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TB Update Current Statistics What’s new in the program

TB Update Current Statistics What’s new in the program. WMLN October, 2013 Lorna Will RN, MA Wisconsin Division of Public Health. CDC National Data. Tuberculosis Disease Wisconsin 2001 - 2012. TB Rates/100,000 (using 2012 data). Wisconsin as a whole: 1.2 Milwaukee County:

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TB Update Current Statistics What’s new in the program

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  1. TB UpdateCurrent StatisticsWhat’s new in the program WMLN October, 2013 Lorna Will RN, MA Wisconsin Division of Public Health

  2. CDC National Data

  3. Tuberculosis DiseaseWisconsin 2001 - 2012

  4. TB Rates/100,000(using 2012 data) Wisconsin as a whole: 1.2 Milwaukee County: 40 cases/955,205 = 4.2 City of Milwaukee: 25 cases/597,867 = 4.2 Dane County: 13 cases/503,523 = 2.6

  5. CDC National Data

  6. WI TB Cases by Race 2012 N=71

  7. CDC National Data

  8. Estimated TB Case Rates by RaceWisconsin 2012 • White: 1.2 • Black: 3.8 • Asian: 25.2

  9. CDC National Data

  10. CDC National Data

  11. CDC National Data

  12. CDC National Data

  13. CDC National Data

  14. Reported Tuberculosis Casesby National Origin Wisconsin, 2006-2012 Number of Cases Year

  15. CDC National Data

  16. Drug-Resistance in WI 20 MDR-TB Cases (2005-2012) • All in foreign-born persons coming from: • Laos (60%) Hmong population • India (20%) • Nepal, China, Burma, Ethiopia (5% each) • Average age is 46 years • Hmong average age is 52 years • India average age is 25 years • All others average age is 17 years

  17. Summary • TB is still a disease of minorities • TB is largely a disease of foreign-born

  18. What’s Next or New? • New drug for MDR TB • Bedaquilin released for general use in April 2013 • Good interim data on 12 week treatment for TB infection • Thousands of patients have used it across the US • CDC collecting data in post-marketing study • At least 200 have used it in WI; data being collected

  19. What’s Next or New? • Trials ongoing for TB vaccines • Continued shortages of tuberculin solution, TB medications • Data collection site soon at tbcontrollers.org • Information on price increases and shortages are shared with FDA and DOJ

  20. WI TB Program Initiatives • New TB Program Manager Jo Mercurio: medication orders and bills, dispensary payments • New initiative on Hmong health and TB: led by Pa Vang and Sheboygan County • Issue of antibiotics for purchase at Hmong markets • Issue of clinician awareness of patient risk factors

  21. 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Patient A: Timeline Aug:Started to cough Oct 23: Diagnosed with pneumonia Dec 4: Diagnosed with pneumonia Dec 20: Treated for reflux Jan 4: CXR interpreted as no active disease Feb 22: Diagnosed with asthma Apr 3: Went to clinic for depression, provider ordered CXR, cavitary lesions April 16: Diagnosed with TB

  22. WI TB Program Initiatives • “TB Toolkit” under development; materials for local health departments to share with clinicians; to be rolled out November 2013 • MDR TB review led by Philip Wegner • Full epidemiology of each case since 2005 • Testing at Milwaukee County Jail • Just began • Testing of other high risk populations • Farm workers

  23. WI TB Program Initiatives • Continue emphasis on risk-based testing • Work with DQA to ensure that facilities are not censored for doing risk-based testing • Education plans: TB Summits across the state • NE Region: November 12, 2013 • Southern Region: April, 2014 • SE Region: week of March 24, 2014 • Still to be scheduled: Northern and Western regions

  24. WI TB Program Initiatives • Medication coverage changes • Using 340b federal program to cut costs • Will start paying for B6 and multivitamin with at least RDA for Vitamin D • New prescription forms • Separate forms for TB infection and TB disease • Easier to read, includes risk factors for infection and disease progression

  25. WI TB Program Initiatives • Collaboration with Preparedness Program on regional readiness for outbreak of infectious respiratory illness • Just beginning…

  26. Questions?

  27. Contact Information Wisconsin TB Program staff Lorna Will RN, MA, Program Director 608-261-6319 lorna.will@wi.gov Philip Wegner RN, MPH, Nurse Consultant 608-266-3729 philip.wegner@wi.gov Pa Vang RN, MPH, Nurse Consultant 608-266-9452 pa.vang@wi.gov Savitri Tsering, Refugee Health Coordinator 608-267-3733 savitri.tsering@wi.gov Norma Denbrook, Interjurisdictional Coordinator 608-261-6388 norma.denbrook@wi.gov Jo Mercurio, TB Program Manager 608-266-9692 joann.mercurio@wi.gov

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