1 / 33

Epidemiology of Tuberculosis in Northeastern United States, 1993-2005

Northeast TB Controllers Meeting Princeton, New Jersey October 24, 2006. Epidemiology of Tuberculosis in Northeastern United States, 1993-2005. Kenneth G. Castro, M.D. Assistant Surgeon General, USPHS Director, Division of Tuberculosis Elimination

kipp
Download Presentation

Epidemiology of Tuberculosis in Northeastern United States, 1993-2005

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Northeast TB Controllers Meeting Princeton, New Jersey October 24, 2006 Epidemiology of Tuberculosis in Northeastern United States, 1993-2005 Kenneth G. Castro, M.D. Assistant Surgeon General, USPHS Director, Division of Tuberculosis Elimination National Center for HIV, Hepatitis, STD, and TB Prevention* Coordinating Center for Infectious Diseases * Proposed

  2. Acknowledgements • United States TB controllers, state and local health departments • CDC, DTBE, SEOIB and FSEB • Lori Armstrong − Sandy Althomsons • Elvin Magee − Val Robison • Tom Navin − Dave Crowder • Dan Ruggiero − John Jereb • Mark Lobato − Margaret Oxtoby • Edwin Rodriguez − Tracy Agerton • Farah Parvez − Sonal Munsiff • Vernard Green − Tom Privett • Zach Taylor

  3. TB Cases Analyzed • National TB Surveillance System • Reported 1993 to 2005 • Northeastern States: Maine, New Hampshire, Vermont, Connecticut, Massachusetts, Rhode Island, New York, New Jersey • Compared to all other states in the U.S.

  4. TB Case Rates,* United States, 2005 NE states D.C. < 3.5 (year 2000 target) 3.6–4.8 > 4.8 (national average) *Cases per 100,000.

  5. Reported TB Case Rates in U.S.,NE vs. Other States, 1993-2005 Rate TB Cases/ 100,000 Year

  6. Reported TB Cases by Age Group, NE States vs. Others, 1993–2005 Percent of Case Count

  7. Reported TB Cases by Race/Ethnicity,*NE States vs. Others, 1993–2005 Amer Indian/Nat Alaskan (<1%) Amer Indian/Nat Alaskan (1%) Nat Hawaiian/Pacific (<1%) White (18%) Asian (20%) Asian (19%) White (25%) Nat Hawaiian/Pacific (<1%) Hispanic (25%) Black (36%) Black (31%) Hispanic (23%) Other States NE States *All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases. Unknown not included.

  8. Reported TB Cases by Birth Origin,NE States vs. Others, U.S., 1993–2005* Note: Unknown not included

  9. TB Cases, by Previous Diagnosis, NE States vs. Others, U.S., 1993–2005* Note: Unknown and missing not included *Updated as of March 29, 2006.

  10. HIV Test Results of TB Cases,NE States vs. Others, U.S., 1993–2005*

  11. Mode of Treatment Administration in Persons Reported with TB,NE States vs. Others, U.S., 1993–2003* * Excludes unknown and missing. Directly observed therapy (DOT); Self-administered therapy (SA)

  12. Percent Completion of TB Therapy,* NE States vs. Others, U.S., 1993-2005 Percent Year *Healthy People 2010 target: 90% completed in 1 yr or less.Note: Excludes persons with initial isolate resistant to rifampin and children <15 years old with meningeal, bone or joint, or miliary disease excluded.

  13. Reason Therapy Stopped in TB Cases, NE States vs. Others, U.S., 1993–2005* Percent

  14. MDR TB* in NE States vs. Others,U.S., 1993-2005 % MDR TB Year of Reporting %MDR TB cases = no. of TB cases with Mycobacterium tuberculosis isolates resistant to isoniazid and rifampin, among all cases tested to isoniazid and rifampin

  15. MDR TB by Birth Origin, NE States vs. Others, U.S., 1993-2005

  16. TB Epidemiology Summary in NE States* • Heterogeneous states (high, medium, low incidence) • Consistently higher rates • Majority (58.6%) younger than 44 years • Most (82%) racial/ethnic minorities • Lower proportion (49.2%) U.S.-born • Higher prevalence (19.2%) HIV infection • Larger proportion on DOT+SA and SA only treatment • COT improving (82%), room for improvement • MDR decreased 1993-2000, recent stagnation * Compared with other states, U.S., 1993-2005

  17. Second-Line Drug Classes for MDR TB Treatment Aminoglycosides Amikacin, Kanamycin Polypeptides Capreomycin Fluoroquinolones Ciprofloxacin, Ofloxacin First line drugs + Thioamides Ethionamide, Prothionamide Serine analogues Cycloserine PAS WHO. Guidelines for the programmatic management of drug-resistant tuberculosis. 2006.

