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The Epidemiology of Tuberculosis in Minnesota, 2004-2008This slide series provides epidemiologic data on demographic and clinical characteristics of the cases of tuberculosis disease reported in Minnesota during the past 5 years. Available in Web, PDF, and PowerPoint formats. On this page: The Epidemiology of Tuberculosis in Minnesota, 2004-2008
Slide 1: The Epidemiology of Tuberculosis in Minnesota, 2004-2008
Slide 1: The Epidemiology of Tuberculosis in Minnesota, 2004-2008. The purpose of this slide set is to characterize the epidemiology of tuberculosis (TB) disease in Minnesota. The slides present data in tabular and graphic format that describe both demographic and clinical characteristics of TB statewide. The data in these slides pertain to cases of active TB disease reported from 2004 through 2008. In accordance with the Minnesota Communicable Disease Reporting Rule, physicians, laboratories, and other health care providers are required to report all confirmed and suspected cases of TB disease among persons residing in Minnesota to the Minnesota Department of Health; such reports serve as the source of information for the data presented in these slides. Slide 2: Tuberculosis Morbidity, Minnesota, 2004-2008
Slide 2: Tuberculosis Morbidity, Minnesota, 2004-2008. In 2008, 211 new cases of active TB disease among residents of Minnesota were reported to the Minnesota Department of Health. This number corresponds to an incidence rate of 4.0 cases per 100,000 population. In comparison, 12,898 new cases of TB disease (4.2 cases per 100,000 population) were reported in the United States during 2008; the median TB incidence rate among 51 states and reporting areas nationally was 3.0 cases per 100,000 population. While the incidence rate of TB in Minnesota during 2008 declined 13% from 2007 and was slightly less than the national rate, the statewide rate was above both the median rate among states and reporting areas in the U.S. and the national "Healthy People 2010" objective of reducing the annual TB incidence rate in the U.S. to no more than 1 case per 100,000 population. Slide 3: Number of Tuberculosis Cases by Place of Birth, Minnesota, 1999-2008
Slide 3: Number of Tuberculosis Cases by Place of Birth, Minnesota, 1999-2008. While the number of cases of TB disease reported in the United States has declined each year since 1993, the incidence of TB disease in Minnesota has been variable during the decade from 1999 through 2008, as depicted in this slide. The total number of TB cases reported in Minnesota during 2008 was similar to that in 1999. Between 1999 and 2008, however, the annual number of TB cases peaked in 2001 (239 cases) and again in 2007 (238 cases). Most notably, while the number of TB cases reported among foreign-born persons in Minnesota during 2008 was essentially the same (i.e., one fewer case) as that in 1999, the number of cases reported among U.S.–born persons increased between those endpoints. In particular, from 2007 to 2008, the number of TB cases reported among foreign-born persons statewide decreased 24%, while the number of cases reported among U.S.-born persons increased 60%. Slide 4: Tuberculosis Morbidity and Mortality, Minnesota, 2004-2008
Slide 4: Tuberculosis Morbidity and Mortality, Minnesota, 2004-2008. This slide depicts the number of deaths attributed to tuberculosis in Minnesota between 2004 and 2008. For the past 5 years, the number of incident TB cases is listed, along with the number and percentage of those cases who subsequently died as a result of TB. The number and percentage of TB case-patients who died as a result of TB ranged from none in 2004 to 4 (2%) in 2007. Overall, 1% of TB case-patients died as a result of TB during this 5-year period. Please note that these data do not include individuals who died while on TB treatment but from causes other than TB. Slide 5: Number of Cases and Incidence of Tuberculosis by Location of Residence, Minnesota, 2004-2008
Slide 5: Number of Cases and Incidence of Tuberculosis by Location of Residence, Minnesota, 2004-2008. This slide presents the number of new TB cases reported and the incidence rate of TB disease by county of residence in Minnesota from 2004 through 2008. County-specific data are presented for Hennepin, Ramsey, and Olmsted counties, which are the only counties in Minnesota with public TB clinics. The slide also presents data for the five-county suburban Twin Cities metropolitan area and for Greater Minnesota, excluding Olmsted County. Although 26 (30%) of the state's 87 counties reported at least one case of TB disease in 2008, the risk of TB disease was focused in certain areas of the state. In 2008, the highest TB incidence rate was reported in Ramsey County (8.8 cases per 100,000 population), followed closely by Hennepin County (8.5 cases per 100,000 population); both Ramsey and Hennepin counties' TB incidence rates were more than twice the statewide rate. In all 5 years shown on this slide, the annual incidence rates in both the five-county suburban Twin Cities metropolitan area and Greater Minnesota were considerably lower than the statewide rates. From 2007 to 2008, the TB incidence rates in Hennepin County, the suburban Twin Cities metropolitan area, and Ramsey County decreased 15%, 9%, and 6%, respectively. In contrast, the TB incidence rate in Greater Minnesota increased 36% from 2007 to 2008. Most notably, from 2007 to 2008, Olmsted County's TB incidence rate declined 80%, to a level approximately three to five time less than its annual rates during the 4 preceding years. Slide 6: Tuberculosis Disease, Minnesota, 2008
Slide 6: Tuberculosis Disease, Minnesota, 2008. This slide presents a map of Minnesota with counties shaded according to the number of TB cases reported in their jurisdictions during 2008. Of the state's 87 counties, 26 (30%) reported at least one case of TB disease during 2008. This slide illustrates, however, that the greatest burden of TB disease was focused in certain areas of the state. In particular, the largest number of cases occurred in Hennepin County, followed by Ramsey County and other counties located primarily in the suburban Twin Cities metropolitan area and south and central Minnesota. Slide 7: Tuberculosis Disease, Minnesota, 2004-2008
Slide 7: Tuberculosis Disease, Minnesota, 2004-2008. This slide presents data on TB cases, by county of residence, reported in Minnesota from 2004 through 2008. Similar to the previous slide, these data emphasize that the greatest burden of TB disease occurred primarily in certain areas of the state, although the geographic distribution of cases was very broad. Of the state's 87 counties, 51 (59%) reported at least one case of TB disease during this 5-year period. Slide 8: Number of Cases of Tuberculosis by Location of Residence, Minnesota, 2004-2008
Slide 8: Number of Cases of Tuberculosis by Location of Residence, Minnesota, 2004-2008. This slide presents data on TB cases reported in Minnesota from 2004 through 2008, by county of residence and year of diagnosis. Similar to previous slides, these data emphasize that the burden of TB disease was focused in certain areas of the state, with the majority of TB cases statewide occurring in a small number of counties. Cumulatively from 2004 through 2008, Hennepin and Ramsey counties, respectively, accounted for 48% and 19% of TB cases reported statewide. During this 5-year period, however, the percentage of TB cases statewide that occurred in Hennepin County declined 12%, whereas the percentage of cases that occurred in Ramsey County increased 50%. Cumulatively during this period, Greater Minnesota (excluding Olmsted County), the five-county suburban Twin Cities metropolitan area, and Olmsted County , respectively, each accounted for approximately 15%, 12%, and 6% of TB cases in Minnesota, although the annual percentages of cases reported in these areas varied from year to year. Slide 9: Tuberculosis Cases by Age and Place of Birth, Minnesota, 2004-2008
Slide 9: Tuberculosis Cases by Age and Place of Birth, Minnesota, 2004-2008. The age distribution of TB case-patients reported in Minnesota differs markedly between U.S.-born and foreign-born patients. The majority (70%) of foreign-born TB case-patients reported in Minnesota from 2004 to 2008 were 15 to 44 years of age, whereas persons 45 years of age or older constituted 45% of U.S.-born TB case-patients. These strikingly different age distributions reflect the differing risks of exposure to TB among these populations. For example, just over half of newly-arrived immigrants with Class B TB designation and refugees that arrived in Minnesota during this 5 year period are young adults; TB case-patients of this age likely were infected with TB in their countries of origin prior to being diagnosed with active TB disease in Minnesota. Among U.S.-born persons, adults who were alive 50 or more years ago, when TB was much more prevalent in Minnesota than during more recent decades, are much more likely than younger U.S.-born persons to have been infected with TB. As these older U.S.-born persons age and develop other medical conditions that may weaken their immune systems, they may progress from remotely acquired latent TB infection to active TB disease. The proportion of children less than 5 years of age was much larger among U.S.-born TB case-patients reported in Minnesota from 2004 through 2008 than among foreign-born case-patients (18% versus 1%, respectively). Approximately 75% of these young U.S.-born pediatric case-patients were attributed to children born in the U.S. to foreign-born parents. These first-generation U.S.-born children appear to experience an increased risk of TB disease that more closely resembles that of foreign-born persons. Presumably, these children may have been exposed to TB as a result of travel to their parents' country of origin and/or visiting or recently-arrived family members who may be at increased risk for TB acquired overseas. Slide 10: Number of Cases and Incidence of Tuberculosis by Race/Ethnicity, Minnesota, 2004-2008
