Announcements All participants must register for the Monthly

Announcements  All participants must register for the Monthly

Announcements All participants must register for the Monthly Disease Surveillance Trainings in order for us to provide CMEs: Log-on or Request log-on ID/password: https://tiny.army.mil/r/zB8A/CME Register for FY17 Epi-Tech Surveillance Training: https://tiny.army.mil/r/4TgNE/EpiTechFY17 Confirm attendance for todays training: Enter your full name/email address in the chat box; enter each individuals information if attending with a group You will receive a confirmation email within 48 hours Contact your Service Hub if you do not receive this email Please put your phones on mute when not speaking. Press *6 to mute/unmute your phone. Introduction to the TB CIR Module

1 Introduction to the DRSi Tuberculosis Contact Investigation Reports Module Courtney Rudiger 29 August 2017 2 Objectives 1. Describe DRSi Tuberculosis Contact Investigation Report module capabilities. 2. Understand how standardized investigation data assist in program and policy planning. 3. Describe current trends in tuberculosis in the military and the importance of data collection to tracking those trends.

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

Why do we have a TB CIR module? Fulfills reporting requirements Navy: Per BUMEDINST 6224.8B (Tuberculosis Control Program), completed TB investigation reports should be provided to NMCPHC. Air Force: Available for use; however, ensure all cases are investigated/reported IAW AFI48-105, Attachment 3. Army: Available for use. Introduction to the TB CIR Module 5 Who should use the TB CIR module? When reporting a case of TB, all reporters should fill out as much information as possible when submitting the MER.

MTFs should fill out a CIR if a contact investigation is conducted. NEPMUs should fill out a CIR if they support or conduct a contact investigation in operational units. A CIR should be filled out whenever a contact investigation takes place, regardless of whether a TB MER has also been submitted. Example: Investigation of a contractor not diagnosed by a DoD MTF, but where active duty were exposed Introduction to the TB CIR Module 6 Accessing the TB CIR Module The TB CIR module is accessed from the DRSi home page, in the Medical Event Reports tab. You can view and edit your TB CIRs from here.

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

Introduction to the TB CIR Module 8 3. These new questions include items that will be relevant to a contact investigation, such as: Laboratory testing: collection/result date, additional result options, susceptibility testing Clinical details: chest radiography and infectious period Risk factors: immunosuppression, TB vaccine history, case identification, LTBI history, country of birth Introduction to the TB CIR Module 9 4. After clicking Submit on the TB MER, the following pop-up window will

appear. To initiate a new contact investigation report (CIR), click Report New TB CIR. The CIR module will appear. Introduction to the TB CIR Module 10 5. If the CIR was created via a MER, Index Case Information will be prepopulated from the corresponding fields within the MER for the patient. To update this information, return to the MER, make necessary corrections, and re-submit. Then return to the CIR and click: Introduction to the TB CIR Module

11 6. The Contact Investigation Summary section allows entry of: Reporting Unit Location of the investigation Lead agency/agencies of the investigation Date the investigation was initiated Setting of tuberculosis exposure Introduction to the TB CIR Module 12 7. The Contact Investigation Summary also allows for entry about

the contacts that were screened and tested as part of the investigation. Note that the fields below Number of Contacts are greyed out. You will not be able to enter anything in these fields until a value is entered for Number of Contacts. Numbers entered here do not have to be final. Reporters can update these numbers as the investigation continues. Introduction to the TB CIR Module 13

Additional Features Linking TB MERs to a CIR When creating a CIR from a TB MER, that MER is linked to the CIR. If other TB MERs are associated with the same contact investigation, they can also be linked to the CIR. Uploading associated files CIRs are standardized so that all reports include the same information, but it is a limited amount of information. The upload function allows reporters to upload briefs, powerpoints, formal reports, and other documents to provide additional details. Provides context for future planning and NEPMU support. Introduction to the TB CIR Module 14

