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

Alexa Stegemoller, MPH, Epidemiologist TB & Refugee Health Epidemiology Resource Center

Epidemiology of TB in Indiana - 2019

May 26, 2020

Annual Tuberculosis Incidence (per 100,000 population), Worldwide, 2018

WHO Estimate TB Incidence Rates, 2018

0.0 2.0 4.0 6.0 8.0 10.0 12.0 5,000 10,000 15,000 20,000 25,000 30,000 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 Incidence Rate per 100,000 Number of Cases Year

Reported Tuberculosis Cases and Rates United States, 1993-2019

• No. of Cases

Incidence Rate

CDC Reported Tuberculosis in the United States, 2019

TB Trends, United States, 2018 72.0% of cases

• ccurred among non-U.S.-

born people.

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.

CDC Reported Tuberculosis in the United States, 2018

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

TB Case Count and Incidence Rate, Indiana, 2010-2019

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
• Top Jurisdictions:
• 1. Marion (49)
• 2. Allen (9)
• 3. St. Joseph (7)
• 4. Lake (7)
• Incidence Rate: 1.6 cases
• f TB per 100,000

population

• Total Reported LTBI

Cases: 961

• Top Jurisdictions:
• 1. Tippecanoe (202)
• 2. Allen (89)
• 3. Hendricks (49)
• 4. St. Joseph (49)
• 5. Lake (46)

Tuberculosis Cases by Site of Disease, Indiana, 2019

Pulmonary 63% Extrapulmonary 29% Both 8% N = 108

Extrapulmonary sites include:

• Lymphatic (35%)
• Pleural (16%)
• Eye and/or Ear (13%)
• Meningeal (10%)
• Bone and/or Joint (10%)
• Genitourinary (10%)
• Other (6%)

4 2 5 6 10 5 2 4 6 8 10 12 2014 2015 2016 2017 2018 2019 Number of Deaths Year

Tuberculosis Deaths, Indiana, 2014-2019

*Excludes unrelated TB deaths

TB Cases by Age Group, Indiana, 2019

< 5 years 1% 5 to 14 years 1% 15 to 24 years 12% 25 to 44 years 42% 45 to 64 years 27% ≥ 65 years 17% N = 108

TB Incidence Rate by Age Group, Indiana, 2015 to 2019

0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 2015 2016 2017 2018 2019 Incidence Rate per 100,000 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 1% Hispanic or Latino 16% Non-Hispanic White 18% Non-Hispanic Black or African American 31% Non-Hispanic Asian 34% N = 108

TB Cases by Country of Birth, Indiana, 2019

United States 38% Other 22% Burma 13% India 10% Mexico 8% Nigeria 5% Honduras 4% N = 108

5 10 15 20 25 10 20 30 40 50 60 70 80 2014 2015 2016 2017 2018 2019 Incidence rate per 100,000 Total Cases Year Total Non-U.S.-Born Total U.S.-Born Incidence Non-U.S.-Born Incidence U.S.-Born

TB Case Count and Rate by National Origin, Indiana, 2014-2019

TB Cases by HIV Status, Indiana, 2019

Negative 82% Positive 7% Refused 7% Not Offered 4%

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 HIV/AIDS) 6.5% 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

5 10 15 20 25 5 10 15 20 25 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Percent Case Count Year Case Count Percent

TB Cases with Non-injection Drug Use, Indiana, 2015-2019

2 4 6 8 10 12 14 16 2 4 6 8 10 12 14 16 2015 2016 2017 2018 2019 Percent Case Count Year Case Count Percent

Percent of TB Cases with Drug Resistance, Indiana, 2015-2019

1 2 3 4 5 6 7 8 9 10 2015 2016 2017 2018 2019 Percent Year INH Resistance Multidrug Resistance Other Drug Resistance

TB Treatment Indicators, Indiana, 2018-2019

*Orange = Goal Met

Percent of Cases National Average Program Goal Initiate RIPE (2019) 96.2% 91.8% 94.0% Culture Conversion < 60 Days (2018) 66.7% 63.0% 72.0% Completion of Therapy < 1 Year (2018) 95.8% 81.1% 95.0%

Contact Investigation Indicators, Indiana, 2018

AFB+ Sputum Smear (# of contacts) Program Goal AFB– Sputum Smear, Culture+ (# of contacts) Contacts Elicited 1354 92.0% 72 Contacts Evaluated 905 75.0% 62 LTBI Treatment Initiated 64 93.0% 12 LTBI Treatment Completed 59 80.0% 10

*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

• 27 Cases in IN
• 2008 to 2019

IN_0074

• 37 Cases in IN
• 2009 to 2019

Risk Factors:

• History of homelessness
• Non-injection and

injection drug use

• Excess alcohol use
• History of incarceration
• U.S.-born

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

Contact Information:

Alexa Stegemoller, MPH TB & Refugee Health Epidemiologist 317-233-7841 AStegemoller@isdh.in.gov

Questions?