Mycobacterium Tuberculosis Shelbi Arnold Northern Arizona University Background image of M. tuberculosis. scanning electron microscope courtesy of CDC

Epidemiology of Tuberculosis Tuberculosis is a infectious disease produced by a pathogenic microorganism caused by the inhalation or ingestion of the bacteria Mycobacterium tuberculosis (M. tuberculosis) Tuberculosis is transmitted via microscopic airborne droplets when an infected person coughs, sneezes, breathes or speaks

Background Information The primary site of TB is in the lungs Infection can spread to other systems Musculoskeletal Genitourinary Central nervous Integumentary TB thrives in overpopulated, developing countries, and among drugs users, the homeless and immunosuppressed individuals.

Strands of Tuberculosis Inactive or latent Person is infected with the disease, but has no signs or symptoms Active Person is infected and is experiencing signs and symptoms such as fever, loss of appetite, hemoptysis, cough, night sweats, and fatigue (Gavrilut & Pop, 2012). Multi-drug Resistant TB Person is infected and is resistant to drugs used to treat the infection Either due to prior noncompliance of drug regimens or specific strands of TB

Clinical Diagnosis Radiological exams Bacteriological exams Chest xray or chest CT scan Presents as pulmonary scarring, cavitary lesions, infiltrates, pleural effusions and atelectasis Bacteriological exams Consecutive collection of sputum for the testing of blood presence Bacterial testing of biopsied tissue from lungs

Recovery, Disability or Death Outcomes of those infected with Tuberculosis: Recovery with no disability Regimens of antibiotics or chemotherapy Surgical resection of affected lobe of lung or lung in its entirety If drug regimens are not followed or TB has progressed into multi-drug resistant strands, recovery is unlikely Death

Demographics and Health Statistics United States 2011 Nationally Age Those 65 and older are the most highly affected Gender Globally the ratio of male to female cases of reported TB stands at 1:1.5-2.1, males are reported almost twice as many times as females (Nur, Ozsahin, Arslan, Sumer, 2009). Race Pacific Islanders the most affected race/ethnicity Geographic location High Tuberculosis burdens occur in large cities such as New York, Florida, Texas and California Account for more than 50% of the national TB cases (Reported Tuberculosis in the United States, 2010, p. 3). Nationally, TB cases continue to decline

TB Morbidity United States, 2005 - 2010 Year Number Rate per 100,000 populations 2005 14,068 4.8 2006 13,732 4.6 2007 13,286 4.4 2008 12,905 4.2 2009 11,537 3.8 2010 11,182 3.6 (Reported Tuberculosis in the United States, 2011, p. 101)

CDC (2011). Tuberculosis Surveillance Slides Trends and Patterns National Impact - Prevalence rate As of 2011, there were an estimated 4.7 per 100,000 populations infected with TB (Global Tuberculosis Report, 2012) CDC (2011). Tuberculosis Surveillance Slides

Epidemiologic Measures International Impact Incidence rate (past 10 years) Between 2010 and 2000 incidence rates declined from 141 per 100,000 populations to 128 per 100,000 populations (Bachh, Gupta, Hag & Varudkar, 2012, p. 83) Prevalence rate As of 2012, there were an estimated 12,000,000 people living with TB (Global Tuberculosis Report, 2012, p. 10) Mortality rate (past 10 years) Between 2000 and 2010 mortality rates declined from 22 per 100,000 populations to 15 per 100,000 populations (Barnes et. al., 2011, p. 141)

International Impact The WHO’s Global Tuberculosis Report, 2012 states that as of 2011 there were an estimated 12,000,000 people living with Tuberculosis worldwide (p. 10). One-third of the world’s population is latently infected with TB (McShane, 2003). The 1990 WHO report on the Global Burden of Disease ranked tuberculosis as the seventh most morbidity-causing disease in the world, and expected it to continue in the same position up to 2020 (Bachh, Gupta, Hag, & Varudkar, 2010).

Demographics and Trends in India “India is highest tuberculosis (TB) burden country globally, accounting for more than one-fifth of the global incidence” (Ananthakrishnan, Jeyaraj, Palani, & Sathiyasekaran, 2012). In 2011, males ages between 35 and 44 were the highest reported group of newly notified cases by age and gender In 2011, females ages between 35 and 44 were the highest reported group of newly notified cases by age and gender Globally, TB cases continue to decline

India Percentages of risk of contracting tuberculosis based on geographic location in India in the year 2004 Urban areas (2.2%; 1.8%−2.6%) Rural areas (1.3%; 1.0%−1.5%) (38) North (1.9%; 1.3%−2.5%) West (1.6%; 1.0%−2.2%) East (1.3%; 1.0%−1.6%) South (1.0%; 0.7%−1.4%) (A brief history of tuberculosis control in India, 2004, p. 7).

