1. 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

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

3. 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.

4. 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!

5. 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 Decrease from 9094 cases in IR = Lowest case counts in the U.S. Ever recorded.
CDC Reported Tuberculosis in the United States, 2017

6. Number of Tuberculosis Cases
Indiana,
No time for complacency!
Stagnant trend within 10 years.
116 cases reported in % increase from 2017.
Incidence rate of 1.7 per 100,000 persons in 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 Below nat’l avg

7. 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

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

9. Number of TB Cases by Place of Birth,
Indiana,
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!

10. 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

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

12. 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)

13. 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)

14. 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

15. 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

16. 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!

17. 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!

18. WHAT TIME IS IT?

19. WHAT TIME IS IT?

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