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Tuberculosis Update in Indiana: Increasing Burden and Addressing Risk Factors

This report provides an update on tuberculosis (TB) in Indiana, including reported cases, incidence rates, TB mortality, and risk factors. It highlights the need for improved TB management and prevention strategies.

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Tuberculosis Update in Indiana: Increasing Burden and Addressing Risk Factors

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  1. Tuberculosis Update for Indiana Sang Thao, MPH, TB Epidemiologist TB/Refugee Health Epidemiology Resource Center March 25, 2019

  2. Reported Tuberculosis (TB) Cases and Rates United States, 1993-2017 CDC Reported Tuberculosis in the United States, 2017

  3. Number of Tuberculosis Cases Indiana, 2009-2018

  4. Steuben LaGrange St Joseph Elkhart 16 LaPorte 5 Porter Lake DeKalb Noble 8 Marshall Starke Kosciusko Whitley Allen Fulton Pulaski 8 Jasper Newton Wabash Huntington Miami Cass Wells Adams White Benton Carroll Grant Howard Blackford Jay 8 Tippecanoe Warren Tipton Clinton Delaware Randolph Madison Hamilton Fountain Boone Montgomery Henry Wayne Verm. Hancock Marion Parke Hendricks 38 Putnam Fayette Union Rush Shelby Johnson Morgan Vigo Franklin Clay Owen Decatur Bartholomew Brown Dearborn Monroe Ripley Sullivan Greene Jennings Ohio Jackson Switzerland Lawrence Jefferson Knox Martin Daviess Scott Washington Orange Clark Pike Dubois Floyd Crawford Gibson Harrison Vander Warrick Perry burgh Spencer Posey Indiana TB cases

  5. Steuben LaGrange St Joseph Elkhart LaPorte 46 39 18 Porter Lake DeKalb Noble 14 Marshall 60 Starke Kosciusko 84 8 Whitley Allen Fulton Pulaski Jasper Wabash Huntington Newton Miami Cass Wells Adams White 7 Benton Carroll Grant Blackford Howard 10 26 Jay 11 Tippecanoe Warren Tipton Clinton 9 Delaware 7 Madison Randolph Fountain Hamilton Boone Montgomery 31 5 Henry Wayne Verm. Hancock Marion Parke Hendricks 408 22 Putnam Fayette Union Rush Shelby 14 Johnson Morgan 7 Vigo 20 Franklin Clay Owen Decatur Bartholomew Brown Dearborn Monroe 11 Ripley 18 Sullivan Greene Jennings 14 Ohio Jackson Switzerland Lawrence Jefferson Martin Knox Daviess Scott Washington Orange Clark 19 Pike Dubois Floyd Gibson Crawford 5 14 Harrison 8 Warrick Perry Vander Posey Spencer burgh 17 TB Cases and Incidence Rates 10-year Period of 2009-2018

  6. TB Cases by Site of Disease, Indiana, 2018 • Extrapulmonary sites • Lymphatic • Pleura • Meningeal • Peritoneal • Genitourinary • Ocular

  7. TB Case Rates by Age GroupIndiana, 2014-2018

  8. Number of Pediatric TB Casesby Age Group, Indiana, 2014-2018

  9. TB Cases by Hispanic Ethnicity and Non-Hispanic Race, Indiana, 2018

  10. Number of TB Cases by Place of Birth, Indiana, 2014-2018

  11. Percentage of TB Cases with HIV Comorbidity, Indiana, 2009-2018

  12. Most Common Risk Factors Indiana, 2018

  13. Percentage of TB Cases by Drug Resistance, Indiana, 2014-2018

  14. TB Treatment IndicatorsIndiana, 2017-2018 Colored base on meeting program goal. Red=Not Met. Green=Met.

  15. Number of TB Deaths Indiana, 2014-2018

  16. TB Mortality, Indiana, 2018 • Average age in years • Alive: 42 years • Died from TB: 60 years • Average length of treatment • Alive and completed: 210 days • Died from TB: 18 days

  17. Percentage of Cases by Site of Disease and Mortality Status, Indiana, 2018

  18. Percentage of TB Cases by Hispanic Ethnicity/Non-Hispanic Race and Mortality Status, Indiana, 2018

  19. Percentage of TB Cases by Place of Birth and Mortality Status, Indiana, 2018

  20. GenotypingIndiana, 2018 • 97.7% of culture positive cases were genotyped • 52.4% of genotyped cases were identified as part of a cluster • Six cases were identified and confirmed as part of recent transmission • Three cases were linked to a case with last exposure >3 years

  21. Genotype LineageIndiana, 2018

  22. Contact Investigation, Indiana, 2017 Colored base on meeting program goal. Red=Not Met. Green=Met.

  23. LTBI, Indiana, 2018 Preliminary data • 73/92 counties reported a case of LTBI • 41 of those counties had 5 or more • 2,048 LTBI reported • Marion, Tippecanoe, Allen, Elkhart and St. Joseph reported most LTBI • Marion County accounts for approximately 58% of all reported LTBI cases

  24. Summary • Indiana TB burden increased in 2018 • Second highest incident rate increase nationally • TB mortality has increased over past five years • Proportion of U.S.-born cases increased • This trend matches national data • Continued success in TB treatment and case management indicators • HIV testing • Contact investigations • Completion of treatment

  25. Questions? Sang Thao, MPH TB Epidemiologist sthao@isdh.in.gov 317.233.7841

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