The Epidemiology of Tuberculosis · 2019-12-18 · Addressing TB in Our Communities November 19,...
Transcript of The Epidemiology of Tuberculosis · 2019-12-18 · Addressing TB in Our Communities November 19,...
Addressing TB in Our Communities November 19, 2015 Curry International Tuberculosis Center
The Epidemiology of Tuberculosis 1
The Epidemiology of Tuberculosis
Scott Lindquist MD MPH
Washington State Communicable Disease Epidemiologist
333
Estimated TB Global Incidence 2014
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Reported TB Cases United States, 1982–2014*
*Updated as of June 5, 2015.
0
5,000
10,000
15,000
20,000
25,000
30,000
No
. of
Cas
es
Year
Year No. Rate*
2009 11,523 3.8
2010 11,161 3.6
2011 10,510 3.4
2012 9,941 3.2
2013 9,565 3.0
2014 9,421 3.0
*Cases per 100,000. Updated as of June 5, 2015.
TB Morbidity United States, 2009–2014
TB Case Rates,* United States, 2014
*Cases per 100,000.
< 3.0 (2014 national average)
>3.0
D.C.
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≥50 10–49.9 ≤9.9
Map of U.S.-Affiliated Pacific Islands
by TB Case Rates,* 2014
*Cases per 100,000
Federated
States of
Micronesia
Marshall
Islands
Northern
Mariana Islands
American
Samoa
Guam
Palau
TB Case Rates,* U.S.-Affiliated Pacific Islands,
2014
*Cases per 100,000
212.7
156.1
44.7
34.8
66.1
1.8
9.6
3.0
0 50 100 150 200 250
Marshall Islands
Federated States of Micronesia
Northern Mariana Islands
Guam
Palau
American Samoa
Hawaii
United States overall
Comparative Incidence − U.S. and WA
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TB Case Rates* by Age Group United States, 1993–2014
* Updated as of June 5, 2015.
Cas
es p
er 1
00,0
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0.0
5.0
10.0
15.0
20.0
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93
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20
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20
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20
14
0 - 14 15 -24 25 - 44 45 - 64 ≥65
Crude Incidence by Select Age Groups − WA1
1 Age calculated in years from DOB to date of case report (2008 and before), and to date
of TB diagnosis (2009 and after). Date of TB diagnosis defined as earliest collection among
positive clinical specimen(s) supporting final case verification – else report date if verified as
provider diagnosed.
Trends in TB Cases in Foreign-born Persons, United States, 1993 – 2014*
*Updated as of June 5, 2015.
No. of Cases Percentage
0%
10%
20%
30%
40%
50%
60%
70%
0
1000
2000
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8000
9000
Number of Cases Percent of Total Cases
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TB Case Rates in U.S.-born vs. Foreign-born Persons, United States, 1993 – 2014*
*Updated as of June 5, 2015.
Cas
es p
er 1
00,0
00
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
U.S. Overall U.S. -born Foreign-born
Proportional Disease Burden by Origin − WA1
1 U.S. territories include: American Samoa, Fed. States of Micronesia, Guam, Marshall
Islands, Midway Island, Northern Mariana Islands, Puerto Rico, Palau, U.S. Virgin Islands,
and U.S. Minor and Outlying Pacific Islands.
TB Case Rates by Age Group and Race/Ethnicity,* United States, 2014
*All races are non-Hispanic. Multiple Race indicates two or more races reported for a person. Does not include persons of Hispanic or Latino origin.
Cas
es p
er 1
00
,00
0
0
5
10
15
20
25
30
35
40
45
50
Under 5 5 - 14 15 - 24 24 -44 45 - 65 ≥65
Hispanic or Latino
American Indian or Alaska Native Asian
Black or African American Native Hawaiian or Other Pacific Islander White
Multiple Race
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Countries of Birth of Foreign-born Persons Reported with TB, United States, 2014
Mexico (21%)
Philippines (12%)
India (8%)
Vietnam (8%)
China (7%)
Guatemala (3%)
Haiti (3%)
Other Countries 39%
Proportional Disease Burden by Race/Ethnicity − WA1
1 AIAN: American Indian or Alaskan Native.
NHOPI: Native Hawaiian or Other Pacific Islander.
