stop tb in the african-american community summit...
TRANSCRIPT
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Tuberculosis
Nickolas DeLuca, PhD
Communications, Education, and Behavioral Studies Branch
Division of Tuberculosis Elimination
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Presentation Outline
– An overview of tuberculosis (TB)
– Epidemiology of TB Globally and in the United States
– Epidemiology of TB the African-American community
– Overview of Division of Tuberculosis Elimination sponsored activities to address TB in the African-American community
– Overview of additional resources to address TB
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Overview of Tuberculosis
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Tuberculosis
• Caused by bacteria Mycobacterium tuberculosis
• Usually attacks the lungs, but can affect any part of
the body
• TB disease can be fatal
• Once the leading cause of death in the United States
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Transmission
The dots in the air
represent droplet
nuclei containing
tubercle bacilli
• When a person with infectious TB disease coughs, sneezes,
speaks, or sings, tiny particles containing M. tuberculosis
(droplet nuclei) may be expelled into the air
• If another person inhales the droplet nuclei, transmission may
occur
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Tuberculosis Transmission
• Expelled when person with infectious TB coughs,
sneezes, speaks, or sings
• Close contacts at highest risk of becoming infected
• Transmission occurs from person with infectious
TB disease (not latent TB infection)
Active TB Disease vs.
Latent TB Infection
Active TB Latent TB Infection
• TB germs in the body
• May be infectious (before
treatment)
• Symptoms of TB (e.g.,
cough)
• An active “case” of TB
• Treatment needed to cure
disease
• TB germs in the body, but
latent (dormant) state
• NOT infectious
• No symptoms
• Not a “case” of TB
• Treatment may be provided
to prevent transition from
TB infection to TB disease
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Symptoms of TB
Productive, prolonged cough
Fever
Chest pain
Hemoptysis
Chills
Night sweats
Weight loss
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Background Epidemiology
Estimated TB incidence rates, 2004
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WHO 2005. All rights reserved
0 - 2425 - 4950 - 99100 - 299
No estimate300 or more
Estimated new TB
cases (all forms) per
100 000 population
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Global TB
• One-third of the world’s population is infected
with TB
• Someone in the world is newly infected with TB
bacilli every second
• Each year, 9 million people around the world
become sick with TB
• In 2005, there were 1.6 million TB-related deaths
worldwide from this curable disease
• TB is the leading killer of people who are HIV
infected
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On average an
untreated
person with
infectious TB
infects between
10 and 15 people
each year
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Reported TB Cases*
United States, 1982–2006
10,000
12,000
14,000
16,000
18,000
20,000
22,000
24,000
26,000
28,000
1982 1985 1990 1995 2000 2006
Year
No
. o
f C
ases
*Provisional Data as of March 23, 2007
13,767
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TB Case Rates,* United States, 2005
< 3.5 (year 2000 target)
3.6–4.8
> 4.8 (national average)
D.C.
*Cases per 100,000.
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Number of TB Cases inU.S.-born vs. Foreign-born Persons
United States, 1993–2005*
0
5000
10000
15000
20000
1993 1995 1997 1999 2001 2003 2005
U.S.-born Foreign-born
No
. o
f C
ases
*Updated as of March 29, 2006.
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Trends in TB Cases in Foreign-born
Persons, United States, 1986–2005*
0
2,000
4,000
6,000
8,000
10,000
86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05
0
10
20
30
40
50
60
No. of Cases Percentage of Total Cases
No. of Cases Percentage
*Updated as of March 29, 2006.
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Percentage of TB Cases Among Foreign-
born Persons, United States*
>50%
25%–49%
<25%
1995 2005
DC DC
*Updated as of March 29, 2006.
