Substance Abuse and Tuberculosis Oklahoma City, Oklahoma November 17, 2010

Transcription

1 Substance Abuse and Tuberculosis Oklahoma City, Oklahoma November 17, 2010 Epidemiology of Substance Abuse and Tuberculosis: Where is the Problem? Mary Long, MPSH; Heartland Phillip Lindsey, MD; OK State HD Diane Wermy; OK City County HD November 17, 2010 Epidemiology of TB Mary Long, MSPH Heartland National TB Center November 17, 2010

2 Objectives 1. TB Epidemiology in the World 2. TB Epidemiology in the U.S. 3. TB Epidemiology in the Heartland Region Estimated TB Incidence by Country, 2009 Global Tuberculosis Control 2010 Report, WHO

3 Global Epidemiology of TB High burden areas: Asia 55% Africa 30% Eastern Mediterranean Region 7% European Region 4% Region of Americas 3% Global Epidemiology of TB Countries with the largest number of incident cases: India ( million) China ( million) South Africa ( million) Nigeria ( million) Indonesia ( million) India alone accounts for an estimated one fifth (21%) of all TB cases worldwide China and India combined account for 35%

4 Global Epidemiology of TB Top 10 Countries with the highest NEW TB CASES per 100,000: Worldwide 137 Swaziland 1,257 South Africa 971 Zimbabwe 742 Namibia 727 Botswana 694 Sierra Leone 644 Lesotho 634 Djibouti 620 Gabon 501 Timor Leste 498 Togo 446 All in Africa! #56 India 168/100,00 #78 China 96/100,000 #15 Myanmar (Burma): 404/100,100 Global Epidemiology of TB There were 9.4 million new TB cases (including 3.3 million women), including 1.1 million cases among people with HIV 1.7 million people died from TB (including women), including people with HIV, equal to 4700 deaths a day TB is among the three greatest causes of death among women aged 15-44

5 Global Epidemiology of TB The TB death rate has fallen by 35% since 1990, and the number of deaths is also declining The estimated global incidence rate fell to 137 cases per population in 2009, after peaking in 2004 at 142 cases per Global Epidemiology of TB There were an estimated new MDR-TB cases in 2008 and deaths from MDR-TB It was estimated that in 2009, 3.3% of all new TB cases had MDR-TB In 2010, the largest WHO MDR-TB survey reported the highest rates ever of MDR-TB, with peaks of up to 28% of new TB cases in some settings of the former Soviet Union

6 Tuberculosis in the United States National Tuberculosis Surveillance System Highlights from 2009 Division of Tuberculosis Elimination Centers for Disease Control and Prevention Reported TB Cases* United States, No. of Cases *Updated as of July 1, Year

7 TB Morbidity United States, Year No. Rate* , , , , , , , *Cases per 100,000, updated as of July 1, TB Case Rates,* United States, 2009 D.C. *Cases per 100,000. < 3.5 (year 2000 target) > 3.8 (national average)

8 TB Case Rates* by Age Group United States, Cases per 100,000 *Updated as of July 1, Age Group (years) Reported TB Cases by Age Group, United States, 2009 >65 yrs (20%) <15 yrs (6%) yrs (11%) yrs (30%) yrs (34%)

9 TB Case Rates by Age Group and Sex, United States, 2009 Cases per 100,000 TB Case Rates by Race/Ethnicity* United States, ** Cases per 100,000 Asian/Pacific Islander Black or African-American Hispanic American Indian/Alaska Native White *All races are non-hispanic. In 2003, Asian/Pacific Islander category includes persons who reported race as Asian only and/or Native Hawaiian or Other Pacific Islander only. **Updated as of July 1, 2010.

10 Reported TB Cases by Race/Ethnicity* United States, 2009 Native Hawaiian or Other Pacific Islander (1%) White (16%) Asian (28%) Hispanic or Latino (29%) American Indian or Alaska Native (1%) Black or African-American (25%) *All races are non-hispanic. Persons reporting two or more races accounted for less than 1% of all cases. Number of TB Cases in U.S.-born vs. Foreign-born Persons United States, * No. of Cases *Updated as of July 1, 2010.

