Wisconsin TB Program Update - PDF Free Download

Wisconsin TB Program Update Pa Vang, RN, MSN Philip Wegner, RN, MPH Wisconsin TB Program WMLN Conference November 2015 1

Disclosure None 2

Objectives To describe US TB epidemiology To describe Wisconsin TB epidemiology To discuss ongoing activities of the Wisconsin TB Program 3

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

World Map as proportion of where TB cases are found

Estimated TB incidence rates, 2014

U.S. TB statistics 7

No. of Cases Wisconsin Department of Health Services Reported TB Cases 30,000 United States, 1982 2014* 25,000 20,000 15,000 10,000 5,000 0 *Updated as of June 5, 2015. CDC. Year

U.S. TB EPIDEMIOLOGY TB Case Rates,* United States, 2014 D.C. < 3.0 (2014 national average) >3.0 *Cases per 100,000.

Cases per 100,000 Wisconsin Department of Health Services TB Case Rates by Race/Ethnicity,* 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 United States, 2003 2014** 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 *All races are non-hispanic. **Updated as of June 5, 2015. CDC. American Indian or Alaska Native Black or African-American White Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino

No. of Cases Wisconsin Department of Health Services 20,000 Number of TB Cases in U.S.-born vs. Foreign-born Persons, United States, 1993 2014* 15,000 10,000 5,000 0 U.S.-born Foreign-born *Updated as of June 5, 2015. CDC.

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Wisconsin Department of Health Services Primary MDR TB, United States, 1993 2014* No. of Cases 500 400 300 200 100 Percentage 3% 2% 1% 0 0% No. of Cases Percentage *Updated as of June 5, 2015. 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.

WISCONSIN TB STATISTICS 13

No. of Cases Rate per 100,000 Wisconsin Department of Health Services 1200 TB Cases & Rates for Wisconsin, 1953-2014 35 1000 30 800 25 600 400 20 15 10 200 5 0 1953 1958 1963 1968 1973 1978 Cases 1983 Incidence 1988 1993 1998 2003 2008 2013 0 Declining rates of TB in Wisconsin from 29.2 in 1953 to 0.83 in 2014 1953 = 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

Rate Per 100,000 Wisconsin Department of Health Services TB Case Rates per 100,000 Population 6 5 4 3 2 WI US 1 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year 15

No. of Cases Wisconsin Department of Health Services 100 90 80 70 60 50 40 30 20 10 0 TB Disease Wisconsin 2001-2014 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 WI 16

30 TB Case Characteristics Wisconsin 2006-2014 25 20 15 10 5 Homeless Alcohol Drugs Jail LTC 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 19

2006-2014: % of all Age (avg.) TB Case Characteristics Wisconsin 2006-2014 Sex (%) M/F Race (%) W B WH A AI LTC 1.74 71 80/20 70 30 0 0 0 40 60 50 100 0 Jail 1.39 45.1 100/0 13 25 50 13 0 37.5 62.5 12.5 50 50 Drugs 4.7 37.1 85/15 22 22 37 15 4 52 48 3.7 70 30 Alcohol 10.98 46.4 83/17 40 25 19 14 2 51 49 11 71 29 MKE % Other % Died % USB % FB % Homeless 3.31 45.1 74/26 26 42 26 5 0 68 32 21 84 16 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

Number of Cases Wisconsin Department of Health Services 60 Number of TB Cases in U.S.-Born vs. Foreign-Born Persons Wisconsin, 2005-2014 50 40 30 20 10 US-Born Foreign-Born 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year 21

TB Cases in Wisconsin by Place of Birth, 2005-2014 U.S. or Foreign Born Count Percent of Total U.S.-Born 258 39.75% Foreign-Born 391 60.25% Total 649 100% 22

18 16 Immigration Status at First Entry to U.S. TB Case, 2010-2014 14 12 10 8 6 4 Employment Family/Fiance Immigrant Refugee Student Tourist 2 0 2010 2011 2012 2013 2014 23

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

rate/100,000 Wisconsin Department of Health Services 6 Wisconsin Rate of TB in US-Born by Race 2005-2014 5 4 3 2 White Black Asian Latino/Hisp Am Indian 1 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Rate for Foreign-born in Wisconsin is 15.2/100,000

Number of TB cases in US-Born by race 2005-2014 18 16 14 12 10 8 6 White Black Asian Latino/Hisp Am Indian 4 2 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Milwaukee Washington Ozaukee Winnebago Calumet Trempealeau Kewaunee Wisconsin Department of Health Services MDR-TB in Wisconsin 2005-2014 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

2014 Data Total cases = 48 Pulmonary = 60% (29) Extra-pulmonary = 23% (11) Both pulmonary & extra-pulmonary = 17% (8) Children <18 yo = 0% Avg. age = 51.25 yrs. Foreign-born = 69% (33) U.S.-born = 31% (15) MDR-TB cases = 6% (3) 29

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

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, 2015. 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 23 3 1 Door 1 City of Milwaukee 17 Northshore 2 Cudahy 1 Greenfield 1 Franklin 1 West Allis 1

WI TB PROGRAM 34

WI TB Program Staff WELCOME! Traci DeSalvo, Program Director 608-261-6387 Traci.DeSalvo@dhs.wisconsin.gov 35

WI TB Program Staff Philip Wegner, RN, MPH, Nurse Consultant 608-266-3729 philip.wegner@wi.gov Pa Vang RN, MSN, Nurse Consultant 608-266-9452 pa.vang@wi.gov 36

WI TB Program Staff Savitri Tsering, Refugee Health Coordinator 608-267-3733 savitri.tsering@wi.gov Chris W. & Maggie N. TB/Refugee Health Office Assistant margarita.northrop@wi.gov 37

WI TB Program Staff Jo Mercurio, TB Program Office Assistant 608-266-9692 joann.mercurio@wi.gov Stephanie Marburger, TB Program Office Assistant 608-266-7338 StephanieA.Marburger@wi.gov 38

Collaborations for Change Co-Presented at the 2015 NTCA Conference 39

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

Medication News 41

Medication News

Ongoing Activities WI TB Program website: https://www.dhs.wisconsin.gov/tb 43

Ongoing Activities WI TB Program website: https://www.dhs.wisconsin.gov/tb/data.htm 44

Ongoing Activities WI TB Prevention Coalition 45

Ongoing Activities Improved instructions for WEDSS WEDSS Sharepoint site: https://share.health.wisconsin.gov/ph/wedss/default.aspx 46

Take On TB!

Thank you! Questions? 48