2013 Annual Report Tuberculosis in Fresno County. Department of Public Health

Transcription

1 2013 Annual Report Tuberculosis in Fresno County Department of Public Health

2 In 2013, provisional data indicates that tuberculosis (TB) affected 3.0 / 100,000 people in the United States (U.S.), 5.7 / 100,000 in California, and 3.97 / 100,000 in Fresno County. In California in 2013, Fresno was ranked 18 th among 61 jurisdictions in TB incidence Case Numbers and Incidence Rates In Fresno County in 2013, 39 cases of TB were reported for an incidence rate of 3.97 per 100,000 population. This is a slight increase (11.43%) from the 2012 incidence rate of 3.69 per 100,000 population (35 cases). Over the last 10 years, however, a significant downward trend has been noted for Fresno County with a decrease of 29.6 % compared to the 5-year average. Of the 39 cases of TB disease in 2013, 23 were male (59%) and 16 were female (41%). See Figure 1: Page 1

3 Disease Sites The site of disease for 36 of the 39 cases was pulmonary (lung). Three (3) of the 39 had disease outside of the lung (extrapulmonary) with one (1) case each in the pleura (lining of the lung), axilla (lymph nodes under the arm), and meninges (lining of the spinal cord). See Figure 2: Page 2

4 Distribution by Race / Ethnicity Of the 39 TB cases in 2013, eighteen (46.15%) were Hispanic / Latino. Ten (10) cases (25.64%) of the 39 were Hmong. For the following categories, these numbers and percentages were noted: Filipino - 2 cases (5.13%); Cambodian 2 cases (5.13%); multiple race 2 cases (5.13%); other 2 cases (5.13%); East Indian 1 case (2.56%); White 1 case (2.56%); Japanese 1 case (2.56%). See Figure 3: Page 3

5 Country of Origin (Birth) Of the 39 cases, 9 (23%) were born in the U.S. and 30 cases (77%) were persons who were foreign-born (not born in the U.S.). Countries of birth and numbers of cases for the 30 foreign-born are: Mexico with 14; Laos with 8; the Philippines with 3; Yemen with 2; Thailand with 1; Cambodia with 1; and Indonesia with 1. See Figure 4: The average time in the U.S. prior to TB diagnosis for foreign-born cases was 20 years with a range from 1 year to 58 years. Page 4

6 Distribution by Contributing Risk Factor(s) Risk for development of TB disease is increased in the presence of certain medical conditions, behaviors, employment, and exposure. These can include: homelessness; illicit injectable and illicit non-injectable drug use; alcohol abuse; HIV-positive status; diabetes; cancer / immunosuppression; employment in a correctional facility or long-term care facility; and exposure to an active TB case. Upon diagnosis of TB disease in Fresno County, HIV testing is offered as a standard of care. In 2013, HIV testing was accepted by all 39 cases (100%). Twenty two (56.4%) of the 39 cases were determined to have increased risk for development of TB disease. Case numbers are listed for the following contributing risk factors determined at the time of diagnosis: homeless with 0 (zero / none); illicit injectable drug use with 0 (zero / none); illicit noninjectable drug use with 3 (three); alcohol abuse with 6 (six); HIV-positive with 1 (one); diabetes with 12 (twelve); cancer / immunosuppression with 1 (one); employment in long-term care facility with 2 (two); employment in correctional facility with 1 (one); and exposure to a TB case with 4 (four). See Figure 5: Page 5

7 Cases by Age The mean age of TB cases reported was 54 years with a range of less than 1(one) year of age to 90 years of age. Two cases of TB were reported in children under the age of 5 years. For the remaining age group categories, cases were reported in the following age ranges: 5 14 years with 3 (three); years with 4 (four); years with 1 (one); years with 4 (four); years with 1 (one); years with 10 (ten); years with 8 (eight); and 75+ years with 6 (six). Twenty seven (69%) of the 39 cases were over the age of 50 years. See Figure 6: Page 6

8 Case Referral by Source Cases were referred to the Fresno County Department of Public Health from various sources. Thirty four (87.18%) of the 39 cases were referred from hospitals; 2 cases (5.13%) were interjurisdictional notifications; 2 cases (5.13%) were self-referrals; and 1 case (2.56%) was identified as a result of a contact investigation conducted by the Fresno County Department of Public Health (FCDPH) for another TB case. See Figure 7: All 39 cases (100%) received treatment from FCDPH. Page 7

9 TB Drug Resistance Of the 39 cases, samples obtained from 35 were cultured for resistance to drugs used to treat TB disease and 4 were not. Thirty one cases (31) showed no resistance to drugs used to treat TB disease. Seven (7) cases (17.9%) were culture-negative. Of the 32 culture positive cases, none were identified as Extensively Drug Resistant Tuberculosis (XDR TB) and one (1) case was identified as Multi Drug Resistant Tuberculosis (MDR TB). See Figure 8: Page 8

10 Cases by Zip Code See Figure 9: Figure 9 -- TB disease by zip code in Fresno County Page 9

11 Cases by Occupation Cases were identified in various occupational environments and work status. Of the 39 cases, 17 (43.6%) were not seeking employment; 8 (20.5%) were migrant / seasonal workers; 7 (17.9%) were retired; 6 (15.4%) self-identified as other occupation ; and 1 (2.6%) worked in a correctional facility. See Figure 10: Tuberculosis Burden in Fresno County In 2013, the FCDPH TB Control Program provided treatment, contact investigation, and follow-up for the 39 County residents newly diagnosed with active TB. Staff continued to provide care for patients who were diagnosed prior to 2013 but had not yet completed treatment (standard treatment regimens are 6-12 months; drug resistant TB patients may be treated for two years and all require at least monthly visits). Additionally, 360 new patients were evaluated and determined to have inactive TB disease, a disease other than TB, or were still in the process of final diagnosis at the end of FCDPH staff visit pulmonary TB patients daily to observe them taking the TB medication to ensure that the medication is taken correctly. Approximately 5,600 such Directly Observed Therapy visits were provided in Fresno County residents at high risk of developing TB include those with close contact to active TB patients and the homeless. Approximately 325 close contacts were evaluated for latent TB infection and approximately 820 TB screenings were completed in the homeless population. The FCDPH TB Control Program also conducted three large contact investigations involving a school, a health care facility, and a jail. In FY 12-13, Fresno County on average expended $928 per TB client for treatment, contact investigation, or screening. Page 10