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Countries of Birth of Foreign-born Persons Reported with TB
United States, 2005
Mexico
(25%)
Philippines
(11%)
Viet Nam
(8%)India
(7%)China
(5%)
Haiti
(3%)
Guatemala
(3%)
Other
Countries
(38%)
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Reported TB Cases by Age Group,
United States, 2005
25–44 yrs
(34%)
<15 yrs
(6%)
15–24 yrs
(11%)
45–64 yrs
(29%)
>65 yrs
(20%)
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Reported TB Cases by Race/Ethnicity*
United States, 2005
Hispanic or Latino
(29%) Black or
African-American
(28%)
Asian
(23%)
White
(18%)
American Indian or
Alaska Native (1%)
Native Hawaiian or
Other Pacific Islander (<1%)
*All races are non-Hispanic. Persons reporting two or more races
accounted for less than 1% of all cases.
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Reported TB Cases by Origin and
Race/Ethnicity,* United States, 2005
*All races are non-Hispanic. Persons reporting two or more races accounted for less
than 1% of all cases.
**American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander
accounted for less than 1% of foreign-born cases and are not shown.
U.S.-born Foreign-born**
Native Hawaiian/Other
Pacific Islander (<1%)
White (34%)
Black or African-
American (45%)
Hispanic or
Latino (15%)
Asian (2%)American Indian or
Alaska Native (2%)
Hispanic or
Latino (40%) Asian (40%)
White (6%)
Black or African-
American (14%)
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Primary MDR TB
United States, 1993–2005*
0
100
200
300
400
500
93 94 95 96 97 98 99 00 01 02 03 04 05
0
1
2
3
No. of Cases Percentage
*Updated as of March 29, 2006.
Note: Based on initial isolates from persons with no prior history of TB.
MDR TB defined as resistance to at least isoniazid and rifampin.
No. of Cases Percentage
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Completion of TB Therapy
United States, 1993–2003*
0
20
40
60
80
100
19931994
19951996
19971998
19992000
20012002
2003
Completed Completed in 1 yr or less
*Updated as of March 29, 2006.
**Healthy People 2010 target: 90% completed in 1 yr or less.
Note: Persons with initial isolate resistant to rifampin and children under 15 years old with
meningeal, bone or joint, or miliary disease excluded.
Perc
en
tag
e **
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TB in the African-American
Community
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TB in African Americans• While overall rates continue to decline in the U.S.,
TB continues to disproportionately affect racial
and ethnic minorities
• In 2005
– 82% of all reported TB cases occurred in racial
and ethnic minorities
– 45% of TB cases reported in U.S.-born persons
were among African Americans
– The TB case rate for U.S.-born blacks
(8.9/100,000) is more than 8 times higher than
the rate in U.S.-born whites (1.1/100,000)
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Characteristics Among Selected
U.S.-born Persons with TB, 2004
Black* White*
No. cases 2,675 2,209
Male 70% 67%
Median age
(years)
46 57
*Non-Hispanic
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< 99
100–399
> 400
D.C.
