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MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Evaluation and Treatment Workflows and
the 2007 DS Forms
22
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Tuberculosis Evaluation
Screening medical examination for tuberculosis may consist of:• Medical history• Physical examination• Chest radiography• Tuberculin skin testing / IGRA• HIV testing• Sputum smear, culture and DST testing
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Screening Workflow
Source: CDC TB Technical Instructions 2007
≥15 years of age
Medical history Physical examination
Chest radiographMedical history,
examination, or chest radiograph suggestive of
tuberculosis or HIV infectionThree sputum smears and
cultures for Mycobacterium
tuberculosis
Drug susceptibility testing on positive culture
TST ≥10 mmor
IGRA positive
Tuberculin skin testor
IGRA
Medical historyPhysical examination
2 – 14 years of age*
*In countries with WHO-estimated TB incidence of >20 cases per 100,000
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
< 10 mm > 10 mm
TB Screening Workflow
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
LTBI Evaluation
Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009
TST < 10mm TST > 10mm
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
LTBI Before• No field
specified for entering TST result in current DS form
• TST result captured in WRx module
WRx data entry WRx printout
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
LTBI After (2007 DS)• LTBI evaluation data must be entered in DS-2054
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Contact Evaluation
Source: US Panel Physician’s Training Summit Workbook, April 2009
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Contact Before• No field
specified for entering contact evaluation results
• Use WRx Contact Evaluation Form
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Contact After (2007 DS)• Contact evaluation data must be entered in DS-2054
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Current vs New (2007) DS Forms
OLD 1991 DS
UPDATED 1991 DS
2007 DS
Classification / Summary Sheet
DS-2053 DS-2053 (updated) DS-2054 (new)
CXR Worksheet DS-3024 DS-3024 (updated) DS-3030 (new)
Vaccination Worksheet
DS-3025 DS 3025 (updated)
History and PE Worksheet
DS-3026 DS 3026 (updated)
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
DS-3030 (New CXR Form) – 1
What’s New?
Positive TST result is listed as an indication for CXR
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
What’s New?
Table is provided for entering sputum culture results
DS-3030 (New CXR Form) – 2
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
What’s New?
Classification list is expanded and includes LTBI and Contact
DS-3030 (New CXR Form) – 3
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Class: 1991 vs 2007
Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Class: 1991 vs 2007
Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Classification Before (DS 2053)Limited classification options
Use WRx Pre-departure TB Classification Form
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Classification After (DS 2054)
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Validity Periods: 1991 TI
Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Validity Periods: 2007 TI
Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Rx, Patients (DS)Class A -Applicants who have positive sputum smears
should not be cleared for travel and should be treated for TB, unless culture is found to be negative.
-Applicants who have negative sputum smears and positive cultures should not be cleared for travel and should be treated for TB.
Class B1 with advanced findings
Must complete DOT prior to immigration
Class B2 (LTBI) In general, preventive treatment should not be initiated overseas (unless pediatric contact or impaired immunity)
Class B3 (Contact)
-Contacts diagnosed with TB disease will need to complete treatment prior to immigration.
-If negative for TB disease: In general, preventive treatment should not be initiated overseas (unless pediatric contact or impaired immunity)
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Rx, patients (WHO)
• New TB case– A/B1– LTBI Rx– Contact Rx
• Rx after default• Rx after failure• Transfer In • Relapse• Other
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Treatment, OverviewTB Dx Cat-ry
TB patients TB treatment regimens
Initial phase
Continuation phase
I New smear-positive patients. New smear-negative PTB Severe concomitant HIV disease or severe forms of ext-PTB.
2HRZEb 4HR (or 6HE daily)
II Relapse, treatment after default, treatment failure.
2HRZES/1HRZE
5HRE
III New smear-negative pulmonary TB (other than in Category I). Less severe forms of ext-PTB.
2HRZEe 4HR (or 6HE dailyc)
IV Chronic and MDR-TB cases (still sputum-positive after supervised re-treatment)f.
Specially designed individualized or standardized regimens are suggested (WHO guidelines, Ch. 5)
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Rx, Monitoring – 1• Side effects captured in WRx follow-up exam form
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Rx, Monitoring – 2• Laboratory
tests captured in WRx module
WRx data entry
WRx printout
WRx data entry
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Rx Recording – 1• DS-2053 / DS-2054 captures treatment regimen
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
TB Rx Recording – 2• Rx outcome captured in WRx exit exam form
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
Pre-departure Exam
• Performed on applicants with equivocal results (history, PE, CXR suggestive of TB but no positive sputum smear or culture)
• Consists of history, PE, CXR and 3 sputum smear specimens (no cultures required)
• Conducted within 3 weeks prior to departure• If results are negative, Class B1 TB,
Pulmonary
MiMOSA Training
1. Opening
2. TB WRx and the 2007 DS Forms
3. Data entry and report generation for the new DS forms
4. Mission settings for DS Forms
5. Exercises (new DS)
6. Issues with new DS
7. Overview of WRx module
8. Data entry for TB WRx scenarios
9. WRx reports
10. Exercises (WRx)
11. WRx module admin & maint.
12. Exercises (WRx admin & maint)
13. Issues with WRx
14. Other MiMOSA features
15. Program evaluation indicators
16. Other systems
17. Change request
18. Final meeting
References
American Thoracic Society, CDC and Infectious Diseases Society of America. Treatment of Tuberculosis. June 2003
Centers for Disease Control and Prevention. CDC Immigration Requirements: Technical Instructions for Tuberculosis Screening and Treatment Using Cultures and Directly Observed Therapy (DRAFT). June 2009
US Panel Physicians Training Summit Workbook. April 2009
