2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Julie Tans-Kersten, MS, BSMT (ASCP) Wisconsin TB Program Wisconsin Mycobacteriology Laboratory Network Conference, Madison, WI November 17, 2016
Wisconsin Tuberculosis (TB) Program Update
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Outline
• TB statistics, globally and nationally • TB in Wisconsin
o Epidemiology o Demographics
• WI partnerships for TB patient management • WI TB Program Updates
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
GLOBAL TB STATISTICS
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
All forms of TB
HIV-associated TB
Multi-drug resistant TB
Estimated number of cases
Estimated number of deaths
9.6 million 1.5 million (16%)*
1.2 million (12%) 390,000 (33%)
480,000 (5%) 190,000 (40%)
* Including deaths attributed to HIV/TB Source: WHO Global Tuberculosis Report 2015
The Global Burden of TB, 2014
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Estimated TB Incidence Rates, 2014
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
2015 World Health Organization Statistics
• TB remained one of the top 10 causes of death worldwide
• Although there was a 1.5% decrease in the overall number of TB cases worldwide from 2014 to 2015, this decrease was too small to meet the first milestone of the 2020 End TB Strategy.
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Source: WHO Global Tuberculosis Report 2015
2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
TB IN THE UNITED STATES
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
2015 CDC US Statistics • In 2015, total of 9,563 TB cases were reported
in the US based on preliminary data from the CDC National TB Surveillance System.
• This represents an increase of 157 cases from the 9,406 case reported in 2014.
• This is the first time since 1991 that the annual number of reported TB cases in the US has increased from one year to the next.
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www.cdc.gov/tb
2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
TB IN WISCONSIN
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Wisconsin TB Case Numbers
• In 2015 Wisconsin had 69 TB cases which is above the average of 59 cases for the previous 5 years.
• In 2016, 33 cases so far this year, which is very low for November
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Reported TB Cases United States, 1982–2014
Wisconsin, 1982–2014
0
5,000
10,000
15,000
20,000
25,000
30,000
No.
of c
ases
Year 0
50
100
150
200
250
No.
of c
ases
Year
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Douglas Bayfield
Ashland
Saywer
Washburn
Burnett
Polk
Barron Rusk Price
Iron
Vilas
Oneida
Lincoln
Taylor
Chippewa St. Croix
Pierce
Dunn
Pepin
Eau Claire
Buffalo
Trem
peale
au
Jackson
Monroe
Clark Marathon
Wood Portage
Juneau
Adams
Sauk
LaCrosse
Vernon
Crawford Richland
Grant
LaFayette Green Rock
Dane Iowa
Columbia Dodge
Jefferson Waukesha
Walworth
Kenosha
Racine
Ozau
kee
Sheboygan Fond du Lac Green Lake
Marquette
Waushara
Winn
ebag
o
Calum
et Manitowoc
Kewa
unee
Brown Outagamie
Waupaca
Shawano
Menominee
Oconto Langlade
Forest Marinette
Florence
Door
Milw
auke
e
Was
hingto
n
Western Region
Northeastern Region
Southeastern Region Southern Region
Northern Region City of Milwaukee 17 Northshore 2 Cudahy 1 Greenfield 1 Franklin 1 West Allis 1
7
3
1
1
1
2
2 2
2 1
1
1
1
23
3
2
1
1
*Preliminary as of November 1, 2015. WI TB Program.
2015 TB Cases by Region
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Douglas Bayfield
Ashland
Saywer Washburn
Burnett
Polk Barron Rusk
Price
Iron
Vilas
Oneida
Lincoln
Taylor
Chippewa St. Croix
Pierce
Dunn
Pepin
Eau Claire
Buffalo Tr
empe
aleau
Jackson
Monroe
Clark Marathon
Wood Portage
Juneau
Adams
Sauk
La Crosse
Vernon
Crawford Richland
Grant
LaFayette Green Rock
Dane Iowa
Columbia Dodge
Jefferson Waukesha
Walworth
Kenosha
Racine
Ozau
kee
Sheboygan Fond du Lac Green Lake
Marquette
Waushara Winnebago Ca
lumet Manitowoc
Kewa
unee
Brown Outagamie
Waupaca
Shawano
Menominee
Oconto Langlade
Forest Marinette
Florence
Door
Milw
auke
e
Was
hingto
n
0.51-1.0
1.1-1.5
1.6-2.0
>2.0
≤ 0.50
10 year average TB rates 2005-2015
*rate = number of cases per 100,000
TB Case Rates,* Wisconsin, 2005-2014
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Reported TB Cases by Age Group
United States, 2014 Wisconsin, 2005-2014 <15 yrs
(5%) 15-24
yrs (10%)
25-44 yrs
(30%) 45-64
yrs (31%)
≥ 65 yrs (24%)
<15 (7%)
15-24 (13%)
25-44 (34%)
45-64 (24%)
>65 (22%)
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
TB Cases by Residence in Correctional Facilities, Age ≥15
United States, 1993-2014 Wisconsin, 2005-2014
0.0
1.0
2.0
3.0
4.0
5.0
6.0
0
200
400
600
800
1000
1200
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0.00.51.01.52.02.53.03.54.04.5
0
0.5
1
1.5
2
2.5
3
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
