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PREVENTING RELAPSE

Jan 15, 2016

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PREVENTING RELAPSE. Lee B. Reichman, MD, MPH Northeast TB Controllers Meeting October 24, 2006 Princeton, New Jersey. Reported TB Cases United States, 1982 – 2005. No. of Cases. 1982. 1987. 1991. 1995. 1999. 2005. Year. Trends in Tuberculosis – United States, 2005. - PowerPoint PPT Presentation

  • PREVENTING RELAPSELee B. Reichman, MD, MPHNortheast TB Controllers MeetingOctober 24, 2006Princeton, New Jersey

  • Reported TB Cases United States, 19822005Year198219871991199519992005No. of Cases

  • Trends in Tuberculosis United States, 2005 Deceleration of the decline in the overall national TB rate, the persistent disparities in TB rates between U.S.-born and foreign-born persons and between whites and racial/ethnic minorities, and the increase in MDR TB cases all threaten progress toward the goal of TB elimination in the United StatesEffective TB control and prevention in the United States require sufficient resources, continued collaborative measures with other countries to reduce TB globally, and interventions targeted to U.S. populations with the highest TB rates

  • The U-Shaped Curve of Concern

  • Tuberculosis: No Longer a Problem?CDC TB Related News Items Weekly Update6 month sample: October 1, 2003 - March 31, 2004117 articles from 33 states on all aspects of TB 76 reports of TB outbreaks: (almost 1 every 2-3 days)Schools and colleges38Prisons8Hospital/Nursing Home7Workplace16Homeless7- J. Seggerson, NCET WIRE, April 2004

  • Federal News Radio

  • CNN

  • NBC 4

  • Results

  • TB Onboard

  • XDRTB1539 Patients with Isolates sent544 Culture-Positive for M.Tb35% of total221 Resistant to Isoniazid & Rifampin (MDR TB)40% of M.Tb and 14% of total53 Resistant to all tested drugs (XDR TB)24% of MDR TB, 10% MTB and 3% of total

    -G. Friedland, Int Conf on AIDS, 2006

  • XDRTB PatientsPrior TB Treatment or Hospitalization-G. Friedland, Int Conf on AIDS, 2006

  • XDRTB Mortality52 of 53 (98%) of XDR patients have diedMedian survival from date sputum collected was 16 days (IQR 2-210 days)No significant difference by HIV status, previous or use of ARVs-G. Friedland, Int Conf on AIDS, 2006

  • The New York TimesSeptember 14, 2006

    EDITORIAL: Extreme TuberculosisMore funding is needed to catch up with new, extensivelydrug-resistant strains of tuberculosis.

  • Patient Involvement in Medical Care Patients and their families have become increasingly involvedand influentialin all aspects of medical careIn the mid-eighties, as the first anti-viral drugs for treating AIDS were being developed, activists demanded to participate in the design of clinical trials directed by the National Institutes of Health and pharmaceutical companiesInspired by the activists example, breast cancer patient-advocacy groups made similar requestsThe AIDS groups interrupted meetings and staged die-ins at the N.I.H.Eventually, the physicians in charge of planning the clinical trials agreed to their demandsLaypeople now routinely sit on committees on the N.I.H. and on hospitals institutional review boards, which assess the ethicality and scientific merit of clinical trials

  • The Patients Charter for Tuberculosis Care

  • The Patients Charter for Tuberculosis Care Initiated and developed by patients from around the worldOutlines rights and responsibilities of people with tuberculosis Sets out the ways in which patients, the community, health providers (both private and public), and governments can work as partners in a positive and open relationship Practices principle of Greater Involvement of People with TuberculosisAffirms that empowerment is catalyst for effective collaboration with health providers and authorities

  • Patients RightsYou have the right to:Care; Dignity; Information; Choice; Confidence; Justice; Organization; Security

  • Patients ResponsibilitiesYou have the responsibility to:Share information;Follow treatment;Contribute to Community HealthShow Solidarity

  • Deaths Due To: TB (annually)2 - 3,000,000 SARS813 Angola Marburg Hemorrhagic Fever 329 Avian Influenza144 Anthrax5 Mad Cow Disease1 (Cow) Smallpox0

  • Reichmans Prediction The continued rise of the TB in the world and the leveling off of tuberculosis in the US portends a significant global resurgence of TB followed by a frightening resurgence of MDRTB still diagnosed and treated with old toolsThe resurgence will continue unabated followed by subsequent transmission to healthcare workers and through that vector to the community at largeSubsequent global re-establishment of control of tuberculosis will then entail more staggering costs, both in cash and hysteria than has ever been contemplatedNew drugs and New Diagnostics and an effective vaccine will enhance the TB communitys success in turning this around which once again will depend on energizing others to make our case

  • INFORMATION LINE18004TBDOCS (482-3627)www.umdnj.edu/globaltb

    Slide 2. Reported TB Cases, United States, 19822004. The resurgence of TB in the mid-1980s was marked by several years of increasing case counts until its peak in 1992. From 1992 until 2002, the total number of TB cases decreased 5%7% annually, and 2004 marked the twelfth year of decline in the total number of TB cases reported in the United States since the peak of the resurgence. From 2002 to 2003, however, the total number of TB cases decreased by only 1.4%, the smallest annual decrease during the past decade. In 2004, a total of 14,517 cases were reported from the 50 states and the District of Columbia. This represents a decline of 2.3% from 2003 and of 46% from 1992. (Note: A provisional total of 14,511 was reported in the MMWR in March 2005.)