Post on 08-Feb-2018
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Epidemiology of Tuberculosis
Andrea Cote, DVM, MPH
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Disclosure
I have no actual or potential conflict of interest in relation to this presentation.
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Objectives
Describe the TB epidemic in terms of susceptible groups
Describe major factors that will affect future trends in TB
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History of tuberculosis (TB) in the world
History of TB in the United States
Incidence Rates
World 2015
United States 2015
Wyoming Incidence
Susceptible groups
Major Factors that affect trends in TB
Outline
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Epidemiology Definitions
Incidence rate: # of new cases over a specific period divided either by the average population or by the cumulative person-time the population was at risk
Endemic: condition that can be thought of as background occurrence in a population
Epidemic: unusual occurrence or occurrence greater than the usual number
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History of TB
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History of TB
2400 BCE: Egyptian mummies spinal column, signs of TB
1679: Identification of tubercles in lungs of ill patients, progression to abscesses and cavities
1720: TB caused by wonderfully minute living creatures
1793: Association of lung tubercles and symptoms experienced
1854: TB patient sent to the Himalayan Mountains was cured, wrote Tuberculosis is a Curable Disease
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History continued
1882: Discovery of Mycobacterium tuberculosis
1895: Discovery of radiographs to identify severity and progression of disease
1921: BCG vaccine introduced after years of research
1944: Antibiotics used against TB
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History continued
1990s: Incidence of TB remained roughly the same
1990s- 2015: Mortality decreased by 50%
Since 2000, global TB rate falling 1.5% yearly
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History of TB United States
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History of TB United States
1889: New York City 10,000 cases/year
1889: New York health department created rules for TB
1904: National TB Association formed
1947-1953: Screening Campaign for TB in the United States
1953: TB is a nationally notifiable disease
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History of TB United States continued
1959: National Guidelines for treating TB
1954-1963: Pyrazinamide, ethambutol, rifampin discovered for treatment of TB
Cases decreased yearly until 1985
1986-1993: 20% increase number of TB cases
Attributed to HIV, increase immigration, spread of TB in congregated settings, spread of drug resistant TB
1994-2010: Cases began to decrease again
2013- present: Case count remains similar
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TB Rates
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2015 Global Active TB Case Count
10.4 million new cases (8.4-12.2 million)
1.4 million deaths from TB
Incidence rate
142 cases per 100,000
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2015 Estimate of TB Incidence Rate
60% of cases worldwide occur in 6 countries
China
India
Indonesia
Nigeria
Pakistan
South Africa
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2015 United States Active TB
9,557 cases reported in the United States
Incidence rate
3 cases per 100,000 persons
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TB Incidence in the United States - 2015
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Cases of TB in the United States 1953-2011
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TB in Wyoming
2010 2011 2012 2013 2014 2015 2016
# of Cases 7 4 3 0 2 4 1
Incidence
Rate per
100,000
1.2 0.70 0.52 0 0.34 0.68 0.17
Based off the estimated population in by U.S.
Census per each year
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Wyoming Incidence Rate, 2011-2015
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Susceptible groups
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Groups More Susceptible to Tuberculosis
Racial and ethnic minority populations
Children
Homeless
Residents of correctional facilities
Individuals with co-morbidities
Drug or alcohol abusers
Health care workers
Low socioeconomic status (SES)
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Asians
2015, 33% of all people in the US were Asian, non-Hispanic
28.5 times more likely to contract TB
Lower SES
Crowding
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African American
2015, nearly 21% of all people in the US were African American, non-Hispanic
Lower SES
Most severe burden of HIV of all racial/ethnic groups in US
Genetics
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Native Hawaiian and other Pacific Islanders