Using the TB CIR Module Example: Case of TB in a Sailor on a ship What would need to be put in DRSi? TB MER for the active duty case TB CIR for the subsequent contact investigation Additional TB MERs (if necessary) for cases identified during the contact investigation These would then be linked to the original CIR Introduction to the TB CIR Module 15 Using the TB CIR Module Example: Case of TB in a civilian contractor who has exposed active

duty service members in the workplace. The case does not receive any medical care from within the MHS. What would need to be put in DRSi? No MER would be expected for this case, as they are not diagnosed by a DoD MTF. A TB CIR would be expected, as a contact investigation would be conducted examining the exposure to those active duty members. If additional TB cases are identified among those active duty service members, then TB MERs would be submitted for those cases. These would then be linked to the original CIR Introduction to the TB CIR Module 16 Investigation Data and TB Policy During a contact investigation, many of the same questions will come

up surrounding the case and the subsequent investigation. Was the case identified during routine screening? Was the case a prior converter? Was the case in a high-risk environment? (e.g., ship or training center) Did the investigation go beyond close family and into workplace contacts? Was the case a contractor? What were the circumstances surrounding their TB screening? Introduction to the TB CIR Module 17 Investigation Data and TB Policy Many of these questions were added to either the TB MER itself or the

TB CIR form. Standardizing these questions helps to ensure they are asked for every TB case and every TB contact investigation. Works towards standardizing TB case and investigation-related data, which contributes to policy reviews and potential changes. Could identify trends that would necessitate a change in the policy. Introduction to the TB CIR Module 18 Current Tuberculosis Trends Number of Cases Number of Tuberculosis Cases by Year and Service, DON Beneficiaries, 2005-2015 16

14 12 10 8 6 4 2 0 2005 2006 2007 2008

2009 2010 Year Marine Corps Introduction to the TB CIR Module 2011 2012 2013

2014 2015 Navy 19 R a te p e r 1 0 0 ,0 0 0 s e r v ic e m e m b e r s Current Tuberculosis Trends Rates of Tuberculosis by Service, DON Active Duty, 2005-2015 1.2 1.0 0.8

0.6 0.4 0.2 0.0 2005 2006 2007 2008 2009 2010

Year Marine Corps Introduction to the TB CIR Module 2011 2012 2013 2014 2015

Navy 20 Current Tuberculosis Trends Tuberculosis Cases by Region of Birth, DON Active Duty, 2005-2015 Unknown 5.00% South America 5.00% Mexico/Caribbean 10.00% Asia 50.00% United States 30.00% Introduction to the TB CIR Module

21 Current Tuberculosis Trends For the Navy, active pulmonary tuberculosis is uncommon, particularly among active duty service members. The majority of cases in Sailors and Marines occur in foreign-born individuals (70% of active duty cases and 80% of recruit cases) Introduction to the TB CIR Module 22 Current Tuberculosis Trends The trends described in the previous slides come from many data sources, including medical event reports and contact investigation

reports. It is important to monitor TB regularly to be aware of any changes in trends that could influence effectiveness of preventive measures. These data are vital to the overall knowledge of TB in the military population as well to informing program and policy decisions related to force health protection. Introduction to the TB CIR Module 23 Contact Information Navy: NMCPHC Preventive Medicine Programs and Policy Support Department COMM: (757) 953-0700; DSN: (312) 377-0700 Email: [email protected]ail.mil

Navy Environmental and Preventive Medicine Units (NEPMU) NEPMU2 COMM: (757) 953-6600; DSN: (312) 377-6600 Email: [email protected]mail.mil NEPMU5 COMM: (619) 556-7070; DSN (312) 526-7070 Email: [email protected]mail.mil NEPMU6 COMM: (808) 471-0237; DSN: (315) 471-0237 Email: [email protected] NEPMU7 COMM (international): 011-34-956-82-2230 (local: 727-2230); DSN: 94-314-727-2230 Email: [email protected] Introduction to the TB CIR Module

24 Contact Information Army: APHC Disease Epidemiology Division Aberdeen Proving Ground, MD COMM: 410-436-7506 DSN: 584-7605 [email protected]l Air Force: Contact your MAJCOM PH or USAFSAM/PHR USAFSAM / PHR / Epidemiology Consult Service Wright-Patterson AFB, Ohio COMM: 937-938-3207DSN: 798-3207 [email protected] Introduction to the TB CIR Module

25 Questions? Introduction to the TB CIR Module 26

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