tb control in new york cityglobaltb.njms.rutgers.edu/downloads/courses/2011... · tb control in new...
Post on 24-Dec-2019
3 Views
Preview:
TRANSCRIPT
1
TB Control in New York City: TB Control in New York City: Current status and progress towards Current status and progress towards
eliminationelimination
11
ChrispinChrispin KambiliKambili, MD, MDAssistant Commissioner of HealthAssistant Commissioner of Health
Director, Bureau of TB Control, NYC DOHMHDirector, Bureau of TB Control, NYC DOHMH
World TB Day ConferenceWorld TB Day ConferenceMarch 23, March 23, 20112011
Every 20 Seconds Every 20 Seconds someone somewhere in the world someone somewhere in the world
dies from TB!dies from TB!
22
dies from TB!dies from TB!
What constitutes TB control?What constitutes TB control?
Identify prevalent casesIdentify prevalent casesTreat the cases to:Treat the cases to:•• Reduce morbidity & mortalityReduce morbidity & mortality
R d t i iR d t i i
33
•• Reduce transmissionReduce transmission
Mitigate impact of newly transmitted TBMitigate impact of newly transmitted TBAddress other LTBIAddress other LTBI
What’s needed for effective TB control?What’s needed for effective TB control?
Set a legal frameworkSet a legal framework——Defines roles Defines roles of government and providersof government and providers•• Legal framework in NYC is defined by Legal framework in NYC is defined by
State’s Public Health Law and Sanitary State’s Public Health Law and Sanitary
44
State s Public Health Law and Sanitary State s Public Health Law and Sanitary Code, and NYC Health CodeCode, and NYC Health Code
Reporting requirementsReporting requirementsDuties, roles and responsibilitiesDuties, roles and responsibilities
Create an infrastructure of carry out Create an infrastructure of carry out the mandatethe mandate
2
Specific StrategiesSpecific Strategies
Accurate and thorough case detectionAccurate and thorough case detection•• DiagnosisDiagnosis•• SurveillanceSurveillance
U i t t d ff ti d i d U i t t d ff ti d i d
55
Uninterrupted, effective and supervised Uninterrupted, effective and supervised treatment, and patient supporttreatment, and patient supportMonitoring and evaluation system and Monitoring and evaluation system and impact measurementimpact measurementAdequate public health infrastructure ($)Adequate public health infrastructure ($)
Main elements of TB Control in USMain elements of TB Control in US
Case findingCase findingpassivepassive -- clinical presentationclinical presentationactiveactive -- contact tracing (source) contact tracing (source)
& screening (migrants)& screening (migrants)
66
& screening (migrants)& screening (migrants)•• Treatment of casesTreatment of cases
•• Chemoprophylaxis (for latent TB)Chemoprophylaxis (for latent TB)
•• BCGBCG
Where can we intervene?Where can we intervene?
77
Prophylactictreatment
Preventivetherapy
Chemotherapy
Patient's delay
Doctor's delay
Transmission
8
Subclinicalinfection
Infectioustuberculosis
Non-infectioustuberculosis
BCGvaccination
DeathExposure
After HL Rieder
3
TB in NYC: Where have we TB in NYC: Where have we been and where are we going?been and where are we going?
99
Tuberculosis Cases and Rates Tuberculosis Cases and Rates New York City, 1980 New York City, 1980 –– 2010*2010*
711 Cases in 2010711 Cases in 2010
2,500
3,000
3,500
4,000
40
50
60Case Rate# Cases
51.1
Number of Cases Rate/100,000
1010
500
1,000
1,500
2,000
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Year
0
10
20
30
8.5
*Rates since 2000 are based on population estimates.
21.4
US1 and Foreign-Born Tuberculosis Cases and Case Rates2
New York City, 1992 - 2010
1,500
2,000
2,500
3,000
3,500Number of Cases
30.0
40.0
50.0
60.0
70.0Rate/100,000
US-born CasesForeign-born CasesUS-born RateForeign-born Rate
1111
0
500
1,000
1,500
92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Year
0.0
10.0
20.0
30.0
1. Puerto Rico and U.S. Virgin Island are included as US-born.2. Rates are based on official Census data and intercensal estimates prior to 2000. Rates since 2000 are based on 2000 Census data.
