Tuberculosis & Refugees in Philadelphia

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1 Tuberculosis & Refugees in Philadelphia Philadelphia TB Control Program Daniel P. Dohony, MPH Philadelphia TB Control Program

2 Health Information Portal Website: hip.phila.gov Contains Information On» Disease Management & Control» Current Disease Surveillance» Disease Reporting: Forms, & Contact Numbers» Health Alert Messages

3 Overview Introduction Transmission and Pathogenesis Epidemiology of TB in the U.S. and PA Diagnosis of TB Treatment of TB Disease Community TB Control

4 Introduction All Immigrants and Refugees have overseas medical exams prior to arrival in the US including TB, STD, Immunizations, etc. TB is the most common medical condition requiring follow-up among newly arriving Refugees and Immigrants , one hundred forty one immigrants (69) and refugees (72) required TB follow-up.

5 Arrivals in Philadelphia, Pennsylvania and the USA Approx.700 refugees/year in Philadelphia Approx refugees/year in PA Approx. 70,000 refugees/year in the US 11/14/2014

6 Introduction Most Foreign-born persons coming to the US do not undergo overseas medical exams Overseas Medical Exams are not required for foreign-born Visitors, Students, Workers, etc. Over 60% of TB Cases in the US and in Philadelphia are among Foreign-born persons

7 Introduction to TB Leading cause of death in early 1900 s TB cases continue to be reported in every state Drug-resistant cases reported in almost every state Estimated million persons in U.S. infected with M. tuberculosis - Without intervention, about 10% will develop TB disease at some point in their lifetime

8 Is TB still a Threat? Worldwide - Yes» TB infects more people than any other infectious disease One-third of the world s population (2 Billion persons) are infected Approximately 8 to 10 Million new TB Cases per year Kills about 2 million per year (more than AIDS, malaria and tropical diseases combined) US and Industrialized Countries -» Under control, however due to global migration TB still enters the U.S.» Drug resistant strains of TB are the new challenge

9 TB Conditions Latent TB Infection (LTBI)» Non-infectious Active TB Disease» Infectious

10 Latent TB Infection (LTBI) TB bacteria in the body but inactive Do not feel sick Not Contagious Potential to develop disease if TB bacteria become active and multiply Is Treatable so progression to TB can be prevented

11 Active TB Disease Active, multiplying TB in the body Patient feels sick and has symptoms such as coughing, fevers, weight loss & fatigue. Capable of spreading disease to others if TB bacteria are active in lungs or throat Is easily cured if diagnosed accurately and early

12 Transmission of M. tuberculosis Spread by droplet nuclei Expelled when person with infectious TB coughs, sneezes, speaks, or sings Close contacts at highest risk of becoming infected Transmission occurs from person with infectious TB disease (not latent TB infection)

13 Droplet Nuclei

14 Pathogenesis of TB

15 Pathogenesis 10% of infected persons develop TB at some point in life» 5% in the first year» 5% later in life Certain medical conditions increase risk that TB infection will progress to TB disease HIV infection strongest risk factor for development of TB if infected» Risk of developing TB disease increases 7% to 10% each year

16 Immune Response Strong Immune System TB TB TB TB TB Weakened Immune System TB TB

17 Common Sites of TB Disease Lungs Pleura Central nervous system Lymphatic system Genitourinary systems Bones and joints Disseminated (miliary TB)

18 Probability TB will be Transmitted Infectiousness of person with TB Environment in which exposure occurred Duration of exposure

19 Cases (Log Scale) 100,000 70,000 Reported TB Cases United States, ,000 * 30,000 * 20,000 10, *Change in case definition Year

20 No. of Cases Reported TB Cases United States, Data 9,951 Cases Rate 3.2/100,000 Data are updated as of 2/22/13 and are provisional Year

21 Cases Philadelphia TB Cases 1947 to Present Years May 2013 Philadelphia Department of Public Health Tuberculosis Control Program City of Philadelphia

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24 Source: PA-NEDSS

25 Epidemiology of TB in the United States Approximately million persons are infected with TB About 9,600 cases in 2013» ~500 Deaths CDC and Local TB Control Programs continue to make great progress. In 2013:» US - 9,600 cases» Pennsylvania cases» Philadelphia - 89 cases

26 Symptoms of Pulmonary TB Productive, prolonged cough (duration of > 3 weeks) Chest pain Hemoptysis (Bloody sputum)

27 Systemic Symptoms of TB Fever Chills Night sweats Appetite loss Weight loss Easy fatigability

28 Basic Principles of Treatment Provide safest, most effective therapy in shortest time Multiple drugs to which the organisms are susceptible Ensure adherence to therapy

29 Preventing and Controlling TB Three priority strategies: Identify and treat all persons with TB disease Identify contacts to persons with infectious TB; evaluate and offer therapy Test high-risk groups for LTBI; offer therapy as appropriate

30 Identify Contacts to Persons with Infectious TB Where» Workplace/School» Home/Residential» Social/Leisure Concentric Circle Approach Priority Contacts» High, Medium and Low

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33 Thank You Any Questions? Call for additional information:» Health Dept. TB Control Program at

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