  18. Characteristics of KZN XDRTB Patients Characteristics No. (%) • No prior TB Treatment 26 (51) • Prior TB treatment • Cure or Completed treatment 14 (28) • Treatment Default or Failure 7 (14) • HIV-infected (44 tested) 44 (100) • Dead (Includes 34% on ARV) 52 (98) • Identical M. tb spoligotype 26/30 * Moll A, Gandhi NR, Pawinski R, Lalloo U, Sturm AW, Zeller K, Andrews J, Friedland G. HIV associated Extensively Drug-Resistant TB (XDR-TB) in Rural KwaZulu-Natal (South Africa MRC Expert Consultation Sept 8, 2006)

  19. HIV-related MDR TB Outbreak Investigations by CDC & Health Departments, USA, 1988–92

  20. U.S. Response to TB Resurgence Updated Diagnostic Labs, Real-time Drug Resistance, & Strain Fingerprinting National MDR-TB Action Plan & New Resources Improved Case Identification & Training Rebuilt Research Capacity DOT & Improved Rx Completion Updated Infection Control and Rx Recommendations AJRCCM 1994;149:1359-74

  21. Global 7-point Action Plan to Combat XDR TBEmphasizes Essentials of Proper TB Control • Conduct rapid surveys of XDR-TB (determine burden) • Enhance laboratory capacity (emphasis on rapid DST) • Improve technical capacity of clinical and public health practitioners to effectively respond to XDR-TB outbreaks and manage patients • Implement infection control precautions (PLHA focus) • Increase research support for anti-TB drug development • Increase research support for rapid diagnostic test development • Promote universal access to ARVs under joint TB/HIV activities MRC Consultation, Johannesburg, South Africa. Sept 7, 2006

  22. Revised WHO Case Definition for XDR TB (Oct 10, 2006) Goals • Public health surveillance • Reliable DST methodology • Clinical relevance • Relatively simple Resistance to at least isoniazid and rifampin (MDR) plus resistance to fluoroquinolones and one of the second-line injectable drugs (amikacin, kanamycin, or capreomycin)

  23. TB Treatment Outcomes, by Selected Drug Resistance Patterns, Latvia, 2000-2003* Percent * Leimane V, et al. WHO XDR TB Task Force Meeting. Oct 9, 2006(from N = 820 evaluated)

  24. XDR(WHO) TB Cases in U.S.,Northeast vs. Other States, 1993-2005 No. XDR TB Cases Year of Report

  25. XDR(WHO) TB Cases in U.S.,Foreign-born vs. U.S.-born, 1993-2005 No. XDR TB Cases Year of Report

  26. XDR(WHO) TB Cases in Northeast States, Foreign-born vs. U.S.-born,1993-2005 No. XDR TB Cases Year of Report

  27. XDR(WHO) TB Cases in Other States, Foreign-born vs. U.S.-born,1993-2005 No. XDR TB Cases Year of Report

  28. XDR(WHO) TB Cases in U.S.-born vs. Foreign-born Persons, 1993-2005

  29. TB Clinical Development Pipeline Diarylquinoline TMC207 Nitroimidazo-oxazole OPC-67683 Nitroimidazole PA-824 Pyrrole LL-3858 *Institut de Recherche pour le Developement World Health Organization, Tropical Disease Research Centers for Disease Control and Prevention Novel compounds, highlighted in blue boxes, are active against MDR/XDR TB

  30. Examples of Rapid Drug Resistance Methods

  31. Microscopic-Observation Drug Susceptibility Assay for the Diagnosis of TB* Moore DAJ, et al. N Engl J Med 2006;355:1539-50

  32. Actual and BRDPI-Adjusted Federal Funds for TB*, CDC, 1990-2006 Actual $ BRDPI Adjusted * Adjusted to 1990 US$ by Biomedical Research & Development Price Index ** Includes TB/HIV and lab dollars

More Related