TB Cases in U.S.-born Blacks
United States, 2000–2004
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Completion of TB Therapy < 1 year
United States,* 1993–2003
0
20
40
60
80
100
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Black** White**
*Timely completion within 12 months
**U.S.-born non-Hispanic
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TB/HIV Co-infection
• HIV is a significant risk factor for progression from
TB infection to TB disease
• TB disease is an AIDS defining illness
• Knowledge of HIV/TB co-infection is important for
patient management
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HIV Infection Among Reported TB
Cases, 2005
• All TB cases
– Estimated 9% HIV/TB co-infection
– Estimated 31% with unknown HIV status
• TB cases in blacks
– Estimated 18% HIV/TB co-infection
– Estimated 21% with unknown HIV status
*Excludes California data
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TB and HIV• CDC has recommended HIV counseling and
testing of all TB patients since 1989
• In September 2006, CDC released guidelines recommending HIV screening for patients in all health-care settings (including TB clinics) after being notified that testing will be performed unless the patient declines (opt-out screening)
• Knowing the HIV status of TB patients is necessary for optimal patient management for contacts, and persons with LTBI or TB disease
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Addressing TB in the
African-American Community
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Division of Tuberculosis Elimination
Activities to Address TB in the
African-American Community
• Research
• Demonstration Projects
• Education and Training
• Communication
• Partnerships
• Community Mobilization
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Georgia Campaign-- HALT TB
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South Carolina
Campaign
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Chicago Campaign
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Summit Goals
• Raise awareness of the
problem
• Build upon
accomplishments from
the 2003 meeting
• Create links and build
networks to lead to
ongoing strategies to
address the problem
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Summit ParticipantsOver 100 individuals from:
– CDC and TB prevention programs
– Professional organizations• National Medical Association, National
Black Nurses Association
– Academic institutions• Representatives from Historically
Black Colleges and Universities
– Local and national advocacy organizations (civic, faith-based, community-based; fraternities)
• NAACP, Rainbow-Push Coalition
– HHS State and Regional Minority Health Consultants
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Summit Breakout Sessions• Convened groups
based on organizational
type to facilitate
working with peers
• Groups devised
actions based upon
group discussion
– Lists of options
– Restricted to items
that could be
implemented in the
upcoming year
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Categorization of Summit
Action Items
•Education and Awareness
•Networking
•Building Capacity
•System Change
•Publicity
•Political Will
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Education and Awareness
Action Items
• Distributed CDC educational materials
– Exhibits and health fairs
– Professional organization conference packets
– Community based organizations
• Increased distribution of TB Challenge Newsletter
• Established TB in African-American Community Website
• Established TB in African-American Community Electronic Mailing List
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TB Challenge
Newsletter:
Partnering to
Eliminate TB
in African
Americans
Stop TB in the African-American
Community Website
.
http://www.cdc.gov/nchstp/tb/TBinAfricanAmericans/
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Stop TB in the African-American
Community Electronic Mailing List
Subscription Information
To subscribe:
http://www.cdcnpin.org/scripts/listserv/tb_aa.asp
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“The Summit was very beneficial in putting TB on our radar screen and brought about new networking. Before the Summit, we were not doing anything in TB.”
---National Advocacy Group participant
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TB Education Resources
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CDC Division of Tuberculosis
Education Resources
• Source for TB education, communication,
and training materials for:
– Health care professionals
– Patients
– General public
•Website
–www.cdc.gov/tb
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TB RTMCCs
Areas of Coverage
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Focus of TB RTMCC Activities
• To increase human resource development through TB education and training activities
• To increase the capacity for appropriate TB medical evaluation and management
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“Stand-up” Training
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Webinars
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Sample of TB RTMCC Products
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TB RTMCC Newsletters
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The TB Training and Education
Resources Website
Your one-stop site to find and
share TB resources
www.findtbresources.org
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Conclusions
• TB is a significant health threat in the world and the
United States
• TB is a health disparity for the African-American
community
• CDC is undertaking activities to address this health
disparity, but additional commitment, political will,
partners, and resources are needed
• CDC has TB education and training resources
available free of charge
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Acknowledgements
• Dr. Rachel Royce (RTI)
• Dr. Charles Wallace (Texas Department of State Health Services)
• Dr. Ana Lopez-Defede (University of South Carolina)
• Juani Muñoz Sanchez (RTI)
• Shelly Harris (RTI)
• Angela Greene (RTI)
• Tammeka Swinson (RTI)
• Brenda Stone-Wiggins (RTI)
• Dr. Cynthia Woodsong (RTI)
• RTI Office of Communications
• Dr. Kenneth Castro (CDC)
• Jeanne Courval
• Suzanne Marks
• Gail Burns Grant (CDC)
• Dr. Cornelia White (CDC)
• Elvin Magee (CDC)
• Dr. Wanda Walton (CDC)
• Patients and staff from the study sites
• NCHHSTP Office of Health Disparities
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Tuberculosis Transmission