Abstract
BackgroundFor a regional project in four low-incidence states, we designed a customizable tuberculosis outbreak response plan. Prior to dissemination of the plan, a tuberculosis outbreak occurred, presenting an opportunity to perform a field assessment of the plan. The purpose of the assessment was to ensure that the plan included essential elements to help public health professionals recognize and respond to outbreaks.MethodsWe designed a semi-structured questionnaire and interviewed all key stakeholders involved in the response. We used common themes to assess validity of and identify gaps in the plan. A subset of participants provided structured feedback on the plan.ResultsWe interviewed 11 public health and six community stakeholders. The assessment demonstrated that (1) almost all of the main response activities were reflected in the plan; (2) the plan added value by providing a definition of a tuberculosis outbreak and guidelines for communication and evaluation. These were areas that lacked written protocols during the actual outbreak response; and (3) basic education about tuberculosis and the interpretation and use of genotyping data were important needs. Stakeholders also suggested adding to the plan questions for evaluation and a section for specific steps to take when an outbreak is suspected.ConclusionAn interactive field assessment of a programmatic tool revealed the value of a systematic outbreak response plan with a standard definition of a tuberculosis outbreak, guidelines for communication and evaluation, and response steps. The assessment highlighted the importance of education and training for tuberculosis in low-incidence areas.
Highlights
For a regional project in four low-incidence states, we designed a customizable tuberculosis outbreak response plan
We describe the outbreak response through participants' own accounts and compare these accounts with guidance provided in the original outbreak response plan (ORP)
Our assessment of a TB outbreak response plan for lowincidence areas demonstrates that (1) almost all the main response activities were reflected in the plan; (2) the plan added value by providing a standard TB outbreak definition and guidelines for response activities, in particular, communication and evaluation, subjects for which a written protocol was lacking during the actual response; and (3) basic education about TB and the interpretation and use of genotyping data were important needs
Summary
For a regional project in four low-incidence states, we designed a customizable tuberculosis outbreak response plan. Areas of low-incidence (≤ 3.5 cases per 100,000 population), where achievement of TB elimination would seem most likely, present distinct challenges to TB control including: (a) variability of local resources; (b) lack of public health and clinical TB experience; and (c) geographic barriers that may present difficulties for individuals seeking medical care [6,7]. These factors contribute to delayed recognition of infectious TB cases and higher frequency of outbreaks which have been increasingly reported [8,9,10,11,12,13]. Regional approaches may offer an innovative way to respond to these difficulties [6,7]
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