1. Washington State Department of Health April 14, 2010 Washington State Cohort Review 2009 trends & 1 st quarter

2. Annual TB Case Rates 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 2000200120022003200420052006200720082009 Tuberculosis Incidence Rate, 2000 - 2009 NationalWA State

3. Highlights of 2009 trends 12.3% increase in number of TB cases in 2009: 228 to 256 12.3% increase in number of TB cases in 2009: 228 to 256 TB case rate: increased from 3.5 in 2008 to 3.8 in 2009(per 100,000 individuals) TB case rate: increased from 3.5 in 2008 to 3.8 in 2009(per 100,000 individuals) Also in 2009: Also in 2009: – Started data management in PHIMS – All time low TB case rate reported in WA in 2008

4. 2009 TB Case Rates by County Largest increase: Clark Co. (1.7 to 3.7) Largest increase: Clark Co. (1.7 to 3.7) Largest decrease: Yakima Co. (4.7 to 2.1) Largest decrease: Yakima Co. (4.7 to 2.1) Top 5 case rates: Top 5 case rates: 1. King: 6.8 2.Pierce: 4.2 3.Snohomish: 4.0 4.Clark: 3.7 5.Thurston 3.2

5. 2009 TB Cases by demographics By race/ethnicity: By race/ethnicity: –Largest increase in Asians (18.6 to 24.7) –Largest decrease in AI/AN (6.3 to 4.2) 78% foreign born (continued trend in increase) 78% foreign born (continued trend in increase) Decrease in proportion of pediatric cases Decrease in proportion of pediatric cases Increase in proportion of 45+ y.o. cases Increase in proportion of 45+ y.o. cases

6. Trend in Age (2004 -2009)

7. Trend in Age in Foreign-born cases (2004 – 2009)

8. Trend in Age in US born cases (2004 – 2009)

9. In progress… Further analysis on timeliness! Further analysis on timeliness!

10. Distribution of 2009 cases by Quarter and County QUARTERS Location Location King Co. Outside King Co. 1 st (n=29) 11 18 (62%) 18 (62%) 2 nd (n=60) 37 23 (38%) 23 (38%) 3 rd (n=82) 31 51 (62%) 51 (62%) 4 th (n=85) 51 34 (40%) 34 (40%) TOTAL (n=256) 130 126 (49%)

11. Quarter 1 (Jan – Mar) of 2009 Highlights for Outside King co.

12. CASES: Treatment Hx TOTAL: 18 cases TOTAL: 18 cases No pediatric cases No pediatric cases 100% initiation on tx 100% initiation on tx DOT 83% of all (100% of Sm+ case) DOT 83% of all (100% of Sm+ case) –67% total DOT –17% DOT in combination with self-admn 6% HIV testing not offered: 6% HIV testing not offered: – 1 Sm-Cul+ case

13. CASES: Tx completion 83% likely to complete 83% likely to complete –78% completed –6% currently on 17% moved: 17% moved: –1 Sm-Cul+ case –2 ‘other’ cases 0% lost 0% lost

14. Timeliness (Median number of days) Start of Meds: 1 day Start of Meds: 1 day Lab sputum collection: 0 (same day) Lab sputum collection: 0 (same day) Culture testing: 20.5 days Culture testing: 20.5 days HCP to LHJ: same day HCP to LHJ: same day Lab to LHJ: same day Lab to LHJ: same day LHJ to DOH: 1 day LHJ to DOH: 1 day Susceptibility: 20.5 days Susceptibility: 20.5 days Sm+ date to contact identification: -2.5 Sm+ date to contact identification: -2.5

15. Contacts: Jan – Mar 2009 86 contacts identified for 18 cases 86 contacts identified for 18 cases 87% tested 87% tested 64% evaluated 64% evaluated 17% infected 17% infected 0% diseased 0% diseased

16. Contacts: Tx history 8% (1 of 13) of infected didn’t start tx 8% (1 of 13) of infected didn’t start tx 20 contacts started treatment: 20 contacts started treatment: –60% infected –40% not infected –55% completed tx –5% refused tx –0% lost, died, moved, provider disc.

17. Thank you!