The US National Tuberculosis Surveillance System: A Descriptive Assessment of the Completeness and Consistency of Data Reported from 2008 to 2012

In 2009, the Tuberculosis (TB) Information Management System transitioned into the National TB Surveillance System to allow use of 4 different types of electronic reporting schemes: state-built, commercial, and 2 schemes developed by the Centers for Disease Control and Prevention. Simultaneously, the reporting form was revised to include additional data fields.Describe data completeness for the years 2008-2012 and determine the impact of surveillance changes.Data were categorized into subgroups and assessed for completeness (eg, the percentage of patients dead at diagnosis who had a date of death reported) and consistency (eg, the percentage of patients alive at diagnosis who erroneously had a date of death reported). Reporting jurisdictions were grouped to examine differences by reporting scheme.Each year less than 1% of reported cases had missing information for country of origin, race, or ethnicity. Patients reported as dead at diagnosis had death date (a new data field) missing for 3.6% in 2009 and 4.4% in 2012. From 2010 to 2012, 313 cases (1%) reported as alive at diagnosis had a death date and all of these were reported through state-built or commercial systems. The completeness of reporting for guardian country of birth for pediatric patients (a new data field) ranged from 84% in 2009 to 88.2% in 2011.Despite major changes, completeness has remained high for most data elements in TB surveillance. However, some data fields introduced in 2009 remain incomplete; continued training is needed to improve national TB surveillance data.

section_name: Table of Contents

section_content: Tuberculosis (TB) is a nationally notifiable disease, and reporting is mandated in all states. In 1953, a national surveillance system was established to collect information on new cases of active TB disease. Since 1985, all states have been reporting TB cases to the Centers for Disease Control and Prevention (CDC) using the Report of Verified Case of Tuberculosis (RVCT), for national TB surveillance. Data are collected by state and local TB programs and submitted electronically to CDC, Division of Tuberculosis Elimination (DTBE). These data are used to monitor national TB trends, identify priority needs, and create the DTBE annual surveillance report, Reported Tuberculosis in the United States. 

To control and eventually eliminate TB, state and local TB control programs must be able to monitor trends in TB disease in high-risk populations, as well as identify new patterns of disease and possible outbreaks. The last major revision of the RVCT was completed in 2009. Since 2016, members of a DTBE-sponsored workgroup consisting of nearly 30 public health professionals from 15 TB control programs, DTBE, and the National TB Controllers Association (NTCA) have been working to revise the RVCT. Modifications to the RVCT data collection now accommodate the changing epidemiology of TB in terms of risk factors, new drug treatments, and enhanced laboratory capacity for diagnostic tests. 

Note: A case of TB is defined as an episode of TB disease in a person meeting the laboratory or clinical criteria for TB as defined in Appendix A -Tuberculosis Case Definition for Public Health Surveillance.
section_name: Introduction Background

section_content: Some states may use a modified version of the 2020 RVCT or a data collection tool that is unique to their jurisdiction. These forms are used to collect the same data contained in the 2020 RVCT. However, just as the actual 2020 RVCT is not sent to CDC, neither are any locally defined variables or additional data. CDC should never receive directly identifying information (e. g., names) of persons with TB for inclusion in the TB surveillance dataset. CDC does receive certain indirect identifiers (e. g., date of birth); these data are protected using strict data security standards as well as an Assurance of Confidentiality. Locally assigned numbers and characters are used for case identification and are included in State and Local Case Numbers (items 3 & 4) for use by CDC to identify cases when communicating with state or local agencies.
section_name: Tuberculosis Surveillance Data

section_content: The 2020 RVCT will assist TB control programs in gathering accurate and useful data. The additions and changes made to the variables of the 2020 RVCT will enable programs to capture data that are more inclusive of a variety of risk factors. These additional data will be essential to efficient and effective TB program management. The following text describes how the 2020 RVCT data can improve TB programs, and the negative effect of using inaccurate or incomplete data.
section_name: Impact of RVCT Data

section_content: • Increased ability to assess program performance, completeness of data collection, and accuracy of reporting • Improved data for program planning and policy development (e. g., personnel, resources, funding) • Facilitation of patient services (e. g., quality of care, continuity of care, sharing of accurate information with patient and health facilities)

Negative effects of Inaccurate, Incomplete, or Unknown RVCT Data
section_name: Benefits of RVCT Data

section_content: Assuring data completeness and quality is encouraged for all case reporting. Each reporting area should develop its own policy or procedure for reviewing and updating incomplete or incorrect data. These procedures should ensure that the data are collected and entered in the surveillance system accurately. 

Although health departments share TB surveillance data with CDC, the responsibility and authority for TB surveillance rests with the health department. States vary in the structure and organization of their surveillance systems. As with any reportable disease, the completeness of TB reporting reflects how actively health departments solicit case report information. Historically, disease surveillance systems have been categorized as passive or active.
section_name: Quality Assurance

section_content: Health departments passively receive case reports from health care providers, depending on the health care providers to know and comply with reporting requirements.
section_name: Passive surveillance

section_content: Health departments actively contact and interact with health care facilities or individual providers to stimulate disease reporting, sometimes directly assuming the primary responsibility of reporting cases from large or highvolume institutions. 

CDC provides funding and technical assistance to health departments to support TB surveillance and has encouraged them to take an active rather than passive approach to TB surveillance. Health departments are encouraged to identify local or private health care facilities that serve people with TB. Health departments are also encouraged to use other data sources to identify TB cases, including death certificates and laboratory reports.
section_name: Active surveillance

section_content: The RVCT is designed for the collection of information on cases of TB. The expanded RVCT was approved by the Office of Management and Budget (OMB) in 2019 to become effective January 2020. 

Note: On the RVCT and throughout this document, the term state is used to refer to the reporting jurisdiction, though not all jurisdictions are states.
section_name: Overview

section_content: Reporting of all verified cases to CDC is required by the cooperative agreement between CDC and state and local TB programs, regardless of whether the case is counted as part of the jurisdiction's official TB case count (e. g., transfer cases already counted in another state or country, which jurisdictions sometimes call "burden cases"). 

U. S. reporting areas include the 50 United States, the District of Columbia, New York City (separate from New York State), five U. S. territories (i. e., Puerto Rico, American Samoa, Guam, Commonwealth of the Northern Mariana Islands, U. S. Virgin Islands), and three freely associated states (i. e., Federated States of Micronesia, Republic of the Marshall Islands, and Republic of Palau). These freely associated states are independent countries but are considered U. S. reporting areas for TB surveillance purposes. 

Cases among persons who have been in the United States (or another U. S. reporting area) for <90 days (inclusive of the report date) should not be reported to CDC. TB disease diagnosed in patients <12 months after completion of treatment for a previous TB episode should not be reported as a new TB case; rather, the previous case report should be reopened and updated. All other countable and noncountable TB cases should be reported to CDC. 

Noncountable TB cases help measure TB morbidity and case management burden, and reporting is required under the current cooperative agreement with reporting areas. 

For the purposes of surveillance, a case of TB is defined based on laboratory or clinical evidence of active disease due to M. tuberculosis complex. For more information on the case definition of M. tuberculosis complex, see Appendix A -Tuberculosis Case Definition for Public Health Surveillance.
section_name: Required and Recommended Uses of the 2020 RVCT

section_content: The 2020 RVCT comprises two data collection reports: 1. Report of Verified Case of Tuberculosis: Complete this for all patients with a verified case of TB. 2. Multidrug-resistant (MDR) TB surveillance form: Complete this for all patients treated as MDR TB, regardless of DST results.
section_name: RVCT

section_content: The revised RVCT includes 43 items. The characteristics are varied; for example,

• Some items include one variable response • Some items include more than one response (e. g., Items 5 and 6)

• Each item is delineated in its own box Items are not necessarily listed in the order in which you might receive the information. 

Data are entered on the RVCT in several ways: 1. Entering dates and other numbers (e. g., Items 1, 2, and 6) 2. Checking boxes (e. g., Items 8, 9, and 10) a. Select one b. Select all that apply 3. Entering specific information (e. g., Items 11, 12)
section_name: RVCT Items

section_content: There are several items that include dates. When entering dates in the RVCT, supply as much known information as possible. If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date (e. g., if a case was reported in February 2021, but the exact date is unknown, enter 02/01/2021 as the date reported). • If the month and day are unknown, enter the first day of the known year as the date (e. g., if the year of report is 2021, but the month is unknown, enter 01/01/2021 as the date reported).
section_name: Partial Dates

section_content: Leave the item blank if the information requested is pending.
section_name: Pending vs. Unknown Information

section_content: It may be necessary to update RVCT information if a case is reopened (e. g., a patient who had been lost to followup is found) or if previously unavailable information is obtained. When updated data are entered in an electronic record, the new data will automatically overwrite the old data.
section_name: Updating of the RVCT

section_content: If the reporting area has its own TB case reporting forms and uses them to complete the RVCT variables, the staff should carefully review the RVCT variables and the instructions in this document to ensure that variables on the reporting area's forms match those of the RVCT.
section_name: Additional Reporting Forms

section_content: Data for the RVCT are entered in the software system designated by your jurisdiction and then transmitted electronically to CDC. Data security is an important responsibility shared by CDC, state, and local health departments. 

Access to the data entry software should be restricted to individuals authorized to perform TB surveillance activities. Access to the approved data entry software, local databases, and all other electronic surveillance files should be controlled using a local user identification (user ID) and password.
section_name: Data Entry and Security

section_content: Case numbers must not include personal identifiers. Do not use names, initials, Social Security numbers, addresses, telephone numbers, or other information that could identify a patient. 

Because of the sensitive nature of some of the data collected, CDC has provided an Assurance of Confidentiality for the surveillance system. Information collected for the RVCT that would permit identification of any individual will be held in confidence and will not be released without the consent of the individual, in accordance with sections 306 and 308(d) of the Public Health Service Act (42 U. S. C. 242k and 242m). Surveillance information reported to CDC is used for statistical and analytic summaries and for special investigations of TB epidemiology.
section_name: Patient Confidentiality

section_content: The RVCT has items that are either new or revised from the previous RVCT that was published in 2009. 

The RVCT State Case Number (Item 3), also known as the RVCT number, remains standardized by adding a 4digit code for report year and a 2-character (alpha) code for state (or jurisdictional code for jurisdictions that are not states) to the 9-character alphanumeric local identifier, so that each state case number is unique for year and state. The State Case Number format is important to help when trying to identify a person with TB who has been transferred from one health jurisdiction (e. g., state) to another, and when trying to link TB cases (e. g., known contacts).
section_name: What is New

section_content: Fifteen new items were added to improve data collection. These items are indicated in the table below.
section_name: New and Updated Items

section_name: New Items on the Revised RVCT

section_content: The RVCT instructions provide information on how to complete the 43 items for the RVCT. The instructions provide details about each item, explain the nuances of how to answer the items, and provide examples to illustrate how to apply the instructions for entering data for a TB case.
section_name: Overview of the RVCT Instructions

section_content: Primary Purpose: The Date Reported is used to determine when the health department was first notified that a person may have TB. 

Note: If this case is counted by a different jurisdiction, the noncounting jurisdiction should still complete RVCT item 1 (Date Reported). This date should correspond to the week that the noncounting jurisdiction first heard about the case (e. g., on an interjurisdictional notification from the other reporting area). In these situations, please be sure to provide the other jurisdiction's state case number in RVCT item 5 (Case Already Counted by Another Reporting Area).
section_name: Administrative Information DATE REPORTED

section_content: Primary Purpose: Used to determine the approximate date that the reporting area reviewed the RVCT and determined that the case meets the official TB surveillance case definition for reporting to the National Tuberculosis Surveillance System.
section_name: DATE COUNTED

section_content: Month, day, and year (e. g., 01/17/2020)

Date that a health department first thought that the patient may have TB. 

or Date the health department received notification (verbal or written) from a health care provider that a patient might have TB. 

If the month and/or day is unknown, enter your best estimate or do the following: If the patient had a previous diagnosis of TB, "Date Reported" applies to the current TB episode.
section_name: Date Format Description Comment

section_name: Item Description Comment

section_content: The Morbidity and Mortality Weekly Report (MMWR) week is the week of the epidemiologic year to when the state health department verified that the case meets the case definition for TB disease. 

The MMWR week reported should represent the week when the reporting area verified that the case meets the TB surveillance case definition. This is the proxy for the TB case count date. 

MMWR week is used to support public health reporting in the annual Summary of Notifiable Diseases, United States.
section_name: MMWR Week: *

section_content: MMWR year is the epidemiologic year to which a Nationally Notifiable Diseases Surveillance System case report is assigned. 

The MMWR year reported should represent the year when the reporting area verified that the case meets the TB surveillance case definition. This is the proxy for the TB case count date. 

MMWR year is used to determine the year in which the case is included for the purposes of determining TB case counts and incidence rates. 

* For more info on MMWR weeks see link below:

https://ndc. services. cdc. gov/wp-content/uploads/MMWR_Week_overview. pdf Note: If this case is counted by a different jurisdiction, the noncounting jurisdiction should still complete RVCT item 2 (Date Counted). However, this date should correspond to the week that the noncounting jurisdiction began to follow or manage the case for public health purposes (e. g., administer TB medications). 

In these situations, please be sure to provide the other jurisdiction's state case number in RVCT item 5 (Case Already Counted by Another Reporting Area).
section_name: MMWR Year:

section_content: Primary Purpose: Used to uniquely identify case reports to facilitate communication between reporting areas and CDC.
section_name: STATE CASE NUMBER

section_content: Year Reported is the year when the case was reported (e. g., 2020). 

This year should correspond to the Report Date, which is not necessarily the same as the MMWR Year.
section_name: Item Description Comment Year

section_name: State

section_content: Primary Purpose: Used to uniquely identify case reports to facilitate communication between local health departments, reporting areas, and CDC.
section_name: LOCAL CASE NUMBER

section_content: Year Reported is the year when the case was reported (e. g., 2020). 

This year should correspond to the Report Date, which is not necessarily the same as the MMWR Year. This item is optional.
section_name: Year

section_content: Primary Purpose: TB cases may be reported by multiple reporting areas in the event that the patient moved between reporting areas while under care for a TB episode; however, to avoid double-counting the case, it is important that only one reporting area officially "count" the case. This question helps to determine whether the case report should be considered "countable" for incidence calculations.
section_name: CASE ALREADY COUNTED BY ANOTHER REPORTING AREA?

section_content: Yes, another U. S. reporting area (Specify state case number from other area. )

The case has already been counted by another U. S. reporting area such as another state (e. g., transfer). 

Under "Specify", enter the state case number assigned to the case by the other reporting area. 

Reporting jurisdictions are encouraged to work collaboratively to resolve disagreements about which reporting area should count a case. If necessary, CDC will arbitrate this determination. 

See Note (below) for definition of U. S. reporting areas.
section_name: Option (select one) Description Comment

section_content: TB case counted by another country that is not a U. S. reporting area. 

Under "Specify", enter the country where TB treatment was initiated. 

It may be difficult to verify whether a case has been counted in another country. If confirmation that the case was counted cannot be obtained, consider the case to have been counted in the other country if the diagnostic evaluation was completed and the patient was prescribed anti-TB medications before arriving in the United States.
section_name: Yes, another country (Specify country)

section_content: Case was not counted by another reporting area. 

None.
section_name: No

section_name: Note

section_name: Demographics and Initial Evaluation

section_content: Primary Purpose: To document the approximate location of the patient's residence for the purpose of geographic analyses. 

