Transcript Trends in Tuberculosis – United States, 2005

PREVENTING RELAPSE
Lee B. Reichman, MD, MPH
Northeast TB Controllers Meeting
October 24, 2006
Princeton, New Jersey
No. of Cases
Reported TB Cases
United States, 1982–2005
25,000
20,000
15,000
10,000
1982
1987
1991
Year
1995
1999
2005
Trends in Tuberculosis –
United States, 2005
• Deceleration of the decline in the overall national
TB rate, the persistent disparities in TB rates
between U.S.-born and foreign-born persons and
between whites and racial/ethnic minorities, and
the increase in MDR TB cases all threaten
progress toward the goal of TB elimination in the
United States
• Effective TB control and prevention in the United
States require sufficient resources, continued
collaborative measures with other countries to
reduce TB globally, and interventions targeted to
U.S. populations with the highest TB rates
The U-Shaped Curve of Concern
Tuberculosis:
No Longer a Problem?
CDC TB Related News Items Weekly Update
6 month sample: October 1, 2003 - March 31, 2004
• 117 articles from 33 states on all aspects of TB
• 76 reports of TB outbreaks: (almost 1 every 2-3 days)
–
–
–
–
–
Schools and colleges
Prisons
Hospital/Nursing Home
Workplace
Homeless
38
8
7
16
7
- J. Seggerson, NCET WIRE, April 2004
Federal News Radio
CNN
NBC 4
Results
TB Onboard
XDRTB
• 1539 Patients with Isolates sent
• 544 Culture-Positive for M.Tb
– 35% of total
• 221 Resistant to Isoniazid & Rifampin (MDR TB)
– 40% of M.Tb and 14% of total
• 53 Resistant to all tested drugs (XDR TB)
– 24% of MDR TB, 10% MTB and 3% of total
-G. Friedland, Int Conf on AIDS, 2006
XDRTB Patients
Prior TB Treatment or Hospitalization
Characteristics
Prior TB Treatment:
No prior TB treatment
Cure or completed treatment
Default or Treatment Failure
Prior Hospitalization:
XDR TB Patients n (%)
26 (51%)
14 (28%)
7 (14%)
32 (64%)
-G. Friedland, Int Conf on AIDS, 2006
XDRTB Mortality
• 52 of 53 (98%) of XDR patients have died
• Median survival from date sputum collected was 16
days (IQR 2-210 days)
– No significant difference by HIV status, previous or use
of ARVs
-G. Friedland, Int Conf on AIDS, 2006
The New York Times
September 14, 2006
EDITORIAL: Extreme Tuberculosis
More funding is needed to catch up with new, extensively
drug-resistant strains of tuberculosis.
Patient Involvement in Medical Care
• Patients and their families have become increasingly involved—
and influential—in all aspects of medical care
• In the mid-eighties, as the first anti-viral drugs for treating AIDS
were being developed, activists demanded to participate in the
design of clinical trials directed by the National Institutes of
Health and pharmaceutical companies
• Inspired by the activists’ example, breast cancer patientadvocacy groups made similar requests
• The AIDS groups interrupted meetings and staged “die-ins” at
the N.I.H.
• Eventually, the physicians in charge of planning the clinical
trials agreed to their demands
• Laypeople now routinely sit on committees on the N.I.H. and on
hospitals’ institutional review boards, which assess the
ethicality and scientific merit of clinical trials
The Patient’s Charter for
Tuberculosis Care
The Patient’s Charter for
Tuberculosis Care
• Initiated and developed by patients from around the
world
• Outlines rights and responsibilities of people with
tuberculosis
• Sets out the ways in which patients, the community,
health providers (both private and public), and
governments can work as partners in a positive and open
relationship
• Practices principle of Greater Involvement of People with
Tuberculosis
• Affirms that empowerment is catalyst for effective
collaboration with health providers and authorities
Patient’s Rights
You have the right to:
Care;
Dignity;
Information;
Choice;
Confidence;
Justice;
Organization;
Security
Patient’s Responsibilities
You have the responsibility to:
Share information;
Follow treatment;
Contribute to Community Health
Show Solidarity
Deaths Due To:
TB (annually)
2 - 3,000,000
SARS
813
Angola Marburg Hemorrhagic Fever
329
Avian Influenza
144
Anthrax
Mad Cow Disease
Smallpox
5
1 (Cow)
0
Reichman’s Prediction
• The continued rise of the TB in the world and the leveling off of
tuberculosis in the US portends a significant global resurgence of
TB followed by a frightening resurgence of MDRTB still
diagnosed and treated with old tools
• The resurgence will continue unabated followed by subsequent
transmission to healthcare workers and through that vector to the
community at large
• Subsequent global re-establishment of control of tuberculosis
will then entail more staggering costs, both in cash and hysteria
than has ever been contemplated
• New drugs and New Diagnostics and an effective vaccine will
enhance the TB community’s success in turning this around
which once again will depend on energizing others to make our
case
INFORMATION LINE
1•800•4TB•DOCS (482-3627)
www.umdnj.edu/globaltb