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, 211 1 2 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
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
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, 198 21* Case Rate # Cases 711 Cases in 21 51.1 Rate/1, 6 5 4 2, 21.4 3 1,5 1, 5 8.5 2 1 8 8182 83 8485 86 8788 89 991 92 9394 95 9697 98 99 1 23 4 56 7 89 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, 1992-21 US-born Cases Foreign-born Cases US-born Rate Foreign-born Rate 92 93 94 95 96 97 98 99 1 2 3 4 5 6 7 8 9 1 1. 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, 7. 6. 5. 4. 3. 2. 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 13 11 12 3
21 NYC TB cases by country of birth Tuberculosis Cases by Borough New York City, 29 and 21 276 3 257 Number of C Cas es 25 25 29 232 21 2 15 1 137 12 116 88 5 18 13 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. 1-9.1-3.8 1-24 3.9-9.1 Fordham - Bronx Park Crotona - Tremont High Bridge - Morrisania 25-49 Flushing - Clearview 9.2-22.5 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. 15 16 4
Top 1 Medical Facilities First Evaluating Patients for TB New York City, 21 Facility Name # of Cases % of all Cases 1. Elmhurst Hospital Center 64 9 2. Bellevue Hospital Center 48 7 3. Mount Sinai Hospital 29 4 4. Kings County 24 3 5. New York Hospital Medical Center of Queens 23 3 6. Fort Greene Chest Center 22 3 7. Beth Israel Medical Center, Maimonides Medical Center 21 3 8. Queens Hospital Center 19 3 9. Corona Chest Center, Jacobi Medical Center, Woodhull 16 2 1. 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) 17 18 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, 1992-2121 Number of Cases 8 6 4 2 % of TB/HIV Infected Cases % TB/HIV+ # TB/HIV+ 34 33 34 33 31 26 3 22 22 18 18 15 16 16 15 13 13 2 11 9 7 1 92 93 94 95 96 97 98 99 1 2 3 4 5 6 7 8 9 1 Year 5 4 19 2 5
5 45 4 35 3 25 2 15 1 5 MDR-TB in NYC,1992-21 21 441 296 176 19 84 53 38 31 25 24 27 21 18 24 21 9 11 9 11 1992 1993 1994 1995 1996 1997 1998 1999 2 21 22 23 24 25 26 27 28 29 21 Those who do not learn from history are doomed to repeat it! f cases Number of 1 Actual Cases Projected Cases 9 8 7 6 5 4 3 2 1 194 1945 195 1955 196 1965 197 1975 198 1985 199 1995 2 Years 21 22 New York City Department of Health and Mental Hygiene Think TB! Bureau of TB Control http://www.nyc.gov/health/tb Tel: 311 or 212-788-4162 (TB Provider Hotline) 23 24 6