The reporting address is intended to represent the location of the patient's "usual residence" as described in the Council of State and Territorial Epidemiologists (CSTE) Position Statement 11-SI-04 ("Revised Guidelines for Determining Residency for Disease Notification Purposes") and the previous Position Statement 03-ID-10. In general, "usual residence" is defined as "…the place where the person lives and sleeps most of the time, which is not necessarily the same as the person's voting residence, legal residence, or the place where they became infected with a reportable disease. "

In most cases, determining a patient's usual residence is unambiguous; however, there are various scenarios where the determination might not be as straightforward. The table of scenarios below presents the more common scenarios for which special guidelines for determining usual residence have been established. Additional guidance for reporting, verifying, and counting cases can be found in Appendix B. 

CSTE Position Statement also established the concept of a "reference point" in time at which the patient's usual residence would be established for surveillance reporting purposes. For the purposes of the RVCT, for consistency with historical practice, the reference point is the date when the TB diagnostic evaluation was initiated. 

In cases where determining usual residence is not straightforward and where specific guidelines have not been established, reporting areas should confer with DTBE to determine the most appropriate reporting address to report on the RVCT.
section_name: REPORTING ADDRESS

section_content: Persons temporarily away from their usual residence (e. g., on vacation or a business trip), and who return to their usual residence to complete TB treatment. 

Count in the reporting area for the patient's usual residence. Enter city, county, ZIP Code, and census tract of the patient's usual residence. 

Persons temporarily away from their usual residence (e. g., on vacation or a business trip), and who remain in the community that they were visiting to complete TB treatment. 

Count in the reporting area where the TB diagnostic evaluation was initiated. 

Enter city, county, ZIP Code, and census tract of location where the patient was staying when the diagnostic evaluation was initiated. 

Persons without housing (e. g., persons experiencing homelessness or without a fixed residence)

Count in the reporting area where the TB diagnostic evaluation was initiated. 

Enter city, county, ZIP Code, and census tract of location where the patient was staying when the diagnostic evaluation was initiated.
section_name: Patient Scenarios How to Count Reporting Address

section_content: Persons with multiple residences Count in the reporting area where the patient lives most of the time, based on the length of the typical cycle between residences, subject to the following specific guidelines:

1. Commuter workers living away part of the week while working (on a weekly cycle) should be reported by the jurisdiction where they stay most of the week. 2. People who live in one state most of the year but who regularly spend part of the year in another state (e. g., snowbirds) can be said to have an annual cycle and should be reported by the jurisdiction of the residence where they live most of the year. 3. Children in joint custody should be reported by the jurisdiction of the residence where they live most of the time. If the time is equally divided, they are reported by the jurisdiction where they were staying at the time the TB diagnostic evaluation was initiated. 4. People who move between residences without any regular cycle should be reported by the jurisdiction of the residence where they live most of the time. If their time is equally divided, report based on where they were staying at the time the TB diagnostic evaluation was initiated. 

Enter city, county, ZIP Code, and census tract of the location where the patient stays in the reporting area that is counting the case. 

Students 1. College or boarding school students on a typical yearly academic cycle should be counted by the reporting area where they live most of the year. 2. Intermittent or part-time students without a regular cycle for moving between parental and school residences should be counted by the reporting area where they were living at the time that diagnostic evaluation was initiated. 

Enter city, county, ZIP Code, and census tract of the location where the patient stays in the reporting area that is counting the case. 

Foster children and wards of the state Count in the reporting area where the patient was living when TB diagnostic evaluation was initiated. 

Enter city, county, and ZIP Code, and census tract where the patient was living when diagnostic evaluation was initiated.
section_name: Patient Scenarios How to Count Reporting Address

section_content: Uniformed service or merchant marine personnel 1. Uniformed service personnel residing in the United States should be counted by the reporting area for their usual residence, either on-or off-base (this is not necessarily the jurisdiction where the military member is registered to vote, pays taxes, etc. ). 2. Crews of uniformed service vessels with a U. S. homeport should be counted by the reporting area for their usual onshore residence if they report one (the place where they live and sleep most of the time when they are onshore); otherwise, they should be counted by the reporting area for their vessel's homeport. 3. Crews of U. S. flag merchant vessels engaged in inland waterway transportation should be counted by the reporting area for their usual onshore residence (the place where they live and sleep most of the time when they are onshore). 4. Crews of U. S. flag merchant vessels docked in a U. S. port or sailing from one U. S. port to another U. S. port should be counted at their usual onshore residence if they report one (the place where they live and sleep most of the time when they are onshore). If they have no onshore residence, count in the reporting area where the diagnostic evaluation was initiated. 

Enter city, county, ZIP Code, and census tract of the location where the patient stays in the reporting area that is counting the case.
section_name: Patient Scenarios How to Count Reporting Address

section_content: Institutionalized
section_name: Patient Scenarios How to Count Reporting Address

section_content: Primary Purpose: To establish the biological sex recorded for the patient at birth for evaluation of epidemiologic trends.
section_name: SEX AT BIRTH

section_content: The biological sex recorded for the patient at birth was male.
section_name: Option (select one) Description Male

section_content: The biological sex recorded for the patient at birth was female.
section_name: Female

section_content: The biological sex recorded for the patient at birth is not known. 

If "Female," enter the following:

Pregnant at Time Diagnostic Evaluation was initiated? Option (select one) Description
section_name: Unknown

section_content: Patient was pregnant when TB diagnostic evaluation was performed or initiated.
section_name: Yes

section_content: Patient was not pregnant when TB diagnostic evaluation was performed or initiated.
section_name: No

section_content: It is not known if patient was pregnant when TB diagnostic evaluation was performed or initiated.
section_name: Option (select one) Description Unknown

section_content: Primary Purpose: To establish the patient's ethnicity for evaluation of epidemiologic trends associated with ethnicity.
section_name: ETHNICITY

section_content: Hispanic or Latino Patient considers himself or herself Cuban, Mexican, Puerto Rican, South or Central American, or of other Latin American culture or origin, regardless of race.
section_name: Option (select one) Description

section_content: Patient does not consider himself or herself Hispanic or Latino.
section_name: Not Hispanic or Latino

section_content: Patient's ethnicity is not reported or unknown. 

Note: Hispanic or Latino Some patients prefer the term "Spanish origin" to Hispanic or Latino
section_name: Unknown

section_content: The response to this item should be based on the patient's self-identity or self-reporting. It should not be based on physical appearance or surname. For example, if a woman who is not Hispanic marries a Hispanic man, she may self-report as "Not Hispanic or Latino. " Similarly, people from the Philippines may have Hispanic names, but self-report as "Not Hispanic or Latino. "
section_name: Self-identity or self-reporting

section_content: The NEDSS/HL-7 case notification message format allows reporting areas to select "other" as a response for this question. For the purposes of national TB surveillance, "other" is not an acceptable response and should not be used.
section_name: "Other" response option

section_content: Primary Purpose: To establish the patient's race(s) for evaluation of epidemiologic trends associated with race.
section_name: RACE

section_content: Patient has origins in any of the original peoples of North and South America (including Central America).
section_name: Option (select all that apply) Description American Indian or Alaska Native

section_content: Patient has origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent (e. g., including Bangladesh, Cambodia, China, India, Indonesia, Japan, Korea, Malaysia, Nepal, Pakistan, the Philippine Islands, Thailand, and Vietnam).
section_name: Asian

section_content: Patient has origins in any of the black racial groups of Africa.
section_name: Black or African American

section_content: Patient has origins in any of the original peoples of Hawaii, Guam, American Samoa, or Other Pacific Islands, except islands considered to be part of Asia (see table on next page).
section_name: Option (select all that apply) Description Native Hawaiian or Other Pacific Islander (NHOPI)

section_content: Patient has origins in any of the original peoples of Europe, the Middle East, or North Africa.
section_name: White

section_content: Patient identifies to another race not listed above.
section_name: Other Race

section_content: Patient's Race is not reported or unknown.
section_name: Unknown

section_content: The response to this item should be based on the patient's self-identity or self-reporting. Therefore, patients should be offered the option of selecting more than one racial designation. Non-Hispanic patients who report more than one race will be reported as "multiple race" in national surveillance data summaries. 

For "Asian" or "Native Hawaiian or Other Pacific Islander", use the detailed race categories on the next page to complete "Specify". The chart below indicates who is considered Asian and who is considered Native Hawaiian or Other Pacific Islander.
section_name: Note: Self-identity or self-reporting

section_content: Other Pacific Islander Asian

Native Hawaiian or Other Pacific Islander
section_name: National Electronic Disease Surveillance System (NEDSS) Person Race Categories for Asian and for Native Hawaiian or

section_content: Primary Purpose: To establish the patient's country of birth and citizenship status at birth for evaluation of epidemiologic trends.
section_name: NATIVITY

section_name: A. Country of Birth

section_name: Item

section_content: Not known if patient was eligible for U. S. citizenship at birth. 

Answer "Unknown" if it is not known whether the person was eligible for U. S. citizenship at birth.
section_name: Unknown

section_content: In order to distinguish persons who were born in another country (whether they had U. S. citizenship by birthright) from those who were born in the United States, this question simply asks to record the actual country of birth. 

Eligible for U. S. citizenship at birth. This information is requested because the U. S. Census Bureau bases its "native-born" and "foreign-born" population estimates on this characteristic. 

As CDC uses the U. S. Census Bureau population estimates as denominator data in calculating incidence rates, this information is needed to correctly categorize people with TB as U. S. -born or non-U. S. born.
section_name: Note: Country of birth.

section_content: Please specify the country of birth for up to two primary guardians. 

Note: Country of birth. In order to distinguish persons who were born in another country (whether they had U. S. citizenship by birthright) from those who were born in the United States, this question simply asks to record the actual country of birth. 

Eligible for U. S. citizenship at birth. This information is requested because the U. S. Census Bureau bases its "native-born" and "foreign-born" population estimates on this characteristic. 

As CDC uses the U. S. Census Bureau population estimates as denominator data in calculating incidence rates, this information is needed to correctly categorize people with TB as U.
section_name: C. Countries of Birth for Primary Guardian(s) (pediatric [<15 years old] patients only)

section_content: Patient remained in the United States <90 days inclusive of report date.
section_name: No

section_content: It is not known how long the patient remained in the United States. 

Note: Summary of updated guidelines for determining "country of usual residence"

The Council of State and Territorial Epidemiologists (CSTE) recommends that cases of nationally notifiable diseases be reported to CDC by the jurisdiction of the person's "usual residence" at the time of disease onset. For the purposes of the RVCT, for consistency with historical practice, this is defined as the date when the TB diagnostic evaluation was initiated. 

The following information has been adapted from CSTE position statement 11-SI-04 ("Revised Guidelines for Determining Residency for Disease Notification Purposes"). In addition, because notifiable disease data are often combined with population data, case notification guidelines based on census residence rules will contribute toward greater consistency in the numerator and denominator data used in disease rates. 

Usual residence is defined as the place where the person lives and sleeps most of the time, which is not necessarily the same as the person's voting residence, legal residence, or the place where they became infected with a notifiable disease. Determining usual residence for most people is easy and unambiguous. However, the usual residence for some people is not obvious. 

Persons (regardless of citizenship) who have established a household or are part of an established household (i. e., a "usual residence") in the United States should be reported with a country of usual residence of "United States. " This includes persons who are in the United States for an extended period for work or study, even if they do not consider the United States to be "home. "

Persons (including U. S. citizens) whose established household is outside of the United States (e. g., they are "just visiting" the United States) should be reported with a country of usual residence that is the country where they have established a household. 

Persons with established households in more than one country should have country of usual residence determined based on the country where they spent the most time during the year preceding diagnosis.
section_name: Unknown

section_content: Primary Purpose: To determine if the patient was alive at the time of TB diagnosis.
section_name: STATUS AT TB DIAGNOSIS

section_content: Description Comment Alive
section_name: Option (select one)

section_content: Primary Purpose: To ascertain trends in how TB cases come to the attention of the medical or public health establishment.
section_name: INITIAL REASON EVALUATED FOR TB

section_name: Option (select one) Description Comment

section_content: A health department investigation to identify persons who had close contact with an infectious TB case. This also includes source case investigations (e. g., to identify the source of TB transmission to a child with TB disease or LTBI). 

Select if TB diagnosis was made based on a contact investigation evaluation and testing results from this investigation.
section_name: Contact investigation

section_content: Any type of planned screening for TB disease or LTBI in a specific population, other than among contacts of a TB case. 

Screening includes "targeted testing" of populations at higher risk for TB (e. g., B notification, status adjusters, intake at correctional facilities or homeless shelters, administrative screening required for employment, preenrollment screening of students, and similar activities), regardless of whether the screening activity was consistent with CDC recommendations. 

TB symptoms Signs and symptoms consistent with TB (e. g., prolonged persistent cough, fever, lymphadenopathy, night sweats, weight loss). 

TB symptoms should only be selected if the patient has TB symptoms at the time of diagnostic evaluation and neither Contact Investigation nor Screening apply to the case. This response is most appropriate when the reason that the patient came to the attention of the medical community was because of the patient's TB symptoms.
section_name: Screening

section_content: Reason that does not fit into any of the above categories. 

Other reasons such as incidental chest radiograph, lab results, or other unexpected clinical findings where TB was not suspected at the time the test was ordered.
section_name: Other

section_content: Reason for evaluating the patient not known. 

Select if the reason the person was evaluated for TB is not known. 

Note: Select the single initial reason the patient was evaluated for TB disease. The definition of "initial reason" is the situation or reason that led to the initial evaluation for TB disease. If the patient was referred for evaluation, but the reason for the evaluation is unknown, try to determine that reason.
section_name: Unknown

section_content: If a person with TB was initially encountered via a contact investigation and during that investigation was also noted to have TB symptoms, select "Contact Investigation" as the initial reason for the evaluation. However, if a patient seeks medical care because of TB symptoms, select "TB Symptoms" as the initial reason for the evaluation.
section_name: Example: TB Symptoms

section_content: Primary Purpose: To evaluate potential associations between workplace exposures and TB by collecting information about the person's current occupations and industries. 

A. Has the patient ever worked as one of the following?

Option (select all that apply)
section_name: Risk Factors CURRENT OCCUPATION AND INDUSTRY

section_name: Description

section_content: Also known as "health care personnel. " Paid or unpaid person working in a health care setting.
section_name: Healthcare worker

section_content: Person working in a correctional facility. Persons who have worked as health care personnel within a correctional facility should have both the "Health care worker" box and the "Correctional facility employee" box checked.
section_name: Correctional facility employee

section_content: Person who is required to be absent from a permanent place of residence for the purpose of seeking employment, or who may vary their employment for the purpose of remaining employed while maintaining a permanent place of residence.
section_name: Migrant/seasonal worker

section_content: Select if confirmed that the individual never worked as a health care worker, correctional facility employee, or migrant/seasonal worker.
section_name: None of the above

section_content: Select only when it cannot be confirmed or denied that the individual ever worked as a health care worker, correctional facility employee, or migrant/seasonal worker. 

B. Current Occupation and Industry (complete this section for all patients ≥14 years of age [NIOSH standard], regardless of answers to item 15A). 

Current Occupation is the type of job that the patient has been doing most recently, whether paid or unpaid (volunteer).
section_name: Unknown

section_content: "What kind of work do you do? For example, registered nurse, custodian, cashier, auto mechanic, barber, civil engineer, volunteer firefighter, etc. "

If the patient has more than one current job, collect information on all of the patient's jobs for entry in the repeating group. 

If the patient is unemployed and is not currently seeking employment (e. g., patient is retired, disabled, or a full-time student), do not leave the Current Industry and Current Occupation fields blank; instead enter "unemployed," "disabled," or "student. " Include the level of study for students, e. g., "college student" or "high school student. "

If he or she works on a voluntary basis, record what they do in the occupation field (e. g., zoo volunteer, school volunteer, library volunteer). 

