stop tb in the african-american community summit...

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Tuberculosis

Nickolas DeLuca, PhD

Communications, Education, and Behavioral Studies Branch

Division of Tuberculosis Elimination

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Presentation Outline

– An overview of tuberculosis (TB)

– Epidemiology of TB Globally and in the United States

– Epidemiology of TB the African-American community

– Overview of Division of Tuberculosis Elimination sponsored activities to address TB in the African-American community

– Overview of additional resources to address TB

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Overview of Tuberculosis

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Tuberculosis

• Caused by bacteria Mycobacterium tuberculosis

• Usually attacks the lungs, but can affect any part of

the body

• TB disease can be fatal

• Once the leading cause of death in the United States

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Transmission

The dots in the air

represent droplet

nuclei containing

tubercle bacilli

• When a person with infectious TB disease coughs, sneezes,

speaks, or sings, tiny particles containing M. tuberculosis

(droplet nuclei) may be expelled into the air

• If another person inhales the droplet nuclei, transmission may

occur

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Tuberculosis Transmission

• Expelled when person with infectious TB coughs,

sneezes, speaks, or sings

• Close contacts at highest risk of becoming infected

• Transmission occurs from person with infectious

TB disease (not latent TB infection)

Active TB Disease vs.

Latent TB Infection

Active TB Latent TB Infection

• TB germs in the body

• May be infectious (before

treatment)

• Symptoms of TB (e.g.,

cough)

• An active “case” of TB

• Treatment needed to cure

disease

• TB germs in the body, but

latent (dormant) state

• NOT infectious

• No symptoms

• Not a “case” of TB

• Treatment may be provided

to prevent transition from

TB infection to TB disease

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Symptoms of TB

Productive, prolonged cough

Fever

Chest pain

Hemoptysis

Chills

Night sweats

Weight loss

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Background Epidemiology

Estimated TB incidence rates, 2004

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of

any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

WHO 2005. All rights reserved

0 - 2425 - 4950 - 99100 - 299

No estimate300 or more

Estimated new TB

cases (all forms) per

100 000 population

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Global TB

• One-third of the world’s population is infected

with TB

• Someone in the world is newly infected with TB

bacilli every second

• Each year, 9 million people around the world

become sick with TB

• In 2005, there were 1.6 million TB-related deaths

worldwide from this curable disease

• TB is the leading killer of people who are HIV

infected

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On average an

untreated

person with

infectious TB

infects between

10 and 15 people

each year

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Reported TB Cases*

United States, 1982–2006

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

26,000

28,000

1982 1985 1990 1995 2000 2006

Year

No

. o

f C

ases

*Provisional Data as of March 23, 2007

13,767

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TB Case Rates,* United States, 2005

< 3.5 (year 2000 target)

3.6–4.8

> 4.8 (national average)

D.C.

*Cases per 100,000.

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Number of TB Cases inU.S.-born vs. Foreign-born Persons

United States, 1993–2005*

0

5000

10000

15000

20000

1993 1995 1997 1999 2001 2003 2005

U.S.-born Foreign-born

No

. o

f C

ases

*Updated as of March 29, 2006.

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Trends in TB Cases in Foreign-born

Persons, United States, 1986–2005*

0

2,000

4,000

6,000

8,000

10,000

86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

0

10

20

30

40

50

60

No. of Cases Percentage of Total Cases

No. of Cases Percentage

*Updated as of March 29, 2006.

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Percentage of TB Cases Among Foreign-

born Persons, United States*

>50%

25%–49%

<25%

1995 2005

DC DC

*Updated as of March 29, 2006.

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Countries of Birth of Foreign-born Persons Reported with TB

United States, 2005

Mexico

(25%)

Philippines

(11%)

Viet Nam

(8%)India

(7%)China

(5%)

Haiti

(3%)

Guatemala

(3%)

Other

Countries

(38%)

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Reported TB Cases by Age Group,

United States, 2005

25–44 yrs

(34%)

<15 yrs

(6%)

15–24 yrs

(11%)

45–64 yrs

(29%)

>65 yrs

(20%)

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Reported TB Cases by Race/Ethnicity*

United States, 2005

Hispanic or Latino

(29%) Black or

African-American

(28%)

Asian

(23%)

White

(18%)

American Indian or

Alaska Native (1%)

Native Hawaiian or

Other Pacific Islander (<1%)

*All races are non-Hispanic. Persons reporting two or more races

accounted for less than 1% of all cases.

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Reported TB Cases by Origin and

Race/Ethnicity,* United States, 2005

*All races are non-Hispanic. Persons reporting two or more races accounted for less

than 1% of all cases.

**American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander

accounted for less than 1% of foreign-born cases and are not shown.

U.S.-born Foreign-born**

Native Hawaiian/Other

Pacific Islander (<1%)

White (34%)

Black or African-

American (45%)

Hispanic or

Latino (15%)

Asian (2%)American Indian or

Alaska Native (2%)

Hispanic or

Latino (40%) Asian (40%)

White (6%)

Black or African-

American (14%)

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Primary MDR TB

United States, 1993–2005*

0

100

200

300

400

500

93 94 95 96 97 98 99 00 01 02 03 04 05

0

1

2

3

No. of Cases Percentage

*Updated as of March 29, 2006.

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

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Completion of TB Therapy

United States, 1993–2003*

0

20

40

60

80

100

19931994

19951996

19971998

19992000

20012002

2003

Completed Completed in 1 yr or less

*Updated as of March 29, 2006.

**Healthy People 2010 target: 90% completed in 1 yr or less.

Note: Persons with initial isolate resistant to rifampin and children under 15 years old with

meningeal, bone or joint, or miliary disease excluded.

