TB Epidemiology 2017 vh aa revienid... · Tuberculosis Epidemiology 3 TB Epidemiology United States 5 Reported Tuberculosis Cases United States, 1982–2015* No. of Cases *Cases per

Tuberculosis Epidemiology 1

Tuberculosis EpidemiologyTB CL IN ICAL INTENS IVE COURSE

Curry Internat ional Tuberculos is Center

October 18, 2017

Varsha Hampole, MPH

Tuberculos is Control Branch

Cal i fornia Department Of Publ ic Health

Outline

TB epidemiology

• Global burden

• United States California

Summary of surveillance data

Demographic characteristics

Clinical characteristics

• Summary


Estimated Global TB Burden, 2015

• 10.4 million incident cases; 1.2 million HIV positive

• 142 cases per 100,000

• 1.8 million deaths • 400,000 deaths among HIV+

• 480,000 developed MDR

WHO, Global Tuberculosis Control 2016

4

WHO, Global Tuberculosis Control 2016


TB Epidemiology United States

5

Reported Tuberculosis Cases United States, 1982–2015*

No. of Cases

*Cases per 100,000 population; as of June 9, 2016.

Division of Tuberculosis Elimination, CDC


TB Morbidity

United States, 2010–2015

*Cases per 100,000; as of June 9, 2016


*Cases per 100,000 population; as of June 9, 2016.

TB Case Rates,* United States, 2015



Which populations in the U.S. developed TB?

Reported TB Cases by Age Group, United States, 2015*

*As of June 9, 2016.



TB Case Rates by Age Group and Sex, United States, 2015*

Cases per 100,000 Population

Age Group (Years)


Reported TB Cases by Race/Ethnicity,*United States, 2015

*All races are non‐Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin. Unknown race consisted of 0.3% and is not shown.

† As of June 9, 2016.



Number of TB Cases AmongU.S.‐born vs. Non‐U.S.‐born Persons,

United States, 1993–2015*No. o

f Cases



TB Case Rates in U.S.‐born vs. Non‐U.S.‐born Persons, United States,1993 – 2015*

Cas

es p

er 1

00,0

00


Cases per 100,000 Population



Countries of Birth of Non‐U.S.‐born Persons Reported with TB, United States, 2015*



What is the prevalence of TB drug resistance in U.S.?

16


Primary Anti‐TB Drug Resistance,United States, 1993 – 2015*

% R

esis

tant

*As of June 9, 2016.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.

Resistan

t (%

)


Primary MDR‐TB,United States, 1993 – 2015*

%R

esis

tant

*As of June 9, 2016.Note: Based on initial isolates from persons with no prior history of TB; multidrug resistant TB (MDR‐TB) defined as resistance to at least isoniazid and rifampin.

No. o

f cases P

erce

ntage



Primary MDR TB Among U.S.‐born vs. Non‐U.S.‐born Persons

United States, 1993 – 2015*% Resistan

t

*As of June 9, 2016.Note: Based on initial isolates from persons with no prior history of TB; multidrug resistant TB (MDR‐TB) defined as resistance to at least isoniazid and rifampin.


TB Epidemiology California


Number of Tuberculosis Cases: California, 1988‐2016

California Department of Public Health, Tuberculosis Control Branch

2,062

Number of Tuberculosis Cases and Case Rates: California, 2006‐2016

Cas

e R

ate

per

100

,000



Tuberculosis in California, 2016

<= 2.9 (national average)

>= 5.2 (state average)

3.0‐ 5.1

< 5 cases


CA Epidemiology Reflects Global Epidemiology


Tuberculosis Cases by Country of Origin: California, 2016*

U.S.-born463 (21.6%)

Foreign-born1,670

(77.8%)

Unknown14 ( 0.7%)

Philippines355 (21.3%)

Mexico450 (26.9%)All Others

404 (24.2%)

Vietnam205 (12.3%)


China160 (9.6%)

India96 (5.7%)

Tuberculosis Cases by Race/Ethnicity: California, 2016

Asian/Pacific Islander1,081 (50.3%)

Hispanic776 (36.1%)

Black118 (5.5%)

American Indian/Alaska Native4 (0.2%)

White Non-Hispanic165 (7.7%)


7

Asian/Pacific Islander(53.2%)

Hispanic(34.3%)

Black(5.2%)

American Indian/Alaska Native (0.2%)

White, Non‐Hispanic(7.1%)


TB Case Rates by Race/Ethnicity: California, 2007 ‐ 2016


Tuberculosis Cases by HIV/AIDS Diagnosis: California, 2011‐2016

Nu

mb

er o

f C

ases

wit

h H

IV/A

IDS



Nu

mb

er o

f M

DR

Tu

ber

culo

sis

Cas

es

*Cases with resistance to at least isoniazid and rifampin reported on the Initial Drug Susceptibility Report (Follow‐up 1) or on the Case Completion Report (Follow‐up 2)


34

4136 37

2832 33

25

36

16

Tuberculosis Cases with Multidrug Resistance (MDR)*: California, 2005‐2016

Deaths in Persons with Tuberculosis: California, 2005‐2014

Per

cen

t o

f C

ases

Nu

mb

ero

f D

eath

s



What are the implications for public health practice?

Continued vigilance, surveillance, and active prevention measures are needed to reach the TB elimination. To continue making strides toward elimination, alignment of domestic TB control activities with international TB control initiatives is needed to address increasing disparities between U.S.‐born and foreign‐born persons. Treatment of persons at high risk with latent Mycobacterium tuberculosis infection is also needed to address this disparity.

‐ CDC MMWR 2015; 64(10); 265‐269

The Challenges of Latent TB Infection• Preventing TB disease by detecting and treating those

with latent TB infection (LTBI) is a cornerstone of the U.S. strategy for TB elimination.

• TB infection is not currently reportable.

• It is estimated that more than 2 million Californians have latent TB infection (~13 million people in the U.S.)

• If not treated, persons with TB infection have a 5‐10% lifetime risk of developing TB disease.



Plan to Eliminate TB

• California Tuberculosis Elimination Plan

– TB Free California

• California TB risk assessment


Summary

Case count• ~ Over 9,000 new cases of TB per year in the U.S.• ~ ¼ of cases in the U.S. occur in California

Disease incident rate• Declining, but the pace of decline has slowed since ~2000• California’s TB incidence rate nearly twice that of the U.S.

Certain groups disproportionately affected• Men (e.g., among 45+ years)• Persons born outside the U.S.• Race/ethnicity disparities

TB Deaths• ~9‐10% of TB case patients die in California

Summary

HIV• ~6% of TB cases in the U.S. and 4% of cases in CA are HIV positive

Drug Resistance• Multidrug resistance in 1‐2% of TB cases

• Isoniazid and multidrug resistance are higher among non‐U.S.‐born than among U.S. born

LTBI• An estimated 13 million people in the U.S. (2.4 million in CA)

have LTBI

• Prioritizing TB screening for groups with elevated LTBI prevalence and medical risk of progression from LTBI to TB may help prevent future TB cases


References• Centers for Disease Control and Prevention. Reported

Tuberculosis in the United States, 2016. Atlanta, GA: U.S. Department of Health and Human Services, CDC

• Tuberculosis Control Branch. Report on Tuberculosis in California, 2017. Richmond, CA: California Department of Public Health

• World Health Organization. Global Tuberculosis Report, 2016. Geneva, Switzerland

TB Epidemiology 2017 vh aa revienid... · Tuberculosis Epidemiology 3 TB Epidemiology United States 5 Reported Tuberculosis Cases United States, 1982–2015* No. of Cases *Cases per

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