Washington State Department of HealthWashington State Department of HealthApril 14, 2010April 14, 2010

Washington State Cohort ReviewWashington State Cohort Review 2009 trends & 12009 trends & 1stst quarter quarter

Annual TB Case RatesAnnual TB Case Rates

Highlights of 2009 trendsHighlights of 2009 trends•12.3% increase in number of TB cases in 2009: 12.3% increase in number of TB cases in 2009:

228 to 256228 to 256•TB case rate: increased from 3.5 in 2008 to TB case rate: increased from 3.5 in 2008 to

3.8 in 2009(per 100,000 individuals)3.8 in 2009(per 100,000 individuals)•Also in 2009: Also in 2009:

– Started data management in PHIMSStarted data management in PHIMS– All time low TB case rate reported in WA in All time low TB case rate reported in WA in

20082008

2009 TB Case Rates by 2009 TB Case Rates by CountyCounty•Largest increase: Clark Co. (1.7 to 3.7)Largest increase: Clark Co. (1.7 to 3.7)

•Largest decrease: Yakima Co. (4.7 to Largest decrease: Yakima Co. (4.7 to 2.1)2.1)

•Top 5 case rates:Top 5 case rates:1.1. King: 6.8King: 6.82.2. Pierce: 4.2Pierce: 4.23.3. Snohomish: 4.0Snohomish: 4.04.4. Clark: 3.7Clark: 3.75.5. Thurston 3.2Thurston 3.2

2009 TB Cases by 2009 TB Cases by demographicsdemographics

•By race/ethnicity:By race/ethnicity:– Largest increase in Asians (18.6 to 24.7)Largest increase in Asians (18.6 to 24.7)– Largest decrease in AI/AN (6.3 to 4.2)Largest decrease in AI/AN (6.3 to 4.2)

•78% foreign born (continued trend in 78% foreign born (continued trend in increase)increase)

•Decrease in proportion of pediatric casesDecrease in proportion of pediatric cases•Increase in proportion of 45+ y.o. casesIncrease in proportion of 45+ y.o. cases

Trend in Age (2004 -2009)Trend in Age (2004 -2009)

Trend in Age in Foreign-born Trend in Age in Foreign-born cases (2004 – 2009)cases (2004 – 2009)

Trend in Age in US born Trend in Age in US born cases (2004 – 2009)cases (2004 – 2009)

In progress…In progress…•Further analysis on timeliness!Further analysis on timeliness!

Distribution of 2009 cases Distribution of 2009 cases by Quarter and Countyby Quarter and County

QUARTERQUARTERSS

LocationLocationKing Co.King Co. Outside King Outside King

Co.Co.11st st (n=29)(n=29) 1111 18 (62%)18 (62%)22nd nd (n=60)(n=60) 3737 23 (38%)23 (38%)33rd rd (n=82)(n=82) 3131 51 (62%)51 (62%)44th th (n=85)(n=85) 5151 34 (40%)34 (40%)TOTAL TOTAL (n=256)(n=256)

130130 126 (49%)126 (49%)

Quarter 1 (Jan – Mar) of 2009 Quarter 1 (Jan – Mar) of 2009 Highlights for Outside King co.Highlights for Outside King co.

CASES: Treatment HxCASES: Treatment Hx•TOTAL: 18 casesTOTAL: 18 cases•No pediatric casesNo pediatric cases•100% initiation on tx100% initiation on tx•DOT 83% of all (100% of Sm+ case)DOT 83% of all (100% of Sm+ case)

– 67% total DOT67% total DOT– 17% DOT in combination with self-admn17% DOT in combination with self-admn

•6% HIV testing not offered:6% HIV testing not offered:– 1 Sm-Cul+ case1 Sm-Cul+ case

CASES: Tx completionCASES: Tx completion•83% likely to complete83% likely to complete

– 78% completed78% completed– 6% currently on6% currently on

•17% moved:17% moved:– 1 Sm-Cul+ case1 Sm-Cul+ case– 2 ‘other’ cases2 ‘other’ cases

•0% lost0% lost

Timeliness Timeliness (Median number of days)(Median number of days)

•Start of Meds: Start of Meds: 1 day1 day•Lab sputum collection: Lab sputum collection: 0 (same day)0 (same day)•Culture testing: Culture testing: 20.5 days20.5 days•HCP to LHJ: HCP to LHJ: same daysame day•Lab to LHJ: Lab to LHJ: same daysame day•LHJ to DOH: LHJ to DOH: 1 day1 day•Susceptibility: Susceptibility: 20.5 days20.5 days

•Sm+ date to contact identification: -2.5Sm+ date to contact identification: -2.5

Contacts: Jan – Mar 2009Contacts: Jan – Mar 2009•86 contacts identified for 18 cases86 contacts identified for 18 cases•87% tested87% tested•64% evaluated64% evaluated•17% infected17% infected•0% diseased0% diseased

Contacts: Tx historyContacts: Tx history•8% (1 of 13) of infected didn’t start tx8% (1 of 13) of infected didn’t start tx•20 contacts started treatment:20 contacts started treatment:

– 60% infected60% infected– 40% not infected40% not infected– 55% completed tx55% completed tx– 5% refused tx5% refused tx– 0% lost, died, moved, provider disc.0% lost, died, moved, provider disc.

Thank you!Thank you!