City of Chicago Communicable Disease Information Department of Public Health Richard M. Daley, Mayor May 2008 Terry Mason, MD, FACS, Commissioner www.cityofchicago.org/health/ West Side Center For Disease Control 2160 West Ogden Avenue Chicago, IL 60612 Communicable Disease Program 312-746-5387 312-743-1059 FAX Immunization Program 312-746-5380 312-746-6144 FAX Tuberculosis Program 312-746-5983 312-746-5134 FAX CDInfo is a surveillance newsletter intended to promote prevention of morbidity and mortality by providing useful data and practical recommendations for clinicians, laboratorians and infection control personnel who diagnose, treat and/or report infectious diseases in Chicago. Additional information on tuberculosis: Illinois Department of Public Health http://www.idph.state.il. us/health/infect/reportdi s/tb.htm Centers for Disease Control and Prevention http://www.cdc.gov/tb Tuberculosis in Chicago 2007 The number of newly diagnosed cases of tuberculosis (TB) reported to the Chicago Department of Public Health (CDPH) TB Control Program in 2007 was 259 (8.9/100,000) (Figure 1). This represents a 10% decrease from 287 cases reported in 2006. Since 1993, the incidence of TB in Chicago has declined by 68%. However, the 2007 Chicago TB rate is still twice the national rate (4.4/100,000; N=13,293) and state rate (4.1/100,000; N=521) (Table 1). Race/Ethnicity Chicago continues to experience disparities in TB incidence across all racial groups, especially among non-hispanic black or African Americans. In 2007, non-hispanic black or African Americans accounted for almost half (48%) of the total TB cases, with a TB case rate of 11.8/100,000. This rate continues to be almost five times the rate for non- Hispanic whites (2.4/100,000). However, the number of TB cases among non-hispanic black or African Americans has declined 74% from 1993, when 485 cases were reported. In 2007, non-hispanic Asians had the highest TB case rate in the city at 34.6/100,000, even though this group comprised only 17% of the total TB cases. Hispanics accounted for 26% of total TB cases, with a TB case rate of 9.0/100,000. Pediatric Cases In 2007, seven children aged 0-14 years were reported with active tuberculosis, representing a case rate of 1.1/100,000 and a 75% decrease from 2006 (N=28) (Figure 2). Of these seven children, two were Hispanic or Latino and five were non-hispanic black or African American. Two of these children were foreign-born, of which one was born in Mexico. Place of Birth From 1993 to 2007, the proportion of TB cases that were foreign-born increased from 13% (N=106) to 51% (N=133), respectively (Figure 3). This increase is largely due to an 81% decline in U.S.-born TB cases over the same time period. In 2007, the largest number of foreign-born TB cases occurred among Hispanics or Latinos (46%), whereas the largest proportion of U.S.-born TB cases occurred among U.S.-born African Americans or Blacks (86%) (Figure 4). In 2005, CDPH set a target TB case rate for U.S.-born African Americans of 12.2 per 100,000 population by 2009. The target rate represents a 25% decrease in the case rate over a 5-year period. Since 2006, the target rate has been met (Figure 5). However, the 2007 U.S.-born African American TB case rate (10.4/100,000) remains ten times the U.S.-born White, Non-Hispanic TB case rate (0.8/100,000). The CDPH TB Control Program will continue to provide clinical care, nurse case management, and directly observed therapy (DOT) services to this population, while continuing to raise awareness of TB in Chicago s African-American communities. Drug Resistance In 2007, the total number of culture-positive TB cases was 202; 196 (97%) had susceptibility results. Of these, 49% (N=97) were foreign-born and 51% (N=99) were U.S.-born. Of the 97 foreign-born TB cases with susceptibility results, 12% (N=12) were resistant to one of the first-line anti-tb drugs and 7% (N=7) were Isoniazid monoresistant. One MDR (multi-drug resistant)-tb case was reported to the Chicago Department of Public Health TB Program during this period.
