Substance Abuse and Tuberculosis Springfield, IL April 27, 2011

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1 5/6/2011 Substance Abuse and Tuberculosis Springfield, IL April 27, 2011 Epidemiology of Substance Abuse and Tuberculosis: Where is the Problem? Debra Stephens, RN, BSN, MPH April 27, 2011 Debra Stephens, RN, BSN, MPH has the following disclosures to make: No conflict of interest. No relevant financial relationships with any commercial companies pertaining to this educational activity. 1

2 5/6/2011 Debra Stephens MPH, BSN, RN April 27, 2011 Correctional Facilities 30 June 2009 Correctional Centers.28 Reception and Classification Centers..4 Medium Security Units 2 Minimum Security Units 4 Work Camps.7 Impact Incarceration Programs.2 Adult Transition Centers.8 Source: State of Illinois, Department of Corrections, Annual Report FY 09 2

3 5/6/2011 Prison Population on June 30, 2009 End-of-fiscal year population 45,545 FY09 Average Daily Population 45,551 Offense Category Controlled Substance Act 8,795 which is 19.3% of inmates Cannabis Control Act 633 which is 1.4% of inmates DUI 1,221 which is 2.7% of inmates 3

4 5/6/2011 Specialized Treatment Centers Intensive Substance Abuse Centers for Treatment Sheridan Correctional Center Medium-security prison, adult males Dedicated to substance abuse, largest in nation at full capacity Collaborates with other organizations Southwestern Illinois Correctional Center First-of-its-kind national model, Meth Prison and Reentry Program with focus on meth specific addiction Collaborates with partners and community-based providers Parole Population on June 30, 2009 Total Parolee Population 31,539 Parole Field Operations Consists of 5 Districts Eighteen offices throughout the state 4

5 5/6/2011 Offense Category Controlled Substance Act 10,333 which is 32.8% of parolees Cannabis Control Act 672 which is 2.1% of parolees DUI 1,379 which is 4.4% of parolees Tuberculosis (TB) and Latent TB Infection Cases for FY 2009 July 1, 2008 Jan 1, 2009 Two rule-out TB situations with one TB case 73 TST positive 385 previous positive January 1, 2009 June 30, 2009 One rule-out TB, zero cases 100 TST positive 344 previous positive 5

6 5/6/2011 QUESTIONS 6

7 Epidemiology of TB: Around the World to Illinois Mary Long, MSPH Heartland National TB Center April 27, 2011 Mary Long, MSPH has the following disclosures to make: No conflict of interest. No relevant financial relationships with any commercial companies pertaining to this educational activity. 1

8 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, WHO 2

9 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% 3

10 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

11 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 5

12 Tuberculosis in the United States National Tuberculosis Surveillance System Preliminary Data from 2010 Division of Tuberculosis Elimination Centers for Disease Control and Prevention Trends in TB United States % decrease in cases from 2009 National case rate of 3.6 cases per 100,00 From the MMWR; Volume 60, Number 11; March 25, 2011; Page 335 6

13 Trends in TB United States 2010 From the MMWR, No. 60, March 25, 2011; Page 335 Trends in TB United States 2010 U.S. Born Persons: 4378 cases 39.5% of total cases 1.6 cases per 100, % decrease from 2009 Blacks have a TB-rate 7 times greater than US-born whites 7

14 Trends in TB United States 2010 Foreign- born Persons: 6707 cases 60.5% of total cases 18.1 cases per 100, % decrease from 2009 Trends in TB United States 2010 Hispanic: 3246 cases highest among ethnic groups 6.5 cases per 100, % decrease from

15 Trends in TB United States 2010 Asians: 3202 cases 23.4 cases per 100,000 highest among ethnic groups 3.9% decrease from 2009 Trends in TB United States 2010 HIV: 8.6% TB cases co-infected with HIV 9

