4/15/2014 1 TB Nurse Case Management San Antonio, TX April 1‐3, 2014 TB Epidemiology Jessica Quintero, BAAS Acting Director of Education April 01, 2014 Jessica Quintero, BAAS has the following disclosures to make: • No conflict of interests • No relevant financial relationships with any commercial companies pertaining to this educational activity.
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4/15/2014
1
TB Nurse Case ManagementSan Antonio, TXApril 1‐3, 2014
TB Epidemiology
Jessica Quintero, BAASActing Director of Education
April 01, 2014
Jessica Quintero, BAAS has thefollowing disclosures to make:
• No conflict of interests
• No relevant financial relationships with any commercial companies pertaining to this educational activity.
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Objectives
• Epidemiology of TB in the world
• Epidemiology of TB in the United States
• Epidemiology of TB in the Heartland Region
• Epidemiology of TB in Texas
Global Epidemiology of TB – 2012
• 8.6 Million New TB Cases Worldwide
– 2% Decline rate per year
– 45% decrease since 1990
– On target for 2015 goal of 50% decrease rate.
• 1.3 Million TB Deaths Worldwide
W.H.O. Report - 2013
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Global Epidemiology of TB – 2012
• South‐East Asia
– 29% of World’s TB Cases
– India (26%) & China (12%)
• Africa
– 27% of World’s TB Cases
• Western Pacific
– 19% of World’s TB Cases
W.H.O. Report - 2013
Global Epidemiology of MDR‐TB 2012
• 3.6% and 20.02%
– New TB Cases and previously treated
• 450,000
– New MDR‐TB cases
– More than half
• India
• China
• Russian FederationW.H.O. Report - 2013
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Global Epidemiology of TB‐XDR – 2012
• Reported in 92 Countries
– 9.6% of MDR‐TB have XDR‐TB
W.H.O. Report - 2013
Global Epidemiology of TB – 2012
• TB Incidence Rate
– 1000 per 100,000 (SA & Swaziland)
– 10 per 100,000 (W. Europe & US)
• Mortality Rate
– Decreased by 45% Since 1990
– Achievement of Global Target by 2015
– Fallen in all WHO’s 6 Regions
– Including 22 High Burden Countries
W.H.O. Report – 2013
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Women and Children
• Women
– 2.9 million new cases
– 410, 000 deaths
• Children (<15 Years)
– 530,000 new cases
– 74,000 deaths
W.H.O. Report - 2012
TB Disease Burden – 2008 ‐ 2013
W.H.O. Report – 2013
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Percentage of new TB cases with MDR‐TB
W.H.O. Report - 2013
Countries with at Least One XDR‐TB Case
W.H.O. Report - 2013
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What’s fueling this epidemic?
• Malnutrition & vitamin deficiencies
• Overcrowded living conditions susceptibility
• HIV
• Diabetes
• Smoking
• Indoor air pollution
• Silicosis Lawn and Zumia, Lancet e-pub 3/18/11
What’s fueling this epidemic?
• Alcohol
• End‐stage renal disease
• Malignancy
• Corticosteroid therapy
• TNF alpha inhibitor
• (>risk TNF antibodies vs
soluble TNF receptor)
Lawn and Zumia, Lancet e-pub 3/18/11
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TB & The US
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Reported TB Cases, US, 2012
• Reported Cases
– 9,945
• Case Rate
– 3.2 Cases per 100,000
• Decline Since 2011
– 5.4%
CDC Reported TB in the US - 2013
TB Case Rates, US, 2012
CDC Reported TB in the US - 2013
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• 50% National Cases
– CA., TX., NY., & FL.
– 12 States & DC Increase
• Demographics
– Asians – 30%
– African Americans – 22%
– Hispanics – 28%
– White 16%
Trends of TB, US, 2012
CDC Reported TB in the US - 2013
Worldwide TB and the US
• Foreign Born Persons
– account for the majority of TB cases in the US.
– account for the majority of drug resistance cases in the US.
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• Nonimmigrant Entries
– 159 Million Admissions
• Refugees & Asylees
– 56,000 Admitted
• US Legal Permanent Resident
– 1 Million Awarded
– 0.5 Million Admitted
Office of Immigration Statistics - 2012
Est. Migrants Entering the US, 2011
Est. Migrants Entering the US, 2011
• Illegal Entries
– Unknown
– 2.5 Million
• Attempted Entry
• Apprehensions
• Relocation to Home Country
• Forced Removal
Office of Immigration Statistics - 2012
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• Foreign Born
– 63% of Cases
• Top 5 Countries
– Mexico, the Philippines, India, Viet Nam, & China
Foreign Born Trends of TB 2012
CDC Reported TB in the US - 2013
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TB in the Heartland
TB Cases in the Heartland Region, 2012
1233
4021188
42
22
89
70
Houston, 30
Total: 1944
CDC Reported TB in the US ‐ 2013
149
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TB Cases and Incidence Rates* Texas, 2004-2013
Provisional
1000
1100
1200
1300
1400
1500
1600
1700
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Ca
se
s
0
1
2
3
4
5
6
7
8
Rat
e*
Cases Rates
*Cases per 100,000 population. Population estimates from EHDP VitalNet, current as of 3/21/2014
TB Cases and Incidence Rates* Texas, 2004-2013
Provisional
*Cases per 100,000 population. Population estimates from EHDP VitalNet, current as of 3/21/2014
In 2013 there were 1224 new TB cases in Texas, or 4.5 cases per 100,000
population
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Proportion of TB Cases by Selected Areas in Texas, 2013
Provisional
Travis3%
Harris4%
Border19%
Dallas16%
Bexar6%
Tarrant6%
Houston20%
QUESTIONS?
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