Wisconsin Tuberculosis (TB) Program Update Department of Health Services. Julie Tans-Kersten, ... Southern Region . ... Pierce . Dunn . Pepin . Eau Claire . Buffalo . Trempealeau

2016 WI TB Update WI TB Program

Wisconsin Department of Health Services

Julie Tans-Kersten, MS, BSMT (ASCP) Wisconsin TB Program Wisconsin Mycobacteriology Laboratory Network Conference, Madison, WI November 17, 2016

Wisconsin Tuberculosis (TB) Program Update

1



Outline

• TB statistics, globally and nationally • TB in Wisconsin

o Epidemiology o Demographics

• WI partnerships for TB patient management • WI TB Program Updates

2



GLOBAL TB STATISTICS

3



All forms of TB

HIV-associated TB

Multi-drug resistant TB

Estimated number of cases

Estimated number of deaths

9.6 million 1.5 million (16%)*

1.2 million (12%) 390,000 (33%)

480,000 (5%) 190,000 (40%)

* Including deaths attributed to HIV/TB Source: WHO Global Tuberculosis Report 2015

The Global Burden of TB, 2014

4



Estimated TB Incidence Rates, 2014

5



2015 World Health Organization Statistics

• TB remained one of the top 10 causes of death worldwide

• Although there was a 1.5% decrease in the overall number of TB cases worldwide from 2014 to 2015, this decrease was too small to meet the first milestone of the 2020 End TB Strategy.

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Source: WHO Global Tuberculosis Report 2015



TB IN THE UNITED STATES

7



2015 CDC US Statistics • In 2015, total of 9,563 TB cases were reported

in the US based on preliminary data from the CDC National TB Surveillance System.

• This represents an increase of 157 cases from the 9,406 case reported in 2014.

• This is the first time since 1991 that the annual number of reported TB cases in the US has increased from one year to the next.

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www.cdc.gov/tb



TB IN WISCONSIN

9



Wisconsin TB Case Numbers

• In 2015 Wisconsin had 69 TB cases which is above the average of 59 cases for the previous 5 years.

• In 2016, 33 cases so far this year, which is very low for November

10



Reported TB Cases United States, 1982–2014

Wisconsin, 1982–2014

0

5,000

10,000

15,000

20,000

25,000

30,000

No.

of c

ases

Year 0

50

100

150

200

250

No.

of c

ases

Year

11



Douglas Bayfield

Ashland

Saywer

Washburn

Burnett

Polk

Barron Rusk Price

Iron

Vilas

Oneida

Lincoln

Taylor

Chippewa St. Croix

Pierce

Dunn

Pepin

Eau Claire

Buffalo

Trem

peale

au

Jackson

Monroe

Clark Marathon

Wood Portage

Juneau

Adams

Sauk

LaCrosse

Vernon

Crawford Richland

Grant

LaFayette Green Rock

Dane Iowa

Columbia Dodge

Jefferson Waukesha

Walworth

Kenosha

Racine

Ozau

kee

Sheboygan Fond du Lac Green Lake

Marquette

Waushara

Winn

ebag

o

Calum

et Manitowoc

Kewa

unee

Brown Outagamie

Waupaca

Shawano

Menominee

Oconto Langlade

Forest Marinette

Florence

Door

Milw

auke

e

Was

hingto

n

Western Region

Northeastern Region

Southeastern Region Southern Region

Northern Region City of Milwaukee 17 Northshore 2 Cudahy 1 Greenfield 1 Franklin 1 West Allis 1

7

3

1

1

1

2

2 2

2 1

1

1

1

23

3

2

1

1

*Preliminary as of November 1, 2015. WI TB Program.

2015 TB Cases by Region

13



Douglas Bayfield

Ashland

Saywer Washburn

Burnett

Polk Barron Rusk

Price

Iron

Vilas

Oneida

Lincoln

Taylor

Chippewa St. Croix

Pierce

Dunn

Pepin

Eau Claire

Buffalo Tr

empe

aleau

Jackson

Monroe

Clark Marathon

Wood Portage

Juneau

Adams

Sauk

La Crosse

Vernon

Crawford Richland

Grant

LaFayette Green Rock

Dane Iowa

Columbia Dodge

Jefferson Waukesha

Walworth

Kenosha

Racine

Ozau

kee

Sheboygan Fond du Lac Green Lake

Marquette

Waushara Winnebago Ca

lumet Manitowoc

Kewa

unee

Brown Outagamie

Waupaca

Shawano

Menominee

Oconto Langlade

Forest Marinette

Florence

Door

Milw

auke

e

Was

hingto

n

0.51-1.0

1.1-1.5

1.6-2.0

>2.0

≤ 0.50

10 year average TB rates 2005-2015

*rate = number of cases per 100,000

TB Case Rates,* Wisconsin, 2005-2014

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Reported TB Cases by Age Group

United States, 2014 Wisconsin, 2005-2014 <15 yrs

(5%) 15-24

yrs (10%)

25-44 yrs

(30%) 45-64

yrs (31%)

≥ 65 yrs (24%)

