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

2. 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

3. Determining Infectiousness Smear Results CXR Findings Symptoms Smear Results CXR Findings Symptoms

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

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

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

7. 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

8. TB Case Rates US &Virginia 1987-1998

9. Epidemiology of Tuberculosis Virginia-1998 339 Cases of TB in 1998 5.2/100,000 4943 people starting INH in 1997 77,000 skin-tests given 4,212 contacts identified

10. Case rates for selected groups In Virginia(1996) Homeless- 411.3 /100,000 Vietnamese- 159.5 /100,000 Guatamalan- 108.3 /100,000 Korean- 63 /100,000 Philipines-59.9 /100,000 Foreign born- 49.7 /100,000 Nursing & Adult Homes- 39.7 /100,000

11. Case Rates for selected groups Chinese- 37.7 /100,000 Corrections- 8.9 /100,000 Hispanic- 26.8 /100,000 >65 years - 17.3 /100,000 U.S. born minorities- 8.1 /100,000 U.S. born whites- 2.1 /100,000

12. 1996

13. Percent of Total TB by Race Virginia -1992-1998

14. US & Foreign-Born TB Cases Virginia 1992-1998

15. % of Total TB By Age Group Virginia 1992-1998

16. % Foreign-Born By Age Group Virginia 1992-1998

17. % US Whites By Age Group Virginia 1992-1998

18. % US Blacks By Age Group Virginia 1992-1998

19. % Foreign-Born By Race Virginia 1992-1998

20. Foreign-Born TB Cases Arrival to Onset of Disease 1995 - 1997 Less than 1 year36.1% From 1 to 2 years11.1% From 3 to 5 years15.3% Over 5 years31.5% Unknown6.0%

21. Tuberculosis by Agegroup and Foreign-born 1998

22. TB/HIV-1998 339 TB Cases 234 were offered HIV testing 206(88%) were tested 14 (6.8%) were Positive Agegroup

23. % TB Cases Tested with Drug Resistance 1993-1998

24. % Drug Resistant Foreign-Born & US Born 1993-1998

25. 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

26. % TB Starting Therapy Placed on DOT 1993-1997

27. % TB Cases with Social Problems that Impact Treatment 1993-1998

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