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This is an official
CDC HEALTH UPDATE
Distributed via the CDC Health Alert Network
September 04, 2013, 13:00 ET (1:00 PM ET)
Recurrent Nationwide Shortage of Tuberculin Skin Test Antigen Solutions: CDC Recommendations for Patient Care and Public Health Practice
Summary: In HAN 345 (http://emergency.cdc.gov/HAN/
TUBERSOL is one of two purified-protein derivative (PPD) tuberculin antigen solutions that are licensed by the United States Food and Drug Administration (FDA). JHP Pharmaceuticals, LLC, manufactures APLISOL, the other PPD tuberculin product that is licensed by FDA. JHP Pharmaceuticals, LLC, has notified FDA that APLISOL is on allocation, meaning that historical customers have precedence for buying the product, and APLISOL is available in restricted quantity. Regional shortages of APLISOL have been reported since healthcare providers switched from TUBERSOL to APLISOL.
Two kinds of immunological methods are used for detecting Mycobacterium tuberculosis infection: tuberculin skin tests (TSTs) and interferon-γ release assay (IGRA) blood tests. The indications for using these tests are the same for both methods, although one or the other method is preferred for certain populations (1). When setting testing priorities because of the current shortage of antigen, these preferences may be considered as factors when one of the methods is unavailable. Together, these tests are the only means for detecting latent M. tuberculosis infection, and they contribute to diagnosing tuberculosis (TB) disease. When findings such as chest radiography and mycobacterial cultures are sufficient for confirming or excluding the TB diagnosis, the results from a TST or an IGRA blood test might be unnecessary (2). Nevertheless, most TB cases in the United States are diagnosed with a set of findings including results from one of these tests. When TB disease is strongly suspected, specific treatment should be started regardless of results from TST or an IGRA blood test (1,3).
In cross-sectional controlled studies, TUBERSOL and APLISOL give similar results for most patients. The agreement between results from a TST and an IGRA blood test or between results from the two commercial IGRA blood tests is lower (1).
CDC recommends any of three general approaches for addressing the shortages of tuberculin skin test antigens:
1. Substitute IGRA blood tests for TSTs. The cost associated with using the blood tests can be greater than the cost of TST because the per-unit cost of the IGRA test materials is greater than for those of TST and, unlike TST, IGRAs entail services external to the point of care in some settings. The blood tests require phlebotomy, preparation of blood specimens, and specific laboratory services for analysis; therefore, these tests are not available in all practice settings. Clinicians who use the IGRA blood tests should be aware that the criteria for test interpretation are different from the criteria for interpreting TSTs (1). IGRAs do not utilize the risk-stratified cut-off measurements that are used for TST. Both IGRA products that are licensed in the United States can give indeterminate results, and one of these can also give borderline results (results between positive and negative). TST does not yield indeterminate or borderline results (1).
2. Substitute APLISOL for TUBERSOL for skin testing if APLISOL is available. In studies, the two products give similar results for most patients. The fixed availability of APLISOL has created a relative shortage because of increased demand at sites where TUBERSOL is unavailable, thus limiting the feasibility of this approach.
3. Allocate TSTs to priority usages, such as TB contact investigations, as determined by public health authorities. Priorities can be set in accordance to relative TB risks (4) and local TB epidemiology. A priority strategy might require deferment of testing some persons, and it might require modification of public health rules, regulations, or policies. CDC does not recommend testing persons who are not at risk for TB (4).
Some surveillance programs for TB infection control rely on routine serial TSTs. Switching products or methods might make serial changes in test results difficult to interpret. The apparent conversions of results from negative to positive or reversions from positive to negative could be caused by inherent inter-product or inter-method discordance (1,5). In settings with a low likelihood of TB exposure, the deferment of routine serial testing should be considered in consultation with public health and occupational health authorities.