Tips for getting the best information on occupation that can be coded:

• Be descriptive:

Clearly describe the kind of work. 

o Unhelpful: "teacher" o Helpful: "preschool teacher," "high school teacher"

• Be specific: General or vague terms do not always provide enough information to code. 

o Unhelpful: "laborer" o Helpful: "bricklayer"

o Unhelpful: "worked in a warehouse," "worked in a shipping department" o Helpful: "forklift operator"

Current Industry is the kind of business or industry the patient works in. For each of the patient's current occupations, the corresponding current industry should be reported. This is not the name of the employer, although if the correct industry is not apparent, it is acceptable to enter the name, city, and state of the employer unless the name of the business would be sensitive or potentially identifiable.
section_name: Ask this question:

section_content: "What type of business or industry do you work in? For example, a hospital, dairy farm, restaurant, trade school, library, etc. "

Tips for getting the best information on industry that can be coded:

• If industry is not obvious, ask what is the main focus or product of the employer for which the person works. 

For example, if a patient says they work in manufacturing, ask what was made at the manufacturing plant. For example:

• Unhelpful: "manufacturing"

• Helpful: "automobile manufacturing"

• Be specific: General or vague terms do not always provide enough information to code:

• Unhelpful: "food industry"

• Helpful: "restaurant" or "grocery store"

Note: Occupation and Industry should be completed for all patients ≥14 years of age (NIOSH standard). NIOCCS occupation codes include "child or infant" and "student. "

Other codes include "disabled," "inmate," "never employed," "unemployed," and "volunteer. "

The standard NIOSH NIOCCS codes are included in the RVCT Message Mapping Guide (MMG). For more information about NIOSH/NIOCCS codes, see this link: https://csams. cdc. gov/nioccs/Default. aspx
section_name: Ask this question:

section_content: Primary Purpose: To evaluate potential risk factors for TB disease.
section_name: OTHER RISK FACTORS

section_name: Risk factor Description

section_content: Patient had diabetes (see description below) when TB diagnostic evaluation was performed or initiated.
section_name: Diabetic at diagnostic evaluation

section_content: Patient has been homeless within the 12 months preceding the TB diagnostic evaluation.
section_name: Homeless in the past 12 months

section_content: Patient has ever experienced homelessness.
section_name: Homeless ever

section_content: Patient was incarcerated or detained in a jail, prison, or other detention center when TB diagnostic evaluation was performed or initiated.
section_name: Resident of correctional facility at diagnostic evaluation

section_content: Patient has ever been incarcerated or detained in a jail, prison, or other detention center at any point in their lifetime.
section_name: Resident of correctional facility ever

section_content: Patient was a resident of long-term care facility when TB diagnostic evaluation was performed or initiated.
section_name: Resident of long-term care facility at diagnostic evaluation

section_content: Patient used injection drugs in the past 12 months not prescribed by a health care provider.
section_name: Injecting drug use in the past 12 months

section_content: Patient used noninjection drugs in the past 12 months not prescribed by a health care provider or approved by FDA for over-the-counter dispensing.
section_name: Noninjecting drug use in the past 12 months

section_content: Patient heavily used alcohol (see definition below) in the past 12 months.
section_name: Heavy alcohol use in the past 12 months

section_content: Patient recently received, or was receiving, tumor necrosis factor-alpha (TNF-α) antagonist therapy when TB diagnostic evaluation was performed or initiated.
section_name: TNF-α antagonist therapy

section_content: Patient has ever received a solid organ transplant (e. g., kidney, heart). 

End-stage renal disease Patient had end-stage renal disease when TB diagnostic evaluation was performed or initiated (e. g., patients on dialysis).
section_name: Post-organ transplantation

section_content: Patient has ever had a diagnosis of Hepatitis B or C (acute or chronic).
section_name: Viral hepatitis (B or C only)

section_content: Patient is immunocompromised because of either a medical condition (e. g., leukemia, Hodgkin's lymphoma, carcinoma of the head or neck), or immunosuppressive therapy, such as prolonged use of high-doses of corticosteroids.
section_name: Other immunocompromise (other than HIV/AIDS)

section_content: Additional risk factors as defined by the reporting area may be entered as "Other. " The particular risk factor being reports should be identified in the "specify" field. An unlimited number of "other" risk factors may be reported.
section_name: Other (specify)

section_content: Patient does not have this risk factor.
section_name: Option (select one) Description No

section_content: Patient has this risk factor.
section_name: Yes

section_content: It is unknown whether the patient has this risk factor.
section_name: Unknown

section_name: Definitions:

section_content: The American Diabetes Association (American Diabetes Association. Dia Care. 2014;37:S81-S90) has established the following criteria for a diagnosis of diabetes:

• Hemoglobin A1c ≥6. 5%, or • Fasting (defined as no caloric intake for ≥8 hours) plasma glucose ≥126 mg/dL (7. 0 mmol/L), or • 2-hour plasma glucose ≥200 mg/dL (11. 1 mmol/L) during an oral glucose tolerance test, as described by the World Health Organization, or • In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11. 1 mmol/L)

Persons who do not meet the above criteria only because they are currently receiving treatment for diabetes should still be reported as diabetic.
section_name: Diabetic

section_content: A person experiencing homelessness may be an individual who has:

1. No fixed, regular, and adequate nighttime residence, and 2. A primary nighttime residence that is a. A supervised publicly or privately operated shelter designed to provide temporary living accommodations, including welfare hotels, congregate shelters, and transitional housing for the mentally ill, or b. An institution that provides a temporary residence for individuals intended to be institutionalized, or c. A public or private place not designated for, or ordinarily used as, a regular sleeping accommodation for human beings. 

A person experiencing homelessness may also be defined as a person who has no home (e. g., is not paying rent, does not own a home, and is not steadily living with relatives or friends). Persons in unstable housing situations (e. g., alternating between multiple residences for short stays of uncertain duration) may also be considered homeless. 

A person experiencing homelessness may be a person who lacks customary and regular access to a conventional dwelling or residence. Included as homeless are persons who live on streets or in nonresidential buildings. Also included are residents of homeless shelters and shelters for battered women. Residents of welfare hotels and single room occupancy hotels could also be considered homeless. 

In the rural setting, where there are usually few shelters, a homeless person may live in nonresidential structures, or substandard housing, or with relatives. Homeless does not refer to a person who is incarcerated or in a correctional facility.
section_name: Homeless

section_content: Injecting drug use involves the use of hypodermic needles and syringes for the injection of drugs not prescribed by a health care provider. Route of administration may be intravenous, subcutaneous (e. g., skin popping), or intramuscular.
section_name: Injecting drug use

section_content: Marijuana use should always be recorded as noninjecting drug use, regardless of whether marijuana is legal for medicinal or recreational use in the state of residence. 

Noninjecting drug use also includes misuse of licensed or prescription drugs, including opioids, or other drugs that were not injected and were not prescribed for the patient by a health care provider or approved for over-the-counter use by FDA. The drugs may be ingested, inhaled, sniffed, or smoked. 

For more information, see Substance Abuse and Mental Health Services Administration, SAMHSA, Opioid Overdose Prevention Toolkit, 2018 at https://store. samhsa. gov/sites/default/files/d7/priv/opioid-use-disorder-facts. pdf.
section_name: Noninjecting drug use

section_content: The National Institute on Alcohol Abuse and Alcoholism defines heavy alcohol use as binge drinking on 5 or more days in the month preceding diagnosis. Binge drinking is defined as a pattern of drinking that brings blood alcohol concentration levels to 0. 08 g/dL. This typically occurs after four drinks for women and five drinks for men in about 2 hours. https://www. niaaa. nih. gov/
section_name: Heavy alcohol use

section_content: Primary Purpose: To categorize the type of correctional facility for those patients who were residing in a correctional facility at the time of diagnostic evaluation.
section_name: IF RESIDENT OF CORRECTIONAL FACILITY AT DIAGNOSTIC EVALUATION, TYPE OF FACILITY?

section_name: Option (select one) Description

section_content: Confinement facility administered by a federal agency (except Immigration and Customs Enforcement); includes privately operated federal correctional facilities.
section_name: Federal prison

section_content: Confinement facility administered by a state agency; includes privately operated state correctional facilities.
section_name: State prison

section_content: Confinement facility usually administered by a local law enforcement agency, intended for adults but sometimes also containing juveniles; holds persons detained pending adjudication and/or persons committed after adjudication, typically for sentences of 1 year or less.
section_name: Local jail

section_content: Public or private residential facility; includes juvenile detention centers, reception and diagnostic centers, ranches, camps, farms, boot camps, residential treatment centers, and halfway houses or group homes designated specifically for juveniles.
section_name: Juvenile correctional facility

section_content: Includes Immigration and Customs Enforcement (ICE) detention centers, Indian reservation facilities (e. g., tribal jails), military stockades and jails, federal park police facilities, police lockups (temporary holding facilities for persons who have not been formally charged in court), or other correctional facilities that are not included in the other specific choices.
section_name: Other

section_content: Inmate when the TB diagnostic evaluation was performed, but the type of correctional facility is not known. 

Note: If the person with TB was a resident of more than one facility during the diagnostic evaluation, select the facility where the initial TB diagnostic evaluation was performed. This question should only be completed if Resident of Correctional Facility at Diagnostic Evaluation" is answered as "Yes" in item 16.
section_name: Unknown

section_content: Primary Purpose: To categorize the type of long-term care facility for those patients who were residing in a long-term care facility at the time of diagnostic evaluation.
section_name: IF RESIDENT OF LONG-TERM CARE FACILITY AT DIAGNOSTIC EVALUATION, TYPE OF FACILITY?

section_content: Description Comment
section_name: Option (select one)

section_content: Freestanding facility with three or more beds (i. e., is classified as a residential facility or congregate residential setting) that provides nursing care services (e. g., nursing or medical care or supervision of medications that may be selfadministered). 

Facilities may be certified by Medicare or Medicaid or may be licensed by the state as a nursing home (e. g., skilled nursing facility, intermediate care facility, nursing care unit of a retirement center). This does not include assisted living facilities.
section_name: Nursing home

section_content: Distinct unit with three or more beds that is physically attached to, or managed by, a hospital. 

Facilities may be certified by Medicare or Medicaid or may be licensed by the state.
section_name: Hospitalbased facility

section_content: Facility with three or more beds (i. e., classified as a residential facility or congregate residential setting) and meets both of the following criteria:

1) Not classified as a nursing home, hospital-based facility, mental health residential facility, or alcohol or drug treatment facility, as described above and 2) Provides personal care or supervision (not nursing care services) to its residents, in addition to room and board (e. g., help with bathing, dressing, eating, walking, shopping).
section_name: Residential facility

section_content: This option should only be used for facilities that are not for mental health, treatment, or alcohol or drug treatment.
section_name: This includes assisted living facilities.

section_name: Option

section_content: Only long-term rehabilitation or residential facilities designated for treatment of 30 days or longer. 

Exclude all ambulatory or outpatient facilities, detoxification units, and facilities designated for fewer than 30 days of treatment. The state agency responsible for alcohol and drug treatment can assist in determining whether a facility is considered residential.
section_name: Alcohol or drug treatment facility

section_content: A facility not mentioned above that is designated for treatment of 30 days or longer and facility type is not Unknown. 

Select if the type of long-term care facility is something other than the settings listed in this table.
section_name: Other

section_content: Patient known to be a resident of a long-term care facility, but the type of facility is not known. 

Select if the type of long-term care facility is not known. 

Note: If the person with TB was a resident of more than one facility during the diagnostic evaluation, select the facility where the initial TB diagnostic evaluation was performed. This question should only be completed if Resident of Long-term Care Facility at Diagnostic Evaluation is answered as "Yes" in item 16.
section_name: Unknown

section_content: Primary Purpose: Surveillance and patient management. To assess factors that might complicate testing, treatment, and follow-up.
section_name: CURRENT SMOKING STATUS AT DIAGNOSTIC EVALUATION

section_content: Patient currently uses tobacco every day.
section_name: Current every day smoker

section_content: Patient uses tobacco some days, but not every day.
section_name: Current some day smoker

section_content: Patient has smoked at least 100 cigarettes/cigars in his/her lifetime and has quit.
section_name: Former smoker

section_content: Patient has not smoked at least 100 cigarettes/cigars in his/her lifetime.
section_name: Never smoker

section_content: Patient was a smoker (or tobacco user), but current status is unknown.
section_name: Smoker, current status unknown

section_content: The definition of smoking includes consumption of tobacco (or nicotine) through combustible tobacco products (e. g., cigarettes) or electronic nicotine delivery systems (ENDS; e. g., vapes, e-cigarettes). It does not include chewing tobacco. 

Smoking of substances other than tobacco (e. g., marijuana) should be recorded under noninjecting drug use.
section_name: Note:

section_content: No information is available about patient's travel history. 

Notes: "Lived" refers to the place where a person stayed or slept most of the time, or the place the person considered home during the stated period.
section_name: Unknown

section_content: Answer "Yes," if patient traveled outside the United States and visited multiple countries for a total of more than 2 uninterrupted months.
section_name: Examples:

section_content: Patient's tobacco use history is not known.
section_name: Unknown if ever smoked

section_content: Primary Purpose: To verify that the case meets the surveillance definition for TB and to identify laboratory test characteristics of TB cases. This date can be found on the laboratory report as the date the specimen was collected or TST placed.
section_name: Diagnostic Testing (Other than Drug Susceptibility Testing [DST]) TUBERCULIN SKIN TEST AND ALL NON-DST TB LAB TEST RESULTS

section_content: If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date collected (e. g., if a specimen was collected in March 2020, enter 03/01/2020 as the date collected). • If the month and day are unknown, enter the first day of the known year as the date collected (e. g., if a specimen was collected in 2020, enter 01/01/2020 as the date collected).
section_name: Specimen

section_content: Month, day, and year (mm/dd/yyyy) the laboratory reported the result, or the date that the TST was read. 

This date can be found on the laboratory report as the date the report is released or made available. 

In many instances, the result date and report date are the same; if not, provide the earliest date available. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date reported (e. g., if a result was reported in March 2020, enter 03/01/2020 as the date reported). • If the month and day are unknown, enter the first day of the known year as the date reported (e. g., if a result was reported in 2020, enter 01/01/2020 as the date reported).
section_name: Date reported/read

section_name: Test Type (select one) Description Comment

section_content: Microscopic examination of specimen (e. g., sputum, using smear technique)

When reporting these results in the qualitative section, select "Positive" if these results were interpreted by the clinician caring for the patient as consistent with TB.
section_name: Smear

section_content: Microscopic examination of specimen using histopathological or cytological methods

When reporting these results in the qualitative section, select "Positive" if these results were interpreted by the clinician caring for the patient as consistent with TB.
section_name: Pathology/ cytology

section_content: Nucleic acid amplification testing (only when the specimen is tested directly; do not include results from tests on isolates obtained via culture)

When reporting these results in the qualitative section, select "Positive" if these results were interpreted by the clinician caring for the patient as consistent with TB.
section_name: NAA

section_content: Mycobacterial culture of specimen to determine presence of M. tuberculosis complex (not nontuberculous mycobacteria)

For sputum specimens, select "Sputum" from the value set.
section_name: Culture

section_name: TST

section_name: HIV

section_content: Patient self-report of HIV status is not acceptable. HIV serology results must be documented. A documented positive test result can be from any date; a negative test result must be documented ≤12 months before the TB diagnostic evaluation.
section_name: Serologic test for human immunodeficiency virus infection

section_content: Select appropriate anatomic source site from Appendix I. 

