Mortality Among a Tuberculosis Outbreak Los Angeles County, 2007–2013 Brian Baker, MD Amit Chitnis, MD MPH Leslie Henry, BSN RN PHN 48th CTCA Educational.

Slides:

Advertisements

Similar presentations

St Marys Hospital Ingrid V. Bassett, MD, MPH Massachusetts General Hospital Harvard Medical School May 25, 2010 Who Starts ART in Durban, South Africa?

Advertisements

Delayed TB Diagnosis Thomas R. Navin MD

STD Screening in HIV Clinics: Value and Implications Thomas Farley, MD MPH Tulane University Deborah Cohen, MD MPH RAND Corporation.

Overview of current case and treatment outcome definitions Malgosia Grzemska TB Operations and Coordination Stop TB Department Consultation Impact of WHO-endorsed.

World Health Organization TB Case Definitions

Nucleic Acid Amplification Test for Tuberculosis

Mortality and causes of death among women living with HIV in the UK in the era of highly-active antiretroviral therapy Sara Croxford, A Kitching, M Kall,

Systematic TB Screening: Philippine Experience The 9th Technical Advisory Group and National TB Program Mangers meeting for TB control in the Western Pacific.

International Standards of Tuberculosis Care Implementation by Pulmonologists in Private Practice in Jakarta E. Burhan 1, M. A. Nawas 1, D. Kusumo Sutoyo.

A Brief Introduction to Epidemiology - VII (Epidemiologic Research Designs: Demographic, Mortality & Morbidity Studies) Betty C. Jung, RN, MPH, CHES.

Most deaths among children enrolled in two program settings in Cambodia occur within the first 6 months after enrolment. Early mortality rates were more.

Concordance of HIV surveillance and medical record data: What do CD4 and viral loads not tell us about linkage to HIV care? Charu Sabharwal, MD MPH Medical.

Mary Foote MD, MPH 1 Infectious Disease Fellow Anne Spaulding MD, MPH 1,2 1 Emory University Schools of Medicine and 2 Public Health Atlanta, Georgia Georgia.

The Public Health Applications of Molecular Epidemiology: Use of HIV-1 Pol Sequences to Identify HIV Transmission Networks in Los Angeles County Jennifer.

Diagnosis of TB.

Module 10: Understanding Laboratory Data *Image courtesy of: World Lung Foundation.

Culture Conversion and Self- Administered Therapy in Privately Managed Tuberculosis Patients Melissa Ehman MPH, Jennifer Flood MD MPH, Pennan Barry MD.

Using surveillance data to initiate public health outreach to persons out of care and assist with re-engagement with care and partner services Chi-Chi.

Figure 1. Number of Tuberculosis Cases: California, California Department of Public Health, Tuberculosis Control Branch Number of Tuberculosis.

Characteristics and Outcomes of a Population of Tuberculosis Inpatients in Lilongwe, Malawi Mina Hosseinipour, MD, MPH Clinical Director UNC Project Lilongwe,

TB Elimination in California Can We Get There? Navigating the Landmines CTCA April 28, 2011 Jennifer Flood MD MPH Chief, Tuberculosis Control Branch California.

TB 101: TB Basics and Global Approaches. Objectives Review basic TB facts. Define common TB terms. Describe key global TB prevention and care strategies.

Tuberculosis Surveillance and Disease Intersections in California

Unit 1: Overview of HIV/AIDS Case Reporting #6-0-1.

IMPLEMENTATION PLAN TO SCALE UP HIV/AIDS PREVENTION AND TREATMENT 1.

1 Epidemiology of Pediatric Tuberculosis in the United States, 1993–2006 Surveillance, Epidemiology, and Outbreak Investigations Branch Division of Tuberculosis.

Use of 12 weekly doses of isoniazid and rifapentine for the treatment of latent tuberculosis − Connecticut , Kelley Bemis, MPH CDC/CSTE Applied.

Colorado Department of Public Health and Environment Tuberculosis Prevention and Control Program.

The Cohort Review Process The Cohort Review Process Kim Field RN, MSN WA State DOH Tuberculosis Program.

Microbiologists from Mexico at South Texas Hospital Lab “Microbiólogos de México en el laboratorio de South Texas Hospital”

Tuberculosis Research of INA-RESPOND on Drug-resistant

Determination of HIV Infection Among TB Patients in California, 2008 Darryl Kong 1, Jennifer Flood 1, Suzanne Marks 2, James Watt 1 1 California Department.