Updates about the shortages of tuberculin skin test solutions are posted by the FDACenter for Biologics Evaluation and Research at http://www.fda.gov/
1. CDC. Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection — United States, 2010. MMWR 2010;59(RR-5). http://www.cdc.gov/mmwr/PDF/
2. American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161:1376–95. http://www.cdc.gov/tb/
3. CDC. Treatment of tuberculosis. MMWR 2003;52(RR-11). http://www.cdc.gov/mmwr/PDF/
4. CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(RR-6). http://www.cdc.gov/mmwr/PDF/
5. CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(RR-17) http://www.cdc.gov/mmwr/pdf/
The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.
Categories of Health Alert Network messages:
Health Alert Requires immediate action or attention; highest level of importance
Health Advisory May not require immediate action; provides important information for a specific incident or situation
Health Update Unlikely to require immediate action; provides updated information regarding an incident or situation
HAN Info Service Does not require immediate action; provides general public health information
ABOHN is seeking new board members to represent our credential holders. Representatives are needed from the Mountain-Western areas of the country. We are especially interested in recruiting representatives from the chemical industry and manufacturing areas of practice.
If you are interested in applying for the Board of Directors please go to our website at www.abohn.org. You will find an application for the board in “About Us” in the Board of Directors area. If you are interested, please submit your application by September 20, 2013.
Ann M. Lachat, CEO
SB 491 Nurse Practitioners (Hernandez) (Support)
The NP Scope of Practice Bill has passed the Assembly and is now in the Business, Professions, and Consumer Protection Committee. Amendments to the bill are expected soon. CANP is collaborating on the amendments.
UPDATE: The bill was initially voted down by the Assembly Committee for Business, Professions, and Consumer Protection on Tuesday August 6 but was granted reconsideration again yesterday. Two more members voted Aye, thus pushing the bill through to the next hurdle, a hearing by the Assembly Appropriations Committee. Though amended to remove full independent practice after 3 years under physician supervision, the bill stiff faces fierce opposition from the CMA.
Mike Horowitz from the DWC last solicited informal comments in March 2013. We emailed Mike regarding the status and our desire for finalization. He emailed back on Jul 19 that hewill be focusing back on First Aid in the near future. We can expect another formal comment period and are ready to respond.
Cal/OSHA Globally Harmonized System (GHS) Update to Hazard Communication
Alert! Employee training on the mechanics of the revised Hazard Communication standard is due by Dec 1, 2013!
See Cal/OSHA regulatory info below.
Fed OSHA and Cal/OSHA require employee training on GHS, including info on pictograms and new Safety Data Sheet (SDS) format by Dec 1, 2013. This is not widely publicized by Cal/OSHA, so see Fed/OSHA web site for comprehensive information on training requirements.
The wonderful Fed/OSHA Hazard Communication Site:
SB 863 Workers’ Compensation Reform Implementation:
Emergency regulations are still in place as rulemaking continues. The DWC held a meeting on July 17 for the new physician fee schedule using Relative Value Resource Based System (RVRBS) that eventually will cap at 120% of Medicare. The big surprise at the hearing was that the DWC realized a math error and RAND posted a revised report on new conversion factors. This report had not been released before the hearing so the comments were based on the old report. It is unsure if they will have another hearing.
Anna Reilly: Attended a meeting with Maximus, the DWC’s contracted provider for Independent Medical Review (IMR) and Independent Bill Review (IBR) services. So far the number of reviews for each program is relatively low but slowly ramping up (100 Bill Reviews, 1000 IMRs with 400 in the last month). More activity is expected as the criteria for review are fully implemented. IMR decisions are posted on the DWC at the bottom of the IMR link on the DWC website.
See the DWC website for further information on SB 863 http://www.dir.ca.gov/dwc/SB863/SB863.htm
Other Issues of Interest
AAOHN is looking at the issue of fracking and deciding whether to make a policy statement or not. Katy participated in the literature search for the Advocacy Committee. This also potentially relates to the proposed federal silica standard as crystalline silica is one of the agents used in fracking.