For TST, the source site is always "skin. "

Test Type (select one) Description Comment
section_name: Specimen source site

section_name: CD4 count

section_content: Report for people with HIV to characterize the patient's immune status. At least one CD4 count should be reported for HIV-infected patients, as close to the time of TB diagnostic evaluation as possible. Subsequent CD4 counts may also be reported.
section_name: Result of test for CD4 Tlymphocytes

section_content: Result of test to determine the average blood glucose level for the preceding several months Report for people with diabetes or persons being screened for diabetes. At least one hemoglobin A1c or fasting blood glucose result should be reported for diabetic patients, as close to the time of TB diagnostic evaluation as possible. Subsequent hemoglobin A1c results may also be reported.
section_name: Hemoglobin A1c

section_content: Result of test to determine the blood glucose at a given moment in a patient who has not eaten in several hours

Typically done with people with diabetes or persons being screened for diabetes. At least one hemoglobin A1c or fasting blood glucose result should be reported for diabetic patients, as close to the time of TB diagnostic evaluation as possible. Subsequent fasting blood glucose results may also be reported.
section_name: Fasting blood glucose

section_content: Any other diagnostic tests that the reporting area wishes to include None.
section_name: Other (specify)

section_name: Qualitative Test Result (select one)

section_content: For tests with a qualitative (or interpreted) result, the test result was considered positive.
section_name: Positive

section_content: For tests with a qualitative (or interpreted) result, the test result was considered negative.
section_name: Negative

section_content: For tests with a qualitative (or interpreted) result, the test result was considered indeterminate (neither positive nor negative).
section_name: Indeterminate

section_content: Used to indicate that initial TST, initial IGRA, initial sputum smear, initial sputum culture, initial NAAT, or initial HIV test was not done in this case.
section_name: Not done

section_content: Used to indicate that the test was done but the result is unknown or that it is unknown if the test was done.
section_name: Unknown

section_name: Quantitative Test Information Description

section_content: For tests with a quantitative (numerical) result, record the result in this field. These tests include the TST, CD4 cell count, hemoglobin A1c, fasting blood glucose. Quantitative result is not required for IGRA tests.
section_name: Quantitative result

section_content: For tests with a quantitative (numerical) result, record the units of measurement (e. g., millimeters for TST, percentage for hemoglobin A1c). 

Note: Results of the tuberculin skin test (TST) should be interpreted according to
section_name: Quantitative units

section_content: Enter results from a TST performed during the current diagnostic evaluation. If the patient has a documented prior positive TST result, that result should be entered, and it is not necessary to repeat the test. 

Do not enter A patient's undocumented self-report of a previous positive TST result is not acceptable.
section_name: Guidelines for Entering Tuberculin Skin Test (TST) Results

section_name: Interpreting the TST

section_content: Primary Purpose: To verify that the case meets the surveillance definition for TB and to identify imaging test characteristics of TB cases.
section_name: CHEST RADIOGRAPH OR OTHER CHEST IMAGING STUDY RESULTS

section_name: Study Type (select all that apply)

section_content: Standard radiological study resulting in a 2-dimensional projection of internal thoracic structures onto film or a screen.
section_name: Plain chest x-ray

section_content: Computed tomography, an advanced imaging technique using radiographs to display 3-dimensional images of thoracic structures with computer assistance.
section_name: CT scan

section_content: Magnetic resonance imaging, an advanced imaging technique using strong magnetic fields to display 3-dimensional images of thoracic structures with computer assistance.
section_name: MRI

section_content: Positron emission tomography, an advanced imaging technique that uses radioactive tracers to identify areas of higher chemical activity in the body.
section_name: PET

section_content: Select this option for imaging studies that do not fit into any of the above categories.
section_name: Other

section_name: Result (select one) Description

section_content: Any initial results showing abnormalities (e. g., hilar adenopathy, effusion, infiltrate[s], cavity, scarring) consistent with TB.
section_name: Consistent with TB

section_content: Results showed no abnormalities consistent with TB. This category includes any other abnormalities that are not consistent with TB.
section_name: Not consistent with TB

section_content: Used to indicate that a chest radiograph or chest CT scan was not done in this case.
section_name: Not done

section_content: Result of chest imaging is not known.
section_name: Unknown

section_name: Cavity (select one) Description

section_content: The chest imaging study showed evidence of one or more cavities.
section_name: Yes

section_content: Results did not show evidence of one or more cavities.
section_name: No

section_content: It is not known if results showed evidence of one or more cavities.
section_name: Unknown

section_name: Miliary (select one) Description

section_content: Results showed evidence of miliary disease (e. g., miliary TB, or miliary or bilateral micronodular pattern).
section_name: Yes

section_content: Results did not show evidence of miliary disease (e. g., miliary TB, or miliary or bilateral micronodular pattern).
section_name: No

section_content: It is not known if results showed evidence of miliary disease (e. g., miliary TB, or miliary or bilateral micronodular pattern). 

Note: Miliary TB is a serious type of TB disease. It is a clinical or radiologic finding, rather than a site of disease. Miliary TB is the result of a TB infection eroding into the bloodstream and from there disseminating throughout the body to multiple organs. It appears on radiographs as a great number of small (1-to 2-mm), well-defined nodules that look like millet seeds scattered throughout the lungs, hence the name "miliary. "
section_name: Unknown

section_name: Clinical History and Findings

section_content: Primary Purpose: To determine whether the patient has a prior history of TB disease or LTBI. 

If "Yes," enter the following:
section_name: HAS THE PATIENT BEEN PREVIOUSLY DIAGNOSED WITH TB DISEASE OR LTBI?

section_name: Previous Diagnosis Information

section_content: TB disease or LTBI
section_name: Diagnosis Type

section_content: Date of previous diagnosis (provide date to the level of specificity that is available; self-report is acceptable). 

If the month and/or day is unknown, enter your best estimate or do the following:
section_name: Diagnosis Date

section_name: Completed Treatment (select one)

section_content: The patient completed treatment for previous TB disease or LTBI. 

Note: Written documentation of the previous episode of TB disease or LTBI is preferred. If the patient had a previous episode of TB that was reported to U. S. surveillance, contact the state in which the case was counted to obtain information about previous diagnoses and case outcomes. Otherwise, self-report is acceptable.
section_name: Yes

section_content: The patient did not complete treatment for previous TB disease or LTBI.
section_name: No

section_content: (select one)
section_name: History of Previous Illness

section_content: The patient has a history of previous TB disease or LTBI diagnoses. Note: Written documentation of the previous episode of TB disease or LTBI is ideal. When written documentation is not available, self-report of a previous episode is acceptable (e. g., medication taken, length of course of medication).
section_name: Yes

section_content: The patient did not have previous TB disease or LTBI diagnoses
section_name: No

section_content: It is not known if the patient had previous TB disease or LTBI diagnoses.
section_name: Unknown

section_content: Primary Purpose: To document site of TB disease.
section_name: SITE OF TB DISEASE

section_content: Pulmonary TB disease inside the lung structure Pleural TB disease in the pleural space outside the lungs (e. g., pleural effusion)

Lymphatic: cervical TB disease in the cervical lymph nodes (e. g., scrofula)
section_name: Option (select all that apply) Description

section_content: TB disease in the intrathoracic lymph nodes (e. g., hilar, paratracheal, and mediastinal sites of disease)
section_name: Lymphatic: intrathoracic

section_content: TB disease in the genitourinary system (except for the BCG strain of M. bovis, which should not be reported as TB)
section_name: Genitourinary

section_content: TB disease that involves the meningeal space of brain or spinal cord Peritoneal TB disease that involves the peritoneum Other (specify:_______) If there is another anatomic site of TB disease not provided in the above list, refer to Appendix I
section_name: Meningeal

section_content: The anatomic site of disease is not known Note: If there is evidence that more than one organ or disease site is involved, select all sites affected by the TB disease process. Report all anatomic sites of disease considered by the clinician caring for this patient to be involved in the TB disease process; laboratory confirmation is not always possible for all sites of disease.
section_name: Site not stated

section_content: The RVCT has no place to select miliary TB in Site of Disease (item 25). If the report of the initial chest radiograph or the initial chest CT scan indicates "miliary TB or a miliary or bilateral micronodular pattern," record this finding under Initial Chest Radiograph (item 22) and enter "Pulmonary" as a Site of Disease (item 25).
section_name: Miliary TB

section_content: Primary Purpose: To determine whether the case meets binational reporting criteria.
section_name: Epidemiologic Investigation CASE MEETS BINATIONAL REPORTING CRITERIA?

section_content: The TB case meets binational reporting criteria. 

A case is considered binational when it meets one or more of the following criteria:

• Exposure to suspected product (e. g., unpasteurized milk or cheese) from Canada or Mexico
section_name: Yes

section_content: The case does not meet binational reporting criteria.
section_name: No

section_content: It is not known if the case meets binational reporting criteria. 

If "Yes," select all the criteria which were met.
section_name: Unknown

section_name: Option (select all that apply) Description

section_content: Patient exposed to a product (e. g., dairy product for M. bovis case)
section_name: Exposure to suspected product from Canada or Mexico

section_content: Patient has case contacts who live in Mexico or Canada
section_name: Has case contacts in or from Mexico or Canada

section_content: Patient was potentially exposed to a person with TB from Mexico or Canada
section_name: Potentially exposed by a resident of Mexico or Canada

section_content: Patient was potentially exposed to TB while physically in Mexico or Canada
section_name: Potentially exposed while in Mexico or Canada

section_content: The patient is a resident of either Mexico or Canada
section_name: Resident of Canada or Mexico

section_content: Select this option if the case meets one of the following descriptions:

• The patient crossed the border into the United States from Mexico during TB treatment, or • The patient was referred to a U. S-funded, binational TB program for treatment continuity (i. e., a patient who was being treated in the United States, but it was known that they would cross the border to Mexico).
section_name: Option (select all that apply) Description Other situations that may require binational notification or coordination of response

section_content: Primary Purpose: To determine whether the case was identified during the contact investigation of another TB case.
section_name: CASE IDENTIFIED DURING A CONTACT INVESTIGATION OF ANOTHER CASE?

section_content: Case was identified during the contact investigation or source case investigation of another case.
section_name: Option (select one) Description Yes

section_content: Case was not identified during the investigation of another case.
section_name: No

section_content: It is not known if the case was identified during the investigation of another case. 

If "Yes," entering the following:
section_name: Unknown

section_content: Patient was evaluated for TB during that investigation, regardless of whether the patient was diagnosed with TB as part of that evaluation.
section_name: Evaluated for TB During that Contact Investigation Option (select one) Description Yes

section_content: Patient was not evaluated for TB during that investigation.
section_name: No

section_content: It is not known if patient was evaluated for TB during that investigation. 

Note: Remember to record epidemiological (epi) link(s) in item 29.
section_name: Unknown

section_content: Primary Purpose: To determine if a contact investigation was performed around this case.
section_name: CONTACT INVESTIGATION CONDUCTED FOR THIS CASE?

section_content: Yes Contact or source case investigation was conducted for this case.
section_name: Option (select one) Description

section_content: An Investigation was not conducted for this case.
section_name: No

section_content: It is not known if an investigation was conducted for this case. 

Epidemiologically linked cases might include any previous, concurrent, or subsequent cases to which this case was linked. 

If epidemiologically linked cases are later identified, please update the RVCT record.
section_name: Unknown

section_name: Initial Drug Regimen

section_content: Primary Purpose: To calculate program management indicators. 

Note: This question should only be completed if the standard initial four-drug therapy (RIPE/HRZE, i. e., isoniazid, rifampin, pyrazinamide, and ethambutol) was not used for this patient as recorded in item 31.
section_name: IF INITIAL DRUG REGIMEN NOT RIPE/HRZE (SEE NOTE), WHY NOT?

section_content: There was a pharmacologic contraindication or interaction that prevented the use of RIPE/HRZE (combination therapy with isoniazid, rifampin, pyrazinamide, and ethambutol) in this patient.
section_name: Option (select one) Description Drug contraindication/interaction

section_content: The patient's drug susceptibility results were already known, so a treatment regimen based on susceptibility results was used immediately.
section_name: Drug susceptibility testing results already known

section_content: Drug susceptibility testing results were not yet available, but the provider suspected drug resistance, (e. g., the patient was a contact of a drug-resistant TB case), so a different regimen was used.
section_name: Suspected drug resistance

section_content: One or more RIPE/HRZE drugs could not be used because of national or local shortage of the drug(s).
section_name: Drug shortage

section_content: Other reason not covered in one of the provided categories.
section_name: Other (specify)

section_content: There is insufficient documentation to determine why a regimen other than standard first-line therapy was used.
section_name: Unknown

section_content: Month, day, and year the specimen was collected. (e. g., 01/17/2020)

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date collected (e. g., if a specimen was collected in March 2020, enter 03/01/2020 as the date collected). • If the month and day are unknown, enter the first day of the known year as the date collected (e. g., if a specimen was collected in 2020, enter 01/01/2020 as the date collected).
section_name: Date collected

section_content: Month, day, and year (mm/dd/yyyy) the laboratory reported the result This date can be found on the laboratory report as the date the report is released or made available. 

In many instances, the result date and report dates are the same, if not, report the earliest date available. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date reported (e. g., if a result was reported in March 2020, enter 03/01/2020 as the date reported). • If the month and day are unknown, enter the first day of the known year as the date reported (e. g., if a result was reported in 2020, enter 01/01/2020 as the date reported).
section_name: Date reported

section_content: Select appropriate anatomic source site from Appendix I. 

None.
section_name: Specimen type

section_content: Resistant Any degree of resistance reported for drug.
section_name: Result Options Description

section_content: Select only if completely susceptible.
section_name: Susceptible

section_content: • It is not known whether the test was performed, or • Results were not available or result is not known for a reason other than pending results. 

Note: Include initial result for all unique combinations of drug tested and specimen type as well as any subsequent tests where the result changed when new test results become available.
section_name: Unknown

section_content: Primary Purpose: Provides information on test results for genetic mutations associated with drug resistance.
section_name: WAS GENOTYPIC/MOLECULAR DRUG SUSCEPTIBILITY TESTING DONE?

section_content: Yes Molecular drug susceptibility testing was performed.
section_name: Option (select one) Description

section_content: Molecular drug susceptibility testing was NOT performed.
section_name: No

section_content: It is not known if molecular drug susceptibility testing was performed. 

If "Yes," enter the following information for each gene tested into the table (examples are in Appendix F):
section_name: Unknown

section_content: Name of the gene associated with resistance to an anti-TB drug. 

None.
section_name: Gene name

section_content: Month, day, and year the specimen was collected (e. g., 01/17/2020). 

Each test result should have a date collected. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date collected (e. g., if a specimen was collected in March 2020, enter 03/01/2020 as the date collected). • If the month and day are unknown, enter the first day of the known year as the date collected (e. g., if a specimen was collected in 2020, enter 01/01/2020 as the date collected).
section_name: Date collected

section_content: Month, day, and year (mm/dd/yyyy) the laboratory reported the result This date can be found on the laboratory report as the date the report is released or made available. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date reported (e. g., if a laboratory result was reported in March 2020, enter 03/01/2020 as the date reported). • If the month and day are unknown, enter the first day of the known year as the date reported (e. g., if a laboratory result was reported in 2020, enter 01/01/2020 as the date reported). 

Note: Include initial result for each combination of gene and test type as well as any subsequent tests where the result changed when new test results become available. 

See Appendix E for additional instructions on completing this item, including examples.
section_name: Date reported

section_content: Primary Purpose: To determine whether a patient was treated as a multidrug-resistant (MDR) TB case, regardless of laboratory results.
section_name: WAS THE PATIENT TREATED AS AN MDR TB CASE (REGARDLESS OF DST RESULTS)?

section_content: The patient was treated as an MDR TB case at any point during therapy. 

