Colorado Department of Public Health and Environment Tuberculosis Prevention and Control Program.

Colorado Department of Public Health and Environment

Tuberculosis Prevention and Control Program

History of TB

On March 24th, 1882, Dr. Robert Koch announced the discovery of

Myco-bacterium tuberculosis

This discovery was the most important step taken toward the elimination of TB.

World TB Day

March 24th

The 22 Countries listed account for

80% of the TB Cases in the World

Global TB

One-third of the world's population, is currently infected with TB

over 90% in developing countries

More than 8.4 million people become sick with active TB each year About 2 million people die each year from TBTB is the leading infectious killer among people living with HIV/AIDS

Figure 1. TB in Colorado: 1999-2008Cases of Active TB by Year of Report

88

104

97

111

101

138

127

111

103

124

50

70

90

110

130

150

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

# o

f c

as

es

TB in Colorado: 2001-2008TB Incidence Rates by Nativity

0.0

5.0

10.0

15.0

20.0

25.0

2001 2002 2003 2004 2005 2006 2007 2008

Ca

se

s p

er

10

0,0

00

po

pu

lati

on

Foreign-born case rate U.S.-born case rate

Patient country of origin

Country # of cases Country # of casesAfghanistan 1 Laos 1Bhutan 2 Liberia 1Burma 2 Madagascar 1Cambodia 1 Mexico 22China 2 Mongolia 1Cuba 1 Morocco 1El Salvador 2 Nepal 3Eritrea 1 Peru 2Ethiopia 4 Phillipines 3Honduras 1 Rwanda 1Hungary 1 Somalia 5India 5 U.S. 30Kenya 1 Vietnam 7

Korea 1 Total 103

TB in Colorado: 2008Cases by Race/Ethnicity (n=103)

White15%

Black19%

Multiple0%

Hispanic34%

Amer Ind/AK native

3%

Asian29%

TB in Colorado: 2008Case rates (per 100,000) by race/ethnicity

Race/ethnicity # cases Pop est. Rate

White 15 3,506,772 0.4

Black 20 187,959 10.6

Hispanic 35 997,062 3.5

Asian/Pacific Islander 30 125,778 23.8

Amer Ind/AK native 3 36,957 8.1

Multiple race 0 79,888 0.0

TOTAL 103 4,934,416 2.0

2007

CDPHE TB Program receives funds from

Centers for Disease Control and PreventionState General FundsPublic Health and Human Services Block Grant

CDC funding formula

Incident cases – 30%U.S.-born minorities and foreign-born persons – 35%Persons co-infected with HIV – 5%Persons with MDR TB – 5%Substance abusers – 5%Homeless – 5%Persons with smear or culture positive pulmonary TB – 15%

The Role of Public Health in TB Prevention and Control

Role of public health

Public health structureCounties receive funding from CDPHE to provide TB services

Active TB diseaseEvaluation of Class B TB Immigrants and Refugees Contact investigationsTreatment for latent TB infection (in partnership with private providers)

Local health agencies

Denver Public Health has a TB clinic that serves 7 metro counties

70-80% of cases

Outlying counties work directly with the private providers to assure appropriate diagnosis, treatment, monitoring, and follow-up of active and latent TBProvide DOTPerform contact investigations

CDPHE TB Program

Provide consultation and technical assistance

active diseaselatent diseasecontact investigationsoutbreaks

Conducts case management oversight of active TB cases in outlying counties

CDPHE Funding Formula for Local Health Departments

Average number of cases (5 years)Number of TB suspects started on treatmentNumber of patients started on LTBI treatment

TB Program Funding Formula

2004

2005

2006

2007

2008

5 yr avg 5 yr x 25

suspect(4 drug

tx started)

suspect x10 LTBI TX

5 yr x 25 plus other % of total % x total $ Total adj 07-08 diff

County A 13 6 17 14 15 13 325 5 50 111 - -$ County B 0 1 0 0 0 0.2 5 1 10 3 18 0.4% 4,160 4,200 -$ 4,200$ County C 18 17 22 17 14 17.6 440 5 50 196 - -$ County D 0 0 0 0 0 0 0 0 0 - -$ County E 0 0 0 1 0 0.2 5 0 0 5 0.1% 1,155 -$

0 0 0 0 0 0 0 0 0 0.0% - -$ 2 3 7 5 7 4.8 120 4 40 8 - -$ 0 1 0 0 0 0.2 5 0 1 - -$ 0 0 0 0 0 0 0 0 4 4 0.1% 924 -$ -$ 0 0 1 0 2 0.6 15 0 0 15 0.3% 3,466 3,600 -$ 3,600$ 0 0 0 0 0 0 0 0 0 0 0.0% - -$ 1 0 0 0 0 0.2 5 0 0 5 0.1% 1,155 -$ -$ 0 0 0 1 0 0.2 5 1 10 2 17 0.4% 3,928 4,200 4,200$

47 42 40 37 24 38 950 10 100 389 - -$ 0 0 0 0 0 0 0 0 0 0 0.0% - -$ 3 0 1 2 3 1.8 45 0 16 - -$ 0 1 0 1 0.5 12.5 0 15 27.5 0.6% 6,355 6,400 4,000$ 2,400$ 9 9 10 7 10 9 225 2 20 77 322 7.3% 74,410 82,500 70,000$ 12,500$ 0 0 0 0 0 0 0 0 0 0.0% - -$ 0 1 0 1 0 0.4 10 1 10 7 27 0.6% 6,239 6,400 3,000$ 3,400$ 0 0 2 2 1 1 25 2 20 24 69 1.6% 15,945 16,000 4,500$ 11,500$ 2 1 2 0 1.25 31.25 0 1 32.25 0.7% 7,453 7,500 7,500$

CDPHE TB Contracts

CDPHE currently contracts with 20 local health departmentsContract period July 1, 2009 through June 30, 2010Contracts include the ability to charge for DOT and Diagnostic testing (xrays).

TB resources

CDC Division of TB Elimination web sitehttp://www.cdc.gov/nchstp/tb/default.htmInteractive Core Curriculum on Tuberculosis: What the Clinician Should KnowSelf Study Modules on Tuberculosis

CDPHE TB Program web sitehttp://www.cdphe.state.co.us/dc/TB/tbhome.html

CDPHE TB Program – 303.692.2638