Slide 10: Number of Cases and Incidence of Tuberculosis by Race/Ethnicity, Minnesota, 2004-2008. This slide presents the number of TB cases and the incidence rate of TB disease by race/ethnicity in Minnesota from 2004 through 2008. Non-white racial and ethnic populations in Minnesota are disproportionately affected by TB. In particular, the incidence rate of TB disease reported during each of the past 5 years was highest among blacks, followed by Asians; the rates of TB disease in these populations, respectively, were, on average, approximately 139 times and 71 times higher than that among non-Hispanic whites. On average during this period, the TB incidence rates among Hispanics/Latinos and American Indians, respectively, were 31 times and 22 times greater than that among non-Hispanic whites. While there was considerable variability in all race/ethnicity-specific TB incidence rates in Minnesota during this 5-year period, two such rates reported in 2008 were notable. Slide 11: Cases of Tuberculosis by Risk Category, Minnesota, 2004-2008
Slide 11: Cases of Tuberculosis by Risk Category, Minnesota, 2004-2008. Tuberculosis disproportionately affects certain high-risk subgroups of the population. This slide presents several of the common risk factors for TB disease and the number and percentage of TB cases reported in Minnesota from 2004 trough 2008 that had any of these risk factors. The risk categories presented in this slide are not mutually exclusive; an individual TB case-patient may have more than one or none of the risk factors. The most distinguishing characteristic of the epidemiology of TB disease in Minnesota is the very large proportion of cases that occur among foreign-born persons. Eighty-two percent of TB case-patients reported in Minnesota during the past 5 years were born outside the United States. In contrast, 5% of TB case-patients reported nationwide in the U.S. during this 5 year period were foreign-born. The very high percentage of TB cases in Minnesota that occur among foreign-born persons is influenced by the large per capita number of refugees and immigrants in Minnesota and the demographics of those newly arriving refugees and immigrants, many of whom come from regions of the world where TB is prevalent. Notably, however, the percentage of foreign-born TB case-patients reported in Minnesota during 2008 declined 14% from the prior year and was the lowest number of foreign-born TB case-patients since 2000. Other high-risk population subgroups represented much smaller proportions of the TB cases reported in Minnesota during this period, each representing no more than 12% of the total cases reported statewide. Persons with certain medical conditions that increase the risk for progression from latent TB infection to active TB disease were the largest of these other high-risk population subgroups, representing 12% of TB cases. Substance abuse (including alcohol abuse and/or illicit drug use) was the second most common of these other risk factors, with 7% of TB case-patients having a history of substance abuse during the 12 months prior to their TB diagnosis. Five percent of TB cases were co-infected with HIV, which was a lower prevalence of co-infection with HIV than that among TB cases reported nationwide during this period. Three percent of TB case-patients reported in Minnesota from 2004 through 2008 were homeless, 1% were correctional facility inmates, and 1% were residents of nursing homes. The percentages of TB cases reported in Minnesota during 2008 who had a history of substance abuse and/or who were homeless were higher than the comparable percentages for those risk factors reported since 2004. This increase can be attributed to 2 outbreaks that occurred in 2008 which had a high percentage of homeless persons and substance abusers. Slide 12: Foreign-Born Tuberculosis Cases by Region of Birth and Year of Diagnosis, Minnesota, 2004-2008