Crude Incidence by Race/Ethnicity − WA1
1 AIAN: American Indian or Alaskan Native.
NHOPI: Native Hawaiian or Other Pacific Islander.
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Years from Arrival to TB Diagnosis − WA Cases with Origins Outside U.S. Proper, 2009-20141,2
1 Countries of origin outside continental U.S. 2 Date of TB diagnosis defined as earliest collection among positive clinical specimen(s)
supporting final case verification – else report date if verified as provider diagnosed.
Select Medical Risk Factors − WA Cases, 2009-20141,2
1 Medical risks recorded at diagnosis, as documented or reported by provider. 2 Immunosuppressing conditions include: TNF alpha-antagonist therapy, post-organ
transplantation, end-stage renal disease, and other immunosuppression.
Number of MDR-TB Cases estimated among notified pulmonary TB cases 2013
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MDR-TB Treatment Outcomes, 2007-11
Primary Anti-TB Drug Resistance, United States, 1993 – 2014*
*Updated as of June 5, 2015.
Note: 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.
% R
esis
tan
t
0
5
10
Isoniazid MDR-TB
Primary MDR TB, United States, 1993 – 2014*
*Updated as of June 5, 2015.
Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.
No. of Cases Percentage
0%
1%
2%
3%
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400
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No. of Cases Percentage
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XDR TB Case Count Defined on Initial DST* by Year, 1993 – 2014**
* Drug susceptibility test. ** Updated as of June 5, 2015. Note: Extensively drug-resistant TB (XDR TB) is defined as resistance to isoniazid and rifampin, plus resistance to any fluoroquinolone and at least one of three injectable second-line anti-TB drugs.
Cas
e C
ou
nt
Year of Diagnosis
0
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4
6
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10
12
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Select Classes of Drug-resistance − Annual Case Counts and Period Totals − WA1
1 1st-line poly-resistant: Isolate resistance to two or more 1st-line drugs (not MDR).
MDR: Isolate resistance to Isoniazid and Rifampin.
Pre-XDR: Isolate resistance to Isoniazid, Rifampin, and 2nd-line injectable agent
OR a fluoroquinolone.
Treatment Start Within 7 Days of Sputum Smear (+) Specimen Collection
NTIP: National TB Indicators Project.
Eligible cases: Alive at diagnosis, AFB smear (+) on sputum.
Excludes: Treatment start > 14 days prior to specimen collection date;
Specimen collection date is < 7 days from date of data analyses.
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Sputum Culture Conversion within 60 Days of Treatment Start
Eligible cases: Patients alive at diagnosis, with (+) initial sputum culture;
initiating treatment with >=1 TB drug.
Excludes: Patients dying or moving out of U.S. within 60 days of treatment start;
Tx start < 120 days prior to date of data export for analyses with conversion disposition
pending; Converted specimen collection date precedes Tx start date.
Treatment Completion Within 12 Months
Eligible cases: Patients alive at diagnosis; initiating treatment with >=1 TB drug.
Excludes: Rifampin resistance; Meningeal site; <=14 y.o. with disseminated disease; Death
or move out of U.S. within 12 mo. of treatment start; Tx start < 366 days prior to date of data
export for analyses with disposition pending; Tx stop date prior to Tx start date; “Not TB.”
How Do We Compare?
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How Do We Compare?
How Do We Compare?
Immigrant and Refugee Follow-up − Process Outcomes by Year of Arrival1
1 Records evaluated include all persons entering the U.S. under an immigrant, refugee, or asylee visa, assigned a TB classification of B1 or B2 as per 1991 or 2007 Technical Instructions.