Perc

en

tag

e **

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TB in the African-American

Community

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TB in African Americans• While overall rates continue to decline in the U.S.,

TB continues to disproportionately affect racial

and ethnic minorities

• In 2005

– 82% of all reported TB cases occurred in racial

and ethnic minorities

– 45% of TB cases reported in U.S.-born persons

were among African Americans

– The TB case rate for U.S.-born blacks

(8.9/100,000) is more than 8 times higher than

the rate in U.S.-born whites (1.1/100,000)

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Characteristics Among Selected

U.S.-born Persons with TB, 2004

Black* White*

No. cases 2,675 2,209

Male 70% 67%

Median age

(years)

46 57

*Non-Hispanic

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< 99

100–399

> 400

D.C.

TB Cases in U.S.-born Blacks

United States, 2000–2004

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Completion of TB Therapy < 1 year

United States,* 1993–2003

0

20

40

60

80

100

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Black** White**

*Timely completion within 12 months

**U.S.-born non-Hispanic

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TB/HIV Co-infection

• HIV is a significant risk factor for progression from

TB infection to TB disease

• TB disease is an AIDS defining illness

• Knowledge of HIV/TB co-infection is important for

patient management

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HIV Infection Among Reported TB

Cases, 2005

• All TB cases

– Estimated 9% HIV/TB co-infection

– Estimated 31% with unknown HIV status

• TB cases in blacks

– Estimated 18% HIV/TB co-infection

– Estimated 21% with unknown HIV status

*Excludes California data

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TB and HIV• CDC has recommended HIV counseling and

testing of all TB patients since 1989

• In September 2006, CDC released guidelines recommending HIV screening for patients in all health-care settings (including TB clinics) after being notified that testing will be performed unless the patient declines (opt-out screening)

• Knowing the HIV status of TB patients is necessary for optimal patient management for contacts, and persons with LTBI or TB disease

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Addressing TB in the

African-American Community

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Division of Tuberculosis Elimination

Activities to Address TB in the

African-American Community

• Research

• Demonstration Projects

• Education and Training

• Communication

• Partnerships

• Community Mobilization

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Georgia Campaign-- HALT TB

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South Carolina

Campaign

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Chicago Campaign

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Summit Goals

• Raise awareness of the

problem

• Build upon

accomplishments from

the 2003 meeting

• Create links and build

networks to lead to

ongoing strategies to

address the problem

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Summit ParticipantsOver 100 individuals from:

– CDC and TB prevention programs

– Professional organizations• National Medical Association, National

Black Nurses Association

– Academic institutions• Representatives from Historically

Black Colleges and Universities

– Local and national advocacy organizations (civic, faith-based, community-based; fraternities)

• NAACP, Rainbow-Push Coalition

– HHS State and Regional Minority Health Consultants

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Summit Breakout Sessions• Convened groups

based on organizational

type to facilitate

working with peers

• Groups devised

actions based upon

group discussion

– Lists of options

– Restricted to items

that could be

implemented in the

upcoming year

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Categorization of Summit

Action Items

•Education and Awareness

•Networking

•Building Capacity

•System Change

•Publicity

•Political Will

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Education and Awareness

Action Items

• Distributed CDC educational materials

– Exhibits and health fairs

– Professional organization conference packets

– Community based organizations

• Increased distribution of TB Challenge Newsletter

• Established TB in African-American Community Website

• Established TB in African-American Community Electronic Mailing List

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TB Challenge

Newsletter:

Partnering to

Eliminate TB

in African

Americans

Stop TB in the African-American

Community Website

.

http://www.cdc.gov/nchstp/tb/TBinAfricanAmericans/

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Stop TB in the African-American

Community Electronic Mailing List

Subscription Information

To subscribe:

http://www.cdcnpin.org/scripts/listserv/tb_aa.asp

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“The Summit was very beneficial in putting TB on our radar screen and brought about new networking. Before the Summit, we were not doing anything in TB.”

---National Advocacy Group participant

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TB Education Resources

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CDC Division of Tuberculosis

Education Resources

• Source for TB education, communication,

and training materials for:

– Health care professionals

– Patients

– General public

•Website

–www.cdc.gov/tb

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TB RTMCCs

Areas of Coverage

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Focus of TB RTMCC Activities

• To increase human resource development through TB education and training activities

• To increase the capacity for appropriate TB medical evaluation and management

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“Stand-up” Training

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Webinars

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Sample of TB RTMCC Products

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TB RTMCC Newsletters

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The TB Training and Education

Resources Website

Your one-stop site to find and

share TB resources

www.findtbresources.org

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Conclusions

• TB is a significant health threat in the world and the

United States

• TB is a health disparity for the African-American

community

• CDC is undertaking activities to address this health

disparity, but additional commitment, political will,

partners, and resources are needed

• CDC has TB education and training resources

available free of charge

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Acknowledgements

• Dr. Rachel Royce (RTI)

• Dr. Charles Wallace (Texas Department of State Health Services)

• Dr. Ana Lopez-Defede (University of South Carolina)

• Juani Muñoz Sanchez (RTI)

• Shelly Harris (RTI)

• Angela Greene (RTI)

• Tammeka Swinson (RTI)

• Brenda Stone-Wiggins (RTI)

• Dr. Cynthia Woodsong (RTI)

• RTI Office of Communications

• Dr. Kenneth Castro (CDC)

• Jeanne Courval

• Suzanne Marks

• Gail Burns Grant (CDC)

• Dr. Cornelia White (CDC)

• Elvin Magee (CDC)

• Dr. Wanda Walton (CDC)

• Patients and staff from the study sites

• NCHHSTP Office of Health Disparities

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Tuberculosis Transmission