2015, 1.1% of all people in the US were Asian, non-Hispanic
Increased comorbidities
diabetes
drug/alcohol abuse
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Foreign-born
2015, 66% of all TB cases in US were foreign born
Migrated from endemic tuberculosis country
Lower SES
Crowding
Access to treatment
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Children
2015, 4.7% of TB cases were children
Children younger than five years of age have higher risk for developing TB disease
Immunologic immaturity
Non-specific signs
Difficult to diagnose
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Homeless
2015, 5.5% of TB cases reported homelessness
Low SES
Substance abuse (drug and alcohol)
HIV
Co-morbidities
Congregation in overcrowded areas
Lack ready access to the medical care
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Residents of Correctional Facilities
2015, 3.6% of all TB cases were incarcerated
Substance abuse (drug and alcohol)
HIV
Co-morbidities
Overcrowding
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Health Care Workers
In 2015, 3.9% of all TB cases worked in health care
Patients present with non-descript symptoms
Congregated settings
Foreign-born patients
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Comorbidities that increase risk of TB
HIV infection
History of inadequately treated TB disease
Recent TB infection (past 2 years)
Abuse of drugs or alcohol
Smoking
Pregnancy
Malnutrition
Silicosis
Diabetes mellitus
Chronic renal failure
Certain types of cancer
Certain intestinal conditions
Low body weight
Receiving immunosuppressive therapy
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Persons Living with HIV
Strongest known risk factor for the development of TB disease
26-31 times more likely to develop TB
Increased progression of HIV and death
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Recent TB Infection or History of Untreated/Inadequately Treated TB Infection
No Risk Factors
Risk about 5% in the first 2 years
Risk about 10% over a lifetime
Latent TB
5-10% will develop an active TB
Untreated/Inadequately Treated
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Diabetes mellitus
3 times more likely to develop TB
TB worsens symptoms of diabetes and worsen glycemic index
Diabetes can worsen clinical course of TB
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Cigarette Smokers, Alcohol or Drug Abuse
Smoking increases the risk of TB disease by 2.5 times
Drugs and alcohol increase risk of TB disease by 3 times
Situations where at risk (correctional facilities, homelessness, etc.)
Make individual immunocompromised
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Socio-economic status
5 fold increase in TB in US born
1.3 fold increase in TB in foreign born
TB rates by US SES variables, 1996-2005
Education Income Crowding
Foreign
born
US born Foreign
born
US born Foreign
born
US born
Low SES 27.2 8.18 28.1 8.83 27.5 3.59
High SES 21.6 1.71 21.3 1.81 19.4 14.9
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Trends in TB
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Factors affecting trends in tuberculosis
Migration and travel
Geographic locations/ overcrowding
Drug resistant tuberculosis
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Migration and travel
Coming and going from endemic countries
Increased exposure
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Migration and travel
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Geographic locations/ Overcrowding
Rates in the United states vary by geographic location
Alaska, Hawaii, California, Texas, New York
Overcrowding
Urban areas
Housing
Low SES
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Geographic locations/ Overcrowding
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Drug-Resistant TB
~5% of world cases are drug resistant
20.5% of previous TB patients resistant
Reasons for resistance
Individuals do not complete treatment
Wrong dose or treatment
Develop TB again
Spend time with someone with drug resistant TB
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TB Control Strategies
1.Detect and treat cases both active and latent
2.Prevent drug resistant tuberculosis
3. Implement better control measures
4.Create more effective vaccination to prevent disease and transmission
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References
http://www.who.int/tb/publications/global_report/gtbr2016_main_text.pdf?ua=1
http://www.who.int/gho/tb/en/
http://www.resmedjournal.com/article/S0954-6111(06)00401-X/pdf
http://globaltb.njms.rutgers.edu/abouttb/tbfaq-intro.html
http://ocw.jhsph.edu/courses/EpiInfectiousDisease/PDFs/EID_lec12_Chaisson.pdf
http://www.sciencedirect.com/science/article/pii/S095461110600401X
http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/
http://web.njms.rutgers.edu/ntbcweb/abouttb/historyoftb.html
http://www.healthenvoy.org/portfolio/tuberculosis/
