Report to the General Assembly (Published)

Document Title

Long-Term Care of Infectious Tuberculosis Patients

Author

Department of Health

Enabling Authority

HJR 189 (Regular Session, 1994)

Executive Summary

The 1994 General Assembly adopted HJR 189 to address the need for facilities to isolate (l) persons with infectious TB who refuse to take medications as prescribed and thereby place their contacts at risk for the disease and themselves at risk for the development of drug resistant TB, and (2) persons with drug resistant-TB who despite taking medications need voluntary isolation to prevent them from transmitting their infection to household members and other close contacts.

HJR 189 requests the Virginia Department of Health (VDH), in consultation with Virginia's teaching hospitals, to study the location of inpatient facilities for long-term care of patients with TB. The facilities mentioned in the Resolution are state-funded teaching hospitals, private facilities, and Department of Mental Health, Mental Retardation and Substance Abuse Services facilities.

TB is not a highly communicable disease. Nationally, only about 30 percent of household contacts to an active case of pulmonary TB become infected. The percentage can increase with overcrowding in poorly ventilated environments. For this reason, TB is most common among persons living in crowded conditions. In Virginia, the reported cases of TB remained fairly steady from 1986 to 1991. Since 1991, reported cases have increased each year, the numbers for 1991, 1992 and 1993, being 379, 456 and 458 respectively. As of October 14, 1994, 264 cases of TB have been reported.

The percentage of TB cases reported in Virginia with resistance to at east one drug is also increasing. Drug resistant (DR)-TB would be prevented if patients complete treatment in accordance with their physicians' instructions. While the prevalence of drug resistant-TB in Virginia is still low (13 percent of TB cases tested for drug sensitivity in 1993), it represents a significant increase over that of previous years. The course of treatment increases from approximately 6 months for drug sensitive-TB to 18-24 months or longer for drug resistant-TB: the cure rate decreases from nearly 100 percent to 60 percent, respectively.