New Case Notifications in 2011 South East Asia Males Females Age New cases 0-14 6,490 15-24 114,254 25-34 136,142 35-44 141,636 45-54 135,592 55-64 106,420 65+ 72,640 Age New cases 0-14 10,654 15-24 85,376 25-34 84,383 35-44 64,868 45-54 50,920 55-64 36,755 65+ 21,593 Global Tuberculosis Report 2012

Disease Prevention and Management The Stop TB Partnership sector of the WHO called DOTS (directly observed therapy, short-course), has a goal to bring the global incidence of active TB to less than one case per 1,000,000 population per year by 2050 (Onozaki & Raviglione, 2010) DOTS goal components Sputum smear microscopy (SSM) Directly observed treatment with standardized short-course chemotherapy A system to deliver drugs without interruption and free of charge Standardized recording and reporting of cases National political commitment (Keeler et al., 2006)

Globalization Due to the spread of the infection via airborne transmission, globalization is a high topic of concern for the spread and containment of the disease Dangers include: Tight, closed quarters Poorly ventilated environments Noncompliant infected individuals Ultimately the health and safety of others is the responsibility of the infected individual to obey physicians orders and remain isolated if infected

Economic Impact Financing TB control in the US in 2012 and 2013 estimates a total budget of $140 million (Global Tuberculosis Report 2012). “Between 2002 and 2009, the annual budget for TB control in India grew from US$ 36 million to US$ 100 million” (A brief history of Tuberculosis control in India, 2010, p. 5) Costs can include Transportation to treatment facilities Diagnosis and consecutive medical treatment Expenses from work and time missed from school In India, some TB patients spend 20% to 40% of their annual family income being treated for TB (A brief history of Tuberculosis control in India, 2010)

References A brief history of tuberculosis control in India. (2010) World Health Organization. Retrieved from http://whqlibdoc.who.int/publications/2010/9789241500159_eng.pdf Ananthakrishnan, R., Jeyaraj, A., Palani, G., & Sathiyasekaran, B. C. (2012). Socioeconomic impact of TB on patients registered within RNTCP and their families in the year 2007 in Chennai, India. Lung India, 29(3), 221-226. Doi:10:4103/0970-2113.99103 Bachh, A. A., Gupta, R., Hag, I., & Varudkar, H. G. (2010). Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role? Lung India, 27(2), 58-62. doi: 10.4103/0970-2113.63607. Barnes, R. W., Moore, M., Garfein, R. S., Brodine, S., Strathdee, S. A., & Rodwell, T. C. (2011). Trends in Mortality of Tuberculosis Patients in the United States: The Long-Term Perspective . Annals Of Epidemiology, 21(10), 791-795. CDC. Reported Tuberculosis in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, CDC, October 2012.

References Găvrilut, A. I., & Pop, C. M., (2012). Study of correlation between several diagnostic tests for latent tuberculosis. Analele Societatii Nationale De Biologie Celulara, 17(2), 125-129. Keeler, E., Perkins, M. D., Small, P., Hanson, C., Reed, S., Cunningham, J., Aledort, J. E., Hillborne, L., Rafael, M. E., Girosi, F., & Dye, C. (2006). Reducing the global burden of tuberculosis: The contribution of improved diagnostics. Nature, p. 49-57. doi:10.1038/nature05446. McShane, H. (2003). Susceptibility to tuberculosis: The importance of the pathogen as well as the host. Clinical and Experimental Immunology, 133(1), 20-21. doi: 10.1046/j.1365-2249.2003.02194.x Nur, N., Ozsahin, L., Arslan, S., & Sumer, H. (2009). An evaluation of gender differences in the epidemiology to tuberculosis. Heatlhmed, 3(4). 352-358. Onozaki, I., & Raviglione, M. (2010). Stopping tuberculosis in the 21st century: Goals and strategies. Respirology, 15(1), 32-42. doi: 10.1111/j.1440-1843.2009.01673.x. WHO. Global Tuberculosis Report, 2012. Switzerland, Information Resource Center, WHO, 2012.