<15 (7%)

15-24 (13%)

25-44 (34%)

45-64 (24%)

>65 (22%)

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TB Cases by Residence in Correctional Facilities, Age ≥15

United States, 1993-2014 Wisconsin, 2005-2014

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0

200

400

600

800

1000

1200

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0.00.51.01.52.02.53.03.54.04.5

0

0.5

1

1.5

2

2.5

3

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

No. of Cases No. of Cases Percentage Percentage

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TB Cases Reported as Homeless in the 12 Months Prior to Diagnosis, Age ≥15

United States, 1993-2014 Wisconsin, 2005-2014 No. of Cases No. of Cases Percentage Percentage

0.01.02.03.04.05.06.07.08.0

0

200

400

600

800

1000

1200

1400

1600

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0.01.02.03.04.05.06.07.08.09.0

0

1

2

3

4

5

6

7

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Number of TB Cases in U.S.-born vs. Foreign-born Persons


0

5,000

10,000

15,000

20,000

Num

ber o

f Cas

es

U.S.-born Foreign-born

0102030405060

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Num

ber o

f Cas

es

Year

US-Born Foreign-Born

18



Countries of Birth of Foreign-born Persons Reported with TB

United States, 2014 Wisconsin, 2005-2014

• Mexico (21%) • Philippines (12%) • India (8%) • Vietnam (8%) • China (7%) • Guatemala (3%) • Haiti (3%) • Other countries (39%)

• Mexico (27%) • Hmong (Laos/Thai) (18%) • India (14%) • Philippines (5%) • China (5%) • Burma (3%) • Somalia (3%) • Other counties (25%)

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Laos/Thailand 68%

Burma 12%

Somalia 12%

Nepal 3%

Cambodia 2%

Sudan 1%

Vietnam 1% Bhutan

1%

Refugee population by country of origin

TB in Wisconsin Refugee Population 2005-2014

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Primary MDR TB


0%

1%

2%

3%

0

100

200

300

400

500

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0%

2%

4%

6%

8%

10%

0

1

2

3

4

5

6

7

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

21



2014 vs 2015 WI TB Data

22

2014 Total case = 48

2015 Total case = 69

% # % #

Pulmonary only 60% 29 59% 41

Extra-pulmonary 23% 11 32% 22

Both pulmonary & extra-pulmonary 17% 8 9% 6

Children <15 yo 0% 0 1% 1

Foreign-born 69% 33 71% 49

US-born 31% 15 29% 20

MDR-TB cases 6% 3 6% 4

Deaths 6% 3 10% 7



TB Summary and Challenges • Two most common factors associated with TB

Disease in Wisconsin: • foreign-born • known contact with someone with active TB disease

• Challenges • Loss of TB expertise in healthcare • Diagnosis and treatment of TB in high-risk foreign-

born populations • Complex case management/patients with co-

morbidities (diabetes, HIV, alcohol/drug use, smoking)

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PARTNERSHIPS FOR TB PATIENT MANAGEMENT

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Wisconsin Partnerships for TB Case Management

• Wisconsin State Laboratory of Hygiene (WSLH) • Wisconsin Mycobacteriology Laboratories (31) • Reference Laboratories • CDC • Health care providers and infection preventionists • Local public health departments • National TB Controller’s Association (NTCA) • Association of Public Health Laboratories (APHL)

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TB Case Management Diagnosis of tuberculosis

Initiation of Therapy

Patient follow-up

Laboratory Involvement



Laboratory Involvement in TB case Management

• Specimen collection and transport for diagnostic and follow-up testing

• Diagnostic testing • Report and interpretation of test results • Referral of specimens or cultures

o Molecular detection of drug resistance o Culture-based drug susceptibility testing (DST) o genotyping

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The Laboratory is Essential • Laboratory is a critical partner in the diagnosis

of TB • Rapid, reliable results are essential for early

detection of MTBC to prevent ongoing transmission

• Drug susceptibility test results identify drug resistance and help guide the clinician in providing appropriate treatment

• Laboratory results important for monitoring patient response to therapy 28



WISCONSIN TB PROGRAM UPDATES

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TB Program Staffing

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Role Name

Phone

TB Program Director

Julie Tans-Kersten 608-261-6387

TB Nurse Consultants

Judy Rabinowitz 608-266-7338

Marjorie Wall 608-266-9452

Lorna Will 608-266-3729

Office Associates for Dispensary

Joey Janz 608-266-9692

Brandon Rufer 608-266-7473



• WI TB Program website: https://www.dhs.wisconsin.gov/tb

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https://www.dhs.wisconsin.gov/tb



THANK YOU! QUESTIONS?

Wisconsin TB Program

1 West Wilson Street, PO Box 2659 Madison, Wisconsin 53701-2659

608-261-6319 (Office) 608-266-0049 (Fax)

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Documents

Wisconsin Tuberculosis (TB) Program Update Department of Health Services. Julie Tans-Kersten, ... Southern Region . ... Pierce . Dunn . Pepin . Eau Claire . Buffalo . Trempealeau