www.ncbi.nlm.nih.gov/pmc/articles/PMC3691414/pdf/586_2012_Article_2334.pdf
https://www.cdc.gov/tb/statistics/
http://www.publichealthmdc.com/disease/documents/HistoryTB2013-03.pdf
https://www.cdc.gov/tb/statistics/reports/2015/default.htm
http://www.who.int/tb/publications/global_report/gtbr2016_main_text.pdf?ua=1http://www.who.int/gho/tb/en/http://www.resmedjournal.com/article/S0954-6111(06)00401-X/pdfhttp://www.resmedjournal.com/article/S0954-6111(06)00401-X/pdfhttp://www.resmedjournal.com/article/S0954-6111(06)00401-X/pdfhttp://www.resmedjournal.com/article/S0954-6111(06)00401-X/pdfhttp://www.resmedjournal.com/article/S0954-6111(06)00401-X/pdfhttp://globaltb.njms.rutgers.edu/abouttb/tbfaq-intro.htmlhttp://globaltb.njms.rutgers.edu/abouttb/tbfaq-intro.htmlhttp://globaltb.njms.rutgers.edu/abouttb/tbfaq-intro.htmlhttp://ocw.jhsph.edu/courses/EpiInfectiousDisease/PDFs/EID_lec12_Chaisson.pdfhttp://www.sciencedirect.com/science/article/pii/S095461110600401Xhttp://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://jmvh.org/article/history-of-tuberculosis-part-2-the-sanatoria-and-the-discoveries-of-the-tubercle-bacillus/http://www.healthenvoy.org/portfolio/tuberculosis/https://www.cdc.gov/tb/statistics/http://www.publichealthmdc.com/disease/documents/HistoryTB2013-03.pdfhttp://www.publichealthmdc.com/disease/documents/HistoryTB2013-03.pdfhttp://www.publichealthmdc.com/disease/documents/HistoryTB2013-03.pdf
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References
https://www.cdc.gov/tb/topic/populations/tbinafricanamericans/
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016317
https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm
https://www.cdc.gov/tb/education/corecurr/pdf/chapter1.pdf
http://digitalcommons.macalester.edu/cgi/viewcontent.cgi?article=1080&context=bildhaan
https://www.ncbi.nlm.nih.gov/pubmed/17413054
http://www.tbfacts.org/tb-children/
http://www.nature.com/pr/journal/v63/n2/full/pr200822a.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867258/
http://www.currytbcenter.ucsf.edu/sites/default/files/product_tools/homelessnessandtbtoolkit/docs/background/Factsheet/Article_2013_TB%20Among%20the%20Homeless,%201994-2010.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796667/
http://cid.oxfordjournals.org/content/48/1/72.full
https://www.usaid.gov/sites/default/files/documents/1864/USAID-TB-Brochure.pdf
https://www.cdc.gov/tb/topic/populations/tbinafricanamericans/http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016317https://www.ncbi.nlm.nih.gov/pubmed/17413054https://www.ncbi.nlm.nih.gov/pubmed/17413054https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867258/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867258/http://cid.oxfordjournals.org/content/48/1/72.fullhttp://cid.oxfordjournals.org/content/48/1/72.full
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References
https://www.ncbi.nlm.nih.gov/books/NBK222462/
http://www.who.int/tb/areas-of-work/treatment/risk-factors/en/
http://hivinsite.ucsf.edu/InSite?page=kb-05-01-06#S4X
https://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf
https://www.cdc.gov/tb/education/corecurr/pdf/chapter5.pdf
http://www.who.int/tb/areas-of-work/treatment/risk-factors/en/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945809/
http://www.tbinfo.ch/fileadmin/user_upload/tbinfo.ch/Muenchenwiler/Alcohol__smoking__tb_Lonnroth.pdf
http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-8-289
http://www.atsjournals.org/doi/full/10.1164/ajrccm.157.4.9704036
https://www.ncbi.nlm.nih.gov/pubmed/22607324
http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-365
http://www.sciencedirect.com/science/article/pii/S0022519308002713
https://www.ncbi.nlm.nih.gov/pubmed/15772584
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References
http://www.sciencedirect.com/science/article/pii/S0022519308002713
https://www.ncbi.nlm.nih.gov/pubmed/15772584
http://www.who.int/tb/publications/global_report/gtbr14_supplement_web_v3.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298382/
https://www.cdc.gov/niosh/topics/tb/
https://www.cdc.gov/niosh/topics/tb/
https://www.ncbi.nlm.nih.gov/pubmed/15772584https://www.ncbi.nlm.nih.gov/pubmed/15772584http://www.who.int/tb/publications/global_report/gtbr14_supplement_web_v3.pdfhttp://www.who.int/tb/publications/global_report/gtbr14_supplement_web_v3.pdfhttp://www.who.int/tb/publications/global_report/gtbr14_supplement_web_v3.pdf
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Which of these does not increase the risk of tuberculosis?
a. HIV infection
b. Diabetes mellitus
c. High socioeconomic status
d. Alcohol consumption
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70% of all TB cases are from six countries.
a. True
b. False
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Which of these affect the trends of tuberculosis?
a. Migration and travel
b. Drug resistant tuberculosis
c. Geographic locations/overcrowding
d. All of the above