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World TB Day

World TB Day. Bradley Allen, MD, PhD, Medical Consultant ISDH TB Control Program Indiana University School of Medicine Division of Infectious Diseases Roudebush VAMC. March 25, 2019. World TB Day. Dr. Robert Koch Reported discovery of Mycobacterium tuberculosis on March 24 th , 1882.

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World TB Day

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  1. World TB Day Bradley Allen, MD, PhD, Medical Consultant ISDH TB Control Program Indiana University School of Medicine Division of Infectious Diseases Roudebush VAMC March 25, 2019

  2. World TB Day Dr. Robert Koch Reported discovery of Mycobacterium tuberculosis on March 24th, 1882 March 25, 2019

  3. World TB Day 2019 Key Messages • It is timeto recognize achievements in TB prevention and control, and renew our commitment to ending this devastating disease in the United States. • Too many people in the U.S. still suffer from TB disease. We must continue to find and treat cases of active TB disease and also test and treat latent TB infection to prevent progression to disease and turn TB elimination into a reality. • Clinicians, health care agencies, and community organizations, especially those serving at-risk populations, have a critical role in TB elimination. • TB anywhere is TB everywhere. TB is an airborne disease that is transmitted from person to person. To end TB, we must continue to work together to fight this epidemic on multiple fronts, and stop the suffering associated with this disease, here at home – and around the world.

  4. World TB Day Key Messages • It is a time to recognize achievements in TB prevention and control, and renew our commitment to ending this devastating disease in the United States. • Too many people in the U.S. still suffer from TB disease. We must continue to find and treat cases of active TB disease and also test and treat latent TB infection to prevent progression to disease and turn TB elimination into a reality. • Clinicians, health care agencies, and community organizations, especially those serving at-risk populations, have a critical role in TB elimination. • TB anywhere is TB everywhere. TB is an airborne disease that is transmitted from person to person. To end TB, we must continue to work together to fight this epidemic on multiple fronts, and stop the suffering associated with this disease, here at home – and around the world. • Who’s With Me in this Battle!

  5. Reported Tuberculosis (TB) Cases and Rates United States, 1993-2017 CDC Reported Tuberculosis in the United States, 2017

  6. Number of Tuberculosis Cases Indiana, 2009-2018 No time for complacency!

  7. TB Cases by Site of Disease, Indiana, 2018 • Extrapulmonary sites • Lymphatic • Pleura • Meningeal • Peritoneal • Genitourinary • Ocular Anywhere!

  8. Number of Pediatric TB Casesby Age Group, Indiana, 2014-2018 Any age!

  9. Number of TB Cases by Place of Birth, Indiana, 2014-2018 From Anywhere!

  10. Percentage of TB Cases with HIV Comorbidity, Indiana, 2009-2018 Keep Testing! 6% co-infected

  11. Number of TB DeathsIndiana, 2014-2018 TB still kills, even in Indiana

  12. TB Mortality, Indiana, 2018 Two deaths occurred prior to TB diagnosis • U.S. born male, incarcerated, known reactor without treatment, on TNF alpha therapy • Cause of death CNS TB with obstructive hydrocephalus • TB isolated from sputum, lymph nodes, meninges (CSF) and spleen • Mexican born male, drug & alcohol abuse • Cause of death was severe hydrocephalus • TB found in CSF (meningeal)

  13. TB Mortality, Indiana, 2018 Eight deaths following TB Diagnosis • Gender - 5 male, 3 female • Origin - 5 U.S. born, 3 born outside the U.S. • 2 born in Mexico, one Burma • Presentation • 5 primary pulmonary • 3 pulmonary & extrapulmonary • Disseminated disease, found in lungs and rectum • Disseminated disease, lungs, small intestine, meninges • Disseminated disease, lungs and meninges (CSF)

  14. Percentage of Cases by Site of Disease and Mortality Status, Indiana, 2018 Over-representation of extrapulmonary presentation of disease

  15. Percentage of TB Cases by Place of Birth and Mortality Status, Indiana, 2018 Need to raise our suspicion of TB as the cause of disease in high-risk native Hoosiers

  16. What Can We Do About It??? • Raise public and provider awareness of TB disease • Detection and treatment of Latent TB Infection • Early suspicion, testing, and treatment of TB disease • Maintain your excellent efforts here in Indiana!

  17. Agenda Line-up • Dr. Muloma on TB Control • Sang Thao on Indiana TB Updates • Rachel Redington-Nobel on International efforts • Dr. Tarver – TB Radiology • Connie Parish and AnumithaVenatraman – Personal TB survival stories • Jessica Gentry – TB Laboratory Update • Kelly White – Case presentations and awards!

  18. WHAT TIME IS IT?

  19. WHAT TIME IS IT?

  20. Questions? Bradley Allen Medical Consultant, TB Control Program bradalle@iu.edu Sang Thao, MPH TB Epidemiologist sthao@isdh.in.gov 317.233.7841

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