All cases believed by the clinician to have MDR TB should have "Yes" entered for this question. Sometimes TB cases are treated as if they were MDR TB, even if laboratory results are not available to confirm the MDR TB diagnosis (e. g., patients with a clinical diagnosis of TB who are a known contact to an MDR TB case, and thus presumed to also have TB).
section_name: Yes

section_content: The patient was not treated as an MDR TB case. 

None.
section_name: No

section_content: It is not known whether the patient was treated as an MDR TB case. 

None.
section_name: Unknown

section_content: Do not mark this question as "Yes" if second-line TB drugs were used for reasons other than presumed or confirmed drug resistance (e. g., drug shortage, drug intolerance, interactions, adverse events). 

If "Yes," complete the MDR TB Supplemental Surveillance Form (Appendices G and H). 

In addition, you are asked to complete the form if second-line drugs were used for reasons other than presumed or confirmed drug resistance.
section_name: Note:

section_content: Primary Purpose: To monitor the rate of sputum culture conversion.
section_name: Case Outcome SPUTUM CULTURE CONVERSION DOCUMENTED?

section_content: Initial sputum specimen was culture-positive, followed by at least one negative sputum culture (not within initial set of sputa). 

There should be no positive cultures after the negative culture(s) and no other positive cultures within the same "set" of sputa (i. e., greater than one consecutive specimen).
section_name: Yes

section_content: Initial sputum specimen was culture-positive, and no subsequent sputum specimens were culturenegative. 

Examples: all follow-up cultures were positive, patient could not produce sputum after therapy started, or no follow-up sputum cultures were obtained.
section_name: No

section_content: Results of all follow-up cultures are not known, or it is not known whether follow-up cultures were done. 

None. 

If "Yes," enter the date specimen was collected for the FIRST consistently negative sputum culture.
section_name: Unknown

section_content: Month, day, and year (e. g., 01/17/2020) Date of collection for the first consistently negative sputum culture

Complete only for patients who had one or more positive sputum cultures and who subsequently had at least one documented negative culture. A follow-up specimen can be collected at any time after treatment initiation. 

There should be no positive cultures after this date. If a subsequent culture is positive after an initially documented sputum culture conversion, delete the originally documented date. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date collected (e. g., if a specimen was collected in March 2020, enter 03/01/2020 as the date collected). • If the month and day are unknown, enter the first day of the known year as the date collected (e. g., if a specimen was collected in 2020, enter 01/01/2020 as the date collected). 

If "No," select the one best reason for not documenting sputum culture conversion:
section_name: Date Format Description Comment

section_content: Repeat sputum collection was attempted (including induced sputum collection), but because of clinical improvement, patient was not able to produce sputum.
section_name: Option (select one) Description No follow-up sputum despite induction

section_content: Repeat sputum collection was attempted, but induced sputum collection was not attempted and patient was not able to produce sputum.
section_name: No follow-up sputum and no induction

section_content: Patient died before having an opportunity to submit sputum to document whether the sputum culture had converted.
section_name: Died

section_content: Patient was lost to follow-up before having an opportunity to submit a sputum to document whether the sputum culture had converted.
section_name: Patient lost to follow-up

section_content: Patient refused to provide a sputum specimen for a repeat culture.
section_name: Patient refused

section_content: A reason not included in the above choices (e. g., treatment failed or the patient moved outside the United States).
section_name: Other (specify)

section_content: It is not known why a repeat sputum culture was not obtained. 

Note: Provide information on sputum culture conversion only for patients with initially positive sputum cultures. Sources for documentation of sputum culture conversion include patient medical records and laboratory reports. 

This item should be completed once sputum culture conversion is documented. If the patient's sputum cultures later become positive again, the response to this item should be updated.
section_name: Unknown

section_content: Primary Purpose: To facilitate efficient communication between TB control programs in providing continuity of care for the patient.
section_name: MOVED DURING THERAPY?

section_content: Yes Patient moved to an area where another reporting area must now provide or coordinate TB care.
section_name: Option (select one) Description

section_content: • Patient did not move, or • Patient moved within the same reporting area. 

If "Yes," select all the options under Moved to Where that apply to the area to which the patient moved:
section_name: No

section_content: Description Comment
section_name: Option (select all that apply)

section_content: Patient moved from one U. S. reporting area to another U. S. reporting area. For this item, "state" refers specifically to U. S. reporting areas. Moves from state to state within a U. S. reporting area (e. g., Federated States of Micronesia) should not be reported as an "out of state" move. 

Enter the name of the state or reporting area to which the patient moved. 

U. S. reporting areas include:

• The 50 U. S. states
section_name: Out of state (specify)

section_content: Patient moved from a U. S. reporting area to a country not considered a U. S. reporting area. 

Enter the name of the country to which the patient moved. 

For the purposes of this question, "U. S. " refers to all U. S. reporting areas, not just the 50 states and the District of Columbia. 

If patient moved "Out of the U. S. ", select one option to indicate whether a transnational referral was made.
section_name: Out of the U.S. (specify)

section_content: Patient was referred to a TB program or physician outside the United States.
section_name: Yes

section_content: Patient was not referred to a TB program or physician outside the United States. 

Transnational referral includes participation in programs such as

Communication between programs is important:

• To help ensure continued case management after a patient leaves the United States. 

• For completing a case management transfer and obtaining information from TB programs or physicians outside the United States for case completion. 

Note: This variable is used to record whether the patient moved during TB treatment. The responsibility for follow-up reporting generally remains with the reporting area that initially reported the case to CDC and counted it. (For a detailed description of the responsibility for submitting follow-up reports to CDC, see the instructions for Reporting Address [item 6]).
section_name: No

section_name: Examples of Moved

section_content: Primary Purpose: To monitor completion of therapy within a specified time.
section_name: DATE THERAPY STOPPED

section_content: Month, day, and year (e. g., 01/17/2020) Date the patient stopped taking medication for confirmed or possible TB disease This should be when the patient last ingested medication. However, if that date is not documented, see below hierarchy for guidance. 

Remember that recurrent TB is not countable as a new case of TB unless it is diagnosed at least 12 months after the last dose of treatment for the earlier case. If the patient had treatment interruptions or experienced relapse within 12 months and had to restart TB medications, use the last date treatment was ingested. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date therapy stopped (e. g., if therapy was stopped in March 2020, enter 03/01/2020 as the date therapy stopped). • If the month and day are unknown, enter the first day of the known year as the date therapy stopped (e. g., if therapy was stopped in 2020, enter 01/01/2020 as the date therapy stopped).
section_name: Date Format Description Comment

section_content: The interval between Date Therapy Started (item 30) and Date Therapy Stopped" (item 39) is meant to encompass the entire period (including interruptions in therapy) that the patient was receiving medication to treat confirmed or possible TB disease. Patient self-report without medical documentation is not acceptable. Although there may be interruptions in TB treatment, enter the final documented date on which the patient last ingested medication for confirmed or possible TB disease. For patients being treated for confirmed or possible TB disease, enter Date Therapy Stopped, according to the following chart:

Hierarchy for Determining Date Therapy Stopped (for entire treatment period)
section_name: Comment: Date Therapy Stopped

section_content: A culture tested positive 4 or more months after treatment began, resulting in prolonged therapy.
section_name: Failure

section_content: Clinical indications (other than adverse drug reactions) include central nervous system TB (e. g., meningitis), severe liver disease, or other criteria as specified by the clinician.
section_name: Clinically indicatedother reasons

section_content: Reason does not include any of the choices listed above. Specify the reason that therapy was extended.
section_name: Other (specify)

section_content: Reason is unknown. 

Note: Use the information entered for Date Therapy Started (item 30) and Date Therapy Stopped (item 39) to calculate the length of TB treatment. Sources for the reason(s) therapy was extended include patient medical records, patient interview, and health care provider interview.
section_name: Unknown

section_content: Primary Purpose: To document administration of TB medications.
section_name: TREATMENT ADMINISTRATION

section_content: Description DOT Directly Observed Therapy (DOT), in person. Response applies if DOT was used for any doses for a patient.
section_name: Option (select all that apply)

section_content: Electronic DOT (eDOT), via video call or other electronic method. Response applies if eDOT (e. g., video call, electronic medication bottle) was used to document adherence to the medication regimen for any doses.
section_name: EDOT

section_content: Any doses of medication were taken by the patient not under DOT or eDOT (including any weekend doses). 

Note: Directly observed therapy (DOT), or supervised therapy, involves the direct visual observation by a health care provider (e. g., public health nurse, outreach worker, nurse, nurse's aide) or other reliable trained person (e. g., worker in a homeless shelter) of a patient's ingestion of medication. Delivering medication to a patient without visual confirmation of ingestion does not constitute DOT. However, electronic confirmation of ingestion of medicine of carefully selected patients (e. g., stable and compliant) constitutes electronic DOT.
section_name: Self-Administered

section_content: Primary Purpose: To collect information on mortality among people with TB.
section_name: DID THE PATIENT DIE (EITHER BEFORE DIAGNOSIS OR AT ANY TIME WHILE BEING FOLLOWED BY TB PROGRAM)?

section_content: The patient died (for any reason) either before the TB diagnosis was made or at any point after TB diagnosis while the TB program was following the status of the patient. If this option is selected, record the date of death.
section_name: Yes

section_content: The patient was alive at the time that the TB program stopped following up with the patient.
section_name: No

section_content: In the absence of laboratory confirmation of M. tuberculosis complex after a diagnostic process has been completed, persons must have all of the following criteria for clinical TB:

• Evidence of TB infection based on a positive tuberculin skin test result or positive interferon-gamma release assay for M. tuberculosis, and • Signs and symptoms compatible with current TB disease, such as a chest radiograph, chest computerized tomography scan, or other chest imaging study with results that are consistent with TB or clinical evidence of current disease (e. g., fever, night sweats, cough, weight loss, hemoptysis), and • Current treatment with two or more anti-TB medications Reporting of all verified TB cases in the United States for ≥90 days (inclusive of the report date) is required by the cooperative agreement between CDC and state and local TB programs, regardless of whether the case is counted as part of the jurisdiction's official TB case count, as explained below.
section_name: Clinical case definition

section_content: The software for TB surveillance developed by CDC includes a calculated variable called VERCRIT, for which one of the values is "Provider Diagnosis. " "Provider Diagnosis" is selected when the user chooses to override a "Suspected" (corresponding to a "possible" case as described in these recommendations) default value in the case verification screen as "Verified by Provider Diagnosis. " Thus, "Provider Diagnosis" is not a component of the case definition for TB in the current "Tuberculosis Case Definition for Public Health Surveillance" (Appendix A). CDC's national morbidity reports have traditionally included all TB cases that are considered verified by the reporting areas, without a requirement that cases meet the published case definition.
section_name: Note:

section_content: A counted TB case exists when the NTSS reporting area (each of the 50 states, New York City, the District of Columbia, and the eight U. S. -affiliated island reporting areas) determines that a verified case has not already been counted in another NTSS reporting area or by another country that is not an NTSS reporting area. For situation-specific guidance on whether and when to count a verified TB case, see below:
section_name: Counted case

section_name: Verified TB cases

section_content: Count only verified TB cases that meet the laboratory or clinical case definitions (see "Verified Case" above). The diagnosis of TB must be verified by the TB control officer or designee.
section_name: Count

section_content: If diagnostic procedures have not been completed, do not count; wait for confirmation of disease. Do not count as a case the patient for which two or more anti-TB medications have been prescribed for preventive therapy for exposure to multidrug-resistant (MDR) TB, or while the diagnosis is pending.
section_name: Do not Count

section_name: Nontuberculous Mycobacterial diseases

section_content: An episode of TB disease diagnosed concurrently with another nontuberculous mycobacterial disease should be counted as a TB case.
section_name: Count

section_content: Disease caused by nontuberculous mycobacteria alone should not be counted as a TB case.
section_name: Do not Count

section_content: Count TB cases first reported to the health department at the time of a person's death are counted as incident cases, provided the person had current disease at the time of death. The TB control officer should verify the diagnosis of TB.
section_name: TB cases reported at death

section_content: Do not count as a case of TB if there is no evidence of current disease at the time of death or at autopsy. 

Immigrants, refugees, lawful permanent residents, undocumented immigrants, foreign visitors (e. g., students, commercial representatives, and diplomatic personnel), and Border Crossers
section_name: Do not Count

section_content: In general, cases should be counted by the jurisdiction where the patient resides (however temporarily) at the time the medical evaluation that led to the TB diagnosis began. 

Immigrants and refugees who are examined after arriving in the United States and are diagnosed with clinically active TB disease requiring TB treatment should be reported and counted by the locality where the diagnostic evaluation for TB began, regardless of citizenship or residency status. 

In addition, border crossers who receive TB treatment from a U. S. locality for a total of ≥90 consecutive (excluding weekends) should be counted by the locality where they receive treatment. 

"Border crosser" is defined, by the U. S. Citizenship and Immigration Services (USCIS) as "an alien resident of the United States reentering the country after an absence of less than 6 months in Canada or Mexico, or a nonresident alien entering the United States across the Canadian border for stays of no more than 6 months, or across the Mexican border for stays of no more than 72 hours. " 2 Foreign visitors (e. g., students, commercial representatives, and diplomatic personnel) who are diagnosed with TB, are receiving anti-TB therapy, and have been, or plan to remain in, the United States for 90 days or more should be reported and counted by the locality of current residence.
section_name: Count

section_content: Any person who was diagnosed and started TB treatment in another country should not be counted as a new case but should be reported as a verified noncountable TB case. 

Border crossers and other foreign visitors who are in the United States for <90 days, inclusive of report date, and begin TB treatment in the United States, but return to their native country to continue therapy should not be reported or counted by the U. S. locality where they receive treatment.
section_name: Do not Count

section_content: Count A person's TB case should be counted by the locality in which he or she resides at the time the diagnostic evaluation for TB began. The TB control officer should notify the appropriate out-ofarea TB control officer of the person's home locality to (1) determine whether the case has already been counted to avoid "double counting," and (2) agree on which TB control office should count the case.
section_name: Out-of-state or out-of-area residents

section_content: Do not count a case in a person with newly diagnosed TB who is an out-of-area resident and whose TB has already been counted by the out-of-area TB control office.
section_name: Do not Count

section_name: Migrants and other persons without a fixed U.S. residence

section_content: Persons without any fixed U. S. residence are considered to be the public health responsibility of their present locality, and their TB case should be counted by the locality in which they stay at the time their diagnostic evaluation for TB began.
section_name: Count

section_content: Cases in transient; people with TB should not be counted when there is evidence that they have already been previously diagnosed and counted by another locality. 

Federal facilities (e. g., military and veterans administration facilities)
section_name: Do not Count

section_content: Cases in military personnel, dependents, or veterans should be reported and counted by the U. S. locality where the persons are residing at the time the diagnostic evaluation for TB began. 

However, if military personnel or dependents are discovered to have TB at a military base outside the United States but are referred to a U. S. locality for treatment (e. g., a military base located within the United States), the TB case should instead be counted where treated and not where diagnosed.
section_name: Count

section_content: Do not count if the case was previously diagnosed and counted by another U. S. reporting area.
section_name: Do not Count

section_content: Count TB should be reported to the local health authority (e. g., state or county) and counted where the diagnostic evaluation for TB began. However, for a group such as the Navajo Nation, which is geographically located in multiple states, health departments should discuss each case and determine which locality should count the case.
section_name: Tribal Lands

section_content: Do not count if the case was previously diagnosed and counted by another U. S. reporting area. 

