the epidemiology of tuberculosis · 2019-12-18 · addressing tb in our communities november 19,...

Addressing TB in Our Communities November 19, 2015 Curry International Tuberculosis Center

The Epidemiology of Tuberculosis 1

The Epidemiology of Tuberculosis

Scott Lindquist MD MPH

Washington State Communicable Disease Epidemiologist

333

Estimated TB Global Incidence 2014



Reported TB Cases United States, 1982–2014*

*Updated as of June 5, 2015.

0

5,000

10,000

15,000

20,000

25,000

30,000

No

. of

Cas

es

Year

Year No. Rate*

2009 11,523 3.8

2010 11,161 3.6

2011 10,510 3.4

2012 9,941 3.2

2013 9,565 3.0

2014 9,421 3.0

*Cases per 100,000. Updated as of June 5, 2015.

TB Morbidity United States, 2009–2014

TB Case Rates,* United States, 2014

*Cases per 100,000.

< 3.0 (2014 national average)

>3.0

D.C.



≥50 10–49.9 ≤9.9

Map of U.S.-Affiliated Pacific Islands

by TB Case Rates,* 2014

*Cases per 100,000

Federated

States of

Micronesia

Marshall

Islands

Northern

Mariana Islands

American

Samoa

Guam

Palau

TB Case Rates,* U.S.-Affiliated Pacific Islands,

2014

*Cases per 100,000

212.7

156.1

44.7

34.8

66.1

1.8

9.6

3.0

0 50 100 150 200 250

Marshall Islands

Federated States of Micronesia

Northern Mariana Islands

Guam

Palau

American Samoa

Hawaii

United States overall

Comparative Incidence − U.S. and WA



TB Case Rates* by Age Group United States, 1993–2014

* Updated as of June 5, 2015.

Cas

es p

er 1

00,0

00

0.0

5.0

10.0

15.0

20.0

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

0 - 14 15 -24 25 - 44 45 - 64 ≥65

Crude Incidence by Select Age Groups − WA1

1 Age calculated in years from DOB to date of case report (2008 and before), and to date

of TB diagnosis (2009 and after). Date of TB diagnosis defined as earliest collection among

positive clinical specimen(s) supporting final case verification – else report date if verified as

provider diagnosed.

Trends in TB Cases in Foreign-born Persons, United States, 1993 – 2014*


No. of Cases Percentage

0%

10%

20%

30%

40%

50%

60%

70%

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Number of Cases Percent of Total Cases



TB Case Rates in U.S.-born vs. Foreign-born Persons, United States, 1993 – 2014*


Cas

es p

er 1

00,0

00

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

U.S. Overall U.S. -born Foreign-born

Proportional Disease Burden by Origin − WA1

1 U.S. territories include: American Samoa, Fed. States of Micronesia, Guam, Marshall

Islands, Midway Island, Northern Mariana Islands, Puerto Rico, Palau, U.S. Virgin Islands,

and U.S. Minor and Outlying Pacific Islands.

TB Case Rates by Age Group and Race/Ethnicity,* United States, 2014

*All races are non-Hispanic. Multiple Race indicates two or more races reported for a person. Does not include persons of Hispanic or Latino origin.

Cas

es p

er 1

00

,00

0

0

5

10

15

20

25

30

35

40

45

50

Under 5 5 - 14 15 - 24 24 -44 45 - 65 ≥65

Hispanic or Latino

American Indian or Alaska Native Asian

Black or African American Native Hawaiian or Other Pacific Islander White

Multiple Race



Countries of Birth of Foreign-born Persons Reported with TB, United States, 2014

Mexico (21%)

Philippines (12%)

India (8%)

Vietnam (8%)

China (7%)

Guatemala (3%)

Haiti (3%)

Other Countries 39%

Proportional Disease Burden by Race/Ethnicity − WA1

1 AIAN: American Indian or Alaskan Native.

NHOPI: Native Hawaiian or Other Pacific Islander.

Crude Incidence by Race/Ethnicity − WA1

1 AIAN: American Indian or Alaskan Native.

NHOPI: Native Hawaiian or Other Pacific Islander.



Years from Arrival to TB Diagnosis − WA Cases with Origins Outside U.S. Proper, 2009-20141,2

1 Countries of origin outside continental U.S. 2 Date of TB diagnosis defined as earliest collection among positive clinical specimen(s)

supporting final case verification – else report date if verified as provider diagnosed.

Select Medical Risk Factors − WA Cases, 2009-20141,2

1 Medical risks recorded at diagnosis, as documented or reported by provider. 2 Immunosuppressing conditions include: TNF alpha-antagonist therapy, post-organ

transplantation, end-stage renal disease, and other immunosuppression.

Number of MDR-TB Cases estimated among notified pulmonary TB cases 2013



MDR-TB Treatment Outcomes, 2007-11

Primary Anti-TB Drug Resistance, United States, 1993 – 2014*


Note: Based on initial isolates from persons with no prior history of TB. Multidrug resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin.

% R

esis

tan

t

0

5

10

Isoniazid MDR-TB

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.


0%

1%

2%

3%

0

100

200

300

400

500




XDR TB Case Count Defined on Initial DST* by Year, 1993 – 2014**

* Drug susceptibility test. ** Updated as of June 5, 2015. Note: Extensively drug-resistant TB (XDR TB) is defined as resistance to isoniazid and rifampin, plus resistance to any fluoroquinolone and at least one of three injectable second-line anti-TB drugs.

Cas

e C

ou

nt

Year of Diagnosis

0

2

4

6

8

10

12

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Select Classes of Drug-resistance − Annual Case Counts and Period Totals − WA1

1 1st-line poly-resistant: Isolate resistance to two or more 1st-line drugs (not MDR).

MDR: Isolate resistance to Isoniazid and Rifampin.

Pre-XDR: Isolate resistance to Isoniazid, Rifampin, and 2nd-line injectable agent

OR a fluoroquinolone.

Treatment Start Within 7 Days of Sputum Smear (+) Specimen Collection

NTIP: National TB Indicators Project.

Eligible cases: Alive at diagnosis, AFB smear (+) on sputum.

Excludes: Treatment start > 14 days prior to specimen collection date;

Specimen collection date is < 7 days from date of data analyses.



Sputum Culture Conversion within 60 Days of Treatment Start

Eligible cases: Patients alive at diagnosis, with (+) initial sputum culture;

initiating treatment with >=1 TB drug.

Excludes: Patients dying or moving out of U.S. within 60 days of treatment start;

Tx start < 120 days prior to date of data export for analyses with conversion disposition

pending; Converted specimen collection date precedes Tx start date.

Treatment Completion Within 12 Months

Eligible cases: Patients alive at diagnosis; initiating treatment with >=1 TB drug.

Excludes: Rifampin resistance; Meningeal site; <=14 y.o. with disseminated disease; Death

or move out of U.S. within 12 mo. of treatment start; Tx start < 366 days prior to date of data

export for analyses with disposition pending; Tx stop date prior to Tx start date; “Not TB.”

How Do We Compare?



How Do We Compare?

How Do We Compare?

Immigrant and Refugee Follow-up − Process Outcomes by Year of Arrival1

1 Records evaluated include all persons entering the U.S. under an immigrant, refugee, or asylee visa, assigned a TB classification of B1 or B2 as per 1991 or 2007 Technical Instructions.

the epidemiology of tuberculosis · 2019-12-18 · addressing tb in our communities november 19,...

Documents