Flight-Related TBCI Assessment

Attachment C - Instrument- Web Version

Flight-Related TBCI Assessment
Introduction

Form Approved
OMB No. 0920-0879
Expiration Date 03/31/2018

Assessing the Impact of the 2011 CDC Protocol Change for Flight-Related
Tuberculosis Contact Investigations (TBCI)
Welcome! The National Tuberculosis Controllers Association (NTCA) and the U.S. Centers
for Disease Control and Prevention (CDC) are conducting an assessment of the impact of the
2011 CDC protocol change for flight-related tuberculosis contact investigations (TBCIs).
Objectives of this assessment, information on the 2011 CDC protocol change, and participant
details are provided below.
Background:
In 2011, the CDC revised its protocol for conducting aircraft flight-related tuberculosis contact
investigations (TBCIs). The updated guidelines had more restrictive criteria for initiating a
TBCI based on the low risk of in-flight TB transmission for flights at least 8 hours in duration
(gate-to-gate time).
Table. Comparison of case-traveler flight and clinical criteria for conducting flight-related TB
contact investigations for the 2008 CDC Protocol and the 2011 Modified CDC Protocol
2011 Modified CDC
Criterion
2008 CDC Protocol
Protocol
Time since flight when CDC is
notified of case-traveler

Within 6 months

Within 3 months

Sputum positive for MTBa by
culture or NAATbAND:
sputum smear positive for

Sputum microscopy and
radiology for isolate susceptible AFBc with or without
to isoniazid and/or rifampin
cavitation on CXR dOR
sputum smear negative with
cavitation on CXR d

Sputum positive for MTB a
by culture or NAATbAND:
sputum smear positive for
AFBc AND
cavitation on CXR d

Sputum microscopy and
radiology for multidrug-resistant All, regardless of sputum
(MDR) isolate (resistant to at
smear or CXR d results
least isoniazid and rifampin)
aMycobacterium tuberculosis; bNAAT: nucleic

All, regardless of sputum
smear or CXR d results

acid amplification test: c AFB: acid-fast bacilli:

dCXR: chest radiograph

Note: MDR and Extremely Drug Resistant (XDR) TB follow the same TBCI criteria.
Objectives:
1. Assess the importance of flight-related TBCIs to state and local health departments’ TB
control efforts
2. Assess knowledge or awareness of the flight-related TBCI protocol change
3. Determine if the 2011 protocol change had an impact on health department TB-related
resources
4. Determine if the 2011 protocol change resulted in missed opportunities to prevent TB
disease
5. Obtain suggestions for improvements to the flight-related TBCI process and outcome
reporting form

Your feedback is important to us and will help us understand the impact of the guidelines on
your agency’s capacity for conducting TBCIs and improve or strengthen the current TBCI
protocol by identifying any concerns with the change and any suggestions for future
modifications.
Participation Details:
This assessment should be completed by the employee(s) that are the most
knowledgeable about procedures at your health department for conducting flightrelated TBCIs.
It will take approximately 20 minutes to complete this assessment.
Participation in this online assessment is completely voluntary and participants may withdraw
at any time. However, in order to obtain as robust and representative distribution as possible,
we encourage the participation of all TB programs with direct federal funding. The responses
will not affect program funding or NTCA representation. There are no known risks or direct
benefits to you from participating or not choosing to participate; but, your answers will help
CDC improve its guidance for conducting flight-related TBCIs.
Responses will be kept secure and results will be reported only in aggregate form. Identifying
information will be used for the sole purposes of assessing the representation of respondents

and conducting necessary follow-up. These data will be removed prior to analysis and
only de-identified data will be provided to CDC.
If you have any questions or concerns about this assessment, please contact
[email protected]
Thank you for participating!
To begin, please click next.

CDC estimates the average public reporting burden for this collection of information as 20
minutes per response, including the time for reviewing instructions, searching existing
data/information sources, gathering and maintaining the data/information needed, and
completing and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to a collection of information unless it
displays a currently valid OMB control number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for
reducing burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road
NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

Demographic information

1. Is your TB Program classified as State, Big City, Territory or Local? *
State
Big City
Territory
Local
Other (please specify)

2. What is your jurisdiction’s TB incidence rate per 100,000? *
>4.0
2.0 - 4.0
<2.0

3. What is your primary role at the health department (HD)? *
TB Controller
TB Program Manager
Contact Investigator
Public Health Nurse
Epidemiologist
Case Manager
Program Evaluator
Other (please specify)

4. How many years have you worked in TB control?
*
<5 years
5-10 years
>10 years

5. What percentage of your work time is spent on TB control?
*
<25%
26-50%
51-75%
76-100%

6. Please provide your name and jurisdiction. This information will be used
for the sole purposes of assessing the representation of respondents and
conducting any necessary follow-up. These data will be removed prior to
analysis. *
Name
Jurisdiction

Flight-related TBCI Protocol and the 2011 Protocol Change
Page exit logic: Skip / Disqualify Logic
IF: Question "Are you aware of any TB cases in your jurisdiction reported since July 2011 that
may have been prevented if the new flight-related TBCI protocol had not been put into place?
That is, were active cases of TB reported in persons that would have been identified as flight
contacts using the previous criteria?" #13 is one of the following answers ("No","Don't
know/not sure") THEN: Jump to page 5 - Flight-related TBCI Passenger Contact Follow-up
and Outcomes Reporting