16 % Resistant MDR TB Trends MDT TB cases reported in % of all reported TB cases New cases of TB only 1.0% have MDR TB Persons with prior history of TB 5.0% have MDR TB 89.4% MDR TB cases in foreign-born person 10 Primary Anti-TB Drug Resistance United States, * *Updated as of July 1, Isoniazid MDR TB 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. 10

17 Percentage No. of Cases Primary MDR TB United States, * Percentage *Updated as of July 1, No. of Cases Percentage Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin Completion of TB Therapy United States, * ** Completed *Updated as of July 1, Completed in 1 yr or less **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. 11

18 Heartland Region TB Information State by state breakdown only available for surveillance data not available from the CDC yet 12

19 2009 TB Heartland Region Texas # cases, 6.1 case rate National case rate 3.8 Illinois #2 418 cases, 3.2 case rate Arizona #3 232 cases, 3.5 case rate Foreign Born TB Minnesota #1-129 cases, 80.1% National average 59.4% Nebraska #2 28 cases, 87.5% Illinois 62.4% TB cases in foreign born 13

20 TB in the Homeless Kansas #1 10.3% in the homeless National average 5.3% Oklahoma and Wisconsin #2 7.7% Illinois 6.4% TB cases in homeless IV Drug Use and TB Oklahoma #1 5.4% TB cases reporting IVDU National average 1.4% New Mexico #2 4.3% Illinois 1.8% 14

21 NON-IV Drug Use and TB Oklahoma #1 13.5% TB cases reporting NON-IVDU National average 7.8% Illinois #2 9.8% Excess Alcohol Use and TB South Dakota #1 27.8% TB cases reporting excessive alcohol use National average 13.0% Texas #2 18.9% Illinois 14.5% 15

22 Some More Interesting Findings from the Heartland Region Oklahoma has the highest percentage of pediatric TB cases: 9.8% New Mexico has the highest percentage of elderly TB cases: 47.9% 60% of North Dakota TB cases are extrapulmonary (national is 20.6%) 17.1% of Arizona TB cases are in residents of corrections (national is 4.2%) Did you know? 10% of Minnesota TB cases are INH resistant (national is 8.8%) 93.1% of Oklahoma TB cases are handled exclusively by the Health Department (national is 59.1%) 100% of Kansas TB cases are DOTonly (national is 56.2%) 16

23 5/6/2011 Substance Abuse and Tuberculosis Springfield, IL April 27, 2011 Epidemiology of Substance Abuse and Tuberculosis: Where is the Problem? Michael Arbisi, BS (MT), MS April 27, 2011 Michael Arbisi, BS (MT), MS has the following disclosures to make: No conflict of interest. No relevant financial relationships with any commercial companies pertaining to this educational activity. 1

24 5/6/2011 April 27, 2011 % Change from Cases 2009 California Texas New York Florida Georgia New Jersey Illinois

25 No. of Cases 5/6/

26 % Change No. of Cases 5/6/2011 4

27 No. of Cases No. of Cases 5/6/ Persons of Hispanic origin may be of any race or multiple race. 5

28 No. of Cases 5/6/ Persons of Hispanic origin may be of any race or multiple race. Percentage Foreign-born vs. U.S.-born Illinois, % 61% 6

29 % Coinfection 5/6/2011 7

30 No. of Cases 5/6/ Resistance based on initial susceptibility testing. *Isolates may be resistant to other drugs, except rifampin. **MDR, or multi-drug resistant, TB is defined as resistance to at least isoniazid and rifampin. 75% DOT = Directly observed therapy; SA = Self-administered therapy 8

31 5/6/2011 Epidemiological Link- Genotypically Linked Clinical Case Suspect Case Pending Genotying Results *Note 1 case counted in July 2010 linked to this outbreak was counted in downstate county Excess Alcohol Non- Injecting Injecting US 13.0% 7.8% 1.4% Illinois 14.5% 9.8% 1.4% Outbreak (n=19) 52.6% 26.3% 10.5% * Cases greater than 14 years old that report substance abuse with 12 months of diagnosis. 9

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