World TB Day Bradley Allen, MD, PhD, Medical Consultant

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Presentation transcript:

World TB Day Bradley Allen, MD, PhD, Medical Consultant ISDH TB Control Program Indiana University School of Medicine Division of Infectious Diseases Roudebush VAMC March 25, 2019

World TB Day Dr. Robert Koch Reported discovery of Mycobacterium tuberculosis on March 24th, 1882 March 25, 2019

World TB Day 2019 Key Messages It is time to recognize achievements in TB prevention and control, and renew our commitment to ending this devastating disease in the United States. Too many people in the U.S. still suffer from TB disease. We must continue to find and treat cases of active TB disease and also test and treat latent TB infection to prevent progression to disease and turn TB elimination into a reality. Clinicians, health care agencies, and community organizations, especially those serving at-risk populations, have a critical role in TB elimination. TB anywhere is TB everywhere. TB is an airborne disease that is transmitted from person to person. To end TB, we must continue to work together to fight this epidemic on multiple fronts, and stop the suffering associated with this disease, here at home – and around the world.

World TB Day Key Messages It is a time to recognize achievements in TB prevention and control, and renew our commitment to ending this devastating disease in the United States. Too many people in the U.S. still suffer from TB disease. We must continue to find and treat cases of active TB disease and also test and treat latent TB infection to prevent progression to disease and turn TB elimination into a reality. Clinicians, health care agencies, and community organizations, especially those serving at-risk populations, have a critical role in TB elimination. TB anywhere is TB everywhere. TB is an airborne disease that is transmitted from person to person. To end TB, we must continue to work together to fight this epidemic on multiple fronts, and stop the suffering associated with this disease, here at home – and around the world. Who’s With Me in this Battle!

Reported Tuberculosis (TB) Cases and Rates United States, 1993-2017 National data Decline in the U.S. *Prelim: 2018 data from CDC, 9029 cases in 2018. Decrease from 9094 cases in 2017. IR = 2.76. Lowest case counts in the U.S. Ever recorded. CDC Reported Tuberculosis in the United States, 2017

Number of Tuberculosis Cases Indiana, 2009-2018 No time for complacency! Stagnant trend within 10 years. 116 cases reported in 2018. 16% increase from 2017. Incidence rate of 1.7 per 100,000 persons in 2018. This is an increase from 1.5 in 2017. Unfortunately, This increase was 2nd highest in the nation behind Ohio (15.5% increase). Rank 32nd in 2017. Below nat’l avg

TB Cases by Site of Disease, Indiana, 2018 Extrapulmonary sites Lymphatic Pleura Meningeal Peritoneal Genitourinary Ocular Anywhere! Pulmonary is most common reported site of disease Proportion of pulmonary cases remain steady from 2017 to 2018, 72% reported in both years. Extrapulmonary cases increased slightly from 14% to 16% in 2018

Number of Pediatric TB Cases by Age Group, Indiana, 2014-2018 Any age! Talk trend Indicative of recent transmission Demographics of children cases

Number of TB Cases by Place of Birth, Indiana, 2014-2018 IR 5 year trend: 18.9 per 100,000 compared to .8 per 100,000 persons in 2018 56.9% of cases occurred in those born outside of U.S.. Only make up 5% of IN total pop. Top 5 Countries: Burma India Mexico Nigeria Malawi From Anywhere!

Percentage of TB Cases with HIV Comorbidity, Indiana, 2009-2018 HIV comorbidity importance (increased risk of progression) Talk trend Proportion of cases with HIV test results known Keep Testing! 6% co-infected

Number of TB Deaths Indiana, 2014-2018 TB still kills, even in Indiana

TB Mortality, Indiana, 2018 Two deaths occurred prior to TB diagnosis U.S. born male, incarcerated, known reactor without treatment, on TNF alpha therapy Cause of death CNS TB with obstructive hydrocephalus TB isolated from sputum, lymph nodes, meninges (CSF) and spleen Mexican born male, drug & alcohol abuse Cause of death was severe hydrocephalus TB found in CSF (meningeal)

TB Mortality, Indiana, 2018 Eight deaths following TB Diagnosis Gender - 5 male, 3 female Origin - 5 U.S. born, 3 born outside the U.S. 2 born in Mexico, one Burma Presentation 5 primary pulmonary 3 pulmonary & extrapulmonary Disseminated disease, found in lungs and rectum Disseminated disease, lungs, small intestine, meninges Disseminated disease, lungs and meninges (CSF)

Percentage of Cases by Site of Disease and Mortality Status, Indiana, 2018 Over-representation of extrapulmonary presentation of disease Sites include Lymph nodes, meningeal, spleen, rectum, small intestine

Percentage of TB Cases by Place of Birth and Mortality Status, Indiana, 2018 Need to raise our suspicion of TB as the cause of disease in high-risk native Hoosiers

What Can We Do About It??? Raise public and provider awareness of TB disease Detection and treatment of Latent TB Infection Early suspicion, testing, and treatment of TB disease Maintain your excellent efforts here in Indiana!

Agenda Line-up Dr. Muloma on TB Control Sang Thao on Indiana TB Updates Rachel Redington-Nobel on International efforts Dr. Tarver – TB Radiology Connie Parish and Anumitha Venatraman – Personal TB survival stories Jessica Gentry – TB Laboratory Update Kelly White – Case presentations and awards!

WHAT TIME IS IT?

WHAT TIME IS IT?

Questions? sthao@isdh.in.gov 317.233.7841 Bradley Allen Medical Consultant, TB Control Program bradalle@iu.edu Sang Thao, MPH TB Epidemiologist sthao@isdh.in.gov 317.233.7841