WORLD TB DAY 2021

World TB Day 2021

Congressional Briefing

Philip LoBue, MD, FAACP, FCCP

March 22, 2021

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

WORLD TB DAY 2021

Philip LoBue, MD, FACP, FCCP

Director, Division of Tuberculosis Elimination

March 22, 2021

0

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0

5,000

10,000

15,000

20,000

25,000

30,000

Ca

ses p

er 1

00

,00

0 p

erso

nsTo

tal N

um

be

r o

f T

B c

ase

s

YearNo. of Cases Incidence Rate

*Provisional surveillance data is embargoed until 03/25/2021 at 1:00 PM EDT.

Too Many People Still Suffer from TB Disease TB in the United States, 1993 - 2020*

Unexpected Decline Raises Concerns About Missed or Delayed Diagnoses

Total number of reported TB cases, 2010–2020*

11,076 10,481

9,926 9,548 9,387 9,538 9,251 9,079 9,019 8,909

7,163

-

2,000

4,000

6,000

8,000

10,000

12,000

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Tota

l nu

mb

er

of

TB

ca

ses

Expected number

of cases: ~8,800

Observed number of cases: 7,163


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World TB Day 2021

Congressional Briefing

Philip LoBue, MD, FAACP, FCCP

March 22, 2021

Reach the Hardest-Hit Places and PopulationsUS states with the highest TB burden, 2020*

DC24%

13%

12%

6%


California, Texas, New York and Florida accounted for

approximately

50%of the total TB cases in the

United States in 2020.

U.S. Cannot Limit TB Control Efforts States reporting increase in 2020*

DC

TB incidence rate (per 100,000 persons)

<= 1.0

>1.0 – 2.0

>2.0 – 3.0

>3.0 – 4.0

>4.0

Relative changes

in TB incidence

rates from 2019*Provisional surveillance data is embargoed until 03/25/2021 at 1:00 PM EDT.

Populations Disproportionately Affected by TB Rate* by birth origin and race/ethnicity, 2020**

Non-U.S.–born persons(n=5,075)

U.S.-born persons+

(n=2,027)

*Incidence per 100,000 persons

**Provisional surveillance data is embargoed until 03/25/2021 at 1:00 PM EDT.+A person is considered U.S.-born if eligible for U.S. citizenship at birth, regardless of place of birth.

3%

2%

2%

28%

36%

24%

5%

0% 10% 20% 30% 40% 50%

Native Hawaiian/Pacific Islander

American Indian/Alaska Native

Multiple or unknown

White, non-Hispanic

Hispanic

Black, non-Hispanic

Asian

2%

1%

4%

13%

32%

48%

0%10%20%30%40%50%

<1%

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World TB Day 2021Congressional Briefing

Philip LoBue, MD, FAACP, FCCPMarch 22, 2021

Potential for Developing TB Disease13 million people in the U.S. have LTBI

More Than 80%

of U.S. TB Cases

Result from Longstanding

Untreated LTBI

TB Disease: Only the Tip of the Iceberg

Up to 13 million people in the U.S. have LTBI

7,163 with TB disease in U.S.

Continue to find and treat people with TB disease and their contacts

Expand efforts to find and treat people with latent TB infection (LTBI)

TB Elimination Requires a Dual Approach

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LTBI Testing and Treatment Prevents TB Disease Estimated LTBI prevalence by county*

*Derived from genotyped cases of tuberculosis disease reported to the U.S. National Tuberculosis Surveillance System, 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. Emerg Infect Dis. 2018;24(10):1930-

1933. https://dx.doi.org/10.3201/eid2410.180716

Expanding LTBI Screening, Testing, and Treatment Engagement with Primary Healthcare Providers

Test for latent TB infection as a routine part of primary care for patients at higher risk of TB disease

Encourage healthcare providers to use newer TB blood tests to screen for latent TB infection

Prescribe shorter course regimens for latent TB infection to prevent the development of TB disease

The cost of treating one person with latent TB infection is $500

The average length of treatment is 3 - 4 months

TB Elimination Saves Lives and Money (2019 dollars)Up to

13 millionpeople are living with LTBI

7,163observed TB cases were

reported to CDC in 2020*

The cost of treating one person with*

extensively drug-resistant TB$553,000

Treatment: 32 months

multidrug-resistant TB$178,000

Treatment: 20-26 months

drug-susceptible TB$20,000

Treatment: 6-9 months

*Provisional surveillance data is embargoed until 03/25/2021 at 1:00 PM EDT.**Marks S et al. Treatment Practices, Outcomes, and Costs of Multidrug-resistant and Extensively Drug-resistant Tuberculosis in the United States. Emerg Infect Dis. 2014;20(5); Aslam et al. Number and Cost of Hospitalizations with Principal and Secondary Diagnoses of Tuberculosis, United States. Int J Tuberc Lung Dis. 2018;22(12).

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Domestic TB Elimination

CDC Drives Innovation and Advancements in TB Prevention and Control

Communications, Education & Evaluation

Clinical Research Data Management

Field Services Laboratory Surveillance, Epidemiology, &

Outbreak Investigations

How TB Expertise is Applied to the COVID-19 Response

CDC’s TB Expertise

• Case investigation and contract tracing

• Clinical care and treatment

• Infection control

• Outbreak investigations in institutional and other congregate settings

Division Deployments

• 72% of eligible Division staff have served on the COVID-19 response

• Contributed 10,192 person-days to the response since February 2020

U.S. State, Local, and Territorial

TB Programs Response

• More than 90 percent of staff have deployed to support their jurisdictions’ COVID-19 response

Combating the Global TB Epidemic

Find, Cure, Prevent Sustain

Infection Prevention & Control

Evaluating new TB & MDR-TB treatment

regimens

Enhance TB Case Finding & Surveillance

Optimize TB/HIV Treatment integration

Global TB Preventive Treatment Scale-up

For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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WORLD TB DAY 2021

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