Global TB Burden, 2017 estimatesnid]/2...Microsoft PowerPoint - 2_printable...

6/25/2019

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TUBERCULOSIS EPIDEMIOLOGY- GLOBAL, UNITED STATES, AND WASHINGTON STATEOffice of Communicable Disease Epidemiology

Global TB Burden, 2017 estimates

Estimated number of TB cases

Estimated number of deaths

Total TB 10 million140 per 100,000*

1.6 million^

1 million children 230,000 in children

HIV‐associated TB 900,000 300,000

Multidrug‐resistant TB MDR/RR

458,000 (3.5% of new TB)558,000 (incl. RR‐TB)

~8.5% of MDR TB is XDR

240,000 (14%)

^Includes HIV/TB deaths

Global tuberculosis report 2018. Geneva: World Health Organization

* 2016 rate

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Washington State Department of Health | 3


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Global Impact of TB Deaths


Reported Tuberculosis (TB) Cases and Rates United States, 1993–2017

0

2

4

6

8

10

12

0

5,000

10,000

15,000

20,000

25,000

30,000

1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 Cases per 100,000 Population

No. o

f Cases

Year

No. of Cases Incidence Rate

9105

2.8

5

6

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Washington State Department of Health | 7Data as of May 8, 2019


100+

25‐100

1‐24

No cases counted in this time period

Whatcom24

Skagit

Snohomish129

Seattle & KingCounty

490

Tacoma-Pierce82

Lewis

Cowlitz

Clark45

Skamania

Klickitat

IslandClallam

Jefferson

GraysHarbor

Pacific

Wahkiakum

28Thurston

Mason

Yakima42

Kittitas

Chelan Douglas

(Chelan-Douglas)

Okanogan

Benton

Franklin(Benton-Franklin)

Grant

FerryStevens

PendOreille

Lincoln Spokane22

Adams Whitman

Walla WallaColumbia

Garfield

Asotin

(Northeast Tri County)San Juan

Kitsap

TB Case Counts in WA (2014-2018)

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Relative TB Incidence in WA (2014-2018)

Above statewide TB rate

At or below statewide TB rate

No reported TB Cases

Washington State Department of Health | 10Data as of May 21, 2019

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TB Cases and Rates Among U.S.‐Born versus Non‐U.S.–Born Persons, United States, 1993–2017

No. o

f cases

0

5

10

15

20

25

30

35

40

0

5,000

10,000

15,000

20,000

25,000

30,000

1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

U.S.‐born Cases

Non‐U.S.–born Cases

U.S.‐born Rate

Non‐U.S.–born Rate

Year

Cases per 100,000 Population

Countries of Birth Among Non‐U.S.–Born Persons Reported with TB, United States, 2017

Mexico 19%

Philippines 13%

India 9%

Vietnam 8%China 6%Guatemala 3%

Haiti 3%

Other countries 39%

*Percentages are rounded.

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Mexico10.9%

China4.2%

Viet Nam9.6%

Philippines14.5%

Ethiopia6.3%

India7.0%

2014‐2018

Data as of May 8, 2019

TB Case Rates by Age Group and Sex, United States, 2017*

*Cases per 100,000 population

Cases per 100,000 persons

0

1

2

3

4

5

6

7

<5 5–14 15–24 25–44 45–64 ≥65

Male Female

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Washington State Department of Health | 15*Age at time of diagnosis


Washington State Department of Health | 16¹ At time of diagnosis² Within past year³ Among those with known HIV status

Known TB Exposure

Place of Residence

Occupation

Substance Use

Baseline Health Status

Demographics


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Prevalence of Risk Factors among TB CasesWashington State, 2014‐2018

19.6%

8.1%

77.3%

0.0% 25.0% 50.0% 75.0% 100.0%

Percent of Cases

Born Outside the U.S.

Contact of Infectious TB

Patient

Diabetes


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Estimated HIV Coinfection Among Persons Reported with TB, United States, 1993–2017*

Coinfection (%)

0

10

20

30

40

50

60

70

1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

All ages Ages 25–44 yrs

Year* Minimum estimates are based on reported HIV‐positive status among all TB patients in the age group.


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Primary MDR TB, United States, 1993–2017*

0

0.5

1

1.5

2

2.5

3

0

50

100

150

200

250

300

350

400

450

1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

Year

Number of cases Percentage of total casesPercentageNo. of cases

* Based on initial isolates from persons with no prior history of TB; multidrug‐resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin.

Primary Anti‐TB Drug Resistance, United States, 1993–2017*

* Based on initial isolates from persons with no prior history of TB; multidrug‐resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin.

Resistan

t (%

)

0

2

4

6

8

10

1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

Isoniazid MDR TB

Year

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9.2%

5.7%

10.6%11.0%

10.2%

9.3%

0.7%

2.3%

1.3%

2.3%1.9% 1.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

2014 2015 2016 2017 2018 Period

Percent of Case Isolates Tested

Select Classes of Drug‐Resistance, Percent of Cases*Washington State, 2014‐2018

Isoniazid resistant (not MDR‐TB) MDR‐TB

*Cases that have been susceptibility tested for at least isoniazid and rifampin*MDR‐TB defined as resistance to at least isoniazid and rifampin


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National Tuberculosis Genotyping Surveillance Coverage* by Year: United States†, 2004–2017

52.6

68.4 70.1

80.8 81.686.9

91.694.2 94.9 95.9 96.7 97.1 97.4 96.3

0

10

20

30

40

50

60

70

80

90

100

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Proportion of culture confirm

ed TB

cases genotyped

(%)

* The proportion of positive cultures with at least one genotyped isolate.† Includes 50 states and the District of Columbia.§ For the year 2020, the national goal for TB genotyping surveillance coverage will change to 100%.

National Goal, 94%§

Number of County‐based Tuberculosis Genotype Clusters* by Cluster Size, United States, 2015–2017

*Genotype cluster is defined as two or more cases with matching spoligotype and 24-locus MIRU-VNTR (GENType) within a county during the specified 3-year time period.

928

229

11046 22 17 11 10 36

0

200

400

600

800

1,000

2 casecluster

3 casecluster

4 casecluster

5 casecluster

6 casecluster

7 casecluster

8 casecluster

9 casecluster

≥10 case cluster

Number of clusters

Number of Persons in Cluster

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TB Infection Estimates, 2018

TB Infection Estimates

Global 1.7 billion (23%)

United States 13 million (4%)

Washington State 200,000 (3%)


Estimated Longstanding LTBI Prevalence by County simple back calculation based on genotyped active TB cases,

2011-2015

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LATENT TB INFECTIONEstimated Longstanding LTBI Prevalence by County simple back calculation based on genotyped active TB cases, 2011‐2015

Haddad MB, Raz KM, Lash TL, Hill AN, Kammerer J, Winston CA, et al. Simple Estimates for Local Prevalence of Latent Tuberculosis Infection, United States, 2011–2015. EmergInfect Dis. 2018;24(10):1930‐1933. https://dx.doi.org/10.3201/eid2410.180716

Estimated Longstanding LTBI Prevalence among U.S.-born, by County based on simple back calculation from all genotyped active TB cases in 2011-2015

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Estimated Longstanding LTBI Prevalence among Non-U.S.-born, by County based on simple back calculation from all genotyped active TB cases in 2011-2015


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Global TB Burden, 2017 estimatesnid]/2...Microsoft PowerPoint - 2_printable...

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