11 Trends in TB Cases in Foreign-born Persons, United States, * No. of Cases Percentage *Updated as of July 1, Reported TB Cases by Origin and Race/Ethnicity,* United States, 2009 Native Hawaiian/ Other Pacific Islander (<1%) Hispanic or Latino (19%) White (32%) U.S.-born American Indian or Alaska Native (2%) Hispanic or Latino (36%) Black or African American (42%) Foreign-born** White (5%) Asian (44%) Asian (3%) Black or African American (14%) *All races are non-hispanic. Persons reporting two or more races accounted for less than 1% of all cases. **American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander accounted for less than 1% of foreign-born cases and are not shown.

12 Percentage of TB Cases Among Foreign-born Persons, United States* DC DC *Updated as of July 1, >50% 25% 49% <25% Countries of Birth of Foreign-born Persons Reported with TB United States, 2009 Other Countries (38%) Mexico (23%) Philippines (12%) Haiti (3%) Guatemala (3%) China (5%) Vietnam (8%) India (8%)

13 Primary Anti-TB Drug Resistance United States, * % Resistant *Updated as of July 1, Note: Based on initial isolates from persons with no prior history of TB. Multidrug resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin. No. of Cases Primary MDR TB United States, * Percentage *Updated as of July 1, Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

14 Primary Isoniazid Resistance in U.S.-born vs. Foreign-born Persons United States, * % Resistant *Updated as of July 1, Note: Based on initial isolates from persons with no prior history of TB. Primary MDR TB in U.S.-born vs. Foreign-born Persons, United States, * % Resistant *Updated as of July 1, Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

15 XDR TB Case Count defined on Initial DST by Year, * Case Count Year of Diagnosis Drug susceptibility test. *Reported incident cases as of July 1, Extensively drug-resistant TB (XDR TB) is defined as resistance to isoniazid and rifampin, plus resistance to any fluoroquinolone and at least one of three injectable second-line anti-tb drugs. Reporting of HIV Test Results in Persons with TB by Age Group United States, * % with Test Results *Updated as of July 1, Note: Includes TB patients with positive, negative, or indeterminate HIV test results. Persons from California reported with AIDS only through (HIV test results are not reported from California)

16 Estimated HIV Coinfection in Persons Reported with TB, United States, * % Coinfection *Updated as of July 1, Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group. Completion of TB Therapy United States, * Percentage ** *Updated as of July 1, **Healthy People 2010 target: 90% completed in 1 yr or less. Note: Excludes persons with initial isolate rifampin resistant, or patient with meningeal disease, or pediatric patient (aged <15) with miliary disease or positive blood culture.

17 Cases Case Rates Rank by Rate Population Estimates Reporting Area July 1, 2009 United States 11,545 12, ,006,550 Arizona ,595,778 Illinois ,910,409 Iowa ,007,856 Kansas ,818,747 Minnesota ,266,214 Missouri ,987,580 Nebraska ,796,619 New Mexico ,009,671 North Dakota ,844 Oklahoma ,687,050 South Dakota ,383 Texas 1,501 1, ,782,302 Wisconsin ,654,774

