wi tb update - wisconsin's public health and … dunn pepin eau claire buffalo u jackson monroe...

2015 WI TB Update WI TB Program

Wisconsin Department of Health Services

Pa Vang, RN, MSN

Philip Wegner, RN, MPH

Wisconsin TB Program

WMLN Conference

November 2015

Wisconsin TB Program Update

1



Disclosure • None

2



Objectives • To describe US TB epidemiology

• To describe Wisconsin TB epidemiology

• To discuss ongoing activities of the Wisconsin TB Program

3



All forms of TB

HIV-associated TB

Multidrug-resistant TB

Estimated number of cases

Estimated number of deaths

9.6 million 1.5 million (16%)*

1.2 million (12%) 390,000 (33%)

480,000 (5%) 190,000 (40%)

* Including deaths attributed to HIV/TB Source: WHO Global Tuberculosis Report 2015

The Global Burden of TB, 2014



World Map as proportion of where TB cases are found



Estimated TB incidence rates, 2014



U.S. TB statistics

7



Reported TB Cases United States, 1982–2014*

*Updated as of June 5, 2015. CDC.

0

5,000

10,000

15,000

20,000

25,000

30,000

No

. of

Cas

es

Year



TB Case Rates,* United States, 2014

*Cases per 100,000.

< 3.0 (2014 national average)

>3.0

D.C.

U.S. TB EPIDEMIOLOGY


Wisconsin Department of Health Services TB Case Rates by Race/Ethnicity,*

United States, 2003–2014**

*All races are non-Hispanic.

**Updated as of June 5, 2015. CDC.

Cas

es p

er 1

00

,00

0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

American Indian or Alaska Native Asian

Black or African-American Native Hawaiian or Other Pacific Islander

White Hispanic or Latino



Number of TB Cases in U.S.-born vs. Foreign-born Persons, United States, 1993–2014*


No

. of

Cas

es

0

5,000

10,000

15,000

20,000

U.S.-born Foreign-born



Primary MDR TB, United States, 1993 – 2014*


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%

0

100

200

300

400

500

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

No. of Cases Percentage



WISCONSIN TB STATISTICS 13



Declining rates of TB in Wisconsin from 29.2 in 1953 to 0.83 in 2014

1953 = 1,024 cases (29.2/100,000) 1965 = 560 cases (13.5/100,000) 1975 = 265 cases (5.8/100,000) 1995 = 117 cases (2.3/100,000) 2004 = 95 cases (1.7/100,000)

2012 = 71 cases (1.2/100,000) 2013 = 50 cases (0.87/100,000) 2014 = 48 cases (0.83/100,000)

0

5

10

15

20

25

30

35

0

200

400

600

800

1000

1200

1953 1958 1963 1968 1973 1978 1983 1988 1993 1998 2003 2008 2013

Rat

e p

er 1

00

,00

0

TB Cases & Rates for Wisconsin, 1953-2014

Cases Incidence

14

No

. of

Cas

es


Wisconsin Department of Health Services TB Case Rates

per 100,000 Population

0

1

2

3

4

5

6

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

WI

US

15

Rat

e Pe

r 1

00

,00

0

Year


Wisconsin Department of Health Services TB Disease

Wisconsin 2001-2014

0

10

20

30

40

50

60

70

80

90

100

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

WI

16

No

. of

Cas

es



17



0

5

10

15

20

25

30

2006 2007 2008 2009 2010 2011 2012 2013 2014

Homeless

Alcohol

Drugs

Jail

LTC

19

TB Case Characteristics Wisconsin 2006-2014



2006-2014:

M=male, F=female W=White, B=Black, WH=White Hispanic, A= Asian, AI= American Indian MKE= Milwaukee USB- U.S. Born, FB= Foreign-Born LTCF= Long Term Care

% of all Age (avg.)

