TUBERCULOSIS IN VIRGINIA Wendy Heirendt, MPA Division of Tuberculosis Control Virginia Department of Health September 10, 2001

Number of Reported Tuberculosis Cases Virginia, 1910-2000 This depiction kinda resembles the topography of Virginia. The mountains are in the west and then flatten out the closer you get to the ocean.

Number of Reported TB Cases Virginia, 1995-2000

Percent of TB Cases By Age Virginia, 1995-2000 Chart 6

Percent of TB Cases By Race Virginia, 1995-2000

Percent of TB Cases By Sex Virginia, 2000 Chart 3

TB Cases By Disease Site Virginia, 1995-2000

TB Cases Diagnosed at Time of Death Virginia, 1995-2000

Percent of Foreign-born vs. US Born TB Cases Virginia, 1995-2000

Percent TB Cases with Drug Resistance* Virginia, 1994-2000 *Culture confirmed cases with drug susceptibility tests performed

Number of TB Cases* with Drug Resistance Virginia, 1994-2000 *Culture confirmed cases with drug susceptibility tests performed

Percent of Drug Resistance Among Foreign-Born & US Born Virginia, 1993-2000

Number of Reported TB/AIDS Cases Virginia, 1995-2000

Percent of TB Cases on DOT vs. Self-administered Virginia, 1995-2000

Completion of Therapy Rates Virginia, 1994-1999

VA Code 18.2-322 Anti-Spitting Law of 1906 No person shall spit, expectorate, or deposit any sputum, saliva, mucus, or any form of saliva or sputum upon the floor, stairways, or upon any part of any public building or place where the public assemble, or upon the floor of any part of any public conveyance, or upon any sidewalk abutting on any public street, alley, or lane of any town or city.

Evaluation Criteria Completion of Therapy (COT) COT in Pulmonary cases with DOT COT for LTBI by contacts Contributing or Complicating Factors Completion of treatment for cases Weight Factor: 30% Proportion of reported tuberculosis cases that complete an adequate and appropriate drug regimen within 365 days. Completion of treatment using DOT Weight Factor: 20% Proportion of pulmonary cases that receive Directly Observed Treatment (DOT) and complete therapy within 365 days. Completion of treatment for LTBI by contacts Weight Factor: 30%Proportion of contacts to known cases who complete an adequate and appropriate course of treatment for latent TB infection within 365 days. This measure does not include reactors or converters identified through other screening activities. Contributing factors Weight Factor: 20% Proportion of cases with at least one documented factor that may make the investigation more difficult or of greater public health significance. The five factors are homelessness (currently without a home or was homeless within the 12 months prior to diagnosis), HIV co-infection (as evidenced by medical documentation), drug abuse (injecting or non-injecting illicit drugs), MDR-TB (defined as resistance to INH and rifampin), and foreign birth (with arrival to the US within the last five years).

Regional Breakdown of TB Cases Virginia, 1990 and 2000

Spittoon Score by Region 2001 State North NW SW Cent East Regional Average 76 73 65 74 70 80 Winner's 100 64.9 90 83.7 86.5 North= Loudoun 100 NW= Cent Shen 64.9 SW= Roanoke 90 Cent= Henrico 83.7 East= Norfolk 86.5

COT Index by Region Virginia, 1999

Pulmonary Cases who Complete Rx with DOT Virginia, 1999

Completion of Therapy by Contacts Virginia, 1999

Proportion of Cases with Complicating Factors

The Travelling Spittoon