18 Cases with Known Homeless Status Cases Reported Being Homeless Reporting Area Total Cases No. (%) No. (%) United States 10,893 10,729 (98.5) 567 (5.3) Arizona (89.8) 8 (4.1) Illinois (97.8) 25 (6.4) Iowa (100.0) 0 (0.0) Kansas (98.3) 6 (10.3) Minnesota (100.0) 4 (2.8) Missouri (93.2) 3 (4.3) Nebraska (100.0) 1 (3.4) New Mexico (100.0) 2 (4.2) North Dakota 5 5 (100.0) 0 (0.0) Oklahoma (91.8) 6 (7.7) South Dakota (100.0) 1 (5.6) Texas 1,395 1,395 (100.0) 39 (2.8) Wisconsin (98.5) 5 (7.7) Total Cases with IVDU Info Cases Reporting IVDU Reporting Area Cases No. (%) No. (%) United States 10,893 10,590 (97.2) 152 (1.4) Arizona (86.6) 3 (1.6) Illinois (94.5) 7 (1.8) Iowa (100.0) 1 (2.5) Kansas (94.9) 0 (0.0) Minnesota (100.0) 0 (0.0) Missouri (98.6) 0 (0.0) Nebraska (93.1) 0 (0.0) New Mexico (97.9) 2 (4.3) North Dakota 5 5 (100.0) 0 (0.0) Oklahoma (87.1) 4 (5.4) South Dakota (100.0) 0 (0.0) Texas 1,395 1,391 (99.7) 32 (2.3) Wisconsin (100.0) 1 (1.5)

19 Total Cases w/ Info Non IVDU Cases Reporting Non IDVU Reporting Area Cases No. (%) No. (%) United States 10,893 10,571 (97.0) 828 (7.8) Arizona (86.6) 17 (9.1) Illinois (94.0) 37 (9.8) Iowa (100.0) 1 (2.5) Kansas (98.3) 5 (8.6) Minnesota (100.0) 6 (4.2) Missouri (94.6) 3 (4.3) Nebraska (93.1) 0 (0.0) New Mexico (100.0) 4 (8.3) North Dakota 5 5 (100.0) 0 (0.0) Oklahoma (87.1) 10 (13.5) South Dakota (100.0) 0 (0.0) Texas 1,395 1,386 (99.4) 107 (7.7) Wisconsin (100.0) 3 (4.5) Cases w/ info Excess Alcohol Use Cases Reporting Excess Alcohol Use Reporting Area Total Cases No. (%) No. (%) United States 10,893 10,609 (97.4) 1,382 (13.0) Arizona (86.1) 16 (8.6) Illinois (94.3) 55 (14.5) Iowa (100.0) 5 (12.5) Kansas (98.3) 9 (15.5) Minnesota (100.0) 7 (4.9) Missouri (100.0) 2 (2.7) Nebraska (93.1) 1 (3.7) New Mexico (97.9) 5 (10.6) North Dakota 5 5 (100.0) 0 (0.0) Oklahoma (89.4) 14 (18.4) South Dakota (100.0) 5 (27.8) Texas 1,395 1,392 (99.8) 263 (18.9) Wisconsin (98.5) 9 (13.8)

20 Cases w/ info HIV Status Cases w/ HIV+ Results Reporting Area Total Cases No. (%) No. (%) United States 3,893 2,754 (70.7) Arizona (91.5) 13 (17.3) Illinois (91.0) 11 (8.3) Iowa (94.4) 1 (5.9) Kansas (100.0) 0 (0.0) Minnesota (92.6) 5 (7.9) Missouri (82.1) 3 (13.0) Nebraska 10 7 (70.0) New Mexico (100.0) 0 (0.0) North Dakota 3 3 (100.0) 0 (0.0) Oklahoma (82.6) 2 (10.5) South Dakota 6 6 (100.0) 0 (0.0) Texas (77.0) 74 (17.5) Wisconsin (91.3) 3 (14.3) Epidemiology of Tuberculosis in Oklahoma Substance Abuse and Tuberculosis November 17, 2010 Phillip H. Lindsey, M.D Medical Consultant/Associate Tuberculosis Control Officer Oklahoma State Department of Health

21 State Rate:

22 Tuberculosis Rates Oklahoma and U.S., Reported Tuberculosis Cases Oklahoma, to date: 78

23 Active TB Case Count, OK Number of Cases Year y = x R 2 = TB Morbidity and Mortality Oklahoma, Estimated 152,000 people in Oklahoma currently infected with MTB 102 new cases of active TB in 2009 (up from 100 in 2008) Thirty-two two (32) cases of active TB with prolonged health provider-based diagnostic delay,, Jan June 2010 (1 every 39 days) Eight deaths directly due to TB, Jan June Six following health provider-based diagnostic delay,, two following prolonged patient-based delay Ten additional deaths with TB as a contributing or co- morbid factor ( ) 2009) Am J Resp Crit Care Med 2008; 177 OSDH TB Division data

