[MCOH-EH] [EXTERNAL] Re: Staff member on Humira with exposure to patient with active TB

[Swift, Melanie D., M.D., M.P.H.]

Charles I recommend talking with your IPAC and/or public health consultants. The extent of exposure is really important here. If this was someone who spent 5 minutes in the same room, it’s different than a household contact or someone performing an intubation on the patient. It also matters how infectious the source patient was. Prophylactic treatment before an IGRA or TST conversion is given but only in really limited circumstances. As far as the regimen to use, consult IPAC/public health if the source patient is known to have MDR/XDR or an INH/RIF resistant organism. Otherwise you wouldn’t deviate from the standard treatment regimen based on the exposed person being on Humira. The big question is whether the exposure itself was intense enough to warrant treatment before test conversion. (I doubt it, but could see it in some extraordinary circs. I would be interested to learn if it is recommended and based on what factors.)
Thanks for sharing an interesting issue!

Melanie

Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center<https://www.mayoclinic.org/departments-centers/preventive-occupational-aerospace-medicine/physician-health-center/referrals>
Associate Medical Director, Occupational Health Service
Senior Associate Consultant
Assistant Professor of Medicine
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org<http://www.mayoclinic.org/>




From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Charles Hackett
Sent: Monday, February 10, 2020 1:27 PM
To: MCOH-EH
Subject: [EXTERNAL] Re: [MCOH-EH] Staff member on Humira with exposure to patient with active TB

We had a similar patient and referred to our TB clinic
This patient was put on window prophylaxis until igra at 8 weeks
Sent from my iPhone


On Feb 10, 2020, at 2:14 PM, Radke, Laura L. M.D. <laura.radke at froedtert.com> wrote:

I’m wondering if I can solicit some opinions from the group regarding a situation we have.  We have a staff member (patient care) with rheumatoid arthritis, currently on Humira and and another RA med, who was exposed to an individual hospitalized with active tuberculosis.  She has had immediate testing with Quantiferon, but the result is pending.  Her last test result was in May of this year and was negative.  The question has arisen as to whether she should receive immediate treatment given her immunosuppression.  I’m interested to hear what members of the group would do in this situation and what drugs you would use for treatment – treat as latent with single agent or treat with more drugs due to her immunosuppression or follow her testing and symptoms and treat as needed.

Thank you in advance for your input!

Laura L Radke, MD
Medical Director, F&MCW Occupational Health Services
Phone:  262-253-8197  | Fax:  262-253-5152 Cell Phone:  414-530-0723
E-mail: laura.radke at froedtert.com<mailto:laura.radke at froedtert.com>

Froedtert & the Medical College of Wisconsin Workforce Health / North Hills Health Center Building B First Floor
W129 N7055 Northfield Dr.
Menomonee Falls, WI 53051


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