Interview Timeframes Conduct a minimum of 2 interviews: 1st interview ≤ 1 business day of reporting for infectious patients ≤ 3 business days for others 2nd interview: 1–2 weeks later Conduct additional interviews as needed Slide Notes: Review slide: Related to 1st interview sub-bullet ask the group to share “Which cases do we consider infectious?” It’s a rare event to get and give all the information you need to in one interview should plan from the start that there will be multiple interview interactions with the patient. All interviews should be done in person, especially the initial IX. (only use the phone if time is short, or you only need very little info) Interviews provide chances to check-in to see how the patient is doing, clinically and emotionally

Estimating Onset of the Infectious Period Characteristic TB symptoms AFB sputum smear positive Cavitary chest radiograph Recommended minimum beginning of likely period of infectiousness Yes No 3 months before symptom onset or 1st positive findings consistent with TB disease, whichever is longer 3 months before 1st positive finding consistent with TB disease 4 weeks before date of suspected diagnosis Slide Notes: Determining an “infectious period” focuses the investigation on those who are at greatest risk for having become infected. It’s important to make sure all team members involved in the care of the TB patient and in the associated contact investigation are aware of the determined infectious period. DOCUMENT THE IP, and if updated after pt. Ix, redocument Refer participants to handout 4 :Estimating Onset of IP This is a modification of a table that guides the estimation of onset of infectiousness based on 3 key characteristics of the TB case which include: the presence or absence of symptoms, sputum smear status and whether the patient has cavitary disease on chest X-ray. Review slide This table doesn’t include all the factors we talked about earlier. There are situations that will arise that might warrant modifying the onset of infectious period to an earlier date than what is recommended in this table such as if: There is evidence of TB transmission among contacts with significant exposure only in early part of the original infectious period and/or There is evidence of significant transmission in the original infectious period (e.g., high TST conversion rate), particularly if the patient’s symptom onset history is questionable and/or the patient’s clinical presentation suggests advanced TB disease (cavitation, disseminated TB, severe wasting, etc.). Onset of infectious period should be given a specific date (e.g. April 15, 2008 vs. April 2008). This date may change as new information is obtained during the course of the investigation. TABLE 2. Guidelines for estimating the beginning of the period of infectiousness of persons with tuberculosis (TB), by index case characteristic. Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. 2005.

Sample Contact Roster

References and Resources Patient interview guide Available upon request from the TB Branch CTCA Contact Investigation guidelines https://ctca.org/guidelines/cdph-ctca-joint-guidelines/ Rutgers TB Center of Excellence materials http://globaltb.njms.rutgers.edu/educationalmaterials/productlist. php CDPH TB Control Branch staff: Anne Cass: anne.cass@cdph.ca.gov Stephanie Spencer: stephanie.spencer@cdph.ca.gov