Tuberculosis Surveillance and Disease Intersections in California Jennifer Flood, M.D., M.P.H. Chief, Surveillance and Epidemiology Section Tuberculosis Control Branch Division of Communicable Disease Control Center for Infectious Diseases California Department of Public Health October 15, 2008
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Tuberculosis Surveillance and Disease Intersections in California Jennifer Flood, M.D., M.P.H. Chief, Surveillance and Epidemiology Section Tuberculosis.
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Tuberculosis Surveillance and Disease Intersections
in California
Jennifer Flood, M.D., M.P.H.Chief, Surveillance and Epidemiology Section
Tuberculosis Control BranchDivision of Communicable Disease Control
Center for Infectious DiseasesCalifornia Department of Public Health
October 15, 2008
Outline
• TB surveillance
• Disease intersections (HIV/TB)
• Opportunities for collaboration
Global– Every second, a new person becomes
infected with TB – TB is curable but kills 5000 people every
day– TB is the number 1 killer of AIDS patients– 2 billion people , 1/3 of world’s population,
infected with TB– MDR/XDR TB growing
Why is TB important?
Span of TB Control Activities
2727 Californians with Tuberculosis
Over 10,000 Suspect Cases
20,000 – 30,000 Contacts
3 million Californians infected
35 million Californians who breathe
Purpose of surveillance
• Quantifies disease magnitude and changes in disease over time
• Identifies disease characteristics
• Provides roadmap for TB control efforts
Data Sources
• TB Case Report (RVCT)• Contact evaluation reports• B-notification Registry• MDR/XDR surveillance• Outbreak reports• Universal genotyping database• TB Death Investigations
How are TB cases reported?
• Providers and laboratories submit confidential morbidity reports (CMR) to local health dept
• Health department conducts patient interview– provides direct TB case management – or private provider oversight – through 6-24 month treatment
TB Reporting from LHD to TBCB
•at initial diagnosis •at time of susceptibility results •at treatment completion
***********•report form with >200 fields• extensive instructions and instructions
Features of TB Case ReportDemographic Country of origin; date of US entry, visa
status
Risk factors Homeless, incarceration, IVDU HCW, HIV, other co-morbidities
Clinical Disease site, infectious, CXR
Laboratory Drug resistance, genotype
Provider type Public, private
Treatment Regimen, doses, DOT, duration
Outcome Death, death related to TB, moved-destination, lost, rx completed, relapse
Slowing Rate of TB Case Decline California, 1992-2007
Nu
mb
er o
f T
ub
ercu
losi
s C
ases
Year
-5.9% per year (1992-2000) -2.8% per year
(2000-2006)
2,500
3,000
3,500
4,000
4,500
5,000
5,500
6,000
-1.9% per year(2006-2007)
0
500
1,000
1,500
2,000
2,500
3,000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
40
50
60
70
80
U.S.-born Foreign-born Percent Foreign-born
Tuberculosis Cases in Foreign-born and U.S.-born Persons: California, 1998-2007
Nu
mb
er o
f C
ases
Per
cen
t o
f C
ases
TB Disparities: US-born vs. Foreign-born, California, 2007
TB cases Case rate
US-born 588 2.2
Foreign-born 2109 21.1*
*Annual case rate decline has been slower for foreign-born than US-born
Adverse Events
• Pediatric cases
• Drug resistance
• Outbreaks
Deaths in Persons with Tuberculosis: California, 1996-2005
0
100
200
300
400
500
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
0
2
4
6
8
10
12
Per
cen
t o
f C
ases
Nu
mb
er o
f D
eath
s
Dead at Diagnosis
Died During Treatment Died Before Starting Treatment