HAWAII TUBERCULOSIS UPDATE APIC HAWAII November 5, 2018 Elizabeth - - PowerPoint PPT Presentation
HAWAII TUBERCULOSIS UPDATE APIC HAWAII November 5, 2018 Elizabeth MacNeill, MD, MPH Chief, Tuberculosis Control Branch Reported TB Cases Hawaii, 1930 2016 1200 1060 1000 No. of cases 717 800 600 339 400 293 270 196 167 200
Elizabeth MacNeill, MD, MPH Chief, Tuberculosis Control Branch
Updated as of May 1, 2017
1060 717 339 293 270 167 196 136 115 117 136 119 200 400 600 800 1000 1200 1930 1940 1950 1960 1970 1980 1990 2000 2010 2012 2014 2016
Year
122 124 117 115 123 117 115 136 127 119 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 20 40 60 80 100 120 140 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Foreign-born (Hawaii Definition) Foreign-born (CDC Definition)
Percentage
Updated as of May 1, 2017
United States 54% Philippines 13% FSM 13% Marshall Islands 14% Burundi 3% Guam 3%
Hawaii Pediatric TB Cases by Birth Country, 2007-2016
Age ≤14 n=37
Parent/Guardian Country of Birth Among US-Born Pediatric Cases, 2007-2016
Philippines 8% Marshall Islands 17% United States 17% Tonga 3% American Samoa 3% FSM 47% Vietnam 5%
90% of US-Born Pediatric Cases have at Least One non-US Born Parent/Guardian n=36 Guardians among 20 US-Born Cases
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Vietnam Federated States of Micronesia Philippines Japan China Other All Foreign- born Unknown* <1 1-4 ≥5
Percent of Foreign-born TB Cases by Time of Residence in U.S. Prior to Diagnosis Hawaii, 2016
*Foreign-born TB cases for whom information on length of residence in the U.S. prior to diagnosis is missing or unknown Updated as of May 1, 2017
Risk Factors for TB Exposure All Hawaii TB Cases, 2012-2016
6% 13% 0.3% 2% 0.3% 5% 7% 0.3% 4% 87%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
No Known Risk Factor for Exposure Other Exposure or Progession Risk Lived Outside the US > 2 Months Resident of Long-Term Care Facility Resident of Correctional Facility Homeless within the Past Year Known Contact to Infectious TB Case Known Contact to MDR-TB Case Occupational Risk* Foreign-Born
Percent with Risk Factor
n=614
*Occupational Risk: Health Care Worker, Migrant/Seasonal Worker, Correctional Facility Employee
Risk Factors for TB Progression All Hawaii TB Cases, 2012-2016
26% 13% 3% 0.2% 4% 0.3% 2.0% 10% 5% 0.5% 57%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
No Known Risk Factor for Progression Other Exposure or Progression Risk End Stage Renal Failure Post-Organ Transplant Immunosuppression HIV Positive Any Drug Use Excess Alcohol Use Incomplete LTBI Treatment TNF-Alpha Use Diabetes History or Positive Diabetes…
Percent with Risk Factor
n=614
6% (6) 12% (12) 13% (12) 1% (1) 9% (7) 22% … 12% (11) 5% (5) 0% (0) 3% (3) 0% … 1% (1) 0% (0) 1% (1)
0% 5% 10% 15% 20% 25% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
% Resistant Isoniazid MDR TB
1% (1) 7% (6) 4% (4) 0% (0) 1% (1) 10% (9) Updated as of May 1, 2017
*Cases are culture positive with initial drug susceptibility testing done. Isolates may be resistant to other drugs. Excludes cases with
susceptibility testing not done or unknown for isoniazid and rifampin.
Rifampin, Ethambutol and Capreomycin. Lost to follow-up.
Active Disease Control
Faster and more complete test results: PCR, MDDR, WHS DOT for all patients Increase surveillance for at-risk settings Genotypic clusters For Latent TB Infection
Increase/improve patient education Work with agencies who serve at-risk groups New Guidelines for healthcare staff screening?