Chest Clinic

Fresno County Tuberculosis Control Program

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1221 Fulton Street, 1st Floor
Phone: (559) 600-3413 Fax: (559) 600-7602
PO Box 11867, Fresno CA 93775-1867

Clinic Hours: Monday thru Friday, 8:00am - 5:00pm
(Closed 12:00p - 12:30p)

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 Our-Mission.png(PDF, 313KB)   Our-Goals.png(PDF, 316KB)
  Chest-Clinic-Program-Services.png(PDF, 294KB)    Shelter-Screening-Guidelines.png(PDF, 595KB)  
 Chest-Clinic-FAQS.png(PDF, 400KB)      Reporting-Requirements.png(PDF, 664KB)  

  

Our Mission

  • To eliminate TB by initiating prompt treatment and ensuring completion of effective therapy to cure disease, reduce further transmission through timely case finding and contact follow-up, and prevent the development of drug-resistance TB.

Our-Mission.pdf(PDF, 313KB)

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Our Goals

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The goal of the Department of Public Health is to eliminate Tuberculosis (TB) among the residents of Fresno County. To achieve this goal, the following objectives have been adopted:

  • Provide consultation and oversight for the TB control activities of local facilities and practitioners, and ensure that these efforts reflect current standards of care and public health practice.
  • Conduct disease surveillance and investigate exposure case contact to prevent the spread of disease.
  • Provide direct observed therapy (DOT) and other adherence promoting methods to ensure all patients with TB disease complete therapy.
  • Provide TB patients case management, regardless of the patient's ability to pay, to initiate prompt treatment and ensure completion of effective therapy to cure disease, reduce transmission, and prevent the development of drug-resistant disease.
  • Serve as an educational resource and consultant for health care providers and community on current TB treatment and control activities.
  • To provide services to the community in a collaborative effort with private and managed care providers in order to control tuberculosis.

Our-Goal.pdf(PDF, 316KB)

Chest Clinic Program Services

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Treatment:

Center around the treatment of tuberculosis (TB) disease. Patients diagnosed with or suspected of having TB are evaluated by our medical staff; the patient receives treatment (medication) and is closely monitored to ensure that treatment is effective.

Direct Observed Therapy:

Medical eligible staff monitors and ensures patient compliance with the prescribed treatment plans through face-to-face contact with the patient.

Contact Investigation:

People who have been in contact with someone known or suspected to have TB are evaluated by a Communicable Disease Specialist. Contacts are provided tuberculin skin tests or Quantiferon test; and if indicated, chest X-Rays are done and preventative treatment may be started.

Testing for Homeless Residents:

The Department of Community Health (DHC) Tuberculosis (TB) Control Program shall provide mechanisms to monitor for TB disease within the un-homed populations. DCH will assist all persons seeking shelter at the Fresno Rescue Mission or other designated facility in obtaining a valid TB Clearance Card required for the client to be admitted to the facility. 

Chest-Clinic-Program-Service.pdf(PDF, 294KB)

Shelter Screening Guidelines

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For the initiation of services in Chest Clinic, Drug Treatment Programs will be required to provide a referral with a request for TB screening. The referral should include the name, DOB, Drug Treatment Program, positive TST result, any prior x-rays, and any prior history of positive TSTs. TSTs for Drug Rehabilitation residents will not be provided in Chest Clinic.

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At Chest Clinic, the client will register and be screened by Chest Clinic personnel for history and symptoms of TB.

Any client without a known past or current positive TST will have a Chest X-Ray done, if Chest X-Ray has not been done within:

  • the last 6 months (with normal report)
  • within  3 months (with abnormal report).

 

Any client with suggestive of TB disease is to be brought to the attention of the TB Physician. Chest Clinic will follow current protocols for screening which may include a TB skin test, chest x-ray, or sputum collection.

All clients with a negative initial TST or QFT will require a repeat TST or QFT, and TB symptom review annually. The following types of clients require specific evaluations:

Table 1

Shelter-Screening-Guidelines.pdf(PDF, 595KB)

Chest Clinic FAQS

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Do you do TB skin tests for free?

TB skin tests are only provided in the TB chest clinic to those recently exposed to a person with active TB disease and referred to this clinic as a result of a current TB investigation. There may be a charge for the skin test depending on your insurance coverage.

Do you do routine Chest X-rays, and are they for free?

The Chest Clinic does not provide routine chest X-rays. Chest X-rays are obtained for persons identified as a contact to an active TB case and for those with active TB. Those with health insurance coverage are referred to an outside radiology lab; Those without insurance are done in the clinic by appointment. Chest X-rays are not provided free, the patient is billed for this service.

I have asthma; can you check my chest? Do you do any other kinds of physicals?

No, the Chest Clinic only provides treatment for active Tuberculosis and TB infection when the patient is part of a current TB exposure and investigation. A private physician or community health center, should follow other medical or respiratory conditions. In emergencies, you should contact your local emergency room or call 911.

I need a TB clearance for work or school. If I have tested positive in the past, what do I need to do?

Please seek follow up for TB clearance requests from your primary care provider. Chest Clinic is only able to provide TB clearance for chest clinic patients who received treatment for active TB disease or for TB infection within the last 12 months. Please see your primary care provider for TB clearance or completion of a TB Risk Assessment Questionnaire.

What are the symptoms of TB?

