Wisconsin TB Program Update
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1 Wisconsin TB Program Update Pa Vang, RN, MSN Philip Wegner, RN, MPH Wisconsin TB Program WMLN Conference November
2 Disclosure None 2
3 Objectives To describe US TB epidemiology To describe Wisconsin TB epidemiology To discuss ongoing activities of the Wisconsin TB Program 3
4 The Global Burden of TB, 2014 Estimated number of cases Estimated number of deaths All forms of TB 9.6 million 1.5 million (16%)* HIV-associated TB 1.2 million (12%) 390,000 (33%) Multidrug-resistant TB 480,000 (5%) 190,000 (40%) Source: WHO Global Tuberculosis Report 2015 * Including deaths attributed to HIV/TB
5 World Map as proportion of where TB cases are found
6 Estimated TB incidence rates, 2014
7 U.S. TB statistics 7
8 No. of Cases Wisconsin Department of Health Services Reported TB Cases 30,000 United States, * 25,000 20,000 15,000 10,000 5,000 0 *Updated as of June 5, CDC. Year
9 U.S. TB EPIDEMIOLOGY TB Case Rates,* United States, 2014 D.C. < 3.0 (2014 national average) >3.0 *Cases per 100,000.
10 Cases per 100,000 Wisconsin Department of Health Services TB Case Rates by Race/Ethnicity,* United States, ** *All races are non-hispanic. **Updated as of June 5, CDC. American Indian or Alaska Native Black or African-American White Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino
11 No. of Cases Wisconsin Department of Health Services 20,000 Number of TB Cases in U.S.-born vs. Foreign-born Persons, United States, * 15,000 10,000 5,000 0 U.S.-born Foreign-born *Updated as of June 5, CDC.
12 Wisconsin Department of Health Services Primary MDR TB, United States, * No. of Cases Percentage 3% 2% 1% 0 0% No. of Cases Percentage *Updated as of June 5, CDC. Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.
13 WISCONSIN TB STATISTICS 13
14 No. of Cases Rate per 100,000 Wisconsin Department of Health Services 1200 TB Cases & Rates for Wisconsin, Cases 1983 Incidence Declining rates of TB in Wisconsin from 29.2 in 1953 to 0.83 in = 1,024 cases (29.2/100,000) 1965 = 560 cases (13.5/100,000) 1975 = 265 cases (5.8/100,000) 1995 = 117 cases (2.3/100,000) 2004 = 95 cases (1.7/100,000) 2012 = 71 cases (1.2/100,000) 2013 = 50 cases (0.87/100,000) 2014 = 48 cases (0.83/100,000) 14
15 Rate Per 100,000 Wisconsin Department of Health Services TB Case Rates per 100,000 Population WI US Year 15
16 No. of Cases Wisconsin Department of Health Services TB Disease Wisconsin WI 16
17 17
18
19 30 TB Case Characteristics Wisconsin Homeless Alcohol Drugs Jail LTC
20 : % of all Age (avg.) TB Case Characteristics Wisconsin Sex (%) M/F Race (%) W B WH A AI LTC / Jail / Drugs / Alcohol / MKE % Other % Died % USB % FB % Homeless / M=male, F=female W=White, B=Black, WH=White Hispanic, A= Asian, AI= American Indian MKE= Milwaukee USB- U.S. Born, FB= Foreign-Born LTCF= Long Term Care 20
21 Number of Cases Wisconsin Department of Health Services 60 Number of TB Cases in U.S.-Born vs. Foreign-Born Persons Wisconsin, US-Born Foreign-Born Year 21
22 TB Cases in Wisconsin by Place of Birth, U.S. or Foreign Born Count Percent of Total U.S.-Born % Foreign-Born % Total % 22
23 18 16 Immigration Status at First Entry to U.S. TB Case, Employment Family/Fiance Immigrant Refugee Student Tourist
24 The Two Most Common Factors Associated with TB Disease in Wisconsin are Foreign-born And/or Known contact with someone with active TB disease 24
25
26 rate/100,000 Wisconsin Department of Health Services 6 Wisconsin Rate of TB in US-Born by Race White Black Asian Latino/Hisp Am Indian Rate for Foreign-born in Wisconsin is 15.2/100,000
27 Number of TB cases in US-Born by race White Black Asian Latino/Hisp Am Indian