Sex (%) M/F

Race (%) MKE %

Other %

Died %

USB %

FB %

W B WH A AI

LTC 1.74 71 80/20 70 30 0 0 0 40 60 50 100 0

Jail 1.39 45.1 100/0 13 25 50 13 0 37.5 62.5 12.5 50 50

Drugs 4.7 37.1 85/15 22 22 37 15 4 52 48 3.7 70 30

Alcohol 10.98 46.4 83/17 40 25 19 14 2 51 49 11 71 29

Home-less

3.31 45.1 74/26 26 42 26 5 0 68 32 21 84 16

20

TB Case Characteristics Wisconsin 2006-2014



0

10

20

30

40

50

60

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Nu

mb

er

of

Cas

es

Year

Number of TB Cases in U.S.-Born vs. Foreign-Born Persons Wisconsin, 2005-2014

US-Born

Foreign-Born

21


Wisconsin Department of Health Services TB Cases in Wisconsin

by Place of Birth, 2005-2014

U.S. or Foreign Born Count Percent of Total

U.S.-Born 258 39.75%

Foreign-Born 391 60.25%

Total 649 100%

22



Immigration Status at First Entry to U.S. TB Case, 2010-2014

0

2

4

6

8

10

12

14

16

18

2010 2011 2012 2013 2014

Employment

Family/Fiance

Immigrant

Refugee

Student

Tourist

23



The Two Most Common Factors Associated with TB Disease in Wisconsin are

Foreign-born

And/or

Known contact with someone with

active TB disease

24



0

1

2

3

4

5

6

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

rate

/10

0,0

00

Wisconsin Rate of TB in US-Born by Race 2005-2014

White

Black

Asian

Latino/Hisp

Am Indian

Rate for Foreign-born in Wisconsin is 15.2/100,000



0

2

4

6

8

10

12

14

16

18

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

White

Black

Asian

Latino/Hisp

Am Indian

Number of TB cases in US-Born by race 2005-2014



Douglas Bayfield

Ashland

Sawyer

Washburn

Burnett

Polk

Barron Rusk

Price

Iron

Vilas

Oneida

Lincoln

Taylor Chippewa

St. Croix

Pierce

Dunn

Pepin

Eau Claire

Buffalo

Tre

mpe

alea

u

Jackson

Monroe

Clark

Marathon

Wood

Portage

Juneau

Adams

Sauk

LaCrosse

Vernon

Crawford Richland

Grant

LaFayette Green Rock

Dane

Iowa

Columbia Dodge

Jefferson Waukesha

Walworth

Kenosha

Racine

Oza

ukee

Sheboygan Fond du Lac Green

Lake

Marquette

Waushara

Win

neba

go

Cal

umet

Manitowoc

Kew

aune

e

Brown Outagamie

Waupaca

Shawano

Menom-

inee Oconto

Langlade

Forest Marinette

Florence

Door

Milw

auke

e

Was

hing

ton

Counties with no MDR-TB

4-Counties with 1 MDR-TB case

3-Counties with 2-3 MDR-TB

3-Counties with >3 MDR-TB

MDR-TB in Wisconsin 2005-2014

28



2014 Data • Total cases = 48

• Pulmonary = 60% (29)

• Extra-pulmonary = 23% (11)

• Both pulmonary & extra-pulmonary = 17% (8)

• Children <18 yo = 0%

• Avg. age = 51.25 yrs.

• Foreign-born = 69% (33)

• U.S.-born = 31% (15)

• MDR-TB cases = 6% (3)

29



2015 Data (as of November 3rd) • Total cases = 57

• Pulmonary only = 63% (36)

• Extra-pulmonary = 30% (17)

• Both Pulmonary & Extra-pulmonary = 7% (4)

• Children = 0%

• Foreign-born = 74% (42)

• U.S.-born = 29% (15)

• MDR-TB cases = 5% (3)

• Deaths = 11% (6)

30



Douglas Bayfield

Ashland

Saywer

Washburn

Burnett

Polk

Barron Rusk

Price

Iron

Vilas

Oneida

Lincoln

Taylor

Chippewa St. Croix

Pierce

Dunn

Pepin

Eau Claire

Buffalo

Tre

mpe

alea

u Jackson

Monroe

Clark Marathon

Wood Portage

Juneau

Adams

Sauk

LaCrosse

Vernon

Crawford Richland

Grant


Dane

Iowa

Columbia Dodge

Jefferson Waukesha

Walworth

Kenosha

Racine

Oza

ukee


Lake

Marquette

Waushara

Win

neba

go

Cal

umet

Manitowoc

Kew

aune

e

Brown Outagamie

Waupaca

Shawano

Menominee

Oconto Langlade

Forest Marinette

Florence

Door

Milw

auke

e

Was

hing

ton

Western Region

Northeastern Region

Southeastern Region

Southern Region

Northern Region City of Milwaukee 17

Northshore 2

Cudahy 1

Greenfield 1

Franklin 1

West Allis 1

7

3

1

1

1

2

2

2

2 1

1

1

1

23

3

2

1

1

2015 TB Cases by Region

*Preliminary as of November 1, 2015. WI TB Program.