Correctional facilities (e. g., local, state, federal, and military), including Immigration and Customs Enforcement (ICE) detention facilities
section_name: Do not Count

section_content: Persons who reside in local, state, federal, or military correctional facilities, as well as ICE detention facilities, are often transferred within and between facilities. TB in these persons should be reported to the local health authority and counted by the locality with the facility where the person was residing when the diagnostic evaluation for TB began.
section_name: Count

section_content: Do not count a correctional facility resident's TB case that previously diagnosed and counted by another U. S. reporting area, even if treatment continues at another locale or correctional facility. 

To promote uniformity in TB case reporting, the following administrative procedures are recommended:

• All countable TB cases verified by the 50 U. S. states, New York City, and the District of Columbia by December 31 and reported to CDC by the prescribed deadline will be included in the annual U. S. incidence count for that year. None.
section_name: Do not Count

section_content: A change in a single nucleotide in the DNA sequence, an A, T, C, or G from what is commonly observed (i. e., wild type). Multiple point mutations can occur within the same locus.
section_name: Single nucleotide polymorphism (SNP)

section_content: A mutation that can occur when a single nucleotide or set of nucleotides is removed from a DNA sequence. A deletion can be small (i. e., one to few nucleotides) or large (i. e., a whole segment of the chromosome) and the effect of the deletion on viability of the organism or antibiotic resistance will depend on the location of the deletion and how the deletion affects protein synthesis.
section_name: Deletion

section_content: A mutation that can occur when a single nucleotide or set of nucleotides is inserted within a DNA sequence. An insertion can be small (i. e., one to few nucleotides) or large (i. e., a whole segment of the chromosome). 

Note: Insertions and deletions are often referred to as indels. Also, insertions and deletions can result in what is known as a frameshift mutation (also called frameshift change or FSC). Therefore, if "frameshift" or "FSC" is listed as the result on the laboratory report, mark the gene name, the result of mutation, and the test type. You can record indels in a separate column (see below).
section_name: Insertion

section_content: For each SNP, insert the nucleic acid change associated with the mutation as indicated on the laboratory report. Nucleic acid changes appear only if a mutation has occurred and a sequencing test type was performed. 

Please insert the nucleic acid change in abc>xyz format, if included in the laboratory report. The abc is the 3letter codon for the NA found in the naturally occurring bacterium, e. g. the nonresistant or sensitive (drugsusceptible) strain of M. tuberculosis. The xyz is the 3-letter codon for the nucleic acid found in the sample tested. Nucleic acid changes and amino acid changes are specific to the gene where the mutation occurs. A codon is three consecutive nucleotides (consisting of adenosine [A], thymidine [T], cytidine [C], or guanosine [G] ) that enables the production of a specific amino acid. If the nucleic acid change is not provided in 3-letter codon format, please enter the information as reflected in the laboratory report (e. g., c>z) or leave blank if not provided. 

Certain genes, such as inhA, ahpC-oxyR, rrs and eis will typically only have nucleic acid changes (i. e., no amino acid change to report). Nucleic acid changes in this group of genes may appear differently and the location of the mutation on the genome will be added to the nucleic acid change, e. g., 'C(-34)G' for inhA, '-45 AT insertion' for ahpC-oxyR, 'A1410G' for rrs, or G(-10)A for eis. 

If no mutation has occurred then no nucleic acid change should be listed on the laboratory report. The examples below show common mutations occurring in drug resistant TB with the nucleic acid and amino acid changes specific to the mutations occurring in the associated genes.
section_name: Nucleic acid change

section_name: Examples

section_content: Pyrosequencing, Sanger sequencing, Next Generation Sequencing (NGS), Targeted-Based Sequencing, Amplicon-Based Sequencing, Whole Genome Sequencing (WGS). Sequencing methods will usually have nucleic acid or amino acid changes recorded on the laboratory report.
section_name: Sequencing

section_content: The testing method was unknown or not indicated on the laboratory report
section_name: Unknown

section_content: The following examples show how molecular DST results should be recorded on the RVCT according to the variable (item) definitions.
section_name: Appendix F -RVCT Molecular Drug Susceptibility Testing (DST) Report Examples

section_content: Laboratory reports contained the following information:

Sputum samples from patient Y collected on 10/25/2017 and 1/6/2018, were sent to state public health laboratory and to CDC, respectively. The first specimen was tested using real-time PCR and found to have mutations in katG and rpoB and reported to the state TB program on 10/27/2017. The second sputum specimen, collected on 1/6/2018, had mutations katG, rpoB, pncA, embB, gyrA and eis and no mutations in inhA, rrs, or tlyA using Sanger sequencing performed on an isolate. These results were reported to the state TB program on 4/15/2018. In Example 2, the patient had two sputum samples sent to the laboratory. In this case it appears that molecular testing was done after the samples were cultured because the reporting dates are delayed. Yet, both specimens had the same results for all genes using the same test type. Therefore, only one set of test results should be recorded on the RVCT. For this situation, choose the earliest sample tested.
section_name: Example 1

section_name: RVCT

section_content: Laboratory reports contained the following information:

A biopsy was collected from the right cervical lymph node from patient W on 11/3/2018 and over a year later, a sputum sample was collected on 12/5/2019.
section_name: Example 3

section_name: Results

section_name: -Mutation detected -Mutation not detected -Unknown

section_name: Nucleic acid change

section_content: Test type -Non-sequencing -Sequencing -Unknown
section_name: Amino acid change Indels

section_content: Record both specimen results collected when the specimen type, test type, or mutation results differ. 

In Example 3, two specimens were collected on 11/3/2018 and 12/5/2019 and both had molecular DST results available. Record the results for both of these specimens because the specimen types differ (right lymph node and sputum). 

Notice that between the two samples the genes that were tested and the mutation pattern found was slightly different. The genes rpoB, embB, pncA, ahpC-oxyR, eis and tlyA were either not tested on both specimens or the results differed. This is another reason to record all results in the RVCT for both specimens.
section_name: Example 3 -Notes

section_content: Primary Purpose: Programmatic function. Data are used for assessing medications that were used as part of a patient's MDR treatment regimen. 

Select an option for each drug listed. Medications should be recorded as part of the regimen for the current episode beginning with the MDR TB treatment start date. Duration of therapy is a cumulative time period and does not have to be consecutively given. This accounts for treatment interruptions and temporary or short stoppages in treatment.
section_name: DRUGS EVER USED FOR MDR TB TREATMENT, FROM MDR START DATE (SELECT ONE OPTION FOR EACH DRUG)

section_name: Length of Time Administered

section_content: Not Used Drug is/was not part of the MDR TB treatment regimen. 

If a drug was recommended, but never prescribed or taken by the patient, this category should be marked.
section_name: Option (select one) Description

section_content: Drug is/was part of the MDR TB treatment regimen and was taken for less than one month.
section_name: <1 month

section_content: Drug is/was part of the MDR TB treatment regimen and was taken for greater than or equal to one month Vestibular dysfunction • Feeling that the world is revolving around the patient (objective vertigo) or the patient is revolving in space (subjective vertigo) Side effect that existed before MDR TB medication start but exacerbated by MDR TB treatment leading to a MDR TB medication discontinuation should be recorded as "Yes. "
section_name: ≥1 month

section_content: Side effect not reported.
section_name: No

section_content: It is unknown whether the side effect was reported.
section_name: Unknown

section_name: When? Option (select one) Description

section_content: Patient reported side effect only during treatment, (i. e., the side effect resolved when treatment was stopped).
section_name: During treatment

section_content: Patient reported report side effect only at the end of treatment, (i. e., after the treatment was stopped).
section_name: At the end of treatment

section_content: Patient reported side effect during treatment and at the end.
section_name: Both

section_content: On February 1, 2020, Manas was admitted to the hospital with night sweats, fever, chills and hemoptysis. He said he was treated for TB in India 10 years ago with some medication that turned his urine red but no injectable medication. His sputum smear was positive and he was started on isoniazid, rifampin, pyrazinamide, and ethambutol on February 2, 2020. 

He remained on this therapy for 3 weeks, until growth-based drug susceptibility testing returned showing the isolate was resistant to isoniazid and rifampin. On February 23, 2020, after consultation with a regional TB expert and hospital infectious disease specialists, he was started on moxifloxacin, ethambutol, pyrazinamide, and linezolid. He was started on capreomycin on March 3, 2020. Because of the cost of capreomycin, he was changed to amikacin April 15, 2020. 

The patient developed progressive high-frequency hearing loss, and his amikacin was discontinued June 6, 2020. 

He was then started on ethionamide on June 8, 2020. He experienced muscle aches, and his moxifloxacin was changed to levofloxacin on November 10, 2020. His muscle aches continued to progress, and his levofloxacin was changed to cycloserine instead on November 20, 2020. 

In February of 2021 his muscle aches had improved, but he developed numbness and tingling of his fingers and toes. Linezolid was stopped, and he was started on para-amino salicylic acid. He began having joint pains in April of 2021 and his pyrazinamide was discontinued. He finished his treatment on August 10, 2021 on cycloserine, ethambutol, para-amino salicylic acid, and ethionamide. At the last visit, he continued to complain of hearing loss and stable numbness and tingling in his fingers and toes. His muscle and joint pains had resolved. 

See example of the MDR Form completed based on this case study on the next page.
section_name: Example Case Study -"Manas"

section_name: Term Definition

section_content: A disease in which the body's ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine. See detailed diagnostic criteria for diabetes elsewhere in this manual.
section_name: Diabetes mellitus

section_content: An evaluation used to diagnose TB disease; includes a medical history, a chest radiograph, the collection of specimens for bacteriologic examination, and possibly a tuberculin skin test or an interferon-gamma release assay.
section_name: Diagnostic evaluation

section_content: Where a designated health care worker watches the person with TB swallow each dose of the prescribed drugs.
section_name: Directly observed therapy (DOT)

section_content: A laboratory method for detecting drug-resistant microorganisms. 

Drug-resistant TB TB caused by organisms that are able to grow in the presence of a particular drug; TB that is resistant to at least one first-line antituberculosis drug.
section_name: Drug susceptibility test

section_content: A condition when chronic kidney failure has progressed to the point where kidney function is less than 10% of normal; requires dialysis or transplantation; also known as stage 5 chronic kidney disease. The most common cause of ESRD in the United States is diabetes.
section_name: End-stage renal disease (ESRD)

section_content: The patient has had contact with one or more persons who have/had TB disease or have been exposed to a point source of infection (i. e., a single source of infection, such as an event or location where one or more patients had a confirmed case of TB disease). Transmission of M. tuberculosis complex by the usual modes of transmission, e. g., aerosol, is plausible. A case may be considered epidemiologically linked to a laboratory-confirmed case if at least one case in the chain of transmission is laboratory confirmed.
section_name: Epidemiologically linked

section_content: A drug used to treat TB disease; may cause vision problems. Ethambutol should be used cautiously in children who are too young to be monitored for changes in their vision.
section_name: Ethambutol (EMB)

section_content: TB disease that occurs in places other than the lungs, such as the lymph nodes, the pleura, the brain, the kidneys, or the bones; most types of extrapulmonary TB are not infectious.
section_name: Extrapulmonary TB

section_content: The initial drugs typically used for treating TB disease. Includes isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB).
section_name: First-line TB drugs

section_content: Human immunodeficiency virus, the virus that causes AIDS.
section_name: HIV

section_content: Therapy that suppresses or weakens the immune system.
section_name: Immunosuppressive therapy

section_content: Protein that is normally produced by the body in response to infection.
section_name: Interferon-gamma (IFN-γ)

section_content: A type of blood test that measures a person's immune reactivity to M. tuberculosis by measuring release of IFN-γ. In the U. S., QuantiFERON ® -TB Gold, QuantiFERON ® -TB Gold In-Tube, QuantiFERON ® -TB Plus and T-SPOT ®. TB are currently available IGRAs.
section_name: Interferon-gamma release assay (IGRA)

section_content: A sample from a specimen that was identified as a certain organism such as M. tuberculosis complex.
section_name: Isolate

section_content: A drug that is used for treating LTBI and one of the drugs used to treat TB disease; although relatively safe, it may cause hepatitis and other severe adverse reaction in some patients.
section_name: Isoniazid (INH)

section_content: Code Alabama AL 01 Code HL7 Concept Code HL7 Concept Name Accessory sinus AC 120228005 Paranasal sinus part (body structure) Code HL7 Concept Code HL7 Concept Name Code HL7 Concept Code HL7 Concept Name

section_name: DATE OF ILLNESS ONSET/SYMPTOM START DATE

section_content: Primary Purpose: To establish the approximate symptom start date to facilitate estimation of infectious period. *
section_name: DATE OF ILLNESS ONSET/SYMPTOM START DATE

section_content: Month, day, and year (e. g., 01/17/2020) Date signs and symptoms started for this TB episode. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the symptom start date (e. g., if symptoms started in March 2020, enter 03/01/2020 as the symptom start date). • If the month and day are unknown, enter the first day of the known year as the symptom start date (e. g., if symptoms started in 2020, enter 01/01/2020 as the symptom start date). 

Note: Some symptoms of TB can be nonspecific. The symptom onset date should be recorded as the approximate time when the patient first noticed any sign or symptom consistent with TB, such as the following:

• Severe cough that lasted at least 3 weeks • Chest pain not explained by another condition • Coughing up blood or sputum • Night sweats • Persistent fever not explained by another condition • Unintentional weight loss not explained by another condition If the patient reports not having experienced TB signs or symptoms, record date of earliest clinical finding consistent with TB disease, such as date of first medical encounter for evaluation of cough or other TB signs or symptoms, or date in medical records that unintentional weight loss was first recorded, or date of first abnormal chest radiograph consistent with TB. 

Note: This item should be answered for all cases, regardless of whether a contact investigation or source case investigation was warranted. Contact investigations include location-based screenings (e. g., homeless shelter, workplace) after a TB case is identified at that location. This question should be answered "Yes" if a contact investigation was conducted that adequately identified contacts related to this case, even if the investigation was prompted by identification of a different case. 

Remember to record epidemiological (epi) links in item 29. 

For more information, see Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR 2005. 54(RR-15):7. https://www. cdc. gov/mmwr/preview/mmwrhtml/rr5415a1. htm
section_name: Date Format Description Comment

section_content: Primary Purpose: To determine potential transmission links between cases.
section_name: COMPLETE TABLE BELOW FOR ALL KNOWN TB AND LTBI CASES EPIDEMIOLOGICALLY LINKED TO THIS CASE

section_name: Item Description Comment

section_content: Year Reported is the year when the case was reported (e. g., 2020). 

This year should correspond to the Report date, which is not necessarily the same as the MMWR Year.
section_name: Year

section_content: State Code indicates the two-letter postal code of the state reporting this case (e. g., GA for Georgia; see Appendix C, Reporting Area Codes). 

The term state is used to refer to the reporting area, though not all reporting jurisdictions are states (e. g., New York City).
section_name: State

section_content: Nine-character string unique within the reporting area. 

This string can contain letters or numbers and is assigned by the reporting area. 

If an epidemiologic investigation (contact, source case, cluster, outbreak, etc. ) was conducted for this case and no other TB cases or LTBI cases were identified that had epidemiological links with this case, please enter "YYYY-ST-999999999. "

Leave blank if an investigation was not conducted, i. e., if item 28 is answered as "No" or "Unknown. "

Note: For this variable, an "epidemiologic link" is defined as either a definite or probable link:

• Definite: patients shared airspace at the same location at the same time during one case's estimated infectious period • Probable: patients shared airspace at the same location during the same general time period, but investigator unable to document that they were there at the same time during one case's infectious period
section_name: Number

section_name: Initial Treatment Information

section_content: Primary Purpose: To calculate program management indicators. 

For each drug listed below, indicate whether it was used:
section_name: INITIAL DRUG REGIMEN

section_name: Option (select one) Description

section_content: Drug is known to be part of the initial regimen. 

