Tuberculosis Chest Clinic

What is tuberculosis?

Tuberculosis (TB) is a disease caused by germs (bacteria) that usually affect the lungs, but it can also affect other parts of the body such as the kidneys, spine, or brain. TB can be serious, but it is preventable and treatable. TB is generally spread only after repeated or prolonged contact with someone who has active TB disease.

How does it spread?

TB spreads through the air when a person with active TB disease in the lungs or larynx is coughing, speaking, laughing, or singing. People nearby may breathe in the germs and become infected.

TB does not spread by shaking hands, sharing food or drinks, or touching surfaces.

How can I protect myself?

Get tested if you are at risk. For example, if you live or work closely with someone who has TB, or if you have certain health conditions.

Seek medical care immediately if you have symptoms of TB. Active TB requires several months of medication to cure and prevent spreading it to others.

Healthcare providers, hospitals, and laboratories are required by law to report cases of tuberculosis to the Health Department’s TB Control Program. This ensures that people with active TB receive proper medical care. Reporting also helps the health department identify and screen anyone who has been in close contact with a person with TB, offering preventive treatment when needed to help stop the spread of the disease

Symptoms

Symptoms of active TB disease may include:

• Cough lasting more than 2–3 weeks
• Coughing up blood
• Fever, chills, or night sweats
• Unexplained weight loss or fatigue

Treatment

TB disease is treated with several medications (usually 3 or 4) taken for 6 to 18 months, depending on the individual (e.g. medication tolerance, antibiotic resistance). It is important to finish all medications as prescribed. Stopping treatment too early or taking the medications incorrectly can make you sick again. It can also allow the TB germs to become resistant, which makes the disease harder and more expensive to treat, as well as extends treatment time.

Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (also called inactive TB) and TB disease (active TB). People with latent TB infection are infected with TB bacteria, but they do not have TB disease.

• If these bacteria become active and multiply, latent TB infection can develop into TB disease. Progression from untreated latent TB infection to TB disease accounts for approximately 80% of U.S. TB cases.
• Treating people with latent TB infection substantially reduces the risk that latent TB infection will progress to TB disease. Treating latent TB infection is 90% effective in preventing the development of TB disease.
• If you are interested in latent TB testing and treatment, please contact your primary health care provider.

If you are a health care provider with questions about latent TB treatment, please contact the Pasadena Public Health Department.

The Pasadena Public Health Department (PPHD) offers specialized services for people who have been diagnosed with tuberculosis (TB) or are suspected of having it (for example, if symptoms are present or a chest X-ray is abnormal). Our clinic also supports people who have been in close contact with someone diagnosed with TB.

Please note the TB Clinic does not provide routine TB tests for employment or school requirements.

If tuberculosis disease is detected, a patient will receive:

• A medical check-up by a doctor who specializes in pulmonary (lung) or infectious diseases who will evaluate and treatment TB disease
• Chest X-ray or chest imaging
• Case management (follow up and ongoing support) by a Public Health Nurse (PHN) throughout the course of treatment
• Prescribed medicine
• Directly Observed Therapy (DOT) by trained staff

What is DOT?

National guidelines recommend Directly Observed Therapy (DOT) as standard treatment for TB disease. Under DOT clinic staff or trained staff assist patients with taking prescribed medicines to treat TB disease by directly observing them take their prescribed medication.

Why use DOT?

Medication adherence cannot be predicted, as individuals from all backgrounds—regardless of social class, education, age, gender, or ethnicity—may struggle to take medications correctly. DOT should be scheduled at around the same timeframe and place convenient for the patient and staff. This promotes compliance by ensuring the correct dose is taken at the correct time, during the entire course of treatment.

The goal of DOT is to prevent:

• Development of drug resistance
• Transmission of infection or disease
• Support medication adherence
• Provide patient support
• Accurately count the medication doses to determine end of treatment date

How is DOT administered?

The designated employee will conduct DOT by:

• Scheduling a home visit or video visit for a specific time on a weekday
• Asking about side effects
• Reporting side effects to clinical personnel as appropriate
• Observing the prescribed medications being swallowed by the patient
• Answering questions

DOT (Directly Observed Therapy) can be conducted in person or remotely, known as virtual or video DOT (vDOT), using devices like smartphones, tablets, or computers. This is only after clinical staff assesses the individual and determines they are meet the criteria for vDOT.

Patients taking daily medications may conduct self-administered therapy (SAT) during the weekends and City Holidays, or under certain circumstances.

DOT appointments should be arranged between the client and trained staff, following our policy of a minimum 30-minute scheduled DOT session. If a client is more than 15 minutes late for the scheduled start time, the appointment will be canceled, and the dose will not be counted. Clients are required to contact staff at least 24 hours in advance if they cannot attend their DOT appointment so it can be rescheduled.

Who can conduct DOT?

A nurse or trained outreach employee from the health department will provide DOT.

Family members should NOT be used for DOT.

In some situations, hospitals, clinics, home care agencies, correctional facilities, schools, employers and other facilities may provide DOT, under the guidance of the local health department.