Douglas Bayfield

Ashland

Saywer

Washburn

Burnett

Polk

Barron Rusk

Price

Iron

Vilas

Oneida

Lincoln

Taylor

Chippewa St. Croix

Pierce

Dunn

Pepin

Eau Claire

Buffalo

Tre

mpe

alea

u Jackson

Monroe

Clark Marathon

Wood Portage

Juneau

Adams

Sauk

LaCrosse

Vernon

Crawford Richland

Grant


Dane

Iowa

Columbia Dodge

Jefferson Waukesha

Walworth

Kenosha

Racine

Oza

ukee


Lake

Marquette

Waushara

Win

neba

go

Cal

umet

Manitowoc

Kew

aune

e

Brown Outagamie

Waupaca

Shawano

Menominee

Oconto Langlade

Forest Marinette

Florence

Door

Milw

auke

e

Was

hing

ton

Western Region

Northeastern Region

Southeastern Region

Southern Region

Northern Region City of Milwaukee 17

Northshore 2

Cudahy 1

Greenfield 1

Franklin 1

West Allis 1

7

3

1

1

1

2

2

2

2 1

1

1

1

23

3

2

1

1

*Preliminary as of November 1, 2015. WI TB Program.

2015 TB Cases by Region



WI TB PROGRAM

34



WI TB Program Staff

WELCOME!

Traci DeSalvo, Program Director

608-261-6387

[email protected]

35

mailto:[email protected]



WI TB Program Staff

Philip Wegner, RN, MPH,

Nurse Consultant

608-266-3729

[email protected]

Pa Vang RN, MSN,

Nurse Consultant

608-266-9452

[email protected]

36





WI TB Program Staff

Savitri Tsering,

Refugee Health Coordinator

608-267-3733

[email protected]

Chris W. & Maggie N.

TB/Refugee Health Office

Assistant

[email protected]

37





WI TB Program Staff

Jo Mercurio,

TB Program Office Assistant

608-266-9692

[email protected]

38

Stephanie Marburger,

TB Program Office Assistant

608-266-7338

[email protected]





Collaborations for Change • Co-Presented at the 2015 NTCA Conference

39



Collaborations for Change • Monthly meetings between WTBP &

WSLH to discuss any current issues and TB

case updates.

• Distributed CDC Core Curriculum on TB:

What the Clinician Should Know and

NTCA TB Nursing manuals to the

Northeastern Region local health

departments

40



Medication News

41

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCIfnw4Pl1sgCFUdLJgodXKYK4g&url=http://www.drugs.com/pro/priftin.html&psig=AFQjCNEHj0PAA3eOEZ-aZRcyGPJIqsUxTQ&ust=1445627711200637

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCLK09s3l1sgCFUlkJgodHUkFkg&url=http://economictimes.indiatimes.com/news/international/business/sanofi-gets-us-approval-for-use-of-priftin-drug-in-latent-tuberculosis/articleshow/45345058.cms&psig=AFQjCNHIYq3jfUkJvu7oekyz3o21AubjDw&ust=1445627867653776



Medication News



Ongoing Activities • WI TB Program website:

https://www.dhs.wisconsin.gov/tb

43





Ongoing Activities • WI TB Program website:

https://www.dhs.wisconsin.gov/tb/data.htm

44





Ongoing Activities • WI TB Prevention Coalition

45



Ongoing Activities • Improved instructions for WEDSS • WEDSS Sharepoint site:

https://share.health.wisconsin.gov/ph/wedss/default.aspx

46






Take On TB!



Thank you!

Questions?

48

wi tb update - wisconsin's public health and … dunn pepin eau claire buffalo u jackson monroe...

Documents