Of the 99 U.S.-born TB cases with susceptibility results, 18% (N=18) were resistant to one of the first-line anti-tb drugs and 14% (N=14) were Isoniazid mono-resistant. Co-Morbid Conditions The HIV epidemic has had a significant impact on TB morbidity in Chicago, and TB prevention remains an important issue for residents living with HIV. For all ages, the HIV-TB co-infection rate declined from 10% (N=41) in 2000 to 6% (N=17) in 2006 (Figure 6). However, this rate increased to 9% (N=23) in 2007. Of the 23 reported HIV-TB co-infected cases: 18 were culture-positive; 10 were foreign-born and 13 were U.S.-born; 18 were African American and five here Hispanic or Latino. Among all TB cases reported in 2007, injecting drug use was reported in less than 1% (N=2), non-injecting drug use in 14% (N=36), alcohol abuse in 23% (N=60), and any substance abuse (drug use or alcohol use) in 30% (N=77) (Table 2). Homelessness within one year of diagnosis was reported in 11% (N=29) of the total TB cases; this represents an increase of 26% from the previous year. TB cases who reported they were a resident of a correctional facility at the time of diagnosis decreased by 7%, from 15 cases in 2005 to 14 in 2006. TB cases who were a resident of a long-term care facility at the time of diagnosis increased by 38% from 2005 (N=8) to 2007 (N=5). How to report TB cases in Chicago 1. FAX: The preferred method of reporting is for the physician or designated clinical staff to complete a copy of the Reported Verified Case of Tuberculosis (RVCT) and fax it to (312) 746-5134, then mail the paper copy to: Chicago Department of Public Health Tuberculosis Control Program 2160 W. Ogden Avenue Chicago, Illinois 60612 Supplies of report forms are available from the same address. 2. Phone: Immediate telephone reporting of TB cases is indicated when a patient is being transferred to another facility, the patient has a large number of close contacts, contacts include children less than 15 years of age, or there is reason to believe that the patient will not report to any outpatient medical provider for continued follow-up and treatment. To report by phone, call (312) 746-6036 or (312) 746-6052. Page 2 of 3
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Patient's Name: Street Address: (Last) (First) (M.I.) (Number, Street, City, State) Zip Code) REPORT OF VERIFIED CASE OF TUBERCULOSIS SOUNDEX REPORT OF VERIFIED CASE OF TUBERCULOSIS 1. State Reporting: Specify: 2. State Case Number: DEPARTMENT OF HEALTH & HUMAN SERVICES PUBLIC HEALTH SERVICE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) ATLANTA, GEORGIA 30333 FORM APPROVED OMB NO. 0920-0026 Exp. Date 09/30/2005 Alpha State Code City/County Case Number: 3. Date Submitted: By: 4. Address for Case Counting: Day City Within City Limits 1 Yes 2 No 5. Month-Year Reported: 6. Month-Year Counted: County Zip Code 7. Date of Birth: 8. Sex: 9. Ethnicity: 10. Race: (Select one) Day (Select Hispanic or Latino one or more) Not Hispanic or Latino Male 2 Female 2 If not U.S., enter country code American Indian or Alaska Native 3 Black or African American 5 White Asian Specify (Optional): Native Hawaiian or 4 Other Pacific Islander Specify (Optional): 11. Country of Origin: 12. Month-Year Arrived in U.S.: 13. Status at Diagnosis of TB: If U.S., check here Alive 2 Dead 2 14. Previous Diagnosis of Tuberculosis: Yes 2 No If yes, list year of previous diagnosis If more than one previous