Slide 12: Foreign-Born Tuberculosis Cases by Region of Birth and Year of Diagnosis, Minnesota, 2004-2008. This slide depicts the number of TB cases reported in Minnesota from 2004 through 2008 by region of birth and year of diagnosis. The different colors represent the year of diagnosis. The bars representing the number of TB cases are grouped by region of birth — for example, South/Southeast Asia, sub-Saharan Africa, etc. The trends visible in this slide are influenced by both the global incidence of TB in specific regions worldwide and also by the constantly changing trends and demographics of immigration to Minnesota. For example, Minnesota is home to a large population of persons born in South/Southeast Asia (including the Hmong population), which is a region of the world where TB is highly prevalent. However, prior to the arrival of a large number of Hmong refugees from a refugee camp in Thailand during the past 2 to 3 years, few new immigrants or refugees have arrived in Minnesota from South/Southeast Asia during the past 5 years. Consequently, the annual numbers of TB cases reported among this population have been moderately high but relatively stable from 2004 through 2008. The number of new immigrants and refugees who arrived in Minnesota from sub-Saharan Africa (which is another area where TB is very common), was high during each of the past 5 years. The significant recent immigration from sub-Saharan Africa is reflected in the very large numbers of TB cases reported among foreign-born persons from sub-Saharan Africa in Minnesota from 2004 through 2008. Slide 13: Tuberculosis Cases by Site of Disease and Place of Birth, Minnesota, 2004-2008
Slide 13: Tuberculosis Cases by Site of Disease and Place of Birth, Minnesota, 2004-2008. Tuberculosis disease most commonly affects the lungs, although almost any site of the body can be affected. For reasons that are not yet understood despite extensive study, extrapulmonary TB occurs more frequently among foreign-born persons with TB disease than among U.S.-born TB case-patients. Consequently, due to the large proportion of TB cases in Minnesota that occur among foreign-born persons, extrapulmonary TB is very common in Minnesota. More than half (53%) of foreign-born TB case-patients reported in Minnesota from 2004 through 2008 had an extrapulmonary site of disease; in contrast, only 37% of U.S.-born TB case-patients had extrapulmonary involvement. This slide illustrates the need, especially in Minnesota, for clinicians to have a high index of suspicion for TB, particularly for foreign-born patients, even when the patient does not present with a cough or other common symptoms of pulmonary TB. Slide 14: Extrapulmonary Tuberculosis Cases by Site of Disease*, Minnesota, 2004-2008
Slide 14: Extrapulmonary Tuberculosis Cases by Site of Disease*, Minnesota, 2004-2008. Among extrapulmonary TB case-patients reported in Minnesota from 2004 through 2008, the majority (53%) had lymphatic disease. Pleural, peritoneal, and bone/joint TB affected 11%, 8%, and 8% of extrapulmonary TB case-patients, respectively. Less than 5% of extrapulmonary TB case-patients each had meningeal, genito-urinary, or miliary sites of disease. Sixty-six (12%) case-patients had extrapulmonary sites of disease that were classified as "other" or did not fall into any of the aforementioned categories. *Includes TB cases with or without concurrent pulmonary disease. Slide 15: Tuberculosis Cases by Sex and Place of Birth, Minnesota, 2004-2008
Slide 15: Tuberculosis Cases by Sex and Place of Birth, Minnesota, 2004-2008.This slide presents TB cases, by sex, reported in Minnesota from 2004 through 2008. These data demonstrate that slightly more males than females were represented among TB cases reported statewide, which is typical of TB cases reported in the United States. The preponderance of males versus females, however, was markedly pronounced among U.S.-born TB cases (62% versus 38%, respectively) but barely evident and not significant among foreign-born cases (51% versus 49%, respectively). Slide 16: Tuberculosis Cases with Pulmonary Involvement by Chest X-Ray Result, Minnesota, 2004-2008
Slide 16: Tuberculosis Cases with Pulmonary Involvement by Chest X-Ray Result, Minnesota, 2004-2008. A posterior-anterior radiograph of the chest is one of the primary diagnostic tests performed to detect and describe abnormalities that may be suggestive of active pulmonary TB disease. In pulmonary TB, chest x-ray abnormalities often are seen in the apical and posterior upper lobes of the lungs or in the superior segments of the lower lobes. Cavitary lesions are indicative of severe or advanced disease and also are a risk factor for increased likelihood of infectiousness in TB patients. In TB patients co-infected with HIV, pulmonary TB may present with atypical, or even normal, radiographic findings. Among 647 pulmonary TB case-patients reported in Minnesota from 2004 through 2008, the vast majority (96%) had radiographic findings consistent with TB disease, including 135 (21%) patients with cavitary lesions. Only 3% of pulmonary TB case-patients had chest x-ray results that were normal or inconsistent with TB disease. Slide 17: Tuberculosis Cases with Pulmonary Involvement by Sputum AFB Smear Result, Minnesota, 2004-2008
