The Epidemiology of Tuberculosis Lex Gibson, Director Virginia TB Program.

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Presentation transcript:

The Epidemiology of Tuberculosis Lex Gibson, Director Virginia TB Program

TB Infection VS TB Disease Infection Disease TB Bacilli in Body Yes Yes PPD Usually Pos. Usually Pos. CXR Usually Normal Usually Abn. Sputum Smears/Cult Neg. Usually Pos. Symptoms None Cough, Fever, Wt. Loss Infected Yes Yes Infectious No Often, before treatment A “Case” of TB No Yes

Determining Infectiousness Smear Results CXR Findings Symptoms Smear Results CXR Findings Symptoms

Increased Risk of Transmission Infectiousness of Source Duration of Exposure Environment Susceptibility of Contact

TB Advances Over Time 400 B.C. Syndrome Described 1882 Bacteria Identified 1895X-Ray Invented 1934PPD Available 1950 Effective Therapy 1990 DOT FUTURE ??

Global Tuberculosis 8-10 Million new cases/year 2-3 million deaths/year Tuberculosis is the 2nd leading cause of deaths by infectious diseases

Tuberculosis in the U.S. 15 million infected 18,000 + new cases per year TB cases decreased steadily until 1985, then increased and has now begun to decrease again

TB Case Rates US &Virginia

Epidemiology of Tuberculosis Virginia Cases of TB in /100, people starting INH in ,000 skin-tests given 4,212 contacts identified

Case rates for selected groups In Virginia(1996) Homeless /100,000 Vietnamese /100,000 Guatamalan /100,000 Korean- 63 /100,000 Philipines-59.9 /100,000 Foreign born /100,000 Nursing & Adult Homes /100,000

Case Rates for selected groups Chinese /100,000 Corrections- 8.9 /100,000 Hispanic /100,000 >65 years /100,000 U.S. born minorities- 8.1 /100,000 U.S. born whites- 2.1 /100,000

1996

Percent of Total TB by Race Virginia

US & Foreign-Born TB Cases Virginia

% of Total TB By Age Group Virginia

% Foreign-Born By Age Group Virginia

% US Whites By Age Group Virginia

% US Blacks By Age Group Virginia

% Foreign-Born By Race Virginia

Foreign-Born TB Cases Arrival to Onset of Disease Less than 1 year36.1% From 1 to 2 years11.1% From 3 to 5 years15.3% Over 5 years31.5% Unknown6.0%

Tuberculosis by Agegroup and Foreign-born 1998

TB/HIV TB Cases 234 were offered HIV testing 206(88%) were tested 14 (6.8%) were Positive Agegroup

% TB Cases Tested with Drug Resistance

% Drug Resistant Foreign-Born & US Born

DOT n The standard of treatment n Where one observes client taking meds n 202 patients on DOT in 1998 n 61 % of cases on DOT in 1998 Percent

% TB Starting Therapy Placed on DOT

% TB Cases with Social Problems that Impact Treatment

Quarantine/Legal Isolation Intervention of last Resort Difficult to Accomplish Limited options for isolation (Corrections) Have other interventions been exhausted?