episode, check here 15. Major Site of Disease: 00 Pulmonary 10 Pleural 2 Lymphatic: Cervical 22 Lymphatic: Intrathoracic 16. Additional Site of Disease: 00 Pulmonary 10 Pleural 2 Lymphatic: Cervical 22 Lymphatic: Intrathoracic 23 Lymphatic: Other 29 Lymphatic: Unknown 30 Bone and/or Joint 40 Genitourinary 23 Lymphatic: Other 29 Lymphatic: Unknown 30 Bone and/or Joint 40 Genitourinary 50 Miliary 60 Meningeal 70 Peritoneal 80 Other* 90 Site not Stated *If site is "Other", enter anatomic code *If site is "Other", enter anatomic code 50 Miliary 60 Meningeal 70 Peritoneal If more than one additional site, 80 Other* 88 check here 17. Sputum Smear: 18. Sputum Culture: 19. Microscopic Exam of Tissue and Other Body Fluids: If positive, enter anatomic code(s) 20. Culture of Tissue and Other Body Fluids: 21. Chest X-Ray: If positive, enter anatomic code(s) 22. Tuberculin (Mantoux) Skin Test at Diagnosis: Millimeters (mm) of Induration If Negative, was patient anergic? Yes 2 No Normal 2 Abnormal If Abnormal (check one) If Abnormal (check one) Cavitary 2 Noncavitary 3 Noncavitary Stable 2 Worsening Consistent with TB 3 Improving Not Consistent with TB Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Project Clearance Officer, 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0026). Do not send the completed form to this address. Information contained on this form which would permit identification of any individual has been collected with a guarantee that it will be held in strict confidence, will be used only for surveillance purposes, and will not be disclosed or released without the consent of the individual in accordance with Section 308(d) of the Public Health Service Act (42 U.S.C. 242m). CDC 72.9A REV 01/2003 1st Copy REPORT OF VERIFIED CASE OF TUBERCULOSIS Page 1 of 2
REPORT OF VERIFIED CASE OF TUBERCULOSIS REPORT OF VERIFIED CASE OF TUBERCULOSIS 23. HIV Status: 0 Negative 2 Indeterminate 3 Refused 4 Not Offered 5 Test Done, Results Unknown If Positive, Based on: Medical Documentation 2 Patient History 24. Homeless Within Past Year: 0 No Yes If Positive, List: CDC AIDS Patient Number (If AIDS Reported before 1993) State HIV/AIDS Patient Number (If AIDS Reported 1993 or Later) City/County HIV/AIDS Patient Number (If AIDS Reported 1993 or Later) 25. Resident of Correctional Facility at Time of Diagnosis: 0 No Yes If Yes, Federal Prison 2 State Prison 3 Local Jail 4 Juvenile Correctional Facility 5 Other Correctional Facility 26. Resident of Long-Term Care Facility at Time of Diagnosis: 0 No Yes If Yes, Nursing Home 2 Hospital-Based Facility 3 Residential Facility 4 Mental Health Residential Facility 5 Alcohol or Drug Treatment Facility 6 Other Long-Term Care Facility 27. Initial Drug Regimen: Isoniazid 0 9 Rifampin 0 9 Pyrazinamide 0 9 Ethambutol 0 9 Streptomycin 0 9 Ethionamide 0 9 Kanamycin 0 9 Cycloserine 0 9 Capreomycin 0 9 Para-Amino 0 9 Salicylic Acid Amikacin 0 9 Rifabutine 0 9 Ciprofloxacin 0 9 Ofloxacin 0 9 Other 0 9 28. Date Therapy Started: 29. Injecting Drug Use Within Past Year: Day 0 No Yes 30. Non-Injecting Drug Use Within Past Year: 0 No Yes 31. Excess Alcohol Use Within Past Year: 0 No Yes 32. Occupation (Check all that apply within the past 24 months): Comments: Health Care Worker 3 Migratory Agricultural Worker 5 Not Employed within Past 24 Months 2 Correctional Employee 4 Other Occupation CDC 72.9A REV 01/2003 1st Copy REPORT OF VERIFIED CASE OF TUBERCULOSIS Page 2 of 2