Connecticut State Department of Public Health

Reporting Active TB Disease, Latent TB Infection, or TB/HIV Co-Infection

 

Forms and instructions for reporting active TB Disease, latent TB infection, or TB/HIV co-infection, including: When to report TB disease or LTBI; which form should be used; and where and how to submit TB Report Forms. Additional TB Control Program forms are found online.

When to report TB disease or LTBI

Tuberculosis (TB) disease is a Category 1 disease and requires immediate reporting by phone to the Connecticut Department of Public Health (DPH) TB Control Program at 860-509-7722 on the day of recognition or strong suspicion of disease. On evenings, weekends, and holidays, please call 860-509-8000. TB must also be reported by fax at 860-730-8271 within 12 hours.

Please report all persons with confirmed or suspected TB disease who:

  • Have positive acid-fast bacilli (AFB) smears, or
  • Have clinical or radiographic evidence of TB, or
  • Have started on at least two anti-TB medications, or
  • Have positive cultures or positive nucleic acid amplification tests (NAAT) for M. tuberculosis.

Latent TB infection (LTBI) should be reported to the TB Control Program within 48 hours of diagnosis.

Please report all persons who:

  • Have a positive (+) tuberculin skin test (TST) or a positive interferon gamma release assay (IGRA) test for M. tuberculosis, and who have a chest x-ray that is normal or not consistent with active disease.
  • Please report LTBI findings for:
    • persons with HIV co-infection
    • persons with known contact to active TB disease
    • children ≤5 years old
    • recent immigrants or refugees
    • anyone for whom medication is requested.

TB/HIV Co-Infection patients should be reported as above, according to whether they have been diagnosed with active TB disease or LTBI. For further information, see CDC’s webpage about TB and HIV Coinfection.

Please contact the TB Control Program at 860-509-7722 for medical consultation for all TB-related diagnosis and treatment questions.

Which Report Form should I use?

Tuberculosis Surveillance Report Form

The TB Surveillance Report Form documents the medical evaluation and testing results of the patient with TB disease or LTBI and documents the timely reporting of TB disease or LTBI.

Use this form to report: Any patient with suspect or confirmed TB (TB) disease; any patient with LTBI, and any patient with TB/HIV Co-infection.

This two-page form should be filled out in its entirety. Please include the following information:

  • Required patient demographic information
  • Results of medical evaluations, including TST and IGRA results, chest x-rays and other imaging
  • Dates and results of bacteriology specimen testing
  • Results of HIV test
    • If HIV-positive, most recent CD4 count and/or viral load result
  • Results of Hepatitis B and C tests
  • Risk factors: social and medical
  • Treatment medications and dosages (must be accompanied by prescriptions)
  • If hospitalized, name and number of person responsible for Discharge Planning
  • Provider and Hospital or Facility information
  • Date the Report Form was signed 
  • Please attach and fax the following medical records to the TB Control Program:
    • All radiology results
    • All bacteriology results (all positive and negative results)
    • List of all current medications and home medications

Tuberculosis Treatment and Follow-up Care Report Form

The TB Treatment and Follow-Up Care Report Form documents the continued recommended supervision of the patient, documents outreach and directly observed therapy (DOT), and validates office visits for payment by the TB Control Program.

Use this form to report each time the patient is medically evaluated while on treatment for TB disease or LTBI.

This one-page form should be filled out in its entirety. Please include the following information:

  • Required patient demographic information
  • Medication changes (must be accompanied by a new prescription)
  • Continuing ingestion, reaction to or completion of medication
  • Sputum conversion
  • Comparative x-rays
  • Patient address changes
  • Other information not known at time of original report
  • Provider and Hospital or Facility information
  • Date the Report Form was signed
Where and How should I submit the Report Forms?

  • Completed TB Surveillance Report Forms for active TB should be faxed within 12 hours to the TB Control Program at 860-730-8271, and sent to the Local Health Director of the town where the patient resides.
  • Completed TB Treatment and Follow-Up Care Report Forms should be completed monthly and faxed to the TB Control Program at 860-730-8271, and sent to the Local Health Director of the town where the patient resides.

Note: For patients on treatment for TB disease: Notify both the TB Control Program at 860-509-7722, and the patient’s Local Health Department when a patient:

  • Refuses care,
  • Misses clinic appointments, or
  • Becomes non-adherent with medication.

This page last updated 7/30/2021.