1. TUBERCULOSIS IN SOUTH CAROLINA Shea Rabley, RN, MN, Director TB Control Division South Carolina Department of Health and Environmental Control

2. General Information about Tuberculosis Tuberculosis, an airborne communicable disease caused by mycobacterium tuberculosis, is primarily found in the lungs (pulmonary) but the bacteria can attack and cause disease in any part of the body (extrapulmonary). Transmission occurs by the expectoration of droplets into the air from a person with active pulmonary disease and the subsequent inhalation of the aeroslized droplets by another person. This can occur while talking, singing, sneezing or coughing.

3. Once a person is exposed and becomes infected, the TB bacilli can remain dominant in the body (latent TB infection or LTBI) or it can progress to active TB disease. LTBI progresses to active TB disease in ~10% of these persons within the first 2 years. The rest remain at risk for life. For persons with a weakened immune system from HIV, other medical conditions or drugs that affect the immune system, the risk of progression is increased greatly and this risk remains higher year after year than it does for others.

4. TREATMENT TB infection requires the use of 1-2 drugs for 6 – 9 months for treatment completion. TB disease requires treatment with 4 or more drugs for the initial 2 months and then 2 drugs for 4 – 7 more months for a total of 6 – 9 months. Drug resistant TB (MDR-TB or XDR-TB) requires treatment with sensitive drugs for 12 – 24 months.

5. Reported TB Cases United States, 1982–2010* *Updated as of July 21, 2011 No. of Cases Year

6. TB Case Rates* United States, 2010 *Cases per 100,000. < 3.6 (2010 national average) >3.6 D.C.

7. >50% 25%–49% <25% 20002010 DC *Updated as of July 21, 2011 Percentage of TB Cases Among Foreign-born Persons, United States* DC

8. Reported TB Cases South Carolina, 2001 - 2010 Case trend over 10 years

9. Abbeville Aiken Allendale Anderson Bamberg Barnwell Beaufort Berkeley Calhoun Charleston Cherokee Chester Chesterfield Clarendon Colleton Darlington Dillon Dorchester Edgefield Fairfield Florence Georgetown Greenville Greenwood Hampton Horry Jasper Kershaw Lancaster Laurens Lee Lexington McCormick Marion Marlboro Newberry Oconee Orangeburg Pickens Richland Saluda Spartanburg Sumter Union Williamsburg York Region 2 Region 1 Region 3 Region 5 Region 4 Region 8 Region 7 Region 6 South Carolina Tuberculosis Case Rates* 2010 3.1- 4.0 4.1 – 6.0 6.1 – 10.0 >10.1 0 0.1- 3.0 3.8 - 2009 National Case Rate 3.4 - 2010 SC Case Rate *Cases per 100,000 population

10. TB CASES BY COUNTRY OF ORIGIN South Carolina 2010

11. TB CASES ETHNICITY South Carolina 2010

12. TB CASES BY RACE South Carolina 2010

13. TB CASES BY AGE GROUP South Carolina 2010 N = 153 Cases

14. TB CASES BY SEX South Carolina 2010

15. HIGHEST TB INCIDENCE COUNTIES South Carolina 2010

16. TB CASES WITH DRUG RESISTANCE South Carolina2006-2010

17. For TB Control Activities: Absence of proof is not proof of absence….. When you near the elimination of your disease, your funding will be eliminated.

18. Questions? Call 803-898-0558. The TB Control Program takes the charge of the Division seriously – protecting the public of South Carolina from the infectious, communicable pulmonary disease, tuberculosis.