Yes indicates that the drug was initially prescribed for treatment of TB disease.
section_name: Yes

section_content: Drug is known to not be part of the initial regimen.
section_name: No

section_content: It is not known if drug is part of the initial regimen.
section_name: Unknown

section_content: For combination drugs, select "Yes," for each drug that is a component of the combination drug
section_name: Note: Combination drugs

section_content: Rifater is a combination of isoniazid, rifampin, and pyrazinamide
section_name: Rifamate is a combination of isoniazid and rifampin

section_content: Primary Purpose: To link genotyping results with RVCT data.
section_name: Genotyping and Drug Susceptibility Testing ISOLATE SUBMITTED FOR GENOTYPING?

section_content: Isolate was submitted for genotyping, regardless of genotyping results.
section_name: Yes

section_content: No isolate was submitted for genotyping. 

If "Yes," enter the following information:
section_name: No

section_content: The genotyping accession number for the current TB episode. This number is assigned by the genotyping reference laboratory. 

Note: If multiple isolates have been submitted for one patient, please consult with your laboratorian or genotyping surveillance coordinator to determine the correct genotyping accession number for the current episode. 

When entering the genotyping accession number, begin at the first box and continue to fill to the right. Include all hyphens and letters. Do not add zeros in the remaining boxes beyond the number provided by the reference lab. 

In 2004, CDC established the National Tuberculosis Genotyping Service (NTGS). The goal was to genotype one M. tuberculosis isolate from every culture-confirmed TB case in the United States. The genotyping accession number is the number assigned by the genotyping reference laboratory. Currently, the numbers are formatted as YY (the 2-digit year), followed by "RF" and 4 digits (e. g., "06RF5678"). This format might change in the future.
section_name: Genotyping accession number

section_content: Primary Purpose: To identify TB cases with drug-resistant isolates using phenotypic/growth-based drug susceptibility testing methods.
section_name: WAS PHENOTYPIC/GROWTH-BASED DRUG SUSCEPTIBILITY TESTING DONE?

section_content: Growth-based drug susceptibility testing was performed.
section_name: Option (select one) Description Yes

section_content: Growth-based drug susceptibility testing was not performed.
section_name: No

section_content: It is unknown whether growth-based susceptibility testing was performed

If "Yes", enter the following for each drug tested
section_name: Unknown

section_name: Specimen Source Information

section_name: Description Comment

section_content: Select appropriate anatomic source site from Appendix I. 

For sputum specimens, select "sputum" from the value set.
section_name: Specimen source site

section_name: Result (select one) Description

section_content: Mutation was detected.
section_name: Mutation detected

section_content: Mutation was not detected
section_name: Mutation not detected

section_content: It is not known if a mutation was detected.
section_name: Unknown

section_content: For each gene mutation, indicate the nucleic acid (NA) change associated with the mutation as indicated on the laboratory report. 

Nucleic acid changes appear only if a mutation has occurred and a sequencing test type was performed.
section_name: Nucleic acid change

section_content: For each gene mutation, indicate the amino acid (AA) change associated with the mutation as indicated on the laboratory report. 

AA changes appear only if a mutation resulting in a substitution has occurred and a sequencing test type was performed.
section_name: Amino acid change

section_name: Indel Option (select one) Description

section_content: Mark this option if an insertion is recorded or noted on the report.
section_name: Insertion

section_content: Mark this option if a deletion is recorded or noted on the report.
section_name: Deletion

section_content: If a laboratory reports an insertion or a deletion but reports it as an "indel," mark this option.
section_name: Indel

section_content: It is unknown whether an insertion, deletion, or "indel" is recorded or noted on the lab report.
section_name: Unknown

section_name: Test Type (select one) Description Comment

section_content: Non-sequencing methods can be realtime PCR, line probe assay, or Xpert® MTB/RIF (Xpert® MTB/RIF applies only to the rpoB gene associated with rifampin resistance). 

Non-sequencing methods do not usually have nucleic acid or amino acid changes reported on the laboratory report.
section_name: Nonsequencing

section_content: Pyrosequencing, Sanger sequencing, Next Generation Sequencing (NGS), Targeted-Based Sequencing, Targeted Sequencing, Amplicon-Based Sequencing, Whole Genome Sequencing (WGS). 

Sequencing methods will usually have nucleic acid or amino acid changes recorded on the laboratory report.
section_name: Sequencing

section_content: The testing method was unknown or not indicated on the laboratory report. 

None.
section_name: Unknown

section_content: Primary Purpose: To document treatment outcome.
section_name: REASON THERAPY STOPPED OR NEVER STARTED?

section_content: Patient completed the prescribed course of therapy per the medical record as recorded by the clinician caring for the patient.
section_name: Completed therapy

section_content: Patient could not be located before the start or the completion of treatment (e. g., the patient moved to an unknown location, or the forwarding address is known but the patient was not found at that address). 

Code patients who move outside the United States and cannot be followed up as "Other. "

Patient choice Patient refused to start or complete therapy (e. g., stopped taking drugs). This option was previously "Uncooperative or Refused. "
section_name: Lost

section_content: Therapy was permanently stopped because of an adverse event due to anti-TB medications. Select this option only if the patient survived the adverse event. 

If the patient died because of an adverse TB treatment event, select Died as the reason therapy stopped and note that the death was TB-related in item 43.
section_name: Adverse treatment event

section_content: Completed diagnostic evaluation did not substantiate the diagnosis of TB (e. g., M. avium or M. bovis BCG was isolated from a clinical specimen).
section_name: Not TB

section_content: Patient was alive at diagnosis but died before the start or completion of treatment.
section_name: Died

section_content: Treatment was stopped or never started by the clinician or at patient request because the patient's condition was terminal and death was imminent.
section_name: Dying

section_content: Therapy was discontinued for a known reason not included in the above choices and is not Unknown (e. g., patient moved outside the United States).
section_name: Other

section_content: Reason that therapy was stopped is not known.
section_name: Unknown

section_content: Primary Purpose: To document reason for extended treatment and to calculate program indicators.
section_name: REASON TB DISEASE THERAPY EXTENDED >12 MONTHS, IF APPLICABLE

section_content: Inability to use rifampin (resistance, intolerance, etc. )

Rifampin (or another rifamycin such as rifabutin) could not be used to treat the patient (e. g., drug-resistant TB, rifampin intolerance), resulting in the treatment protocol lasting more than 12 months. 

This option includes all rifamycins. 

Adverse drug reaction Patient had a significant adverse drug reaction or experienced an adverse treatment event from anti-TB medications (other than a rifamycin) that prolonged therapy.
section_name: Option (select all that apply) Description

section_content: There were barriers to the patient's adherence to TB treatment (e. g., treatment interruption), resulting in extension of therapy beyond 12 months.
section_name: Nonadherence

section_content: It is unknown whether the patient was alive or dead at the time that the TB program stopped following up with the patient. 

If "Yes," enter the date of death and indicate whether or not TB or complication of TB treatment contributed to death:
section_name: Option (select one) Description Unknown

section_content: Month, day, and year (e. g., 10/20/2020) Patient's date of death should be entered (i. e., month, day, and year). 

If the month and/or day is unknown, enter your best estimate or do the following: Written documentation of the cause of death (e. g., death certificate, autopsy report, medical record) is recommended. However, oral information from a reliable source (e. g., a health care provider) will be accepted. A death certificate is not necessarily required to complete this field, and TB does not need to be listed as a cause of death on the death certificate to conclude that the death was TB-related for the purposes of the RVCT.
section_name: Date Format Description Comment

section_content: TB or complications of TB treatment did not contribute to death. 

TB was not the immediate cause, an underlying cause, or another significant condition contributing to death.
section_name: No

section_content: It is not known if TB or complications of TB treatment contributed to death. 

Every effort should be made to determine if the death was related to TB disease before classifying as unknown.
section_name: Unknown

section_content: The following appendices provide information and codes that are used to complete the RVCT:

•
section_name: Appendices

section_content: Clinical description A chronic bacterial infection caused by Mycobacterium tuberculosis, usually characterized pathologically by the formation of granulomas. The most common site of infection is the lung, but other organs may be involved.
section_name: Appendix A -Tuberculosis Case Definition for Public Health Surveillance Council of State and Territorial Epidemiologists (CSTE) Position Statement 09-ID-65

section_content: A case that meets all the following criteria:
section_name: Clinical criteria

section_content: • Isolation of M. tuberculosis from a clinical specimen, * OR • Demonstration of M. tuberculosis complex from a clinical specimen by nucleic acid amplification test, ** OR • Demonstration of acid-fast bacilli in a clinical specimen when a culture has not been or cannot be obtained or is falsely negative or contaminated.
section_name: Laboratory criteria for diagnosis

section_content: A case that meets the clinical case definition or is laboratory confirmed.
section_name: Case classification Confirmed

section_content: A case should not be counted twice within any consecutive 12-month period. However, a case occurring in a patient who had previously had verified TB disease should be reported and counted again if more than 12 months have elapsed since the patient completed therapy. A case should also be reported and counted again if the patient was lost to supervision for greater than 12 months and TB disease can be verified again. In the National Tuberculosis Surveillance System (NTSS), a TB case goes through three distinct stages: possible (also known as "suspected"), verified, and counted.
section_name: Comments

section_content: A possible TB case exists when the local TB program is initially made aware of a patient with clinical signs, symptoms, or diagnostic test results that are consistent with TB. Ideally, reporting of possible cases occurs early in the diagnostic evaluation of the patient so that the local TB program can ensure appropriate case supervision, completion of appropriate therapy, and initiation of any necessary epidemiologic investigations.
section_name: Possible case

section_content: Possible TB cases will either be verified or refuted with regard to meeting the TB surveillance case definition in Appendix A, "Tuberculosis Case Definition for Public Health Surveillance. " Refuted cases require no further action with regard to TB surveillance, and generally should not be reported to CDC. A verified TB case exists when the local TB program confirms that the patient's laboratory results and clinical signs and symptoms meet the TB surveillance case definition. Verified cases are classified as either laboratory-confirmed or clinical cases as outlined below:
section_name: Verified case

section_content: Isolation of Mycobacterium tuberculosis complex 1 from a clinical specimen. 

• The use of identification techniques for M. tuberculosis performed on growth from culture of a clinical specimen, such as DNA probes or sequencing, is acceptable under this criterion, or • Demonstration of M. tuberculosis complex from a clinical specimen by nucleic acid amplification (NAA) test. NAA tests must be accompanied by cultures of mycobacterial species. However, for surveillance purposes, CDC will accept results obtained from NAA tests approved by the Food and Drug Administration (FDA) and used according to the approved product labeling on the package insert, or a test produced and validated in accordance with applicable FDA and Clinical Laboratory Improvement Amendments (CLIA) regulations, or • Demonstration of acid-fast bacilli (AFB) in a clinical specimen when a culture has not been or cannot be obtained or is falsely negative or contaminated; historically this criterion has been most commonly used to diagnose TB in the postmortem setting.
section_name: Laboratory case definition

section_content: Name Alpha
section_name: Appendix C -Reporting Area Codes

section_name: Appendix E -RVCT Molecular Drug Susceptibility Testing (DST) Report

section_content: The RVCT Molecular DST Report provides information on test results for mutations associated with drug resistance. Complete this section for confirmed TB cases that have molecular testing performed for drug resistance. For each patient, report the full test results for the samples that have unique features, such as specimen type (sputum or another anatomic site), test type (sequencing or non-sequencing) or mutation (detected or not detected). There is no need to report test results that differ only by date or laboratory and where all other aspects are identical in regards to specimen type, test type, and/or the results of mutation. For example, if patient X has two sputum specimens collected one week apart and the first is sent to a hospital laboratory and found to have a mutation in rpoB by Xpert ®, and the second is sent to the state laboratory and found to have the same result by Xpert ®, then record only the earlier laboratory report. Enter any test result occurring for the first time, or if repeated, the result or conditions change (for example, a mutation for rpoB non-sequencing test is performed first, then a mutation for rpoB sequencing test is performed two weeks later). Enter as many tests as needed to document possible drug resistance, drug susceptibility, or acquired resistance occurring throughout the patient's clinical care.
section_name: Instructions

section_content: The gene name is the name of the gene associated with resistance to an anti-TB drug. The most common gene names associated with anti-TB drug resistance, with their associated drug names, are listed in Appendix D. 

Indicate the gene name listed on the laboratory report in the appropriate field.
section_name: Gene name

section_content: The collection date is the date that the specimen (clinical sample) was collected from the patient as it is listed on the laboratory report. Enter the month, day, and year (mm/dd/yyyy) that the sample was collected as reported on the laboratory report. If the day is unknown, enter the first day of the known month as the collection date (e. g., if a specimen was collected in March 2020, enter 03/01/2020 as the collection date). 

Each test result should have a date specimen collected.
section_name: Collection date

section_content: The report date is the date that the molecular DST test result was reported by the laboratory. The date is found on the laboratory report as the date the report is released or made available to the requestor. Enter the month, day, and year (mm/dd/yyyy) the test result was made available by the laboratory as shown on the lab report (some labs don't report this date but most do). If the day is unknown, enter the first day of the known month as the report date (e. g., if a lab result was reported in March 2020, enter 03/01/2020 as the report date).
section_name: Report date

section_content: The specimen type (Appendix I) is the source of clinical sample or isolate (sputum or other) that has been tested for a mutation associated with drug resistance.
section_name: Specimen type

section_content: Select the results as shown on the laboratory report for the selected gene. If the gene was not tested leave the option blank.
section_name: Results

section_content: There are other items you may see on a laboratory report. Below are a few definitions associated with mutations.
section_name: a. Mutation detected b. Mutation not detected c. Unknown

section_content: Indicate the amino acid change associated with the mutation as indicated on the laboratory report. Amino acid changes appear only if a mutation resulting in a substitution has occurred and a sequencing test type was performed. Nucleic acid and amino acid changes do not usually appear on a laboratory report if the test type used was a non-sequencing method. 

Amino acid changes are associated with mutations to genes katG, rpoB, pncA, embB, tlyA, gyrA, gyrB, ethA and rpsL. If a mutation has not occurred then the amino acid change, as well as a nucleic acid change, should not appear on the laboratory report. The genes inhA and eis are usually associated with only nucleic acid changes but some research has shown that amino acid changes can occur. 

A common amino acid change found in drug resistant TB is the amino acid change for the gene associated with rifampin resistance, rpoB, Ser531Leu (or Ser450Leu depending on numbering system used). In this example, 531 refers to the location or position of the codon in the rpoB gene and Ser to Leu refers to the change in amino acid (serine to leucine). 

The following explains the nomenclature used for reporting amino acid changes, using Ser531Leu as an example:
section_name: Amino acid change

section_content: Ser is the abbreviation for serine, the amino acid found in wild-type M. tuberculosis. 

531 refers to the location or position of the codon in the rifampin-resistant determining region (RRDR) of the rpoB gene where the mutation occurred. 

Leu is the abbreviation for leucine, the amino acid substitution found in the resistant M. tuberculosis. 

This amino acid change indicates there was a mutation in the RRDR of the rpoB gene at location 531 resulting in a change of the corresponding amino acid from serine to leucine.
section_name: Ser531Leu

section_content: If a laboratory reports an insertion or a deletion (or just simply calls it an "indel") select the appropriate option.
section_name: Indels

section_content: If a deletion is recorded or noted on the lab report
section_name: Option (select one) Description Deletion

section_content: If an insertion is recorded or noted on the lab report "Indel" If an "Indel" is recorded or noted on the lab report
section_name: Insertion

section_content: Select the test type (method) used for the molecular test as reported on the laboratory report.
section_name: Test type

section_name: Method (select one) Description

section_content: Non-sequencing methods can be real-time PCR, line probe assay, or Xpert® MTB/RIF (Xpert ® MTB/RIF applies only to the rpoB gene associated with
section_name: Nonsequencing

section_content: Record both sputum specimen results collected on different dates when the results or test type differ. 