7. Are you aware that the CDC protocol for flight-related TBCIs was changed
in 2011? *
Yes
No
Don't know/not sure

8. To your knowledge, since the TBCI protocol change, has your health
department conducted more or fewer flight-related TBCIs, or has the number
remained the same? *
More
Less
Remained the same
Don't know/not sure

9. How important are flight-related TBCIs in your TB-control efforts? *
Very important
Somewhat important
Not at all important
Don't know/not sure

10. Do you have adequate funding resources to conduct flight-related
TBCIs? *
Yes
No
Don't know/not sure

11. Do you have adequate staffing resources to conduct flight-related
TBCIs? *
Yes
No
Don't know/not sure

12. Have you noticed any changes in your health department’s resources for
TB control efforts since July 2011? Resources include both local and
federal funding for personnel, program operations, or a combination of these.
*
Resources have increased
Resources have decreased
Resources have remained the same
Don't know/not sure

13. Are you aware of any TB cases in your jurisdiction reported since July
2011 that may have been prevented if the new flight-related TBCI protocol
had not been put into place? That is, were active cases of TB reported in
persons that would have been identified as flight contacts using the previous
criteria? *
Yes
No
Don't know/not sure

Case Identified

14. Did the person convert a previously negative TST or IGRA? *
Yes
No
Don't know/not sure
Comments

15. Was the active TB newly diagnosed? *
Yes
No
Don't know/not sure
Comments

Flight-related TBCI Passenger Contact Follow-up and Outcomes Reporting
Page exit logic: Skip / Disqualify Logic
IF: Question "Since January 2012, DGMQ has been preparing flight-related TBCI outcomes
summary reports. DGMQ Quarantine Station staff forward the reports to the designated points
of contact at state or local HDs. Have you seen these?" #23 is one of the following answers
("No","Don't know/not sure") THEN: Jump to page 7 - Suggestions for Potential Future FlightRelated TBCI Protocol Revisions

16. Approximately how many flight notifications have you received in the past
12 months? *

17. Does your health department attempt to reach the TBCI passenger
contacts provided by DGMQ? *
Always
Sometimes
Seldom
Never
Don’t know/not sure

18. If your health department does not regularly follow up with air TBCI
passenger contacts, please provide the reason(s). Check all that apply. *
Limited funding
Not enough staff
Low risk of TB transmission
Historically, we have not had success with receiving accurate TBCI
contact information so have decided not to continue with follow-up
Not applicable
Other (please specify)

19. Do you receive the CDC flight-related TBCI Outcome Reporting forms? *
Yes
No
Sometimes
Don't know/not sure

20. In the past 12 months, how often have you reported TBCI outcomes back
to DGMQ? *
Always
Sometimes
Seldom
Never
Don’t know/not sure
Not applicable

21. Are you responsible for filling out the flight-related TBCI Outcome
Reporting forms? *
Yes
No
Don't know/not sure

22. In your opinion, what could be done to improve outcomes reporting by
HDs to DGMQ? Check all that apply.
Simplify outcome reporting form
Provide a secure on-line outcome reporting method
Provide a reminder to health departments to return the form
We don’t receive the outcome reporting form
Other suggestions

23. Since January 2012, DGMQ has been preparing flight-related TBCI
outcomes summary reports. DGMQ Quarantine Station staff forward the
reports to the designated points of contact at state or local HDs. Have you
seen these? *
Yes
No
Don't know/not sure

If you answered no and would like to receive TBCI outcome summary reports, please contact
your state TB program to request the reports.

Has seen reports

24. Do you find these summary reports useful? *
Yes
No

25. Would you like to continue receiving the summary reports? *
Yes
No

Suggestions for Potential Future Flight-Related TBCI Protocol Revisions

26. Do you have any questions or concerns about the flight-related TBCI
protocol that was implemented in 2011? *
Yes

Please describe

No
Don't know/not sure

27. Do you think further changes are needed for the current TBCI protocol? *
Yes

Please specify:

No
Not sure/too early to tell

28. Many European countries advocate doing flight-related TBCIs ONLY if
there is documented evidence of transmission (positive TST or IGRA test) to
close contacts such as household contacts, co-workers, classmates, etc. Do
you think this criterion would be sufficient to capture secondary cases
transmitted on flights? *
Yes

Why?

No

Why not?

Don't know/not sure

29. The current guidance requires CDC to conduct TBCIs for all MDR/XDR
TB cases if a flight was within 3 months of notification to DGMQ and the case
was diagnosed within 3 months of the flight, regardless of sputum smear or
CXR results. What would you recommend regarding MDR/XDR cases?
Continue to do TBCIs for all MDR/XDR TB cases regardless of sputum
smear or CXR results
Do TBCIs only for those with MDR/XDR TB cases who are either smear
positive or have cavitation on CXR
Do TBCIs only for those MDR/XDR TB cases that are sputum smear
positive AND have cavitation on CXR (this is the current protocol for nonMDR TB)
Other - Write In

Thank You!

Thank you for taking our survey. Your response is very important to us.