tb in north dakota: changing demographics john r. baird, md, mph fargo cass public health north...
TRANSCRIPT
TB in North Dakota:Changing Demographics
John R. Baird, MD, MPHFargo Cass Public Health
North Dakota Department of Health
April 11, 2012
Objectives
Shift of US TB cases to foreign born
Change in ND TB demographics
Challenges in TB evaluation and treatment in new ethnic groups
Module 1 – Transmission and Pathogenesis of Tuberculosis
• M. tuberculosis causes most TB cases in U.S.
• Mycobacteria that cause TB:– M. tuberculosis – M. bovis– M. africanum– M. microti– M. canetti
• Mycobacteria that do not cause TB– e.g., M. avium complex
M. tuberculosis
Types of Mycobacteria
Module 1 – Transmission and Pathogenesis of Tuberculosis
Sites of TB Disease
Bacilli may reach any part of the body, but common sites include:
Brain
Lym ph node
Pleura
Lung
SpineKidney
Bone
Larynx
Module 2 – Epidemiology of Tuberculosis
• TB is one of the leading causes of death due to infectious disease in the world
• Almost 2 billion people are infected with M. tuberculosis
• Each year about:
– 9 million people develop TB disease
– 2 million people die of TB
Global Epidemiology of TB
Reported TB Cases United States, 1982–2010*
*Updated as of July 21, 2011
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
5,000
10,000
15,000
20,000
25,000
30,000
No.
of
Case
s
Year
TB Case Rates,* United States, 2010
*Cases per 100,000.
< 3.6 (2010 national average)
>3.6
D.C.
TB cases in ND - Numbers
TB cases in ND - Rates
TB rates – US vs. ND
TB Case Rates* by Age Group United States, 1993–2010
* Updated as of July 21, 2011
1993
1995
1997
1999
2001
2003
2005
2007
2009
0.0
5.0
10.0
15.0
20.0
0- 14 15 - 24 25 - 44 45-65
Case
s p
er
10
0,0
00
Age Group (years)
TB cases in ND - Age
TB cases in ND - Sex
Reported TB Cases by Race/Ethnicity*United States, 2010
*All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.
Hispanic or Latino(30%)
Native Hawaiian or Other Pacific Is-
lander(1%)
White(16%)
Asian(28%)
American Indian or Alaska Native
(1%)
Black or African American
(24%)
TB cases in ND - Race
Number of TB Cases inU.S.-born vs. Foreign-born Persons
United States, 1993–2010*
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
5,000
10,000
15,000
20,000
U.S.-born Foreign-born
*Updated as of July 21, 2011
No. of
Case
s
>50%25%–49%<25%
2000 2010
DC
*Updated as of July 21, 2011
Percentage of TB Cases Among Foreign-born Persons, United States*
DC
TB cases in ND US vs. Foreign Born
Countries of Birth of Foreign-born Persons Reported with TB, United
States, 2010
Mexico(23%)
Philippines(11%)
India(9%)
Vietnam(8%)
China(5%)
Guatemala(3%)
Haiti(3%)
Other Countries38%
TB cases in ND - Origin Foreign Born 2007 - 2011
Africa – Somalia (5), Ethiopia (2), Kenya (2), Sudan, ZambiaSouth Asia – Bhutan (4), Nepal (2), IndiaAsia – China, Mongolia, KoreaSE Asia – Vietnam, Philippines
Refugee Arrivals North Dakota
LSS of ND
Resettlement Cities North Dakota
Countries of Origin - Refugees to ND
Maps adapted from The Perry-Castañeda Library Map Collection, The University of Texas at Austin http://www.lib.utexas.edu/maps
Latent TB Infection (LTBI)
LTBI is the presence of M. tuberculosis organisms (tubercle bacilli) without symptoms or radiographic evidence of TB disease.
25
Latent TB Infection
TST* or QFT† positive
Negative chest radiograph
No symptoms or physical findings suggestive of TB disease
Pulmonary TB Disease TST or QFT usually
positive
Chest radiograph may be abnormal
Symptoms may include one or more of the following: fever, cough, night sweats, weight loss, fatigue, hemoptysis, decreased appetite
Respiratory specimens may be smear or culture positive
*tuberculin skin test†QFT (QuantiFERON-TB and QuantiFERON-Gold) is a blood test to detect M. tuberculosis infection.
LTBI vs. Pulmonary TB Disease
Cases in ND – LTBI & TB
Challenges Language Culture Proper & prompt evaluation Care coordination Complete LTBI treatment Homeless Others?
TBNet http://www.migrantclinician.org
Case #1 4 month old – adopted from Africa Birth mother HIV+ Baby HIV neg @ 6 mo Staph skin and proctitis on US entry BCG given in Africa – no TST done is US Hospitalized at 11 mo
sore ankle, limp, temp 101-103 refused to bear weight 3 days Splinted for possible fracture
Case #1 (cont.) TST 16 mm – QuantiFERON neg Dx – abcess left distal tibia,
staph, ? TB Rx – IV Rocephen, Vacomycin,
Septra DOT – INH, RIF, EMB, PZA Daycare concerns Culture – PZA resistant – Bovine TB
http://www.heartlandntbc.org/casestudies/cs9.pdf
Case PresentationJune 2008 – Adherence Difficulties in a Child with Tuberculosis
Case History: A 15 month old child with active pulmonary tuberculosis became a significant management challenge to his public health nursing providers because of his consistent refusal to take medications.
Consultation may be requested through your state's TB Control Program or by contacting Heartland National TB Center directly at our toll-free number:
1-800-TEX-LUNG (1-800-839-5864)
Consultation line staffed Mon — Fri, from 8:00 AM until 5:00 PM, Central Time http://www.heartlandntbc.org
Questions Craig Steffens, MPH [email protected]
TB Controller, NDDoH 701.328.2377 http://www.ndhealth.gov/disease/tb
John R. Baird, MD, MPH [email protected] Field Med Officer, NDDoH Health Officer, FCPH 701.241.8118
http://www.heartlandntbc.org http://www.migrantclinician.org http://www.cdc.gov/tb