EFFECTIVE JANUARY 1, 2025 FOR HEALTHCARE PROVIDERS: Assembly Bill No. 2132

California Assembly Bill (AB) 2132 is a bill that requires health care providers to offer tuberculosis (TB) screening and risk assessments to patients who are 18 years of age or older and receiving primary care services:

• The bill applies to patients receiving services in a facility, clinic, center, office, or other setting.
• The bill requires screening if TB risk factors are identified and if the patient's health insurance covers the services.
• The bill requires health care providers to offer follow-up care or refer patients to a provider who can offer follow-up care if the screening test is positive.
• The bill does not subject health care providers who fail to comply with these provisions to disciplinary action, civil or criminal liability, or any other consequences related to their licensure or certification.
• The bill is based on screening recommendations from the state Department of Public Health, the federal Centers for Disease Control and Prevention, the American Thoracic Society, or the United States Preventative Services Task Force.

View the Assembly Bill No. 2132

What is Reportable?

Healthcare providers are required by law to report suspected or confirmed tuberculosis (TB) cases to the local health department within one working day of identification. This is mandated under California Health and Safety Code §121050 and Title 17 California Code of Regulation 2500. Reportable TB cases include individuals diagnosed with active TB disease and extrapulmonary TB.

Use the Confidential Morbidity Report to report suspected or active TB.

Email: nursing@cityofpasadena.net

Fax: 626-744-6115

Hospital Discharge Guidelines

Under GOTCH law (California Health and Safety Code §121361) "Discharge and Transfer Guidelines for Tuberculosis Patients and Suspects," hospitals in Pasadena must receive approval from the City of Pasadena TB Control Program before discharging or transferring any patient with suspected or confirmed TB. The TB Control Program must be notified of the hospital’s discharge plans at least 24 hours in advance.

Hospitals are required to complete and submit both of the following:

• Confidential Morbidity Report
• TB Discharge Care Plan

Completed forms should be sent to the TB Control Program at fax # 626-744-6115 or email nursing@cityofpasadena.net.

Is TB Infection (LTBI) Reportable?

Latent TB infection (LTBI) occurs when a person has TB bacteria but does not have symptoms and is not contagious. In California, LTBI is not routinely reportable under Health and Safety Code §120130, except in certain situations:

• Children: A positive tuberculin skin test (TST or PPD) for a child aged 3 years or younger, as this group is considered high-risk.
• High-risk individuals such as the following:
  • People with HIV infection or at risk for HIV infection.
  • Individuals who have had contact with a person with infectious TB.
  • People with medical conditions that increase the risk of progressing to active TB, such as those with diabetes mellitus, end-stage renal disease, or who are on prolonged steroid or immunosuppressive therapy.
  • Individuals with a documented conversion from a negative to a positive TB test result.

Providers can contact City of Pasadena TB Control Program to determine if reporting LTBI is required in specific circumstances.

Civil surgeons are essential in preventing tuberculosis (TB) during immigration medical examinations. Follow these California-specific protocols and CTCA guidance:

What Must Be Reported

Civil surgeons must report the following to the local health department (LHD):

• Latent TB Infection (LTBI): Positive IGRA, normal chest X-ray, no HIV, no TB symptoms.
• Active or Suspected TB Disease: Abnormal chest X-ray, symptoms of disease, or extrapulmonary TB.

Reports must include the applicant’s name, contact information, IGRA and chest X-ray results, and treatment details.

Reporting Requirements

All civil surgeons must complete Form I‑693 for each applicant, documenting TB testing and evaluation results.

Reporting should be done via eMedical for immigration purposes, or as directed by your LHD.

Patient Education & LTBI Referrals

Educate applicants on their TB or LTBI status and the benefits of treatment—even if treatment is not mandatory for immigration clearance.

Referral options:

• Treat LTBI yourself or
• Refer to local primary care providers, local TB clinics or local health department.

Please refer to CTCA Civil Surgeon Resources for more information.

Since 2014, the universal testing policy includes all entering pre-K through 12 grade students be screened for TB if at elevated risk for TB.

This policy includes a risk-based screening tool that  helps avoid potential false positive results, lower the childhood exposure to unnecessary chest x-rays, and prevents treatment regimens that can have harmful side effects.

Under this policy, children will receive TB testing if they are at increased risk of TB, which is indicated in the “Health Care Provider Follow-Up” column of the questionnaire.

Healthcare providers completing the assessment should complete and sign the form, PM 171 A, “Report of Health Examination for School Entry,” and provide to the school as documentation of physical examination prior to school enrollment.

See below for more information:

• Addendum to School TB Policy
• 2012-Updated TB Screening Requirement Policy Statement
• Pediatric TB Risk Assessment Questionnaire
• PM 171 A Report of Health Examination for School Entry

For more information about tuberculosis disease treatment, prevention and control, please visit the following agency websites.

• The Centers for Disease Control and Prevention Tuberculosis Branch
• TB Prevention Materials for Public Health Professionals
• California Tuberculosis Controllers Association

Resources For Healthcare Providers

• California Tuberculosis Controllers Association (CTCA) Provider Resources
• CDC Health Care Provider Communication and Education Resources
• Medical Board Letter AB 2132
• Registered Nursing Board Letter AB 2132
• Questions and Answers About AB 2132