1. TB in Yorkshire and the Humber Dr Simon Padfield 14 th Sept 2007

2. Why prioritise TB? TB is a preventable, curable, transmissible disease rates are increasing inequality issue low costs of intervention avoidance of outbreaks avoidance of MDR cases

3. Insert Image Comparison UK vs. US 1990-2005 England & Wales - 48% increase USA – 53% decrease

4. Comparison Western Europe,1995-2005 Countries with rate > 9 per 100,000 in 2005

5. Regional trend

6. Trend by PCT Insert Image

7. Migration from high incidence countries

8. Inequalities UK born vs. non UK born Working age population

9. Delay from onset of symptoms to start of treatment Complex reasons for delay – inequality issue Overall median delay 69 days – but should be a rapid access service Potential to infect an estimated further 8 people

10. Treatment outcomes 2001-2003 Generally high levels of completion Need to ensure meeting CMO target – transmission is important to avoid!

11. Outbreaks and incidents

13. Multi Drug Resistance 5 cases of MDR TB in 2006 in Yorkshire and Humber 51 cases in England, Wales and NI

14. TB Pathway Refer to TB Specialist Clinician population symptomatic presentation to GP population or occupational screening symptomatic or high risk Correct diagnostic tests administered and interpreted by experienced professional TB suspecte d PaediatricsGUM presentation to other medical speciality Correct clinical and diagnostic investigations and tests administered and interpreted by experienced professional Samples collected and stored appropriately and delivered quickly Immediate referral to appropriate laboratory with relevant experience and facilities where the latest methods are employed to determine diagnosis, infectivity, resistance and strain Diagnosis TB unlikely. Consider alternative diagnosis TB confirmed. Notfiy. TB likely but unconfirmed. Consider treatment and review at 4 weeks. Baseline tests (weigh), commence treatment, minimum monthly clinic visits: weigh, review clinical condition and drug tolerance, review meds re drug sensitivity testing TB Specialist Community Team establish and maintain contact educate, evaluate, monitor, encourage commence contact tracing Screen close, vulnerable and those with high transmission risk with appropriate test by those experienced in test administration and reading. Give tb information to casual contacts Refer <16 to Paediatrics Screen negative Screen positive results communicated quickly and efficiently Presentation & Screening Contact Tracing Diagnosis Treatment and follow-up Cure maintain communication results communicated quickly and efficiently

15. Next steps TB toolkit workshop Regional taskforce