Slide 17: Tuberculosis Cases with Pulmonary Involvement by Sputum AFB Smear Result, Minnesota, 2004-2008. Persons with pulmonary or laryngeal TB disease may be infectious or able transmit TB to others. Except for very unusual circumstances, extrapulmonary TB disease is not infectious. Acid-fast bacillus (AFB) smear results of sputum specimens collected from a patient with pulmonary TB disease are considered one indicator of the patient's likely level of infectiousness. Patients with positive AFB smears from sputum are considered potentially infectious. Although transmission of TB germs from sputum AFB smear-negative patients has been documented, such patients are less likely than sputum AFB smear-positive patients to be infectious. Among 647 patients with pulmonary TB disease reported in Minnesota from 2004 through 2008, 36% had at least one sputum specimen with an AFB-positive smear result. Twelve percent had no sputum smear result reported to the Minnesota Department of Health. These data suggest that nearly 40% of pulmonary TB case-patients in Minnesota likely are infectious and have the potential to spread TB germs to others prior to receiving several weeks or more of adequate treatment for TB disease. Slide 18: Tuberculosis Cases by Mycobacterial Culture Result, Minnesota, 2004-2008
Slide 18: Tuberculosis Cases by Mycobacterial Culture Result, Minnesota, 2004-2008. Identification of Mycobacterium tuberculosis grown in culture from a clinical specimen is the "gold standard" for definitive diagnosis of TB disease, although the national surveillance case definition for TB disease also allows cases to be counted on the basis of clinical signs and symptoms in the absence of a positive culture for M. tuberculosis. In particular, culture confirmation of TB disease is critically important for the clinical management of TB case-patients, because drug susceptibility testing is performed on isolates grown in culture. Also, for pulmonary TB case-patients, documentation of the conversion of a sputum culture result from an initially positive culture to a negative culture is an important marker of successful response to TB treatment. Seventy-five percent of TB cases reported in Minnesota from 2004 through 2008 were confirmed by the identification of M. tuberculosis from culture. Mycobacterial culture was not performed or culture results were not reported for only 3% of case-patients. Slide 19: Tuberculosis Cases by Case Verification Criterion*, Minnesota, 2004-2008
Slide 19: Tuberculosis Cases by Case Verification Criterion*, Minnesota, 2004-2008. This slide shows the proportions of TB cases reported in Minnesota from 2004 through 2008 who met the various hierarchical levels of the national surveillance case definition for reportable TB disease. Over three-fourths (76%) of Minnesota's TB cases were counted on the basis of a culture that was positive for Mycobacterium tuberculosis. Cultures were either negative for M. tuberculosis or not done in the remaining 24% of cases. Most of those cases (19% of cases reported statewide) met the clinical component of the national TB case definition, which includes case-patients with positive Mantoux tuberculin skin tests, but without positive cultures, who show clinical and/or radiologic improvement after several months of multi-drug therapy for TB disease. Very few (5%) cases met neither the laboratory nor clinical criteria and, therefore, were counted based solely on provider diagnosis, which the national surveillance TB case definition allows. *Based on the public health surveillance definition for TB [MMWR 1997:46(No. RR-10):40-41] Slide 20: Tuberculosis Cases by Drug Susceptibility Patterns and Year, Minnesota, 2004-2008
Slide 20: Tuberculosis Cases by Drug Susceptibility Patterns and Year, Minnesota, 2004-2008. Drug-resistant TB is a serious public health concern globally, nationally, and in Minnesota. This slide presents drug susceptibility data among culture-confirmed TB cases reported in Minnesota from 2004 through 2008. Drug susceptibility testing was performed on all culture-confirmed TB cases reported in Minnesota during this period. Among culture-confirmed TB cases reported in Minnesota from 2004 through 2008, 14% were resistant to at least one first-line anti-TB medication [i.e., isoniazid (INH), rifampin, pyrazinamide, or ethambutol]. Ten percent of such cases were resistant to INH, and 2% were multidrug-resistant, meaning that their Mycobacterium tuberculosis isolates were resistant to at least INH and rifampin. Of the 16 multidrug-resistant (MDR) TB cases reported during this period, two (13%) were resistant to all four first-line anti-TB drugs. One of these MDR-TB cases (reported in 2006) also met the definition of extensively drug-resistant (XDR) TB. Slide 21: Tuberculosis Cases by Drug Susceptibility Patterns and Year, Minnesota, 2004-2008 NOTE: THIS SLIDE PRESENTS THE SAME DATA AS SLIDE #20, BUT IN GRAPHICAL FORMAT.
