West Virginia’s Tuberculosis Control Program Hx and Epi MissionTransmissionRequirements Channels of Communication

Reported TB Cases United States, Year 10,000 20,000 * * 30,000 50,000 70, ,000 Cases (Log Scale) *Change in case definition

Factors Contributing to the Increase in TB Morbidity: Deterioration of the TB public health infrastructure HIV/AIDS epidemic Immigration from countries where TB is common Transmission of TB in congregate settings

Background During , the number of incarcerated persons in the US increased fourfold, from approximately 500,000 in 1980 to approximately 2 million in In 2003 at midyear, although 0.7% of the total US population was confined in prisons and jails, 3.2% of all TB cases nationwide occurred among residents of correctional facilities. For example, the incidence of TB among inmates in New Jersey during 1994 was 91.2 cases per 100,000 inmates, compared with 11.0 cases per 100,000 persons among all New Jersey residents “Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC” July 7, 2006 / 55(RR09);1-44

Contributing Factors Incarcerated persons are high risk for TB –illicit drug use –low socioeconomic status –HIV infection Physical structure of the facilities –close living quarters –might have inadequate ventilation –can be overcrowded Movement of inmates into and out of facilities “Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC” July 7, 2006 / 55(RR09);1-44

Tuberculosis in the World

MISSION MISSION “to achieve the absence of indigenous transmission indigenous transmission of tuberculosis infection in West Virginia, which results in clinically apparent which results in clinically apparent tuberculosis disease” tuberculosis disease”

Promptly identify persons with TB Isolate Initiate appropriate treatment Ensure completion of therapy by DOT Identify contacts with latent TB infection Treat latent TB infection (LTBI). To Reduce Risk of Transmission

Transmission and Pathogenesis

Transmission of M. tuberculosis Spread by droplet nuclei Expelled when person with infectious TB coughs, sneezes, speaks, or sings Close contacts at highest risk of becoming infected Transmission occurs from person with infectious TB disease (not latent TB infection)

Reporting WV Code § 16 Article 3D. Tuberculosis Testing, Control, Treatment and Commitment. [Passed April 9, 2005; in effect from passage.] WV Code Legislative Rule Title 64 Series 7 Reportable Diseases, Events and Conditions.

Reporting Report to your Local Health Department Active disease or suspects of active disease → within 24 hours [TB-34] LTBI (positive tuberculin skin test, in the last 2 years) → within 1 week [TB-101]

WV Tuberculosis Control Program Dominic Gaziano, MD, Medical Director Carmen Priddy, BSN, Program Director or Carolyn Winkler, RN, Surveillance Nurse or Barbara Simpkins, HHR Specialist or

West Virginia Office of Laboratory Services AFB smears and cultures MTD Direct rRNA Testing Drug susceptibility testing Genotyping For any culture + for MTB; isolet → OLS FREE – EFFICIENT – RELIABLE PREFERABLE

RESOURCES Centers for Disease Control and Prevention (CDC) New Jersey Medical School Global Tuberculosis Institute or call: West Virginia Tuberculosis Control Program or in WV ٭

Recommendations and Reports July 7, 2006 / 55(RR09);1-44 Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC Endorsed by the Advisory Council for the Elimination of Tuberculosis, the National Commission on Correctional Health Care, and the American Correctional Association