rural indiana outbreak county/state and cdc response
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Rural Indiana Outbreak County/State and CDC Response. Shameer Poonja MPH CDC Assignee Indiana State Department of Health TB Program. TB Incidence — United States, 2005. < 3.5 cases per 100,000. >3.5 cases per 100,000. Indiana Small Rural County. 2002 - PowerPoint PPT PresentationTRANSCRIPT
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Rural Indiana Outbreak County/State and CDC Response
Shameer Poonja MPHCDC Assignee
Indiana State Department of HealthTB Program
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TB Incidence—United States, 2005
>3.5 cases per 100,000
<3.5 cases per 100,000
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Indiana Small Rural County
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Recent outbreaks 2002
– School setting –linked to four secondary cases. One additional case linked to previous investigation in 1990’s.
– Social setting-four cases genetically linked to past case in three other counties.
2003– African American Community
•25 cases in cluster
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TB Cases—County A, 1999–2004
0
1
2
3
4
5
Year by quarter
Cou
nt
1999 2000 2001 2002 2003 2004 2005
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Do we have a problem? County- Spring 2005
– Noticed increase in cases – Placed call to state for recommendations
State- September/October 2005– Noticed problem with DOT– Patient interviews revealed 3 potential sites of
exposure – genotyping
CDC– TB news articles in 09/30– Called State for update on issue
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Initial Response State Health Department
– Communicated with county health nurse– Provided staff persons– Provided emergency funding – Requested Epi-Aid team
CDC– Epi-Aid team arrives 11/9/05 -12/16/05 to
re-interview, identify additional sites of exposure, screening contacts
– 10/06 Requested (1999-2004) isolates be sent for genotyping
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CDC Epi- Aid Team Pre-Investigation Data
October 2005 10 cases detected
All 10 genotypes matched
Archived isolate (1999–2004) genotypes matched
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TB Cases—County A, 1999–2005
0
1
2
3
4
5
Year by quarter
Cou
nt
1999 2000 2001 2002 2003 2004 2005
Outbreak-relatedNot outbreak-related
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0
1
2
3
4
5
Year by quarter
Cou
nt
1999 2000 2001 2002 2003 2004 2005
Genotype-matched and epi-linked
Outbreak-Related Cases, 1999–2005 (N=23)
Genotype-matched onlyEpi-linked only
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Outbreak Response State
– Continued to have staff available to interview, provide education
– Medical residents– Pulmonary and ID consultation– Press release
CDC– Reviewed patient records– Interviewed patients diagnosed in 2005
and their contacts– Reviewed national TB genotyping data
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Patient Characteristics (N=23)
Characteristic nMedian age (range) 46 years (4–70)Male 17White and US-born 23HIV-infected 0Diabetes 8Heavy alcohol use 18Methamphetamine use 1
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Disease Characteristics (N=23)
Characteristic nPulmonary 22 Cavitary 15 Smear positive 17Culture positive 20 Drug susceptible 20Fatal 2
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Risk Factors
Delay (>60 days) n/N median (range)
Diagnosis 11/18 135 days (74–389)
Smear conversion 9/12 94 days (62–210)
Culture conversion 10/15 96 days (63–141)
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Public Health Impact
Contacts 109
LTBI25 (23%)
Treatment Initiated 19 (76%)
Additional Contacts 226 + 294 = 520
LTBI25 + 24 = 49
Treatment Initiated 41 (84%)
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Ongoing activities County
– Hired and trained additional staff– Establish ½ day TB clinic
State– Reorganization and build linkages
with other programs– Resources (EPI, 2 Regional RN)– Requested public health advisor
Federal (CDC) – Deployed field staff (2/6-6/30)– Developed Data Management
system
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Geographic Distribution* of Outbreak Strain—United States
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Acknowledgments
County A Health Department
Indiana State Department of Health
CDC Division of TB Elimination
CDC Experience and Epi Elective Programs