Responding to a TB Event Bismarck, North Dakota June 24-25, 2008

Transcription

1 Responding to a TB Event Bismarck, North Dakota June 24-25, 2008 TB Epidemiology: Global and State Lynelle Phillips, RN, MPH June 24, 2008 TB Epidemiology Global and State Lynelle Phillips RN MPH Nurse Consultant Heartland National TB Center

2 Objectives Describe the current epidemiology of TB Globally United States Heartland Region

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4 HIV and TB Dye, C. Global epidemiology of tuberculosis. Lancet, (9514) p Worldwide risk factors for TB Although HIV infection has clearly had a profound effect on TB spread, other risk factors have been neglected Diabetes Undernutrition Respiratory illnesses Tobacco Air pollution Dye, C. Global epidemiology of tuberculosis. Lancet, (9514) p

5 Worldwide risk factors for TB Completion of treatment DOTS directly observed therapy short course Appropriate regimen most countries do not do cultures and sensitivities Contact investigations and treatment of contacts Usually not done heavy reliance on BCG

6 Distribution of Multi-drug Resistant Tuberculosis 2006 Global Distribution of MDR TB Among New Cases Source: Zignol, Dye et al, JID 2006:194

7 Global Drug-Resistant TB: How Bad Is It? 2004 MDR TB estimates: 424,203 (4.3%) (estimate includes new and previously treated cases) 2000 MDR TB estimates: 272,906 (1.1%) (estimate includes new cases only) Estimated 43% of global MDR TB cases have had prior treatment China, India, and Russian Federation account for 62% of the MDR burden Zignol, Dye et al, JID 2006:194 Prevalence of XDR TB not known Number of MDR and XDR Cases, by Countries Submitting 1 M. tuberculosis Isolate to Participating SRLs, Ind. Nations MDR 821 XDR 53 (6%) Latin America MDR 543 XDR 32 (6%) Africa, Middle East MDR 156 XDR 1 (< 1%) E. Europe MDR 406 XDR 55 (14%) Total MDR= 3520; XDR= 347 (~ 10% of MDR)* * Country unknown, MDR= 102; XDR= 2 (2%) Rep. Korea MDR 1298 XDR 200 (15%) Asia MDR 274 XDR 4 (1%)

8 KZN Drug Resistant TB Survey Results* 1539 isolates tested 544 (35%) Cx+ 995 (65%) Cx Negative M. tuberculosis 221(41%) MDRTB 323 (59%) Susceptible 53 (10%) XDRTB (24% of MDRTB) * Moll A, Gandhi NR, Pawinski R, Lalloo U, Sturm AW, Zeller K, Andrews J, Friedland G. HIV associated Extensively Drug-Resistant TB (XDR-TB) in Rural KwaZulu-Natal (South Africa MRC Expert Consultation Sept 8, 2006)

9 Global Drug-Resistant TB: MDR/XDR TB Fuel Suboptimal TB control practices (e.g., poor DOT, infection control, and treatment without drug susceptibilities or culture) MDR TB is pre-xdr TB: poor use of second-line TB drugs in low and middle income countries HIV amplification of disease and transmission (example: KwaZulu-Natal (KZN) South Africa) Fact in 2005: only ~2% of estimated culture proven MDR TB cases are treated with 2 nd line drugs (Global Plan to Stop TB ) Have germs, will travel Migrating populations in the 1990s Compared to , four-fold increase in migration Source: Population Action International 1994

10 No. of Cases Reported TB Cases* United States, ,000 26,000 24,000 22,000 20,000 18,000 16,000 14,000 12,000 10, Year *Updated as of April 6, TB Case Rates,* United States, 2006 D.C. *Cases per 100,000. < 3.5 (year 2000 target) > 4.6 (national average)

11 Number of TB Cases in U.S.-born vs. Foreign-born Persons United States, * No. of Cases U.S.-born Foreign-born *Updated as of April 6, Percent Foreign Born TB Cases Heartland Region % foreign born AZ IL IA KS MN MO NM ND SD TX WI

12 Genotyping and epidemiology Understand Transmission Patterns Better Identify Lab Cross Contamination Learn About Unsuspected Relationships and Non-Traditional Settings for Transmission Detect and Investigate Outbreaks Sooner Focus and Prioritize Contact Investigations Evaluate Intervention Effectiveness Discern Exogenous Reinfection vs Relapse Purpose Cluster Busters To identify genotype clusters of interest Illinois, Kansas, Missouri Kansas City St. Louis Electronic match state genotyping databases New clusters Growing clusters Location-based clusters

13 Results of search for genotype MO 030 TB Case with corrections history TB case with no corrections history Secondary transmission KS MO OK AR TX Low incident states Medium incident state High incident states Cluster Analysis Results-Wisconsin Epi Links by Person and Place Household Case 11 sex partners Case 3 Case 1 Case 2 Liquor store Worksite SRO hotel In County B in County Case 10 B Restaurant Case 4 Case 7 Case 6 Case 8 Household sex partners Case 9 Source: Tanya Oemig Wisconsin TB Program Household aunt & nephew Case 5

14 Preliminary IL_003 Wichita Grace KC Rescue City Union Restart Jackson Cty Jail Local Jail Wyandotte Cty Jail

15 1998 Cases City Union Jackson Cty Jail Restart Local Jail Wyandotte Cty Jail

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19 Summary Global TB epidemiology TB on the increase expect foreign-born TB to increase in your state MDR XDR TB expected to increase be ready have a plan! Regional/state TB Considering using genotyping data and regional approach to analysis Location-based prevention strategies References Dye, C., Global epidemiology of tuberculosis. Lancet, (9514): p WHO (2008) WHO Report 2008, Global Tuberculosis Control Surveillance Planning Financing. Retrieved May 30, 2008, from WHO_2008_global_TB_report.pdf Zignol, M., et al., Global incidence of multidrug-resistant tuberculosis. Journal of Infectious Diseases, (4): p