28 Milwaukee Washington Ozaukee Winnebago Calumet Trempealeau Kewaunee Wisconsin Department of Health Services MDR-TB in Wisconsin Douglas Bayfield Iron Burnett Polk St. Croix Pierce 3-Counties with >3 MDR-TB 3-Counties with 2-3 MDR-TB Barron Washburn Dunn Pepin Buffalo 4-Counties with 1 MDR-TB case Counties with no MDR-TB Rusk Sawyer Chippewa Eau Claire LaCrosse Vernon Crawford Ashland Jackson Taylor Clark Monroe Grant Price Richland Wood Juneau Iowa Vilas Oneida Lincoln Marathon Sauk Adams Portage Waushara Marquette Green Lake Columbia Dane Langlade LaFayette Green Rock Shawano Waupaca Forest Menominee Fond du Lac Dodge Jefferson Florence Outagamie Walworth Oconto Marinette Waukesha Sheboygan Racine Brown Manitowoc Kenosha Door 28
29 2014 Data Total cases = 48 Pulmonary = 60% (29) Extra-pulmonary = 23% (11) Both pulmonary & extra-pulmonary = 17% (8) Children <18 yo = 0% Avg. age = yrs. Foreign-born = 69% (33) U.S.-born = 31% (15) MDR-TB cases = 6% (3) 29
30 2015 Data (as of November 3rd) Total cases = 57 Pulmonary only = 63% (36) Extra-pulmonary = 30% (17) Both Pulmonary & Extra-pulmonary = 7% (4) Children = 0% Foreign-born = 74% (42) U.S.-born = 29% (15) MDR-TB cases = 5% (3) Deaths = 11% (6) 30
31 Milwaukee Washington Ozaukee Winnebago Calumet Trempealeau Kewaunee Wisconsin Department of Health Services 2015 TB Cases by Region Douglas Bayfield 1 Iron Washburn Ashland Vilas Burnett Polk Barron Rusk Saywer Price Lincoln Oneida Forest Florence Marinette Northern Region Western Region Northeastern Region Southeastern Region Southern Region St. Croix Dunn Pierce Pepin Buffalo *Preliminary as of November 1, WI TB Program. Chippewa Eau Claire 2 1 LaCrosse 1 Vernon Crawford Jackson Taylor Clark Monroe Grant Richland Wood Juneau Iowa Marathon Sauk 1 Adams Portage Waushara Marquette Green Lake Dane Langlade Columbia LaFayette Green Rock 7 1 Shawano Waupaca Menominee 3 Dodge Jefferson Oconto 2 Outagamie 2 Fond du Lac Walworth 1 1 Waukesha 2 2 Brown Sheboygan Racine Kenosha Manitowoc Door 1 City of Milwaukee 17 Northshore 2 Cudahy 1 Greenfield 1 Franklin 1 West Allis 1
32 Milwaukee Washington Ozaukee Winnebago Calumet Trempealeau Kewaunee Wisconsin Department of Health Services 2015 TB Cases by Region Douglas Bayfield 1 Iron Washburn Ashland Vilas Burnett Polk Barron Rusk Saywer Price Lincoln Oneida Forest Florence Marinette Northern Region Western Region Northeastern Region Southeastern Region Southern Region St. Croix Dunn Pierce Pepin Buffalo *Preliminary as of November 1, WI TB Program. Chippewa Eau Claire 2 1 LaCrosse 1 Vernon Crawford Jackson Taylor Clark Monroe Grant Richland Wood Juneau Iowa Marathon Sauk 1 Adams Portage Waushara Marquette Green Lake Dane Langlade Columbia LaFayette Green Rock 7 1 Shawano Waupaca Menominee 3 Dodge Jefferson Oconto 2 Outagamie 2 Fond du Lac Walworth 1 1 Waukesha 2 2 Brown Sheboygan Racine Kenosha Manitowoc Door 1 City of Milwaukee 17 Northshore 2 Cudahy 1 Greenfield 1 Franklin 1 West Allis 1
33
34 WI TB PROGRAM 34
35 WI TB Program Staff WELCOME! Traci DeSalvo, Program Director
36 WI TB Program Staff Philip Wegner, RN, MPH, Nurse Consultant Pa Vang RN, MSN, Nurse Consultant
37 WI TB Program Staff Savitri Tsering, Refugee Health Coordinator Chris W. & Maggie N. TB/Refugee Health Office Assistant 37
38 WI TB Program Staff Jo Mercurio, TB Program Office Assistant Stephanie Marburger, TB Program Office Assistant
39 Collaborations for Change Co-Presented at the 2015 NTCA Conference 39
40 Collaborations for Change Monthly meetings between WTBP & WSLH to discuss any current issues and TB case updates. Distributed CDC Core Curriculum on TB: What the Clinician Should Know and NTCA TB Nursing manuals to the Northeastern Region local health departments 40
41 Medication News 41
42 Medication News
43 Ongoing Activities WI TB Program website: 43
44 Ongoing Activities WI TB Program website: 44
45 Ongoing Activities WI TB Prevention Coalition 45
46 Ongoing Activities Improved instructions for WEDSS WEDSS Sharepoint site: 46
47 Take On TB!
48 Thank you! Questions? 48
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