TB Program News and Announcements
Drug Shortage Alert: Moxifloxacin
Dear Colleagues:
Our office has received notification from the DSHS Pharmacy Branch regarding a drug shortage of moxifloxacin affecting multiple manufacturers. While the medication is not currently listed on the Food and Drug Administration’s (FDA’s) official list of drug shortages, we are unable to secure an adequate supply to meet our patient demand.
Effective immediately:
- All patients currently prescribed moxifloxacin will need to switch to levofloxacin, unless the following apply:
- They are resistant to levofloxacin or have proven intolerance to levofloxacin as documented on the DSHS-Recognized Medical TB Consultant’s written consult.
- They have 1 month (30 days) or less remaining on their moxifloxacin regimen to complete therapy.
All current or new orders for moxifloxacin must be approved by the TB and Hansen’s Disease Branch starting 1/21/20
- To switch from moxifloxacin to levofloxacin, ensure the following:
- There is a new medication order from the treating physician.
- An updated medication consent form is completed for levofloxacin (see “Resources for Levofloxacin Administration” below).
- Fluoroquinolone susceptibility is known:
- If susceptible to ofloxacin, no further susceptibility testing is needed.
- If ofloxacin resistant, obtain levofloxacin susceptibility before starting levofloxacin.
- The patient is notified of the change in medication, side effects, and monitoring needed.
- Monitor and adjust dosing for renal patients - see “Resources for Levofloxacin Administration” below.
- Order levofloxacin from the DSHS Pharmacy Branch based on patient’s current weight and kidney function. See page 40 of the
Texas TB Work Plan for ordering second-line medications.
- Patients may take the remainder of their moxifloxacin doses on hand and then start levofloxacin with no interruption. Continue to count DOT doses as usual.
- New patients needing a fluoroquinolone will likely be prescribed levofloxacin after the following:
- Place a consult with a DSHS-Recognized Medical TB Consultant.
- Confirmation of ofloxacin susceptibility and if ofloxacin resistant, confirmation of levofloxacin susceptibility.
Resources for Levofloxacin Administration:
Posted 1/17/2020
The Standing Delegation Orders and Standing Medical Orders
Standing Delegation Orders and Standing Medical Orders for Tuberculosis Prevention and Care for FY 2020 are now available.
The Standing Delegation Orders (SDOs) and Standing Medical Orders (SMOs) are written instructions, orders and procedures prepared by the Department of State Health Services Tuberculosis and Hansen’s Disease Branch to promote consistent evaluation and treatment practices for persons with suspected or confirmed TB disease and for latent TB infection.
The purpose of this document is to provide authority for specific acts of tuberculosis (TB) clinical services under authority of Rule Title 22, Texas Administrative Code §193.2, Standing Delegation Orders.
The intended audience for the SDOs and SMOs includes physicians, registered nurses, licensed vocational nurses, and non-licensed staff working in local health departments with TB programs and in DSHS Public Health Regions.
The revised Standing Delegation Orders and Standing Medical Orders for Tuberculosis Prevention and Care are effective September 1, 2019.
Posted 8/30/2019
Updated Recommendations for Screening of Health Care Personnel TB
On May 17, 2019, the Centers for Disease Control and Prevention (CDC) published
updated recommendations for screening of health care personnel (HCP) for tuberculosis (TB) [CDC]. These recommendations may impact current screening practices in health care facilities that routinely provide TB testing annually to all HCP.
The DSHS Tuberculosis and Hansen’s Disease Branch is currently reviewing these recommendations and will update the
Frequently Asked Questions (FAQ) web page when the review is final.
In the interim, health care facilities may opt to modify screening practices to fit the recent CDC recommendations, or continue their current screening practices. The DSHS TB Branch cannot approve or deny TB screening and testing policies developed by individual health care facilities, therefore it is recommended that facilities consult with their licensing or credentialing agency for any change in policy.
Posted 8/21/2019
DSHS Recommendations for Tubersol Use During the Aplisol Shortage
Due to the nationwide shortage of Aplisol announced by the Centers for Disease Control and Prevention (CDC) on June 6, 2019, the DSHS Tuberculosis and Hansen’s Disease Branch has issued recommendations to ensure continued availability of Tubersol, the purified-protein derivative (PPD) tuberculin antigen used exclusively in tuberculin skin tests (TSTs) administered in Texas.
It is anticipated there will be a greater nationwide demand for Tubersol due to the shortage of Aplisol, which is expected to last three to ten months. During this time, public health providers in Texas should adhere to the following recommendations:
- Closely monitor the distribution and use of purified protein derivatives (PPDs) among jails that meet Texas Health and Safety Code Chapter 89 requirements.