Slide 21: Tuberculosis Cases by Drug Susceptibility Patterns and Year, Minnesota, 2004-2008 (in graphical format). Drug-resistant TB is a serious public health concern globally, nationally, and in Minnesota. This slide presents drug susceptibility data among culture-confirmed TB cases reported in Minnesota from 2004 through 2008. Drug susceptibility testing was performed on all culture-confirmed TB cases reported in Minnesota during this period. Among culture-confirmed TB cases reported in Minnesota from 2004 through 2008, 14% were resistant to at least one first-line anti-TB medication [i.e., isoniazid (INH), rifampin, pyrazinamide, or ethambutol]. Ten percent of such cases were resistant to INH, and 2% were multidrug-resistant, meaning that their Mycobacterium tuberculosis isolates were resistant to at least INH and rifampin. Of the 16 multidrug-resistant (MDR) TB cases reported during this period, two (13%) were resistant to all four first-line anti-TB drugs. One of these MDR-TB cases (reported in 2006) also met the definition of extensively drug-resistant (XDR) TB. Slide 22: Cases of Drug-Resistant Tuberculosis by Place of Birth and Year, Minnesota, 2004-2008
Slide 22: Cases of Drug-Resistant Tuberculosis by Place of Birth and Year, Minnesota, 2004-2008. The prevalence of drug resistance among culture-confirmed TB cases reported among foreign-born persons in Minnesota from 2004 through 2008 varied from year to year, ranging from 10% in 2005 to 19% in 2008, with 15% of cases reported overall having resistance to at least one first-line TB medication. The prevalence of drug resistance among culture-confirmed TB cases reported among U.S.-born persons increased steadily, from 5% in 2004 to 17% in 2007, but dropped to 3% in 2008. Overall during this period, drug resistance was approximately 1.6 times more common among foreign-born TB case-patients than among U.S.-born case-patients. Slide 23: Tuberculosis Cases by Drug Susceptibility Patterns and Place of Birth, Minnesota, 2004-2008
Slide 23: Tuberculosis Cases by Drug Susceptibility Patterns and Place of Birth, Minnesota, 2004-2008. Among culture-confirmed TB cases reported in Minnesota from 2004 through 2008, foreign-born case-patients were approximately 1.6 times more likely than U.S.-born case-patients to be resistant to any first-line anti-TB drug and 1.8 times more likely than U.S.-born case-patients to be resistant to isoniazid, in particular. Although the reported prevalence of multidrug-resistant TB among U.S.-born case-patients exceeded that among foreign-born case-patients, many of the U.S.-born multidrug-resistant TB case-patients either had lived extensively outside the U.S. or resided in a household with foreign-born persons. These cases also had several other TB risk factors such as history of drug/alcohol use and homelessness. Slide 24: Tuberculosis Cases by Method of Case Identification, Minnesota, 2004-2008
Slide 24: Tuberculosis Cases by Method of Case Identification, Minnesota, 2004-2008. While the vast majority (80%) of TB cases reported in Minnesota from 2004 through 2008 were identified as a result of the case-patient presenting at a clinic or hospital with symptom of TB disease, a significant number of cases also were identified through other public health disease prevention and control activities. For example, TB contact investigations surrounding individual infectious TB case-patients accounted for 7% of TB cases reported statewide. Notably, the percentage of TB cases identified through TB contact investigations increased from an annual average of 5% from 2004 through 2007 to 13% in 2008. This increase can be attributed to cases identified as part of contact investigations surrounding 3 outbreaks that occurred in 2008. During the past 5 years, 6% of TB cases reported in Minnesota were identified through the domestic health examination that is recommended for all refugees within 3 months of their arrival in the U.S. Similarly, 2% of cases were identified through the follow-up of notifications received by the Minnesota Department of Health from the national Centers for Disease Control and Prevention for newly arrived immigrants or refugees who were identified as having an abnormal chest x-ray and/or positive sputum smear during a required medical examination performed overseas prior to immigration. The purpose of this overseas exam is to identify individuals who may have active infectious pulmonary TB disease and may therefore pose an immediate public health threat. Six percent of TB cases were identified through other means, such as occupational TB screening or other targeted tuberculin skin testing. Slide 25: Tuberculosis Cases by Mode of Treatment Administration, Minnesota, 2004-2008