Top 10 Countries of Birth for Top 10 Countries of Birth for NYC TB ForeignNYC TB Foreign--born TB Patientsborn TB Patients
20102010 NN 20092009 NNChinaChina 103103 ChinaChina 110110EcuadorEcuador 4141 MexicoMexico 4343Dominican RepublicDominican Republic 4141 EcuadorEcuador 4242MexicoMexico 3434 Dominican RepublicDominican Republic 3939
1212
BangladeshBangladesh 3030 IndiaIndia 3232PhilippinesPhilippines 2828 HaitiHaiti 2929IndiaIndia 2626 PhilippinesPhilippines 2525HaitiHaiti 2323 BangladeshBangladesh 2222PakistanPakistan 2020 NepalNepal 1818South KoreaSouth Korea 1717 Guyana & South Guyana & South
KoreaKorea1313
4
2010 NYC TB cases by country of birth
1313
No 2010 cases born in this country
One or more 2010 cases born in this country
Top 20 2010 country of birth
Tuberculosis Cases by Borough Tuberculosis Cases by Borough New York City, 2009 and 2010New York City, 2009 and 2010
276
205
257232
200
250
300
Cas
es
2009 2010
1414
120 137
18
88116
130
50
100
150
Manhattan(5.4*)
Queens(11.1*)
Brooklyn (9.0*) Bronx (8.3*) Staten Island(2.6*)
* Rate per 100,000 based on 2009 population estimates
Num
ber o
f C
West Queens
Flushing - Clearview
Fordham - Bronx Park
TB cases counted in New York City by UHF neighborhood, 2010
Number of TB cases0
1 - 9
10 - 24
25 - 49
50 - 96
1515
Borough Park
Sunset Park
East Flatbush - Flatbush
Bedford Stuyvesant - Crown Heights
West Queens
Flushing - Clearview
Fresh MeadowsLong Island City - Astoria
Fordham - Bronx Park
Crotona - Tremont
Williamsburg - Bushwick
High Bridge - Morrisania
Central Harlem - Morningside Heights
TB rates in New York City by UHF neighborhood, 2010
TB case rate0.0
0.1 - 3.8
3.9 - 9.1
9.2 - 22.5
1616
Rates are based on 2009 population estimates.
Borough Park
Sunset Park
Bensonhurst - Bay Ridge
Bedford Stuyvesant - Crown Heights
Williamsburg Bushwick
5
Top 10 Medical Facilities First Evaluating Top 10 Medical Facilities First Evaluating Patients for TBPatients for TB
New York City, 2010New York City, 2010
Facility NameFacility Name # of Cases# of Cases % of all % of all CasesCases
1. Elmhurst Hospital Center1. Elmhurst Hospital Center 6464 992. Bellevue Hospital Center2. Bellevue Hospital Center 4848 773. Mount Sinai Hospital3. Mount Sinai Hospital 2929 44
1717
4. Kings County4. Kings County 2424 335. New York Hospital Medical Center of Queens5. New York Hospital Medical Center of Queens 2323 336. Fort Greene Chest Center6. Fort Greene Chest Center 2222 337. Beth Israel Medical Center, Maimonides Medical Center 7. Beth Israel Medical Center, Maimonides Medical Center 2121 338. Queens Hospital Center 8. Queens Hospital Center 1919 339. Corona Chest Center, Jacobi Medical Center, 9. Corona Chest Center, Jacobi Medical Center, WoodhullWoodhull 1616 2210. Lutheran Hospital, Washington Heights Chest Center10. Lutheran Hospital, Washington Heights Chest Center 1515 22
Tuberculosis Cases by Site of DiseaseTuberculosis Cases by Site of DiseaseNew York City, 2010New York City, 2010
BOTH PULMONARY AND
EXTRAPULMONARY DISEASE 75 (11%)
ONLY EXTRAPULMONARY DISEASE 155 (22%)
ONLY PULMONARY DISEASE 481 (68%)
1818
Note: Denominator = All confirmed cases in 2010 (n=711)
Extrapulmonary Sites among TB Cases Extrapulmonary Sites among TB Cases New York City, 2010New York City, 2010
Sites*Sites* % of Total Extra% of Total Extra--pulmonary pulmonary SitesSites
LymphaticLymphatic 4242PleuralPleural 2626
1919
Other Other 1313Bone/JointBone/Joint 99PeritonealPeritoneal 88GenitourinaryGenitourinary 77MeningealMeningeal 55
*Categories are not mutually exclusive
Trend in HIVTrend in HIV--Infection and TBInfection and TBNew York City, 1992New York City, 1992--20102010
34 33 34 3331
1,000
1,200
1,400
40
50
% TB/HIV+# TB/HIV+
% of TB/HIV Infected CasesNumber of Cases
2020
2622 22
1815
1816 16 15
13 1311
97
200
400
600
800
92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10Year
0
10
20
30
6
MDRMDR--TB in NYC,1992TB in NYC,1992--20102010441
296
250
300
350
400
450
500
2121
176
10984
53 38 31 25 24 27 21 18 24 219 11 9 11
0
50
100
150
200
250
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Those who do not learn from history Those who do not learn from history are doomed to repeat it!are doomed to repeat it!
6000
7000
8000
9000
10000
f cas
es
Actual Cases Projected Cases
2222
0
1000
2000
3000
4000
5000
1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
Years
Num
ber
of
Think TB!Think TB!
2323
New York City Department of Health New York City Department of Health and Mental Hygieneand Mental Hygiene
Bureau of TB ControlBureau of TB Control
http://www nyc gov/health/tbhttp://www nyc gov/health/tb
2424
http://www.nyc.gov/health/tbhttp://www.nyc.gov/health/tb
Tel: 311 or Tel: 311 or 212212--788788--4162 (TB Provider Hotline)4162 (TB Provider Hotline)
top related