Transcript TB Update: Current Statistics – What`s New in the Program

Wisconsin Department of Health Services
TB Update
Current Statistics
What’s new in the program
WMLN October, 2013
Lorna Will RN, MA
Wisconsin Division of Public Health
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
Tuberculosis Disease
Wisconsin 2001 - 2012
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Wisconsin Department of Health Services
TB Rates/100,000
(using 2012 data)
Wisconsin as a whole: 1.2
Milwaukee County:
40 cases/955,205 = 4.2
City of Milwaukee:
25 cases/597,867 = 4.2
Dane County:
13 cases/503,523 = 2.6
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
WI TB Cases by Race 2012
Hmong
8%
White
33%
Asian
47%
Other Asian
39%
Black
18%
N=71
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American
Indian
2%
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
Estimated TB Case Rates by Race
Wisconsin 2012
• White: 1.2
• Black: 3.8
• Asian: 25.2
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
Reported Tuberculosis Cases
by National Origin
Wisconsin, 2006-2012
Number of Cases
60
Foreign Born
50
US Born
40
30
20
10
0
2006
2007
2008
2009
2010
2011
2012
Year
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Wisconsin Department of Health Services
CDC National Data
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Wisconsin Department of Health Services
Drug-Resistance in WI
20 MDR-TB Cases (2005-2012)
• All in foreign-born persons coming from:
o Laos (60%) Hmong population
o India (20%)
o Nepal, China, Burma, Ethiopia (5% each)
• Average age is 46 years
o Hmong average age is 52 years
o India average age is 25 years
o All others average age is 17 years
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Wisconsin Department of Health Services
Summary
• TB is still a disease of minorities
• TB is largely a disease of foreign-born
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Wisconsin Department of Health Services
What’s Next or New?
• New drug for MDR TB
o Bedaquilin released for general use in April 2013
• Good interim data on 12 week treatment for
TB infection
o Thousands of patients have used it across the US
o CDC collecting data in post-marketing study
o At least 200 have used it in WI; data being
collected
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Wisconsin Department of Health Services
What’s Next or New?
• Trials ongoing for TB vaccines
• Continued shortages of tuberculin solution, TB
medications
o Data collection site soon at tbcontrollers.org
o Information on price increases and shortages are
shared with FDA and DOJ
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Wisconsin Department of Health Services
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Wisconsin Department of Health Services
WI TB Program Initiatives
• New TB Program Manager Jo Mercurio:
medication orders and bills, dispensary
payments
• New initiative on Hmong health and TB: led
by Pa Vang and Sheboygan County
o Issue of antibiotics for purchase at Hmong markets
o Issue of clinician awareness of patient risk factors
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Wisconsin Department of Health Services
2013
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Patient A: Timeline
Aug: Started to cough
Oct 23: Diagnosed with pneumonia
Dec 4: Diagnosed with pneumonia
Dec 20: Treated for reflux
Jan 4: CXR interpreted as no active disease
Feb 22: Diagnosed with asthma
Apr 3: Went to clinic for depression,
provider ordered CXR, cavitary lesions
April 16: Diagnosed with TB
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Wisconsin Department of Health Services
WI TB Program Initiatives
o “TB Toolkit” under development; materials for
local health departments to share with clinicians;
to be rolled out November 2013
• MDR TB review led by Philip Wegner
o Full epidemiology of each case since 2005
• Testing at Milwaukee County Jail
o Just began
• Testing of other high risk populations
o Farm workers
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Wisconsin Department of Health Services
WI TB Program Initiatives
• Continue emphasis on risk-based testing
o Work with DQA to ensure that facilities are not
censored for doing risk-based testing
• Education plans: TB Summits across the state
o NE Region: November 12, 2013
o Southern Region: April, 2014
o SE Region: week of March 24, 2014
o Still to be scheduled: Northern and Western
regions
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Wisconsin Department of Health Services
WI TB Program Initiatives
• Medication coverage changes
o Using 340b federal program to cut costs
o Will start paying for B6 and multivitamin with at
least RDA for Vitamin D
• New prescription forms
o Separate forms for TB infection and TB disease
o Easier to read, includes risk factors for infection
and disease progression
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Wisconsin Department of Health Services
WI TB Program Initiatives
• Collaboration with Preparedness Program on
regional readiness for outbreak of infectious
respiratory illness
• Just beginning…
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Wisconsin Department of Health Services
Questions?
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Wisconsin Department of Health Services
Contact Information
Wisconsin TB Program staff
Lorna Will RN, MA, Program Director
608-261-6319 [email protected]
Philip Wegner RN, MPH, Nurse Consultant
608-266-3729 [email protected]
Pa Vang RN, MPH, Nurse Consultant
608-266-9452 [email protected]
Savitri Tsering, Refugee Health Coordinator
608-267-3733 [email protected]
Norma Denbrook, Interjurisdictional Coordinator
608-261-6388 [email protected]
Jo Mercurio, TB Program Manager
608-266-9692 [email protected]
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