The symptoms of active TB disease are night sweats, fever and chills, unexpected weight loss, chest pains, persistent coughing more than 3 weeks, often with sputum which may include some blood. If you feel that you are having these symptoms, see your primary care provider for evaluation.

 

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Chest-Clinic-FAQs.pdf(PDF, 400KB)

Resources

Resources for Providers 

Resources for The public

patient and general public Education materials: https://www.cdc.gov/tb/education/patient_edmaterials.htm

 

Reporting Requirements

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Definition of Suspected Tuberculosis

A suspected case of tuberculosis can be defined as any person who, based on clinical or epidemiological evidence, has a reasonable likelihood of having active tuberculosis whether started on antitubercular therapy or not. These persons must be reported to the Department of Public Health within one working day of suspicion. Examples of suspected cases include:

  • Any person with clinical or laboratory evidence consistent with active tuberculosis, even if the diagnostic evaluation is incomplete or culture results pending.
  • Any person who has been started on anti-tuberculosis therapy for suspicion of active tuberculosis.
  • Any person with findings consistent with active tuberculosis, unless other clinical evidence make a diagnosis of tuberculosis unlikely.

How to Report

Complete the CMR Form (use only to report Tuberculosis) and notify the Department of Public Health:

  • By Phone: Monday through Friday, 8am - 5pm, call the Chest Clinic at 600-3413.
  • Fax Chest Clinic: 600-7602 (Monday - Friday)

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CMR Form (use only to report Tuberculosis)

Reporting all patients with confirmed or suspected tuberculosis is mandated by California Health and Safety Code, Division 4, Chapter 5, and Administrative Code Title 17, Chapter 4, Section 2500. All health care providers, health facilities, and clinics attending a patient with confirmed or suspected active tuberculosis must report these findings to the local Health Officer, or his/her designee, within one working day.

 

IGRA Laboratory Reporting

Both positive and non-positive IGRA results are required to be reported by laboratories by the California Department of Public Health per the California Code of Regulations, Title 17, Section 2505, Section A. Non-positive IGRA results include results that are negative, indeterminate, or borderline. Non-positive IGRA results are required to be reported as of November 1, 2022. Positive IGRA results have been required to be reported by laboratories since October 2019. More details on tuberculosis disease reporting requirements including tuberculosis laboratory reporting requirements can be found at the Fresno County Department of Public Health website Disease Reporting Requirements.    

Reporting-Requirements.pdf(PDF, 664KB)

TB Laws in California

Issues addressed there include:

  • The role of the California Department of Public Health in TB Control
    § 121350 § 121357
  • The process by which a county health department may provide a one year certificate for TB skin test technicians
    § 121360.5
  • The requirement for a written treatment plan approved by the health officer before a hospital or detention facility can discharge, release, or transfer a patient or inmate known or suspected of having TB disease (Gotch Legislation)
    § 121361
  • The requirement for any health care provider to promptly report any information on TB patients that may be required by the health officer
    § 121362
  • The responsibility of all health care providers to see that household contacts to TB patients are examined for TB infection or disease
    § 121363
  • The authority of the health officer to order examination for TB infection
    § 121364
  • The authority of the health officer to issue orders to assure the detection and complete treatment of TB disease (click here for more information on health officer orders)
    § 121365 through § 121370
  • Provisions for an annual subvention paid by the state Department of Public Health to local health departments for TB Control
    § 121450 121460
  • The authority of the health officer to mandate TB examination of anyone entering any school in the jurisdiction for the first time
    § 121475 through 121520
  • The requirement that employees of all schools be initially and regularly screened for TB
    § 121525 through 121555

Statute requiring local health care providers to report diagnosed or suspected TB disease to the local health department by telephone or fax within one working day is found in California Administrative Code Title 17 Section 2500 through 2540.

TB-Laws-in-California.pdf(PDF, 320KB)

    

Links to Tuberculosis Websites

External Links to Tuberculosis Websites

CDHS / CTCA Joint Guidelines

Targeted Testing and Treatment of Latent Tuberculosis Infection in Adults and Children.

Additional Information About LTBI Treatment (slideshow)
Targeted Testing and Treatment of Latent TB Infection
L. Masae Kawamura, M.D. Director, TB Control Section
San Francisco Department of Public Health
Francis J. Curry National TB Center
University of California, San Francisco

Center for Disease Control and Prevention, Division of Tuberculosis Elimination
Highlights include Tuberculosis Guidelines, online ordering system for educational materials, self-paced interactive TB study modules and epidemiological reports.

World Health Organization
Highlights include international epidemiological reports, TB fact sheets, and information on how to advocate for strengthening the fight against TB.

Ethnomed, Ethnic Medicine Guide, Harborview Medical Center, University of Washington
Highlights include information about cultural beliefs, medical issues and other related issues pertinent to the health care of recent immigrants.

Curry International Tuberculosis Center
This is one of three Model Tuberculosis Centers funded by the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention. These centers develop and disseminate methods and materials for TB control and TB education.

The National Jewish Medical and Research Center
This is a long-established major referral center for management of complicated tuberculosis, as well as for clinical and research laboratory, consultation and education services.

The TB section of the CDC National Prevention Information Network (NPIN)
This site is designed to facilitate the sharing of information and resources on tuberculosis for individuals searching for prevention information.