west virginia’s tuberculosis control program hx and epi missiontransmissionrequirements channels...
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West Virginia’sWest Virginia’sTuberculosis Control ProgramTuberculosis Control Program
Hx and EpiHx and EpiMissionMission
TransmissionTransmissionRequirementsRequirements
Channels of CommunicationChannels of Communication
Reported TB CasesUnited States, 1953 - 1998
Year
10,000
20,000
*
*
30,000
50,000
70,000
100,000
Case
s(L
og
Sca
le)
*Change in case definition
53 60 70 80 90 98
Factors Contributing to the Increase in TB Morbidity: 1985-1992
•Deterioration of the TB public health infrastructure
•HIV/AIDS epidemic
•Immigration from countries where TB is common
•Transmission of TB in congregate settings
BackgroundBackground• During 1980--2003, the number of incarcerated persons
in the US increased fourfold, from approximately 500,000 in 1980 to approximately 2 million in 2003.
• In 2003 at midyear, although 0.7% of the total US population was confined in prisons and jails, 3.2% of all TB cases nationwide occurred among residents of correctional facilities.
• For example, the incidence of TB among inmates in New Jersey during 1994 was 91.2 cases per 100,000 inmates, compared with 11.0 cases per 100,000 persons among all New Jersey residents
“Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC” July 7, 2006 / 55(RR09);1-44
Contributing FactorsContributing Factors
• Incarcerated persons are high risk for TB– illicit drug use– low socioeconomic status – HIV infection
• Physical structure of the facilities – close living quarters – might have inadequate ventilation – can be overcrowded
• Movement of inmates into and out of facilities
“Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC” July 7, 2006 / 55(RR09);1-44
Tuberculosis in the WorldTuberculosis in the World
MISSIONMISSION
““to achieve the absence ofto achieve the absence of
indigenous transmission indigenous transmission
of tuberculosis infection in West Virginia,of tuberculosis infection in West Virginia,
which results in clinically apparentwhich results in clinically apparent
tuberculosis disease”tuberculosis disease”
•Promptly identify persons with TB
•Isolate
•Initiate appropriate treatment
•Ensure completion of therapy by DOT
•Identify contacts with latent TB infection
•Treat latent TB infection (LTBI).
To Reduce Risk of TransmissionTo Reduce Risk of Transmission
Transmission and Pathogenesis
Transmission of M. tuberculosis
•Spread by droplet nuclei
•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)
ReportingReporting
WV Code § 16 Article 3D. Tuberculosis Testing, Control, Treatment and
Commitment. [Passed April 9, 2005; in effect from passage.]
WV Code 16-3-1Legislative Rule Title 64 Series 7
Reportable Diseases, Events and Conditions.
ReportingReporting
Report to your Local Health Department
• Active disease or suspects of active disease → within 24 hours [TB-34]
• LTBI (positive tuberculin skin test, in the last 2 years) → within 1 week [TB-101]
WV Tuberculosis Control ProgramWV Tuberculosis Control Program
Dominic Gaziano, MD, Medical Director304-558-3669
Carmen Priddy, BSN, Program [email protected] or 304-558-6417
Carolyn Winkler, RN, Surveillance [email protected] or 304-558-0126
Barbara Simpkins, HHR [email protected] or 304-558-6465
West VirginiaWest Virginia Office of Laboratory ServicesOffice of Laboratory Services
• AFB smears and cultures• MTD Direct rRNA Testing• Drug susceptibility testing• Genotyping• For any culture + for MTB; isolet → OLS
FREE – EFFICIENT – RELIABLEPREFERABLE
RESOURCESRESOURCES
• Centers for Disease Control and Prevention (CDC) http://www.cdc.gov
• New Jersey Medical School Global Tuberculosis Institute
http://www.umdnj.edu/ntbcweb/pr_frame.html or call: 973-972-0979 http://www.umdnj.edu/globaltb/home.htm
• West Virginia Tuberculosis Control Program 304-558-3669 or 800-330-8126 in WV
www.wvtb.org ٭
Recommendations and Reports
July 7, 2006 / 55(RR09);1-44
Prevention and Control of Tuberculosis in Correctional and
Detention Facilities: Recommendations from CDC
Endorsed by the Advisory Council for the Elimination of Tuberculosis, the National Commission on Correctional Health Care, and the American Correctional Association