Epidemiology of Tuberculosiscenterfortuberculosis.mayo.edu/.../cote-epidemiology_of_tb_final.pdf ·...

2014 MFMER | slide-1

Epidemiology of Tuberculosis

Andrea Cote, DVM, MPH


Disclosure

I have no actual or potential conflict of interest in relation to this presentation.


Objectives

Describe the TB epidemic in terms of susceptible groups

Describe major factors that will affect future trends in TB


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


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


History of TB


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


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


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


History of TB United States


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


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


TB Rates


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


2015 Estimate of TB Incidence Rate

60% of cases worldwide occur in 6 countries

China

India

Indonesia

Nigeria

Pakistan

South Africa


2015 United States Active TB

9,557 cases reported in the United States

Incidence rate

3 cases per 100,000 persons


TB Incidence in the United States - 2015


Cases of TB in the United States 1953-2011


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


Wyoming Incidence Rate, 2011-2015


Susceptible groups


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)


Asians

2015, 33% of all people in the US were Asian, non-Hispanic

28.5 times more likely to contract TB

Lower SES

Crowding


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


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


Foreign-born

2015, 66% of all TB cases in US were foreign born

Migrated from endemic tuberculosis country

Lower SES

Crowding

Access to treatment


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


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


Residents of Correctional Facilities

2015, 3.6% of all TB cases were incarcerated

Substance abuse (drug and alcohol)

HIV

Co-morbidities

Overcrowding


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


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


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


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


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


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


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


Trends in TB


Factors affecting trends in tuberculosis

Migration and travel

Geographic locations/ overcrowding

Drug resistant tuberculosis



Coming and going from endemic countries

Increased exposure


Geographic locations/ Overcrowding

Rates in the United states vary by geographic location

Alaska, Hawaii, California, Texas, New York

Overcrowding

Urban areas

Housing

Low SES


Geographic locations/ Overcrowding


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


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


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


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


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


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



http://www.who.int/tb/areas-of-work/treatment/risk-factors/en/


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


http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-365

http://www.sciencedirect.com/science/article/pii/S0022519308002713



References

http://www.sciencedirect.com/science/article/pii/S0022519308002713


http://www.who.int/tb/publications/global_report/gtbr14_supplement_web_v3.pdf


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


Which of these does not increase the risk of tuberculosis?

a. HIV infection

b. Diabetes mellitus

c. High socioeconomic status

d. Alcohol consumption


70% of all TB cases are from six countries.

a. True

b. False


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

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