WMLN October 2013 Wisconsin Department of Health Services WMLN October, 2013 Lorna Will RN, MA Wisconsin Division of Public Health TB Update Current Statistics What’s new in the program

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 2

WMLN October 2013 Wisconsin Department of Health Services Tuberculosis Disease Wisconsin

WMLN October 2013 Wisconsin Department of Health Services TB Rates/100,000 (using 2012 data) Wisconsin as a whole: 1.2 Milwaukee County: 40 cases/955,205 = 4.2 City of Milwaukee: 25 cases/597,867 = 4.2 Dane County: 13 cases/503,523 = 2.6 4

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 5

WMLN October 2013 Wisconsin Department of Health Services WI TB Cases by Race N=71

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 7

WMLN October 2013 Wisconsin Department of Health Services Estimated TB Case Rates by Race Wisconsin 2012 White: 1.2 Black: 3.8 Asian:

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 9

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 10

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 11

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 12

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 13

WMLN October 2013 Wisconsin Department of Health Services Reported Tuberculosis Cases by National Origin 14 Wisconsin, Number of Cases Year

WMLN October 2013 Wisconsin Department of Health Services CDC National Data 15

WMLN October 2013 Wisconsin Department of Health Services Drug-Resistance in WI 20 MDR-TB Cases ( ) All in foreign-born persons coming from: o Laos (60%) Hmong population o India (20%) o Nepal, China, Burma, Ethiopia (5% each) Average age is 46 years o Hmong average age is 52 years o India average age is 25 years o All others average age is 17 years 16

WMLN October 2013 Wisconsin Department of Health Services Summary TB is still a disease of minorities TB is largely a disease of foreign-born 17

WMLN October 2013 Wisconsin Department of Health Services What’s Next or New? New drug for MDR TB o Bedaquilin released for general use in April 2013 Good interim data on 12 week treatment for TB infection o Thousands of patients have used it across the US o CDC collecting data in post-marketing study o At least 200 have used it in WI; data being collected 18

WMLN October 2013 Wisconsin Department of Health Services What’s Next or New? Trials ongoing for TB vaccines Continued shortages of tuberculin solution, TB medications o Data collection site soon at tbcontrollers.org o Information on price increases and shortages are shared with FDA and DOJ 19

WMLN October 2013 Wisconsin Department of Health Services 20

WMLN October 2013 Wisconsin Department of Health Services WI TB Program Initiatives New TB Program Manager Jo Mercurio: medication orders and bills, dispensary payments New initiative on Hmong health and TB: led by Pa Vang and Sheboygan County o Issue of antibiotics for purchase at Hmong markets o Issue of clinician awareness of patient risk factors 21

WMLN October 2013 Wisconsin Department of Health Services Patient A: Timeline Aug: Started to cough Oct 23: Diagnosed with pneumonia Dec 4: Diagnosed with pneumonia Dec 20: Treated for reflux Apr 3: Went to clinic for depression, provider ordered CXR, cavitary lesions Feb 22: Diagnosed with asthma Jan 4: CXR interpreted as no active disease April 16: Diagnosed with TB

WMLN October 2013 Wisconsin Department of Health Services WI TB Program Initiatives o “TB Toolkit” under development; materials for local health departments to share with clinicians; to be rolled out November 2013 MDR TB review led by Philip Wegner o Full epidemiology of each case since 2005 Testing at Milwaukee County Jail o Just began Testing of other high risk populations o Farm workers 23

WMLN October 2013 Wisconsin Department of Health Services WI TB Program Initiatives Continue emphasis on risk-based testing o Work with DQA to ensure that facilities are not censored for doing risk-based testing Education plans: TB Summits across the state o NE Region: November 12, 2013 o Southern Region: April, 2014 o SE Region: week of March 24, 2014 o Still to be scheduled: Northern and Western regions 24

WMLN October 2013 Wisconsin Department of Health Services WI TB Program Initiatives Medication coverage changes o Using 340b federal program to cut costs o Will start paying for B6 and multivitamin with at least RDA for Vitamin D New prescription forms o Separate forms for TB infection and TB disease o Easier to read, includes risk factors for infection and disease progression 25

WMLN October 2013 Wisconsin Department of Health Services WI TB Program Initiatives Collaboration with Preparedness Program on regional readiness for outbreak of infectious respiratory illness Just beginning… 26

WMLN October 2013 Wisconsin Department of Health Services Questions? 27

WMLN October 2013 Wisconsin Department of Health Services Contact Information Wisconsin TB Program staff Lorna Will RN, MA, Program Director Philip Wegner RN, MPH, Nurse Consultant Pa Vang RN, MPH, Nurse Consultant Savitri Tsering, Refugee Health Coordinator Norma Denbrook, Interjurisdictional Coordinator Jo Mercurio, TB Program Manager