1. 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:
Register for FY17 Epi-Tech Surveillance Training:
Confirm attendance for today’s training:
Enter your full name/ address in the chat box; enter each individual’s information if attending with a group
You will receive a confirmation within 48 hours
Contact your Service Hub if you do not receive this
Please put your phones on mute when not speaking. Press *6 to mute/unmute your phone.
Introduction to the TB CIR Module

2. Courtney Rudiger 29 August 2017
Introduction to the DRSi Tuberculosis Contact Investigation Reports Module
Courtney Rudiger 29 August 2017

3. Objectives
Describe DRSi Tuberculosis Contact Investigation Report module capabilities.
Understand how standardized investigation data assist in program and policy planning.
Describe current trends in tuberculosis in the military and the importance of data collection to tracking those trends.
Introduction to the TB CIR Module

4. What’s 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.
Additional questions include:
Specimen collection dates and results
Antibiotic susceptiblity testing results
Clinical details such as chest radiography
Risk factors including immunosuppression, BCG vaccination history, LTBI history, country of birth
Note that these additional questions only appear after clicking “yes” to the question “is an active TB case contact investigation being conducted” (which will be demonstrated later)
Introduction to the TB CIR Module

5. Why do we have a TB CIR module?
Fulfills reporting requirements
Navy: Per BUMEDINST B (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.
Army/AF requirements??
Introduction to the TB CIR Module

6. 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

7. 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.
Following slides are a general walkthrough of the new TB MER and the CIR module so that you have an idea of what to expect when you report a TB case and/or a contact investigation.
Introduction to the TB CIR Module

8. 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:
Highlighting the new question for contact investigations
Introduction to the TB CIR Module

9. Clinical details: chest radiography and infectious period
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
These will only appear if you click YES to “is a TB case contact investigation being conducted?” (as mentioned previously)
Additional details on the case that would be relevant to a contact investigation.
Introduction to the TB CIR Module

10. 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.
Note the other button “link to existing TB CIR” will come back to this later. For this example, will just look at starting a new TB CIR
Introduction to the TB CIR Module

11. 5. If the CIR was created via a MER, Index Case Information will be pre-populated 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:
Highlighting the auto-fill in capability for convenience/efficiency and how to ensure the CIR stays consistent
Introduction to the TB CIR Module

12. 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

13. 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.
Emphasize that reports can be continuously updated as investigations continue.
Introduction to the TB CIR Module

14. 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.
Linking other TB MERs to the CIR
Recall the second button that appeared when submitting the TB MER earlier. If a CIR has already been created, you can link the individual cases reported later to that CIR
Examples of uploads:
Tables or figures related to contact investigation
Risk communication materials
Briefs used to inform leadership
Introduction to the TB CIR Module

15. 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
This slide and the next slide give example TB case scenarios and how those would be reported into DRSI.
Introduction to the TB CIR Module

16. 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
Emphasizes that a TB CIR can be created independently of a TB MER.
Introduction to the TB CIR Module

17. 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?
Next two slides provide context into why questions were added to the TB MER screen and why the TB CIR module was added.
Introduction to the TB CIR Module

18. 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

19. Current Tuberculosis Trends
Number of Tuberculosis Cases by Year and Service, DON Beneficiaries,
The following figures come from NMCPHC’s bi-annual tuberculosis report, a report that summarizes the burden of tuberculosis in Navy and Marine Corps beneficiaries.
Number of cases year to year relatively low.
Introduction to the TB CIR Module

20. Current Tuberculosis Trends
Rates of Tuberculosis by Service, DON Active Duty,
Rates for active duty only year to year. Also very low, all below or around 1/100,000
Introduction to the TB CIR Module

21. Current Tuberculosis Trends
Tuberculosis Cases by Region of Birth, DON Active Duty,
Region of birth for active duty TB cases – primarily foreign-born
Introduction to the TB CIR Module

22. 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)
Summary of the figures we have viewed
Introduction to the TB CIR Module

23. 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

24. Contact Information
Navy: NMCPHC Preventive Medicine Programs and Policy Support Department
COMM: (757) ; DSN: (312)
Navy Environmental and Preventive Medicine Units (NEPMU)
NEPMU2
COMM: (757) ; DSN: (312)
NEPMU5
COMM: (619) ; DSN (312)
NEPMU6
COMM: (808) ; DSN: (315)
NEPMU7
COMM (international): (local: ); DSN:
Introduction to the TB CIR Module

25. Contact Information
Army: APHC – Disease Epidemiology Division Aberdeen Proving Ground, MD COMM: DSN:
Air Force: Contact your MAJCOM PH or USAFSAM/PHR USAFSAM / PHR / Epidemiology Consult Service Wright-Patterson AFB, Ohio COMM: DSN:
Introduction to the TB CIR Module

26. Questions?
Introduction to the TB CIR Module