Epidemiology of TB in Indiana - 2019 Alexa Stegemoller, MPH, - PowerPoint PPT Presentation

Epidemiology of TB in Indiana - 2019 Alexa Stegemoller, MPH, Epidemiologist TB & Refugee Health Epidemiology Resource Center May 26, 2020

Annual Tuberculosis Incidence (per 100,000 population), Worldwide, 2018 WHO Estimate TB Incidence Rates, 2018

Reported Tuberculosis Cases and Rates United States, 1993-2019 30,000 12.0 25,000 10.0 Incidence Rate per 100,000 20,000 8.0 Number of Cases 15,000 6.0 10,000 4.0 5,000 2.0 0 0.0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Year No. of Cases Incidence Rate CDC Reported Tuberculosis in the United States, 2019

TB Trends, United States, 2018 Minority populations continue to be disproportionately affected by TB disease. American Indian/Alaska Natives had a 10 % increase in incidence from 2017 • to 2018. • Native Hawaiians and other Pacific Islanders had a 2.7% increase in incidence from 2017 to 2018. • Hispanics and Whites remained stagnant. Non-Hispanic Asians and Non-Hispanic Blacks had a decrease in incidence, • 4.7% and 6.7% respectively. 19.8% of cases reported having diabetes. 72.0% of cases occurred among non-U.S.- born people. CDC Reported Tuberculosis in the United States, 2018

TB Case Count and Incidence Rate, Indiana, 2010-2019 140 2.0 1.9 120 1.8 100 1.7 Incidence Rate per 100,000 Number of cases 1.6 80 1.5 60 1.4 1.3 40 1.2 20 1.1 0 1.0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Year Count Cases Rate

TB Cases by County, Indiana, 2010-2019 Shaded by Shaded by

TB Cases by County, Indiana, 2019

Overview of TB in Indiana, 2019 • Total TB Cases: 108 • Total Reported LTBI Cases: 961 • Top Jurisdictions: • Top Jurisdictions: 1. Marion (49) 1. Tippecanoe (202) 2. Allen (9) 2. Allen (89) 3. St. Joseph (7) 3. Hendricks (49) 4. Lake (7) 4. St. Joseph (49) • Incidence Rate: 1.6 cases of TB per 100,000 5. Lake (46) population

Tuberculosis Cases by Site of Disease, Indiana, 2019 Both 8% Extrapulmonary sites include: Extrapulmonary • Lymphatic (35%) 29% • Pleural (16%) • Eye and/or Ear (13%) Pulmonary • Meningeal (10%) 63% • Bone and/or Joint (10%) • Genitourinary (10%) • Other (6%) N = 108

Tuberculosis Deaths, Indiana, 2014-2019 12 10 10 8 Number of Deaths 6 6 5 5 4 4 2 2 0 2014 2015 2016 2017 2018 2019 Year *Excludes unrelated TB deaths

TB Cases by Age Group, Indiana, 2019 5 to 14 years < 5 years 1% 1% 15 to 24 years ≥ 65 years 12% 17% 45 to 64 years 27% 25 to 44 years 42% N = 108

TB Incidence Rate by Age Group, Indiana, 2015 to 2019 3.50 3.00 2.50 Incidence Rate per 100,000 2.00 1.50 1.00 0.50 0.00 2015 2016 2017 2018 2019 Year <15 years 15-24 years 24 to 44 years 45 to 64 years Older than 65

TB Cases by Hispanic Ethnicity and Non- Hispanic Race, Indiana, 2019 Non-Hispanic Hawaiian/Other Pacific Islander Hispanic or Latino 1% 16% Non-Hispanic Asian 34% Non-Hispanic White 18% Non-Hispanic Black or African American 31% N = 108

TB Cases by Country of Birth, Indiana, 2019 Honduras Nigeria 4% 5% Mexico 8% United States 38% India 10% Burma 13% Other 22% N = 108

TB Case Count and Rate by National Origin, Indiana, 2014-2019 80 25 70 20 60 Incidence rate per 100,000 50 15 Total Cases 40 10 30 20 5 10 0 0 2014 2015 2016 2017 2018 2019 Year Total Non-U.S.-Born Total U.S.-Born Incidence Non-U.S.-Born Incidence U.S.-Born

TB Cases by HIV Status, Indiana, 2019 Not Offered Refused 4% 7% Positive 7% Negative 82% N = 108

Most Commonly Reported Risk Factors among TB Cases, Indiana, 2019 Risk Factor Percent Diabetes 19.4% Non-Injection Drug Use 13.9% History of Homelessness 9.3% Contact of Infectious TB Patient 8.3% Excess Alcohol Use 7.4% Immunosuppression (not 6.5% HIV/AIDS) Correctional Facility at Diagnosis 3.8% Incomplete LTBI Therapy 3.7% End-Stage Renal Disease 2.8% Injection Drug Use 1.9% *Risk Factors are not mutually exclusive

TB Cases with Diabetes, Indiana, 2010-2019 25 25 20 20 15 15 Case Count Percent 10 10 5 5 0 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Year Case Count Percent

TB Cases with Non-injection Drug Use, Indiana, 2015-2019 16 16 14 14 12 12 10 10 Case Count Percent 8 8 6 6 4 4 2 2 0 0 2015 2016 2017 2018 2019 Year Case Count Percent

Percent of TB Cases with Drug Resistance, Indiana, 2015-2019 10 9 8 7 6 Percent 5 4 3 2 1 0 2015 2016 2017 2018 2019 Year INH Resistance Multidrug Resistance Other Drug Resistance

TB Treatment Indicators, Indiana, 2018-2019 Percent of National Program Goal Cases Average Initiate RIPE 96.2% 91.8% 94.0% (2019) Culture Conversion < 66.7% 63.0% 72.0% 60 Days (2018) Completion of Therapy < 1 95.8% 81.1% 95.0% Year (2018) *Orange = Goal Met

Contact Investigation Indicators, Indiana, 2018 AFB+ Sputum Program Goal AFB– Sputum Smear Smear, Culture+ (# of contacts) (# of contacts) Contacts Elicited 1354 92.0% 72 Contacts 905 75.0% 62 Evaluated LTBI Treatment 64 93.0% 12 Initiated LTBI Treatment 59 80.0% 10 Completed *Orange = Goal Met

Genotyping, Indiana, 2019 • 98.6% of culture positive cases were genotyped. 49.3% of genotyped cases were identified as • part of a cluster. • 3 new genotype clusters were identified. • No ongoing outbreaks • Recurring cases from previous outbreaks

Genotyping Clusters of Interest IN_0069 Risk Factors: 27 Cases in IN History of homelessness • • • 2008 to 2019 • Non-injection and injection drug use • Excess alcohol use IN_0074 • History of incarceration • 37 Cases in IN U.S.-born • • 2009 to 2019

Summary • Indiana TB case count decreased in 2019. • -6.9% change • The number of TB deaths in Indiana has decreased for the first time in four years. • Proportion of U.S.-born cases decreased. • This trend matches national data. • Risk Factors: Non-injection drug use and diabetes are increasing. • Continued success in TB treatment and case management indicators: • HIV testing; • Genotyping; • Completion of treatment; and • Contact Investigations. CDC MMWR: Tuberculosis — United States, 2019

Questions? Contact Information: Alexa Stegemoller, MPH TB & Refugee Health Epidemiologist 317-233-7841 AStegemoller@isdh.in.gov