In Example 1, the patient had two sputum specimens collected on different dates (10/25/2017 and 1/6/2018) using two different testing methods. The first specimen was sent to the state public health laboratory and was tested using a real-time PCR test which found two mutations, one for katG (isoniazid) and one for rpoB (rifampin). For the second specimen, collected on 1/6/2016, the laboratory report noted that the testing method was Sanger sequencing. Due to the two different methods used in testing you would want to record both specimens and test results on this patient in the RVCT. 

Record the test type for all tests used to test for mutations. 

The test type or method used on the first specimen was recorded as real-time PCR on the laboratory report. Therefore, one would mark "Nonsequencing" as the test type. Since non-sequencing tests do not provide nucleic acid or amino acid changes, one would not mark responses to those variables. 

The test type or method used on the second specimen was reported as Sanger sequencing on the laboratory report. Therefore, one would mark "Sequencing" as the test type and because sequencing tests often provide the nucleic acid and amino acid changes, one would mark responses to those items as well. 

When a mutation occurs record the nucleic acid or amino acid changes, as applicable. This patient's sputum had mutations using a sequencing method for genes katG, rpoB, pncA, embB, eis, and gyrA. Therefore, you would expect to find the nucleic acid or amino acid changes recorded on the laboratory report. The genes katG, rpoB, pncA, embB and gyrA typically have nucleic acid changes and the corresponding amino acid changes when a mutation occurs. The genes inhA, rrs, and eis typically have only nucleic acid changes when a mutation occurs and no corresponding amino acid changes. 

Leave cells in the table blank when the necessary information is not available on the laboratory report.
section_name: Example 1 --Notes

section_content: Laboratory reports contained the following information:

Sputum samples from patient X collected on 7/4/2018 and 7/26/2018, were sent to the state public health laboratory. They were tested using real-time PCR and found to have no mutations in katG, inhA, or rpoB. The specimen collected on 7/4/2018 was reported to the state TB program on 11/10/2018. The specimen collected on 7/26/2018 was reported to the state TB program on 11/18/2018 and found to have identical results.
section_name: Example 2

section_name: RVCT Molecular DST Report

section_content: To be completed for all cases treated with MDR TB medications 1. History of treatment before current episode with secondline TB drugs for the treatment of TB disease (not LTBI)?

□Yes □No □Unknown
section_name: Appendix G -Multidrug-Resistant (MDR) TB Supplemental Surveillance Form

section_content: To be completed for all cases treated with MDR TB medications, regardless of DST results
section_name: Appendix H -Instructions For Multidrug-Resistant (MDR) TB Supplemental Form

section_content: • Confirmed to have MDR TB through laboratory evidence (growth-based DST or molecular sequencing tests) of resistance to at least isoniazid and rifampin, or • Presumed to have MDR TB, such as patients whom clinicians believe to have MDR TB despite lack of laboratory evidence (e. g., patients with a clinical diagnosis of TB who are known contacts to an MDR TB case), or • Not thought to have MDR TB but are treated with second-line TB drugs for other reasons (e. g., drug shortage, drug intolerance, interactions, adverse events). 

Note: this form should also be completed for patients with XDR TB (an organism that is resistant to isoniazid, rifampin, a fluroquinolone, and a second-line injectable [amikacin, capreomycin, and kanamycin] OR by an organism that is resistant to isoniazid, rifampin, a fluroquinolone, and bedaquiline or linezolid) and pre-XDR TB (an organism that is resistant to isoniazid, rifampin, and a fluroquinolone OR by an organism that is resistant to isoniazid, rifampin, and a second-line injectable [amikacin, capreomycin, and kanamycin]).
section_name: To be completed for all cases treated with MDR TB medications, regardless of DST results. This will include patients:

section_content: Primary Purpose: Case management and surveillance. Data are used to determine if the patient has been previously exposed to second-line TB drugs.
section_name: HISTORY OF TREATMENT BEFORE CURRENT EPISODE WITH SECOND-LINE TB DRUGS FOR THE TREATMENT OF TB DISEASE (NOT LTBI)?

section_content: Patient was treated with second-line TB medications.
section_name: Yes

section_content: Patient has not been treated in the past with second-line TB medications.
section_name: No

section_content: It is not known whether the patient was previously treated with secondline TB medications. 

Second-line TB drugs include all drugs used to treat TB that is resistant to first-line TB drugs (e. g., capreomycin, ethionamide, cycloserine, ciprofloxacin, amikacin).
section_name: Unknown

section_content: Often there is no documentation of the patient having been treated in the past if they were treated before arriving in a U. S. reporting area. When documentation is not available, self-report of treatment for a previous episode of MDR TB disease is acceptable. Do not enter a previous diagnosis of, or treatment course for, latent TB infection (LTBI).
section_name: Note:

section_name: DATE MDR TB TREATMENT STARTED FOR CURRENT EPISODE

section_content: Primary purpose: Programmatic function. Data will be used to determine the duration of injectable medication use in situations where injectables were administered and estimate the intensive phase in situations where applicable.
section_name: DATE INJECTABLE MEDICATION WAS STOPPED

section_content: Month, day, year (e. g., 01/15/2020) Date the patient ended the injectable medication. 

If an injectable was started, stopped, and restarted, indicate the last day the injectable was stopped. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date injectable stopped (e. g., if an injectable was stopped in March 2020, enter 03/01/2020 as the date injectable stopped). • If the month and day are unknown, enter the first day of the known year as the date injectable stopped (e. g., if an injectable was stopped in 2020, enter 01/01/2020 as the date injectable stopped. 

If patient did not receive any injectable medications, mark N/A.
section_name: Date Format Description Comment

section_content: Primary purpose: Case management and surveillance function. Data will be used to determine the number of patients needing surgery for MDR TB treatment.
section_name: WAS SURGERY PERFORMED TO TREAT MDR TB?

section_content: Description Comment
section_name: Option (select one)

section_content: Surgery was performed as part of MDR TB treatment for the current episode of MDR TB. 

Biopsy done to diagnose MDR TB is not considered surgery to treat MDR TB. However, excisional biopsy for the treatment of extrapulmonary TB is considered surgical treatment for MDR TB.
section_name: Yes

section_content: Surgery was not done for the purpose of MDR TB treatment for the current episode of MDR TB. 

None.
section_name: No

section_name: Date of Surgery

section_content: Month, day, year (e. g., 01/15/2020) Date the patient had surgery for MDR TB. 

If the month and/or day is unknown, enter your best estimate or do the following:

• If the day is unknown, enter the first day of the known month as the date of surgery (e. g., if surgery was performed in March 2020, enter 03/01/2020 as the date of surgery). • If the month and day are unknown, enter the first day of the known year as the date of surgery (e. g., if surgery was performed in 2020, enter 01/01/2020 as the date of surgery.
section_name: Date Format Description Comment

section_content: Primary purpose: Case management and surveillance function. Data will be used to determine the nature and number of patients experiencing side effects due to MDR TB treatment. 

Side effects potentially related to medications is defined as not existing before MDR TB medication start, but having occurred during treatment.
section_name: SIDE EFFECTS?

section_content: • Prolonged feelings of sadness or dejection, or documentation of depression by provider
section_name: Side Effect Description Depression

section_content: • Suicidal attempt or ideation (thoughts or attempt to hurt oneself)

Cardiac abnormalities • QTc >500 ms (confirmed by repeat ECG or documented "prolonged QTc") • Clinically significant ventricular arrhythmia
section_name: Suicide attempt or ideation

section_content: • Subjective hearing loss or noticing the need to turn up the volume on phones or TVs • Requiring the needs for a hearing aid or intervention
section_name: Hearing loss

section_content: Acid-fast bacilli (AFB) Microorganisms that when stained, retain color even after they have been washed in an acid solution; may be detected under a microscope in a stained smear.
section_name: Appendix J -Glossary Term Definition

section_content: Looking for undiagnosed cases by screening a population.
section_name: Active case finding

section_content: Following the recommended course of treatment by taking all the prescribed medications for the entire length of time necessary.
section_name: Adherence to treatment

section_content: Negative side effect resulting from the use of a drug (for example, hepatitis, nausea, rash).
section_name: Adverse effect

section_content: A procedure used to obtain pulmonary secretions or lung tissue with an instrument called a bronchoscope.
section_name: Bronchoscopy

section_content: A system in which a specific health department employee is assigned primary responsibility for the patient, systematic regular review of patient progress is conducted, and plans are made to address any barriers to adherence.
section_name: Case management

section_content: The number of cases that occur during a certain time period, divided by the size of the population during that time period; the case rate is often expressed in terms of a population size of 100,000 persons.
section_name: Case rate

section_content: Informing the state or local health department when a new possible or confirmed case (an occurrence) of TB disease has been diagnosed.
section_name: Case reporting

section_content: A hollow space within the lung, visible on a chest radiograph or CT scan.
section_name: Cavity

section_content: An evaluation done to find out whether a patient has symptoms of TB disease or is responding to treatment; also done to check for adverse reaction to TB medications.
section_name: Clinical evaluation

section_content: A physician, physician's assistant, or nurse/nurse practitioner.
section_name: Clinician

section_content: A setting in which a group of usually unrelated persons reside in close physical proximity. These settings may include long-term care facilities, assisted living facilities, correctional facilities, or homeless shelters (see residential facilities).
section_name: Congregate setting

section_content: A procedure for interviewing a person who has TB disease to determine who may have been exposed to TB. People who have been exposed to a person with TB are located and tested for TB infection and TB disease, and treated if indicated.
section_name: Contact investigation

section_content: People exposed to someone with TB disease, generally including family members, roommates or housemates, close friends, coworkers, classmates, and others.
section_name: Contacts

section_content: The country where a person was born.
section_name: Country of birth

section_content: To grow organisms in or on media (substances containing nutrients) so that they can be identified.
section_name: Culture

section_content: A treatment schedule in which the patient takes a dose of each prescribed medication every day.
section_name: Daily regimen

section_content: Refers to the condition when a person is infected with tubercle bacilli, but TB disease has not developed. Persons with LTBI do not have TB disease symptoms and they cannot spread TB to others. Persons with LTBI usually have a positive result to the Mantoux tuberculin skin test or an interferongamma release assay.
section_name: Term Definition Latent TB infection (LTBI)

section_content: Medication that is given to people who have latent TB infection to prevent them from developing TB disease.
section_name: LTBI treatment

section_content: A method of testing for TB infection; a needle and syringe are used to inject 0. 1 ml of 5 tuberculin units of liquid tuberculin between the layers of the skin (intradermally), usually on the forearm; the reaction to this test, sometimes a palpable swollen area (induration), is measured 48 to 72 hours after TST placement and is interpreted as positive or negative depending on the size of the induration in millimeters (mm) and the patient's risk factors for TB.
section_name: Mantoux tuberculin skin test (TST)

section_content: Miliary TB is a serious type of tuberculosis infection. It is a histological or radiologic finding, rather than a site of disease. It appears on radiographs as a great number of small, well-defined nodules that look like millet seeds scattered throughout the lungs, hence the name "miliary. "
section_name: Miliary TB

section_content: Resistant to at least the drugs isoniazid and rifampin; MDR TB is more difficult to treat than drug-susceptible TB.
section_name: Multidrug-resistant TB (MDR TB)

section_content: One of the organisms causing TB in humans, and sometimes called the tubercle bacillus; belongs to a group of bacteria called mycobacteria.
section_name: Mycobacterium tuberculosis

section_content: A group of closely related mycobacteria that can cause TB (e. g., M. tuberculosis, M. bovis, M. africanum). Most TB in the United States is caused by M. tuberculosis.
section_name: Mycobacterium tuberculosis complex

section_content: National Electronic Disease Surveillance System (NEDSS)/Health Level 7 (HL-7)

Non-U. S. -born persons Persons who are not eligible for U. S. citizenship at birth, regardless of the actual country of birth (formerly called "foreign-born").
section_name: NEDSS/HL-7

section_content: A technique that amplifies (copies) DNA or RNA segments, in order to directly identify microorganisms in clinical specimens.
section_name: Nucleic acid amplification (NAA)

section_content: A high index of suspicion for active TB (e. g., a known contact to an active TB case or to a person with signs or symptoms consistent with TB) who is currently under evaluation for TB disease. Also referred to as "Suspected" in some surveillance data systems.
section_name: Possible TB case

section_content: Pre-extensively drug-resistant TB. The occurrence of TB in persons whose M. tuberculosis isolates are resistant to isoniazid, rifampin, and a fluroquinolone OR whose M. tuberculosis isolates are resistant to isoniazid, rifampin, and a second-line injectable (amikacin, capreomycin, and kanamycin). 

Pulmonary TB TB disease that occurs in the lungs, typically causing a cough and an abnormal chest radiograph. Pulmonary TB is usually infectious if untreated. 

Most TB cases reported in the United States are pulmonary TB.
section_name: pre-XDR TB

section_content: • Negative smear and culture result (e. g., clinical case) at diagnosis and while receiving TB treatment, but at some point after therapy is completed, either the patient has a culture result that is positive for M. tuberculosis or has clinical or radiologic deterioration that is consistent with TB disease.
section_name: Term Definition

section_content: A combination of isoniazid (INH) and rifampin (RIF); used to treat TB disease or LTBI
section_name: Rifamate

section_content: A combination of isoniazid (INH), rifampin (RIF), and pyrazinamide (PZA); used to treat TB disease or LTBI
section_name: Rifater

section_content: A drug used as a substitute for rifampin (RIF) in the treatment of TB disease and LTBI.
section_name: Rifabutin

section_content: A drug used to treat TB disease and LTBI.
section_name: Rifampin (RIF)

section_content: A drug used to treat TB disease and LTBI.
section_name: Rifapentine

section_content: Drugs used to treat TB that is resistant to first-line TB drugs (e. g., capreomycin, ethionamide, cycloserine, ciprofloxacin, amikacin).
section_name: Second-line TB drugs

section_content: A specimen that has been smeared onto a glass slide, stained, washed in an acid solution, and then placed under the microscope for examination; used to detect acid-fast bacilli in a specimen.
section_name: Smear

section_content: A sample collected from a person for testing.
section_name: Specimen

section_content: Phlegm from deep in the lungs, collected in a sterile container for processing and examination.
section_name: Sputum

section_content: An organism's ability to be killed by a particular drug.
section_name: Susceptibility

section_content: An illness, caused by bacteria called Mycobacterium tuberculosis, in which tuberculosis (TB) bacteria are multiplying and attacking parts of the body, most commonly the lungs. A person with TB disease is capable of spreading the disease to others if the TB bacteria are active in the lungs or throat. The symptoms of TB disease include weakness, weight loss, fever, no appetite, chills, and sweating at night. Other symptoms may include a bad cough, pain in the chest, and coughing up blood.
section_name: TB disease

section_content: Extensively drug-resistant TB. The occurrence of TB in persons whose M. tuberculosis isolates are resistant to isoniazid, rifampin, a fluroquinolone, and a second-line injectable (amikacin, capreomycin, and kanamycin) OR whose M. tuberculosis isolates are resistant to isoniazid, rifampin, a fluroquinolone, and bedaquiline or linezolid.
section_name: XDR TB

section_content: Another name for vitamin B6; it is given to prevent peripheral neuropathy; should always be given to pregnant and breastfeeding women on isoniazid.
section_name: Pyridoxine

section_content: A patient who has either a • Negative culture result while receiving TB treatment, but at some point after therapy is completed, either the culture result becomes positive for M. tuberculosis again or the patient has clinical or radiologic deterioration that is consistent with TB disease, or
section_name: Recurrence