- Jails meeting Chapter 89 requirements have a capacity of at least 100 beds; or house inmates transferred from a county that has a jail that has a capacity of at least 100 beds; or house inmates transferred from another state.
https://statutes.capitol.texas.gov/Docs/HS/htm/HS.89.htm
- Note: The number of vials distributed should not dramatically exceed the expected number of tests administered per month as reported on the Monthly Correctional TB Report, Form number EF12-11462.
- Stop distribution of state purchased PPDs to non-Chapter 89 facilities.
- Stop distribution of PPDs to hospitals.
- Stop distribution of PPDs to targeted sites where the TB infection rate remains at or below the rate of infection for that community.
- State purchased T-SPOT tests shall not be distributed to correctional facilities, community based organizations or hospitals as a replacement for Tubersol.
Please contact Sandra Morris at 512-533-3128 or
sandra.morris@dshs.texas.gov with questions about these recommendations.
Posted 6/12/2019
Prescription Medication Shortages Policy and Procedures
The TB/HIV/STD Section released Prescription Medication Shortages Policy and Procedures. The new guidance seeks to establish uniform procedures used by the Section for distributing medications when there are prescription drug shortages and communicating information about the shortages to internal and external stakeholders. This is a new policy. Please submit comments to
Betsy.Cohn@dshs.texas.gov. Public comment will be accepted until July 24, 2019. Learn more...
Posted 6/7/2019
March 24 is World TB Day
 World TB Day is observed annually on March 24, to raise public awareness that tuberculosis (TB) remains an epidemic in much of the world. It also commemorates the day in 1882 when Dr Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes TB.
The U.S. theme for World TB Day 2019 is, “It’s Time. End TB.”
Tuberculosis is one of world’s oldest diseases and continues to be the world’s deadliest infectious killer. Each day, nearly 4,500 people lose their lives to TB and close to 30,000 people fall ill to this preventable and curable disease.
Learn more
Tuberculosis in Texas
In 2017, 1,127 cases of tuberculosis (TB) were reported in Texas, a rate of 4.0 per 100,000 population. TB can affect anyone but is more likely to be diagnosed in persons born in a foreign country where TB is prevalent, persons living with diabetes or HIV/AIDS, persons who abuse alcohol and other drugs, persons who live in congregant settings (including prisons and other detention centers), people who experience homelessness, and health care workers. Learn more... (PDF : 440 kB)
Posted 7/20/2018
Take on TB
DSHS has developed the Texas-specific TB disease data fact sheet
"Take on TB" (PDF : 208 kB) based on data from the
2016 TB Surveillance report (PDF : 675 kB). This fact sheet was adapted from
CDC’s infograph [CDC] for national data. DSHS partners are free to use surveillance and other local data to create their own
tailored [CDC] publication based on the DSHS fact sheet.
Posted 12/12/2017
Enroll in Medicaid as a TB Medicaid Provider
The Tuberculosis and Hansen’s Disease Branch encourages local health department TB programs to enroll in Medicaid as a TB Medicaid Provider.
Information on the enrollment process for first time enrollees can be found on the
Texas Medicaid and Healthcare Partnership (TMHP) website.
Clinics requesting reimbursement for TB services must also enroll as a TB Medicaid Provider. To enroll, the clinic must apply for a DSHS letter verifying their TB services, and may attach the letter to their Medicaid application. To apply for the letter, clinics may fill out the Medicaid Provider Application which may be downloaded from the
TB forms page.
Updated 9/8/2017
Cohort Review Implementation
In March 2013, the Tuberculosis Services Branch implemented the cohort review system in Texas. A cohort review is a systematic and retrospective review of the management of TB cases and contacts. It is an effective management tool that identifies trends impacting outcomes and provides the impetus for developing systems that enhance program performance.
It is the policy of the Tuberculosis Services Branch that in order to promote optimal case management and contact investigation practices statewide, DSHS health service regions and contracted local health department TB programs will hold quarterly cohort reviews. DSHS health service regional TB programs will work with low morbidity public health jurisdictions to implement the cohort review process. The Health Service Regions' Tuberculosis
Cohort Review Infrastructure form (PDF : 67 kB) provides the reporting framework for the cohort reviews.
Please refer to the
Cohort Review Policy (PDF : 45 kB) for further information.
The followings tools are available to conduct the cohort review and report findings to DSHS Tuberculosis Program Services Branch:
For help completing the summary form, download
An Overview of the Cohort Review Summary Form (PDF : 141 kB).
Updated 11/10/2015
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