Tuberculosis Treatment Completion Among Persons Incarcerated at Diagnosis, U.S. TB Surveillance System, 1999–2008 Kiren Mitruka, MD, MPH (presented on.

Epidemiology of tuberculosis. Peymane Adab, Richard Fielding, Susana Castan.

Alliance Discussion with Office of AIDS: November HIV/AIDS Surveillance Surveillance overview HIV Incidence Surveillance Second Surveillance Stakeholder.

Treatment of Tuberculosis: New Case Case Studies Module 7A2 – March 2010.

Smear negative TB and HIV: urgent research priorities to inform a rolling global policy Haileyesus Getahun, MD, MPH, PhD Stop TB Department WHO/HQ.

1 How Complete is California’s HIV Status Determination Among 2008 TB Cases? Darryl Kong, MPH TB Control Branch California Department of Public Health.

Surveillance Data in Action: Tuberculosis Indicators Melissa Ehman, MPH Tuberculosis Control Branch (TBCB) Division of Communicable Disease Control Center.

Epidemiologic Studies Consortium Research CTCA meeting October 22, 2010 Lisa Pascopella, PhD, MPH California Department of Health Services.

Factors Associated with Survival in HIV-Infected African Patients on Antiretroviral Therapy: The Impact of a Sampling-Based Approach to Address Losses.

Beyond Sputum Cups and Four Drugs The Responsibility of the Practicing Clinician in the Community Control of Tuberculosis V. R. Koppaka, MD, PhD Division.

High cost of Xpert MTB/RIF ® testing per tuberculosis case diagnosed at Partners in Hope Medical Center, a public private HIV care clinic in Lilongwe,

Epidemiology of Tuberculosis in African-American Population, United States Kenneth G. Castro, M.D. Assistant Surgeon General, USPHS Director,

Results Compliance with Breast Cancer Screening Guidelines in the HIV Clinic: A Quality Improvement Tool E. Patrozou M.D., E. Christaki M.D., L. Hicks.

NAAT Is it Time for a New Option in California?. Background CDC 2009 guidelines recommend NAAT for each patient with suspected TB for whom the test result.

Epidemiology of Tuberculosis in Correctional Facilities, United States, Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Surveillance, Epidemiology, and Outbreak Investigations Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention (CDC) Epidemiology.

California Update : TB Epidemiology and Indicators CTCA October 22, 2010 Jennifer Flood MD MPH Chief, Surveillance and Epidemiology Tuberculosis Control.

Scale up TB/HIV activities in Asia Pacific 8-9Aug09 1 TB/HIV collaborative activities in Thailand Sriprapa Nateniyom, M.D. TB Bureau, Department of Disease.

Surveillance, Epidemiology, and Outbreak Investigations Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention (CDC) Epidemiology.

Factors associated with concurrent Heroin use among patients on Methadone maintenance treatment in Vietnam from 2008 to 2013 Hoang Nam Thai MD, MPH – CDC/DGHT.

L.A. County Public Health Partnering with the Private Community to Control TB Myrna Mesrobian, MD, MPH.

Introduction to Contact Investigation Process Amy Schmitt, BSN, RN Public Health Grand Rounds Tuberculosis November 19, 2015.

TB Prevention and Control in Correctional and Detention Facilities Mark Lobato, MD Division of TB Elimination Centers for Disease Control and Prevention.

Predictors of Failure in Timely TB Treatment Completion, United States Carla Winston,PhD TB PEN Focal Point Open Forum June 5,

Tuberculosis in Children and Young Adults

CD4 trajectory among HIV positive patients receiving HAART in a large East African HIV care centre Agnes N. Kiragga 1, Beverly Musick 2 Ronald Bosch, Ann.

Roundtable. Detection and treatment of TB Andrew Black.

TB Control Program County of San Diego County of San Diego Health and Human Services Agency Tuberculosis Control Branch Trends in Tuberculosis Highlights.

CONCLUSIONS New Jersey’s Emergency Department HIV testing sites report higher seroprevalence than non-ED testing sites. Since University Hospital began.

Whole-Genome Sequencing; It’s Not Just For Epis

Believed discrimination occurred because of their:

This is an archived document.

