Epidemiology of TB in Maryland

TB Annual Meeting

March 9, 2017

Alexandra Pyan, MPH, Epidemiologist Center for TB Control and Prevention

Prevention and Health Promotion Administration Maryland Department of Health and Mental Hygiene

Prevention and Health Promotion Administration

Thursday, March 9, 2017

2

Tuberculosis Globally

• Estimated 10.4 million new cases globally in 2015

• 1.4 million deaths from TB

• Six countries account for 60% of new cases: India,

Indonesia, China, Nigeria, Pakistan and South Africa

• 9th leading cause of death

Prevention and Health Promotion Administration

Thursday, March 9, 2017

3

World Health Organization, Global Tuberculosis Report 2016

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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TB Case Rates 2015

National and Statewide

CDC, as of June 9, 2016

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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Maryland TB, 2009-2016

0

1

2

3

4

5

0

50

100

150

200

250

2009 2010 2011 2012 2013 2014 2015 2016

Ca

se

Ra

te p

er

10

0,0

00

Cases

Cases Case Rate Linear (Cases)

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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Maryland Case Rates, 2016

<3.7/100,000

>3.7 /100,000

No reported cases

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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TB Rates among US and Foreign

Born, 2012-2016

0

2

4

6

8

10

12

14

16

18

20

22

24

2012 2013 2014 2015 2016

Case R

ate

per

10

0,0

00

MD US-Born MD Foreign-Born

US US-Born US Foreign-Born

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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Percent of TB Cases by Origin

Maryland, 2014-2016

0

50

100

150

200

250

2014 2015 2016

Cases

Foreign-Born US-Born

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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Top Countries of Origin-MD, 2015

El Salvador, 5%

Ethiopia, 10%

India, 11%

Nigeria, 7%

Philippines, 8%

Vietnam, 8%

Others, 51%

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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Foreign-born TB Case Numbers, by Time

from U.S. Arrival to Diagnosis, 2014-2016

0 20 40 60 80 100

2014

2015

2016

>10 years >5-10 years 1-5 years <1 year

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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TB Cases by Race and Origin, 2015

Hispanic

0%

White 34%

Asian 3% Black/Africa

n American 63%

U.S Born

Hispanic 20%

White 1%

Asian 46%

Black 31%

Multi-race 2%

Foreign Born

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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Cases by Age Group 2014-2016

0

10

20

30

40

50

60

70

80

90

2014 2015 2016

<5 5-14 15-24 25-44 45-64 65+

Prevention and Health Promotion Administration

Thursday, March 9, 2017

13

Numbers of TB HIV Co-Infection,

Origin of Birth, 2013-2016

0

2

4

6

8

10

12

14

2013 2014 2015 2016

Cases

U.S Born Foreign Born

6%

6%

17%

7%

5%

8%

8%

8%

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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TB and Diabetes, 2011-2016

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

0

5

10

15

20

25

30

35

2012 2013 2014 2015 2016

Perc

enta

ge

Cases

Cases Percentage Linear (Cases)

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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MDR/XDR TB in Maryland,

2012-2016

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

0

1

2

3

2012 2013* 2014 2015 2016

Perc

enta

ge

Cases

Cases Percentage *One XDR Case

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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LTBI Reporting

• CTBCP is currently working to amend COMAR

regulations

• CDC voluntary reporting in 2020

• Any positive TST or IGRA

• All reports and data management will be handled by

CTBCP

• Early stages, feedback welcome!

http://phpa.dhmh.maryland.gov

Prevention and Health Promotion Administration

Thursday, March 9, 2017

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Prevention and

Health Promotion

Administration