24 Tuberculosis Cases and Deaths Oklahoma, OK TB deaths in OK TB deaths in ,707 US TB deaths in 1953 Tuberculosis Cases by Origin of Birth Oklahoma,

25 Rates of Tuberculosis by Race/Ethnicity Oklahoma, RACE** American Indian/Alaska Native Asian Black Native Hawaiian/ Pacific Islander White Muliple Races ***Hispanic *Rate is 100,000 per population **Race and Age calculations using census data ***Persons of Hispanic ethnicity may be represented in other races. INH mono resistance and MDR Oklahoma,

26 Tuberculosis Cases and HIV Co Infection Oklahoma, TB/AIDS Co-Diseased Oklahoma, Number of Cases Year OSDH/TB Division

27 Tuberculosis Cases by Housing Status Oklahoma, Tuberculosis Cases (12+ y/o) Oklahoma 1/1/09-10/31/10 (N=156) Current smokers 64 (41%) Current smokers, 12+ Oklahoma (24.5%) * Current/recent alcohol abuse 48 (31%) Past year alcohol dependence or abuse 12+ Oklahoma (7%)** *Behavioral Risk Factor Surveillance System (BRFSS) 2009 **National Surveys on Drug Use and Health NSDUH

28 Tuberculosis Cases (12+ y/o) Oklahoma 1/1/09-10/31/10 (N=156) Intravenous drug use 13 (8%) Non- IV illicit drug abuse 15 (10%) Past year illicit drug dependence or abuse 12+ Oklahoma (2.66%)* *National Surveys on Drug Use and Health NSDUH

29 Prescription Drugs Fatal poisonings involving opioid analgesics in in US 2006: Oklahoma ranked 4 th in the nation* In 2007, Oklahoma was 232% above the national average in consumption of prescription painkillers* In , 2008, 6.9% of all Oklahomans 12+ y/o used prescription opioid analgesics for non-medical purposes. This ranks #1 among all states** *CDC,National Center for Health Statistics **NSDUH Prescription Drugs CDC, National Center for Health Statistics. Multiple Causes of Death,

30 Contact Info/Helpful Websites Oklahoma State Department of Health TB Division (on-call 24/7) Oklahoma County TB Control Center Tulsa City-County County TB Program OSDH Tuberculosis Laboratory Oklahoma State Department of Health Website - CDC Division of TB Elimination - Heartland National TB Center- San Antonio, TX - Questions?

31 Substance Abuse Issues in Oklahoma City/County Diane Wermy BA, BS Disease Investigator OCCHD Signs of Meth

32 The Face of Meth ** Maintain current photo for patient s chart ** What We See in Oklahoma City/County ETOH Marijuana Cocaine Huffers American Indians Meth few seen in clinic

33 Working With Cases With Substance Abuse Issues Patients may not use/abuse but are some how involved in the drug culture Children Other relatives Legal system ( I( I just sell it but don t t use it ) Some don t t believe they have a a problem so the actual total may be higher Working With Cases With Substance Abuse Issues May find them under bridges, camped by the road Live in their own time; will call when they want Moody, angry, depressed Contact Investigation can be difficult

34 Oklahoma Cases With Abuse Issues # of TB Cases Inj ecti ng Dr ug Use Non Inj ecting Dr ug Use Excess Alcohol Use Year OKC/County Case Stats Abusers Total Cases

35 Patterns Most cases with substance abuse issues are American born ETOH is drug of choice Foreign born cases are not abusers Most cases also tobacco smokers Majority are male Couch homeless DOC or jail visit Unnecessary End death deaths death death death death so far