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  • Technical Bulletin
  • Tuberculosis

Tuberculosis Drug Susceptibility Testing for Pyrazinamide Suspended by Nevada State Public Health Laboratory as of July 29, 2024.

Situation

Culture-based (phenotypic) drug susceptibility testing (DST) for one of the primary anti-tuberculosis (TB) medications, Pyrazinamide (PZA), is suspended by the Nevada State Public Health Laboratory (NSPHL) as of July 29, 2024. The sole manufacturer of the PZA DST system has recalled multiple lots and the Centers for Disease Control and Prevention’s (CDC) TB Reference Laboratory has suspended all PZA DST with this product. In accordance, PZA DST was suspended by the Nevada State Public Health Laboratory (NSPHL) until further notice. Additionally, molecular-based PZA resistance testing is unavailable through the CDC or NSPHL currently. The Office of State Epidemiology (OSE) TB Program and NSPHL will issue guidance when the CDC determines the situation is resolved.’

Interim Measures

  • PZA monoresistance for non-multi-drug-resistant (MDR) Mycobacterium tuberculosis complex (MTBC) is rare except for M. bovis, which is identified through the standard national genotyping protocol followed by the NSPHL.
  • Capacity for molecular sequencing to detect PZA resistance is limited to a few U.S. laboratories.
  • TB programs within a local health authority (LHA) may need to prioritize which isolates will be referred for PZA molecular sequencing, which may include cases with poor response to treatment, and:
    • Non-public health care providers treating TB disease should work with LHA TB programs (see contact information below) to determine if additional molecular testing for drug-resistance is recommended.
    • LHA TB programs should consult with the NSPHL for cases in which MDR TB is suspected.
    • For situations when PZA might be essential for building a multidrug treatment regimen but PZA susceptibility cannot be ascertained, a TB Center of Excellence consultation in conjunction with the LHA TB program is strongly recommended.

Local Health Authority Contact Information

Health DepartmentCountyPhone Number and Fax
Carson City Health and Human Services (CCHHS)Carson City, Douglas, and Lyon(775) 887-2190 (24 hours) Confidential Fax: 775-887-2138
Central Nevada Health District (CNHD)Churchill, Mineral, Eureka, and Pershing(775) 866-7535 (24 hours) Confidential Fax: 877-513-3442
Northern Nevada Public Health (NNPH, formerly WCHD)Washoe(775) 328-2447 (24 hours) Confidential Fax: 775-328-3764
Southern Nevada Health District (SNHD)  ClarkTuberculosis Program: Phone: 702-759-1015 Confidential Fax: 702-759-1435 Alternate Phone: (702) 759-1300 (24 hours)
Nevada Division of Public and Behavioral Health (DPBH) Office of State Epidemiology (OSE)  All other counties(775) 684-5911 (M-F 8 a.m. to 5 p.m.) (775) 400-0333 (after hours) Confidential Fax: 775-684-5999

Questions

For updated guidance, review the Division of Public and Behavioral Health Technical Bulletin web page regularly. Email stateepi@health.nv.gov for other questions regarding suspension of PZA DST by NSPHL.