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TB in North Dakota: Changing Demographics

TB in North Dakota: Changing Demographics. John R. Baird, MD, MPH Fargo Cass Public Health North Dakota Department of Health April 11, 2012. Objectives. Shift of US TB cases to foreign born Change in ND TB demographics Challenges in TB evaluation and treatment in new ethnic groups.

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TB in North Dakota: Changing Demographics

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  1. TB in North Dakota:Changing Demographics John R. Baird, MD, MPH Fargo Cass Public Health North Dakota Department of Health April 11, 2012

  2. Objectives • Shift of US TB cases to foreign born • Change in ND TB demographics • Challenges in TB evaluation and treatment in new ethnic groups

  3. Types of Mycobacteria • M. tuberculosis causes most TB cases in U.S. • Mycobacteria that cause TB: • M. tuberculosis • M. bovis • M. africanum • M. microti • M. canetti • Mycobacteria that do not cause TB • e.g., M. avium complex M. tuberculosis Module 1 – Transmission and Pathogenesis of Tuberculosis

  4. Sites of TB Disease Bacilli may reach any part of the body, but common sites include: Module 1 – Transmission and Pathogenesis of Tuberculosis

  5. Global Epidemiology of TB • TB is one of the leading causes of death due to infectious disease in the world • Almost 2 billion people are infected with M. tuberculosis • Each year about: • 9 million people develop TB disease • 2 million people die of TB Module 2 – Epidemiology of Tuberculosis

  6. Reported TB Cases United States, 1982–2010* No. of Cases Year *Updated as of July 21, 2011

  7. TB Case Rates,* United States, 2010 D.C. <3.6 (2010 national average) >3.6 *Cases per 100,000.

  8. TB cases in ND - Numbers

  9. TB cases in ND - Rates

  10. TB rates – US vs. ND

  11. TB Case Rates* by Age Group United States, 1993–2010 Cases per 100,000 Age Group (years) * Updated as of July 21, 2011

  12. TB cases in ND - Age

  13. TB cases in ND - Sex

  14. Reported TB Cases by Race/Ethnicity*United States, 2010 *All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.

  15. TB cases in ND - Race

  16. Number of TB Cases inU.S.-born vs. Foreign-born Persons United States, 1993–2010* No. of Cases *Updated as of July 21, 2011

  17. Percentage of TB Cases Among Foreign-born Persons, United States* 2000 2010 DC DC >50% 25%–49% *Updated as of July 21, 2011 <25%

  18. TB cases in ND US vs. Foreign Born

  19. Countries of Birth of Foreign-born Persons Reported with TB, United States, 2010

  20. TB cases in ND - Origin Foreign Born 2007 - 2011 Africa – Somalia (5), Ethiopia (2), Kenya (2), Sudan, Zambia South Asia – Bhutan (4), Nepal (2), India Asia – China, Mongolia, Korea SE Asia – Vietnam, Philippines

  21. Refugee Arrivals North Dakota LSS of ND

  22. Resettlement Cities North Dakota

  23. Countries of Origin - Refugees to ND Maps adapted from The Perry-Castañeda Library Map Collection, The University of Texas at Austin http://www.lib.utexas.edu/maps

  24. Latent TB Infection (LTBI) LTBI is the presence of M. tuberculosis organisms (tubercle bacilli) without symptoms or radiographic evidence of TB disease.

  25. Latent TB Infection TST* or QFT† positive Negative chest radiograph No symptoms or physical findings suggestive of TB disease Pulmonary TB Disease TST or QFT usually positive Chest radiograph may be abnormal Symptoms may include one or more of the following: fever, cough, night sweats, weight loss, fatigue, hemoptysis, decreased appetite Respiratory specimens may be smear or culture positive LTBI vs. Pulmonary TB Disease *tuberculin skin test †QFT (QuantiFERON-TB and QuantiFERON-Gold) is a blood test to detect M. tuberculosis infection.

  26. Cases in ND – LTBI & TB

  27. Challenges • Language • Culture • Proper & prompt evaluation • Care coordination • Complete LTBI treatment • Homeless • Others?

  28. TBNethttp://www.migrantclinician.org

  29. Case #1 • 4 month old – adopted from Africa • Birth mother HIV+ • Baby HIV neg @ 6 mo • Staph skin and proctitis on US entry • BCG given in Africa – no TST done is US • Hospitalized at 11 mo • sore ankle, limp, temp 101-103 • refused to bear weight 3 days • Splinted for possible fracture

  30. Case #1 (cont.) • TST 16 mm – QuantiFERONneg • Dx – abcess left distal tibia, staph, ? TB • Rx – IV Rocephen, Vacomycin, Septra • DOT – INH, RIF, EMB, PZA • Daycare concerns • Culture – PZA resistant – Bovine TB

  31. Consultation may be requested through your state's TB Control Program or by contacting Heartland National TB Center directly at our toll-free number: 1-800-TEX-LUNG (1-800-839-5864) Consultation line staffed Mon — Fri, from 8:00 AM until 5:00 PM, Central Time http://www.heartlandntbc.org Case Presentation June 2008 – Adherence Difficulties in a Child with Tuberculosis Case History: A 15 month old child with active pulmonary tuberculosis became a significant management challenge to his public health nursing providers because of his consistent refusal to take medications. http://www.heartlandntbc.org/casestudies/cs9.pdf

  32. Questions • Craig Steffens, MPH csteffens@nd.gov • TB Controller, NDDoH 701.328.2377 http://www.ndhealth.gov/disease/tb • John R. Baird, MD, MPH jbaird@nd.gov • Field Med Officer, NDDoH • Health Officer, FCPH 701.241.8118 http://www.heartlandntbc.org http://www.migrantclinician.org http://www.cdc.gov/tb

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