a case or suspected case.”

Extrapulmonary tuberculosis (tuberculosis in any other part of the body other than the lungs) needs to be reported within the same time frames.

The TB Program uses the following criteria to indicate suspect status:

1. Clinical signs and symptoms in a person with risk of infection that suggest TB is definitely suspected by a health care provider, generally documented as a suspicion in the patient’s medical record (e.g., chest x-ray impression states probable TB). This does not include every person who has "rule out TB" as a differential diagnosis just because they have a cough and the physician has ordered a skin test.
   OR
2. Acid Fast Bacillus (AFB) positive smears where there is no previous laboratory report of nontuberculosis mycobacteria.
   OR
3. Health care provider’s suspicion of TB as indicated by written prescription of at least two antituberculosis medications for a period of more than two months. (The two-drug regimen, isoniazid and rifapentine, for three months to treat TB infection does not apply to this criterion.)

What if a specimen was smear negative, but the culture is positive for not-yet-identified mycobacteria? (Smear negative, culture positive for AFB, identification pending)

If the patient meets at least one of the above criteria for a suspect TB case: report.

If the patient does not meet the above criteria, and if identification of the AFB is imminent (i.e., identification will be completed in-house or at a reference laboratory within the week), report according to requirements after identification is known.

If the patient does not meet the above criteria, but identification is expected to be delayed (i.e., reference laboratory is located out of state), report as a suspect TB case. (Correct later if TB is ruled out.)

Excerpts from: Wis. Admin. Code ch. DHS 145 - CONTROL OF COMMUNICABLE DISEASES

DHS 145.03 Definitions. In this chapter:

(2) “Case” means a person determined to have a particular communicable disease on the basis of clinical or laboratory criteria or both.

(27) “Suspected case” means a person thought to have a particular communicable disease on the basis of clinical or laboratory criteria or both.

DHS 145.04 Reports of communicable diseases.
(1) RESPONSIBILITY FOR REPORTING.

(a) Any person licensed under ch. 441 or 448, Stats., knowing of or in attendance on a case or suspected case shall notify the local health officer or, if required under Appendix A of this chapter, the state epidemiologist, in the manner prescribed in this section.

(b) Each laboratory shall report the identification or suspected identification of a disease–causing organism or laboratory findings indicating the presence of a communicable disease to the local health officer or, if required under Appendix A of this chapter, to the state epidemiologist.

(c) Each health care facility shall ensure that reports are made to the local health officer or, if required under Appendix A of this chapter, to the state epidemiologist, in the manner specified in sub. (3). When a case is identified or suspected in a health care facility having an organized program of infection control, the person in charge of the infection control program shall ensure that the case or suspected case is reported to the local health officer or, if required under Appendix A of this chapter, to the state epidemiologist, minimizing unnecessary duplication.

(3) URGENCY OF REPORTS. (a) A person, laboratory or health care facility required to report under sub. (1) shall report communicable diseases of urgent public health importance as listed in category I of Appendix A of this chapter to the local health officer immediately upon identification of a case or suspected case. If the local health officer is unavailable, the report shall be made immediately to the state epidemiologist.

(4) HANDLING OF REPORTS BY THE LOCAL HEALTH OFFICER. (a) The local health officer shall notify the state epidemiologist immediately of any cases or suspected cases reported under sub. (3) (a).