No. of Cases No. of Cases Percentage Percentage
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
TB Cases Reported as Homeless in the 12 Months Prior to Diagnosis, Age ≥15
United States, 1993-2014 Wisconsin, 2005-2014 No. of Cases No. of Cases Percentage Percentage
0.01.02.03.04.05.06.07.08.0
0
200
400
600
800
1000
1200
1400
1600
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0.01.02.03.04.05.06.07.08.09.0
0
1
2
3
4
5
6
7
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Number of TB Cases in U.S.-born vs. Foreign-born Persons
United States, 1993-2014 Wisconsin, 2005-2014
0
5,000
10,000
15,000
20,000
Num
ber o
f Cas
es
U.S.-born Foreign-born
0102030405060
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Num
ber o
f Cas
es
Year
US-Born Foreign-Born
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Countries of Birth of Foreign-born Persons Reported with TB
United States, 2014 Wisconsin, 2005-2014
• Mexico (21%) • Philippines (12%) • India (8%) • Vietnam (8%) • China (7%) • Guatemala (3%) • Haiti (3%) • Other countries (39%)
• Mexico (27%) • Hmong (Laos/Thai) (18%) • India (14%) • Philippines (5%) • China (5%) • Burma (3%) • Somalia (3%) • Other counties (25%)
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Laos/Thailand 68%
Burma 12%
Somalia 12%
Nepal 3%
Cambodia 2%
Sudan 1%
Vietnam 1% Bhutan
1%
Refugee population by country of origin
TB in Wisconsin Refugee Population 2005-2014
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Primary MDR TB
United States, 1993-2014 Wisconsin, 2005-2014
0%
1%
2%
3%
0
100
200
300
400
500
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0%
2%
4%
6%
8%
10%
0
1
2
3
4
5
6
7
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
2014 vs 2015 WI TB Data
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2014 Total case = 48
2015 Total case = 69
% # % #
Pulmonary only 60% 29 59% 41
Extra-pulmonary 23% 11 32% 22
Both pulmonary & extra-pulmonary 17% 8 9% 6
Children <15 yo 0% 0 1% 1
Foreign-born 69% 33 71% 49
US-born 31% 15 29% 20
MDR-TB cases 6% 3 6% 4
Deaths 6% 3 10% 7
2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
TB Summary and Challenges • Two most common factors associated with TB
Disease in Wisconsin: • foreign-born • known contact with someone with active TB disease
• Challenges • Loss of TB expertise in healthcare • Diagnosis and treatment of TB in high-risk foreign-
born populations • Complex case management/patients with co-
morbidities (diabetes, HIV, alcohol/drug use, smoking)
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
PARTNERSHIPS FOR TB PATIENT MANAGEMENT
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Wisconsin Partnerships for TB Case Management
• Wisconsin State Laboratory of Hygiene (WSLH) • Wisconsin Mycobacteriology Laboratories (31) • Reference Laboratories • CDC • Health care providers and infection preventionists • Local public health departments • National TB Controller’s Association (NTCA) • Association of Public Health Laboratories (APHL)
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
TB Case Management Diagnosis of tuberculosis
Initiation of Therapy
Patient follow-up
Laboratory Involvement
2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
Laboratory Involvement in TB case Management
• Specimen collection and transport for diagnostic and follow-up testing
• Diagnostic testing • Report and interpretation of test results • Referral of specimens or cultures
o Molecular detection of drug resistance o Culture-based drug susceptibility testing (DST) o genotyping
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
The Laboratory is Essential • Laboratory is a critical partner in the diagnosis
of TB • Rapid, reliable results are essential for early
detection of MTBC to prevent ongoing transmission
• Drug susceptibility test results identify drug resistance and help guide the clinician in providing appropriate treatment
• Laboratory results important for monitoring patient response to therapy 28
2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
WISCONSIN TB PROGRAM UPDATES
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
TB Program Staffing
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Role Name
Phone
TB Program Director
Julie Tans-Kersten 608-261-6387
TB Nurse Consultants
Judy Rabinowitz 608-266-7338
Marjorie Wall 608-266-9452
Lorna Will 608-266-3729
Office Associates for Dispensary
Joey Janz 608-266-9692
Brandon Rufer 608-266-7473
2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
• WI TB Program website: https://www.dhs.wisconsin.gov/tb
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2016 WI TB Update WI TB Program
Wisconsin Department of Health Services
THANK YOU! QUESTIONS?
Wisconsin TB Program
1 West Wilson Street, PO Box 2659 Madison, Wisconsin 53701-2659
608-261-6319 (Office) 608-266-0049 (Fax)
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