A long-awaited report from the CDPH to support a lower PEL for Lead should be coming out in Sept or Oct. This could substantially lower the PEL and medical removal requirements for lead. The report is many years in the making and long-anticipated. Cal/OSHA feels the updated research is needed to establish a variance from the Fed/OSHA lead standard. Once the report is out it will need to go through a peer review process. Stay tuned!
Planning for the Active Shooter
Thursday, September 5, 2013
9am to 1pm Continental Breakfast/Workshop
Location: Burbank Fire Training Center
1845 N Ontario Street Burbank CA 91505
It is a subject no one wants to talk about, but many of us recognize the potential for having an active shooter incident at our workplace. BICEPP brings together experts from the FBI, Los Angeles County Public Health and the private sector to talk about planning and preparing for an active shooter scenario.
This workshop includes:
· Threat assessment and potential risks
· Early warning signs
· Employee training – Run, hide, fight
· Conducting an exercise
Includes continental breakfast and copy of tabletop exercise materials
$35 BICEPP members
Join BICEPP today for only $50 and save $20 on the fee for this workshop.
DEADLINE to register is August 30, 2013
Tuesday August 20, 2013 at 8:00 AM
Thursday August 22, 2013 at 5:00 PM
Zephyr Environmental Corporation
2600 Via Fortuna, Suite 450, Austin, TX 78746
Click HERE for directions.
This course parallels the curriculum developed by the Alliance of Hazardous Materials Professionals’ Hazardous Materials Management Desk Reference in order to assist professionals preparing for the Certified Hazardous Materials Manager (CHMM) national certification exam administered by the Institute of Hazardous Materials Management (IHMM).
**This course has been awarded 2.3 CEUs! **
Who Should Attend
EHMM is the perfect preparation for anyone planning to take the CHMM exam or anyone with responsibilities related to hazardous materials management and waste handling, such as:
- Facility Managers and Supervisors
- Compliance Officials
Brought to you by the Southwest Center for Occupational and Environmental Health, University of Texas School of Public Health at 1200 Herman Pressler, Houston, TX 77030.
The Affordable Care Act & Viral Hepatitis: Opportunities and Challenges
Thursday, June 27, 2013
3 pm – 4 pm Eastern
All are welcome to participate!
Expansion of health care coverage under the Affordable Care Act begins on January 1, 2014. Many states are well underway with developing their programs, while some states haven’t even agreed to expand Medicaid to serve low-income people. This webinar will provide an update on ACA implementation, some key things viral hepatitis advocates need to know to help ensure the ACA provides access to hepatitis B and C testing, care, and treatment services, the role of state-level advocacy, and useful ACA implementation resources.
Martha Saly, Executive Director, National Viral Hepatitis Roundtable
Malinda Ellwood, Health Law and Policy Clinical Fellow, from Center for Health Law and Policy Innovation of Harvard Law School
Isha Weerasinghe, Hepatitis B Policy Fellow, Association of Asian Pacific Community Health Organizations
Heather Lusk, Executive Director, the C.H.O.W. Project and Hep B Free Hawaii
Ryan Clary, Director of Public Policy and Programs, National Viral Hepatitis Roundtable
NVHR thanks AIDS Foundation of Chicago and HIVHealthReform.org for hosting this webinar.
2013 Membership Awards Available
The Awards Committee is asking you to nominate a colleague that deserves recognition for achievement, leadership qualities, and contribution to the profession. CSAOHN has the following annual awards to enable a deserving member to be recognized. Instead of nominating a colleague, you may apply for recognition and support for your own work in pursuit of greater knowledge and expertise.
Please read about the specific awards and their criteria listed below:
CSAOHN offers assistance to chapters to promote leadership development among its members. Stipends are available to assist with attendance at Conference of Leaders, the Annual State Conference and certain legislative events. Presidents please download the eligibility criteria and application above and submit to the awards committee by August 1st, 2013 . (Note change in submission deadline)