Integrating Surveillance of Contacts of Sputum Culture Positive Tuberculosis Cases into the Existing Web-based Tuberculosis Surveillance System - A Pilot Project

Project Name: Integrating Surveillance of Contacts of Sputum Culture Positive Tuberculosis Cases into the Existing Web-based Tuberculosis Surveillance System - A Pilot Project

Project Status: Proposed

Point of Contact: Lilia Manangan

Center: NCHHSTP

Keywords: TB contacts, Integrated TB web-based system

Project Description: The National Tuberculosis Surveillance System (NTSS) at DTBE has been conducting surveillance on tuberculosis (TB), a contagious airborne disease, since 1953. NTSS is the only national repository of TB surveillance data in the United States and receives data through the Report of Verified Case of Tuberculosis (RVCT), a standardized data collection form. NTSS currently has 60 reporting jurisdictions: all 50 U.S. states, the District of Columbia, New York City, American Samoa, the Federated States of Micronesia, Guam, the Republic of the Marshall Islands, Commonwealth of the Northern Mariana Islands, Puerto Rico, Republic of Palau, and U.S. Virgin Islands.

Since 2009, NTSS has successfully transitioned into a web-based system receiving data through the TB Case Notification message from four types of systems used by the 60 NTSS reporting jurisdictions:

• The National Electronic Disease Surveillance System (NEDDS)-Base System- has an infrastructure developed by CDC that uses Public health Information Network (PHIN) and NEDSS messaging standards.
• Electronic RVCT (eRVCT)- developed by CDC’s DTBE and available to all reporting jurisdictions based on the RVCT form.
• State-developed surveillance system- developed by a reporting jurisdiction which may serve purposes other than just surveillance, such as case management.
• Commercial surveillance software- developed by a private company.

In 2012, NTSS had 9,945 new TB cases with 63% occurring among foreign-born persons. It has been estimated that for every TB case, there are 10 contacts, meaning these 10 people have been exposed to contagious TB (TB disease) and may have been infected. Among contacts infected with TB (have latent TB infection [LTBI] and not contagious) progression to TB disease is especially high in the first two years of becoming infected.

After patients with TB disease have been detected and treated, contact investigation (i.e, finding, evaluating, and treating) the patients’ contacts (i.e, contact investigation) is a priority of TB programs. Most TB programs have a paper-based monitoring system to record data from these contacts while several programs have established an electronic monitoring system. However, at the national level, there is no database that is integrated with NTSS where a TB case is linked to contacts.

1. Potential impact of project if successful
   It is currently estimated that more than 11 million people in the United States have LTBI, which is about 4 percent of the total population. While not everyone with LTBI will develop TB disease, about 5 to 10 percent of infected people will develop TB disease if not treated. This equates to approximately 550,000 to 1,100,000 people who will develop TB at some point in their life, unless they receive adequate treatment for LTBI.
   TB prevention requires that TB infection is identified and treated. This project has the potential of providing the framework for a national surveillance system of TB infection, which would provide for the first time the ability to monitor and evaluate CDC’s TB prevention efforts.
2. Scalability – applicability to wider audiences within CDC
   This project can serve as a model electronic system for other infectious diseases such as HIV and STD where partners of patients with these infectious diseases are notified, evaluated, and treated similar to TB contact investigation. Results of this project can also be applied to an integrated surveillance system for other diseases or conditions, for example. TB, HIV, STD, viral hepatitis, Hansen’s Disease in one integrated system.
3. Methodology –
   In collaboration with TB program consultants, TB programs, preferably one for each of the 4 web-based systems being used by NTSS jurisdictions, will be solicited to participate in this pilot project. Northrop Grumman staff and at least one CDC staff will conduct site visits to the participating programs to assess how TB contacts are being monitored and how to link the contacts to NTSS. From these site visits, a standardized data collection form for TB contacts will be developed for a prototype database.
4. Measure of success –
   By September 30, 2014, the project team has conducted site visits to participating sites. The team has written a summary report that describes the systems used by the states to monitor their TB patients’ contacts with LTBI and determine the states’ ability to integrate these systems to the web-based NTSS. This report also specifies the variables currently collected which will form the draft data collection form for database integration or development.

For more information about this project, please contact the CHIIC at chiic@cdc.gov or Brian Lee at brian.lee@cdc.hhs.gov.