Using Pagebuilder for Latent Tuberculosis Infection Surveillance in Tennessee

BACKGROUND:   Latent Tuberculosis Infection (LTBI) affects nearly one-third of the global population.  LTBI is a non-reportable condition in Tennessee and thus, morbidity is unknown. Previously, there was no central repository for LTBI surveillance data statewide in Tennessee and each of the thirteen regional health offices tracked LTBI differently. Tennessee is one of the 19 jurisdictions using the NEDSS Base System (NBS), an electronic disease surveillance system supported by the Centers for Disease Control and Prevention (CDC).  Recent versions of the NBS offer a new functionality, PageBuilder, which allows for the creation of new disease modules using standardized questions and vocabulary through a user interface.

METHODS:   In preparation, the Tennessee Tuberculosis Elimination Program (TTBEP) researched how other states perform LTBI surveillance, reviewed the Report of a Verified Case of Tuberculosis (RVCT) for questions common to TB and LTBI surveillance, and developed LTBI-specific questions.  The CDC facilitated several conference calls with various states interested in LTBI surveillance, including Tennessee.  A comprehensive list of relevant questions and variables (risk factors, laboratory, and treatment information) was developed collaboratively. The template page was built by CDC with assistance from the Tennessee NBS staff.

RESULTS:   Using the template as a starting point, Tennessee staff from the TTBEP and the Surveillance Systems and Informatics Program reviewed the template and tailored it to meet state-specific needs.  The page was harmonized with the NBS TB page to allow an LTBI case to become a TB case without duplicate data entry (utilizing case reporting functionality available in NBS).  The page was tested and went into production in August 2012.  All LTBI cases (942) from 7/1/12 forward were entered into NBS.    

CONCLUSIONS:   Incomplete treatment for LTBI is a risk factor for progression to active disease.  With implementation of the LTBI page, standardized surveillance and treatment outcomes are now documented across the state.  The LTBI page in NBS marked the first use of the PageBuilder functionality for surveillance of a non-reportable condition in Tennessee. Through this process, staff gained experience with PageBuilder, enhancing our ability to respond to evolving surveillance needs. The most challenging part of the process was identifying and standardizing the data elements to be collected when compared with the actual building of the page in NBS. Though collaboration with various stakeholders was time-intensive, this worthwhile effort showcases the collaborative process between the CDC and NBS jurisdictions around surveillance for a condition of public health interest.