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Dr Martin Dedicoat PhD Mrs Cathy Browne RGN Presented by Dr Christine Burt PhD.

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Presentation on theme: "Dr Martin Dedicoat PhD Mrs Cathy Browne RGN Presented by Dr Christine Burt PhD."— Presentation transcript:

1 Dr Martin Dedicoat PhD Mrs Cathy Browne RGN Presented by Dr Christine Burt PhD

2 Trend in TB incidence in Birmingham and London 1990 - 2009

3 - 70% of TB cases in Birmingham - people born overseas - Each new case is reported to the Birmingham Chest Clinic - Each new case of TB is allocated to a specialist nurse - To improve the number of contacts identified for each new case of TB a service evaluation and improvement programme was undertaken by the Birmingham and Solihull TB service - One of the aims of the evaluation was to use social network analysis to investigate clusters of TB patients - This report contains preliminary results for the project

4 New cases Evaluation of the number of notifications and the outcome of their contacts was made by analysing anonymous data Local database National database

5 Contact Tracing: Extra Pulmonary TB – screening = close family only Respiratory TB – screening = close family >10% = active/latent TB wider screening This method of contact tracing is known as ‘Stone in the Pond’ tracing

6 - Cluster definition and action taken is based on HPA guidance - Conventional approaches to contact screening may miss cases - Samples cultured and isolates typed using variable number tandem repeats (VNTR) of 24 loci - Samples from all cases are sent to the HPA Labs for culture - These 24 loci VNTR are used to identify clusters of TB patients

7 Many clusters have obvious links between different cases often no link is found Data from these interviews was used to construct network diagrams to illustrate links In these cases a specialist nurse was tasked to visit and interview patients

8 - Between 1990 and 2012 = 43,968 contacts of TB - 22,191 (50.5%) females mean age = 25 - Overall 42% did not complete their screening - Outcomes were available for 92% of cases - 20,759 (49.5%) males mean age = 19 - The proportion of smear positive contacts receiving chemoprophylaxix rose from 4.3% to 9.4%

9 - Clusters for further investigation were identified based on several factors: Links between patients were not known - To date 15 clusters have been investigated The cluster was growing

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11 Analysis of the contact database revealed 42% of people Identified as contacts TB nursing team taking a more proactive approach in follow up: The impact of this change will be assessed after one year - Patents with latent TB who do not complete treatment - Patients who start screening but do not complete it

12 - Using the social network questionnaire a cluster of Eritrean patients were found attending a single place of worship - More still needs to be done - An enhanced contact tracing service may contribute to reducing the incidence of TB in Birmingham - More specific methods are becoming available

13 TB nurses investigating the clusters and managing patients TB nurses investigating the clusters and managing patients This service evaluation is funded by Heart of Birmingham Primary Care Trust Health Protection Agency – Dr Grace Smith and Dr Jason Evans The health protection unit in Birmingham - Helen Bagnall


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