Nucleic Acid Amplification Test for Tuberculosis

Poster WP41; Contact: David A. Katz,

Using Whole Genome Sequencing Analysis in California

Laura Lane, Epidemiologist

Varicella Vaccine Efficacy Estimates

Illustrative Cluster Detection and Response Strategy

Presentation transcript:

Mortality Among a Tuberculosis Outbreak Los Angeles County, 2007–2013 Brian Baker, MD Amit Chitnis, MD MPH Leslie Henry, BSN RN PHN 48th CTCA Educational Conference April 24, 2014

Mortality Among Patients with Tuberculosis Most cases of tuberculosis (TB) are curable with appropriate treatment for 6 to 9 months However, an estimated 7–10% of patients with TB die prior to diagnosis or during treatment Better understanding of deaths is needed to guide future strategies to reduce mortality

Objectives Describe deaths among outbreak cases, including frequency and timing Assess demographic and clinical factors among outbreak deaths Identify possible opportunities for intervention

Methods Reviewed reported cases of tuberculosis in Los Angeles County during 2007–2013 Defined outbreak cases based upon: –Genotype results from a Mycobacterium tuberculosis isolate OR –Epidemiologic link to a confirmed outbreak case For outbreak patients who died, medical records were reviewed

Methods Timing of death was measured from TB treatment start date (for those alive at diagnosis) Severity of TB disease was assessed using standardized tool

Outbreak Cases Los Angeles County, 2007–2013

Timing of Outbreak Deaths (n=21)

Demographic and Clinical Characteristics Among Outbreak Deaths (n=21) No.(%) Age<250(0.0) 25–449(42.8) 45–648(38.1) >654(19.1) SexMale21(100.0) Female0(0.0)

Demographic and Clinical Characteristics Among Outbreak Deaths (n=21) No.(%) OriginU.S.-born9(42.9) Foreign-born10(47.6) Unknown2(9.5) Race/EthnicityHispanic15(71.4) Black5(23.8) White1(4.8) Asian / Other0(0.0)

Demographic and Clinical Characteristics Among Outbreak Deaths (n=21) No.(%) HomelessYes15(71.4) No4(19.1) Unknown2(9.5) Substance abuseYes9(42.9) No3(14.3) Unknown9(42.9) Incarceration at diagnosis Yes1(4.8) No20(95.2)

Demographic and Clinical Characteristics Among Outbreak Deaths (n=21) No.(%) HIVPositive8(38.1) Negative8(38.1) Unknown5(23.8) Sputum smearPositive12(57.1) Negative8(38.1) Not done1(4.8) Chest radiographCavitary3(14.3) Non-cavitary17(81.0) Normal0(0.0) Not done1(4.8)

Demographic and Clinical Characteristics Among Outbreak Deaths (n=21) No.(%) Site of diseasePulmonary17(81.0) Extrapulmonary1(4.8) Both3(14.3) TB severity indexMild1(4.8) Moderate1(4.8) Severe19(90.5) Co-morbid conditionsCirrhosis3(14.3) Diabetes3(14.3) Cancer2(9.5)

Adherence Among Outbreak Deaths No.(%) Type of non-adherence Left against medical advice3(14.3) Eloped2(9.5) Refused treatment1(4.8) Any of above6(28.6)

Deaths Among Patients with TB and HIV n=8No.(%) CD4 count, median (range)54(2–154) New HIV diagnosis3(37.5) Already receiving ART at TB diagnosis0(0.0) Received ART during TB treatment2(25.0) Poor adherence5(62.5) ART = antiretroviral therapy

Time from hospital admission to first specimen collection Days MedianMeanRange Hospitalized patients with suspected TB (n=20) 120–12

Time from first specimen collection to initiation of treatment, by AFB smear status Initial smear results Days MedianMeanRange AFB smear positive (n=11) 141–26 AFB smear negative (n=7) 17244–80

Treatment among patients with initially smear negative specimens (n=9) Precipitating factorNo.(%) Subsequent positive smear4(44.4) Positive culture3(33.3) Never initiated treatment2(22.2) NAAT performed0(0.0) Received empiric treatment0(0.0) NAAT = nucleic acid amplification test

Limitations Some data missing, particularly among patients dead at diagnosis or during initial hospitalization Deaths were not necessarily related to TB

Summary Most deaths occurred early among patients with severe disease at the time of diagnosis Large number of patients with other contributing medical conditions (e.g., HIV) Patients were evaluated for TB, but treatment only started after positive smear or culture Adherence to TB treatment is a substantial challenge

Areas of Opportunity Implementing policies and practices to diagnose homeless patients earlier Connecting HIV-infected homeless persons to HIV- related care and treatment before TB diagnosis Improving availability of rapid diagnostics for active TB disease (i.e., NAATs) Continuing use of public health resources to support patients during treatment

Acknowledgments Los Angeles County Department of Public Health –Tuberculosis Control Program –Community Health Services California Tuberculosis Control Branch Partners in shelters, clinics, and hospitals

Questions?