Epidemiology of Tuberculosis in the Northeast Region of the United States Surveillance Data Source. States included in the Northeast Region
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1 Epidemiology of Tuberculosis in the Northeast Region of the United States Marian R. Passannante, PhD UMDNJ-New Jersey Medical School UMDNJ-School of Public Health Epidemiologist, New Jersey Medical School Global TB Institute Northeast TB Controllers Meeting Annapolis, Maryland September 4, Surveillance Data Source The Online Tuberculosis Information System (OTIS) contains information on verified tuberculosis (TB) cases reported to the Centers for Disease Control and Prevention (CDC) by state health departments, the District of Columbia and Puerto Rico. These data were extracted from the CDC national TB surveillance system. Each year these data are updated with an additional year of cases plus revisions to cases reported in previous years. National Tuberculosis Surveillance System Highlights from 8 States included in the Northeast Region Source: on July, Connecticut Delaware District of Columbia Indiana Maine Maryland Massachusetts Michigan New Hampshire New Jersey New York Ohio Pennsylvania Rhode Island Vermont West Virginia
2 Epidemiology in TB Control Provides information on patterns of disease that can help : Identify groups at risk Prioritize cases Allocate staff and other resources Assess program performance measures Reported TB Cases* United States, 98 8 No. of Cases 8, 6, 4,,, 8, 6, 4,,, *Updated as of May, 9. Year 5 Reported TB Cases Northeast Region Source: Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Jul, 4:35:3 PM
3 Reported TB Cases Other Regions Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 6, :46:3 AM Year Cases in NE Region as a Percentage of all Verified TB Case in the US # Verified Cases NE Region % of all Verified Cases in the US and Puerto Rico Chart 35 % of tot tal cases Year Data source: Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9,. TB Case Rates,* United States, 8 D.C. < 3.5 (year target) > 4. (national average) 9 *Cases per,. 3
4 Incidence (Case) Rates by Region, Chart Incidence Rate per, NE Incidence Rate per, year Other RTMCC Region year Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9.. TB Case Rates by Age Group and Sex, United States, 8, Cases per <5 yrs 5 4 yrs 5 44 yrs yrs >65 yrs Male Female Morbidity Northeast Region, 4-8 hart OptionsNotesCitationQuery Criteria Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9, 5:3:5 PM 4
5 Morbidity Other Regions* Combined, 4-8 Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9, 6:3:33 PM * Data for Puerto Rico not included in these graphs due to OTIS data limitations. TB Case Rates by Age Group and Race/Ethnicity,* United States, 8 Cases s per, < >65 Age Group (yrs) American Indian/Alaska Native Hispanic or Latino Asian Native Hawaiian/Other Pacific Islander Black or African-American White *All races are non-hispanic. Persons reporting two or more races accounted for less than % of all cases. Morbidity Northeast Region, 4-8 Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9, 5:6:48 PM 5
6 Morbidity Other Regions* Combined, 4-8 Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9, 6:8:49 PM * Data for Puerto Rico not included in these graphs due to OTIS datalimitations. No. of Cases, 8, 6, Trends in TB Cases in Foreign-born Persons, United States, 988 8* 4,, Percentage No. of Cases Percentage of Total Cases *Updated as of May, 9. Percentage of TB Cases Among Foreignborn Persons, United States* DC DC *Updated as of May, 9. >5% 5% 49% <5% 6
7 No. of Cases Primary MDR TB United States, 993 8* Percentage No. of Cases Percentage *Updated as of May, 9. Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin. TB Drug Resistance- 8 Northeast Region Multidrug-resistant Count Percent of Total No % Yes 36.48% Not Reported 4.58% Total 47.% Other Regions Multidrug-resistant Count Percent of Total No % Yes 68.94% Not Reported 5 3.% Total 767.% Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9, 5:3:4 PM and 6:7:44PM. Mode of Treatment Administration in Persons Reported with TB United States, 993 6* % ** 8% 6% 4% % % DOT only DOT + SA SA only *Updated as of May, 9. **Percentage of total cases in persons alive at diagnosis, with an initial regimen of one or more drugs prescribed, and excluding cases with missing or unknown mode of treatment administration. Directly observed therapy (DOT); Self-administered therapy (SA) 7
8 Mode of Administration-6 Northeast Region Other Regions Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9, 5:33:9 PM and 6:9:4PM. ercentage Pe Completion of TB Therapy United States, 993 6* Completed Completed in yr or less ** *Updated as of May, 8. **Healthy People target: 9% completed in yr or less. Note: Persons with initial isolate resistant to rifampin and children under 5 years old with meningeal, bone or joint, or miliary disease excluded. Northeast Region Other Regions TopChart OptionsNotesCitationQuery Criteria Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance System, United States, U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), Division of TB Elimination, CDC WONDER On-line Database, February. Accessed at on Sep 9, 6:3:36 PM and 6:3:36PM. 8
9 TB Surveillance Update 9 9 Surveillance Reports due Fall MMWR March 9, / 59();89-94 Decrease in Reported Tuberculosis Cases --- United States, 9* MMWR March 9, / 59();89-94 For 9, a total of,54 tuberculosis (TB) cases were reported in the United States. The TB rate was 3.8 cases per, population, a decrease of.4% from the rate of 4. per, reported for 8. The 9 rate showed the greatest single-year decrease ever recorded and was the lowest recorded rate since national TB surveillance began in 953 (). *based on 9 provisional data FIGURE. Rate* of tuberculosis (TB) cases, by state/area --- United States, 9 MMWR March 9, / 59();89-94 SOURCE: National TB Surveillance System. * Per, population. Data are updated as of February 6,, and are provisional. 9 states had TB case rates of. (range: ) per,, states had TB case rates of.--4. (range: ) per,, and states and the District of Columbia had TB case rates of 4. (range: ) per,. 9
10 Possible Explanations for the 9 Decline in the TB Case Rate Artifact? Surveillance reporting changes Changes in population p demographics Under diagnosing or underreporting of disease Real? Improved TB control efforts Thank you Any questions?
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