Slide 25: Tuberculosis Cases by Mode of Treatment Administration, Minnesota, 2004-2008. This slide and the following two slides present data on the treatment of TB disease in Minnesota. This slide presents the mode by which TB treatment was administered for all TB case-patients reported in Minnesota from 2004 through 2008. The use of directly observed therapy (DOT) for the treatment of TB disease in Minnesota increased from 79% of TB case-patients in 2004 to 91% of patients in 2008. DOT, which involves having a health care provider or trained outreach worker observe a TB case-patient taking each dose of TB medications, is the recommended standard of care for the treatment of TB disease. The vast majority of patients who did not receive standard DOT received some other less frequent form of supervision of their TB therapy. For example, since 2004, only 1% to 2% of TB case-patients reported each year received self-administered TB treatment. The increased and widespread use of DOT in Minnesota is facilitated by the highly dedicated and diligent work of the local public health nurses in each county who are primarily responsible for administering DOT for TB case-patients residing in their jurisdictions. Slide 26: Tuberculosis Cases by Mode of Treatment Administration and Type of Health Care Provider, Minnesota, 2004-2008
Slide 26: Tuberculosis Cases by Mode of Treatment Administration and Type of Health Care Provider, Minnesota, 2004-2008. The use of directly observed therapy (DOT) is considered the standard of care for the treatment of TB disease. This slide illustrates that, among TB cases reported in Minnesota from 2004 through 2008, the use of DOT was significantly more common among patients who received treatment for TB disease at public TB clinics than among patients who received TB treatment from private clinicians. Specifically, 94% of new TB case-patients treated at any of the three public TB clinics statewide from 2004 through 2008 received DOT, whereas only 68% of such patients treated for TB by private providers received DOT. Four percent of TB case-patients treated by private providers received exclusively self-administered therapy, while no TB case-patients treated at public TB clinics received self-administered therapy. Some intermediate form of less-than-daily supervision was used more commonly among TB case-patients treated by private clinicians (28%) than among those treated at public TB clinics (6%). Slide 27: Completion and Length of Therapy Among Tuberculosis Cases by Type of Health Care Provider, Minnesota, 2007
Slide 27: Completion and Length of Therapy Among Tuberculosis Cases by Type of Health Care Provider, Minnesota, 2007. This slide presents the outcome of TB treatment for the 226 TB case-patients reported in Minnesota during 2007 who began a course of treatment and for whom 12 months or less of treatment was indicated. (2007 is the most recent annual cohort of patients for whom data on the outcome of therapy are available.) This slide excludes patients with rifampin-resistant or meningeal TB and pediatric patients with miliary TB, all of whom require a longer course of treatment. While most uncomplicated cases of TB disease are eligible for a 6-month course of treatment, the Centers for Disease Control and Prevention (CDC) has established an objective of 90% of TB case-patients completing adequate therapy within 12 months, which allows a margin of error for the often unavoidable obstacles that can prolong therapy. These data indicate that a strong majority (89%) of 226 eligible TB case-patients reported in Minnesota during 2007 successfully completed an adequate course of treatment within 1 year, although the statewide outcome narrowly fell short of the national objective. Of the 226 eligible TB case-patients, 94% ultimately completed a full course of TB treatment, although 11 patients did so in longer than 12 months. The data on this slide also indicate that patients who received treatment administered by public TB clinics were both more likely to complete treatment within 1 year and also more likely to complete treatment overall than those patients treated by private clinicians. These data, however, do not take into account potentially confounding differences between the characteristics of the patient populations at each type of clinic. If you have questions or comments about this page, use our IDEPC Comment Form or call 651-201-5414 (TTY: 651-201-5797) for the MDH Infectious Disease Epidemiology, Prevention and Control Division. |
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Updated Wednesday, 03-Jun-2009 10:23:58 CDT
