Table 2

Selected themes identified during key informant interviews

Themes

Related section(s) in the outbreak response plan

Observations

Identification of the outbreak relied on both epidemiologic methods and genotyping information.

Definition of a TB outbreak; ten steps to take when an outbreak is suspected; exceptional TB circumstances; data management; glossary

The district became aware of the outbreak by epidemiologic methods; the state, by genotyping matches. A standard TB outbreak definition was not used.

Legal authority for responding to the outbreak was clearly established.

Legal authority; indications for initiating the plan; de-activation of the TB outbreak response plan

All respondents agreed that legal authority for the outbreak rested with the district; a TB-specific plan was not used to guide the response.

Technical assistance was requested when the outbreak was first identified.

Notification and request for assistance

The state TB program notified the Division of TB Elimination, CDC, allowing technical assistance to be deployed in a timely manner.

Additional resources were needed to respond to the outbreak.

Composition of the outbreak response team; public health roles and responsibilities; sources of additional staffing; training and education

In low-incidence areas, multiple roles are often filled by one individual; additional employees from other public health programs were brought in to help with the outbreak, but lacked TB training.

Communication relied on multiple channels, both formal and informal.

Guidelines for internal and external communication; risk communication checklist

The state TB controller and district epidemiologists communicated using standard operating procedures with health professionals; however, within the public health sector, staff relied on informal mechanisms for communication across multiple jurisdictions.

Contributions by community members were an integral part of the outbreak response.

Community partnerships

All community members had knowledge of and were engaged in response activities (e.g., care of TB patients, education of co-workers, TB screening at the shelter, conduction of contact investigations) at their respective facilities.

The basics of TB and interpretation of genotyping information were important areas for education.

Training and education

The assessment highlighted the importance of continued TB education and training in low-incidence areas.

CDC, Centers for Disease Control and Prevention; TB, tuberculosis.

Freimanis Hance et al. BMC Public Health 2007 7:307   doi:10.1186/1471-2458-7-307