- contact tracing (source)

Transcription

1 TB Control in New York City: Current status and progress towards elimination Chrispin Kambili, MD Assistant Commissioner of Health Director, Bureau of TB Control, NYC DOHMH Every 2 Seconds someone somewhere in the world dies from TB! World TB Day Conference March 23, What constitutes TB control? Identify prevalent cases Treat the cases to: Reduce morbidity & mortality Reduce transmission i Mitigate impact of newly transmitted TB Address other LTBI What s needed for effective TB control? Set a legal framework Defines roles of government and providers Legal framework in NYC is defined by State s Public Health Law and Sanitary Code, and NYC Health Code Reporting requirements Duties, roles and responsibilities Create an infrastructure of carry out the mandate 3 4 1

2 Specific Strategies Accurate and thorough case detection Diagnosis Surveillance Uninterrupted, t effective and supervised treatment, and patient support Monitoring and evaluation system and impact measurement Adequate public health infrastructure ($) Main elements of TB Control in US Case finding passive active Treatment of cases - clinical presentation - contact tracing (source) & screening (migrants) Chemoprophylaxis (for latent TB) BCG 5 6 Transmission Chemotherapy Doctor's delay Where can we intervene? Prophylactic treatment Preventive therapy Patient's delay Infectious tuberculosis Exposure Subclinical infection Non-infectious tuberculosis Death 7 BCG vaccination After HL Rieder 8 2

3 TB in NYC: Where have we been and where are we going? Number of Cases 4, 3,5 3, 2,5 Tuberculosis Cases and Rates New York City, * Case Rate # Cases 711 Cases in Rate/1, , ,5 1, Year *Rates since 2 are based on population estimates. 9 1 Number of Cases 3,5 3, 2,5 2, 1,5 1, 5 US 1 and Foreign-Born Tuberculosis Cases and Case Rates 2 New York City, US-born Cases Foreign-born Cases US-born Rate Foreign-born Rate Puerto Rico and U.S. Virgin Island are included as US-born. 2. Rates are based on official Census data and intercensal estimates prior to 2. Rates since 2 are based on 2 Census data. Year Rate/1, Top 1 Countries of Birth for NYC TB Foreign-born TB Patients 21 N 29 N China 13 China 11 Ecuador 41 Mexico 43 Dominican Republic 41 Ecuador 42 Mexico 34 Dominican Republic 39 Bangladesh 3 India 32 Philippines 28 Haiti 29 India 26 Philippines 25 Haiti 23 Bangladesh 22 Pakistan 2 Nepal 18 South Korea 17 Guyana & South Korea

4 21 NYC TB cases by country of birth Tuberculosis Cases by Borough New York City, 29 and Number of C Cas es Manhattan (5.4*) No 21 cases born in this country Queens (11.1*) Brooklyn (9.*) Bronx (8.3*) Staten Island (2.6*) * Rate per 1, based on 29 population estimates One or more 21 cases born in this country Top 2 21 country of birth 13 TB cases counted in New York City by UHF neighborhood, 21 Number of TB cases 14 TB rates in New York City by UHF neighborhood, 21 TB case rate Fordham - Bronx Park Fordham - Bronx Park Crotona - Tremont High Bridge - Morrisania Flushing - Clearview West Queens Central Harlem - Morningside Heights Flushing - Clearview 5-96 Fresh Meadows Long Island City - Astoria West Queens Williamsburg - Bushwick Bedford Stuyvesant - Crown Heights Bedford Stuyvesant - Crown Heights Sunset Park Sunset Park Bensonhurst - Bay Ridge Borough Park Borough Park East Flatbush - Flatbush Rates are based on 29 population estimates

5 Top 1 Medical Facilities First Evaluating Patients for TB New York City, 21 Facility Name # of Cases % of all Cases 1. Elmhurst Hospital Center Bellevue Hospital Center Mount Sinai Hospital Kings County New York Hospital Medical Center of Queens Fort Greene Chest Center Beth Israel Medical Center, Maimonides Medical Center Queens Hospital Center Corona Chest Center, Jacobi Medical Center, Woodhull Lutheran Hospital, Washington Heights Chest Center 15 2 Tuberculosis Cases by Site of Disease New York City, 21 BOTH PULMONARY AND EXTRAPULM ONARY DISEASE 75 (11%) ONLY PULMONARY DISEASE 481 (68%) ONLY EXTRAPULMONARY DISEASE 155 (22%) Note: Denominator = All confirmed cases in 21 (n=711) Extrapulmonary Sites among TB Cases New York City, 21 Sites* % of Total Extra-pulmonary Sites Lymphatic 42 Pleural 26 Other 13 Bone/Joint 9 Peritoneal 8 Genitourinary 7 Meningeal 5 *Categories are not mutually exclusive 1,4 1,2 1, Trend in HIV-Infection Infection and TB New York City, Number of Cases % of TB/HIV Infected Cases % TB/HIV+ # TB/HIV Year

6 MDR-TB in NYC, Those who do not learn from history are doomed to repeat it! f cases Number of 1 Actual Cases Projected Cases Years New York City Department of Health and Mental Hygiene Think TB! Bureau of TB Control Tel: 311 or (TB Provider Hotline)