Wisconsin Tuberculosis (TB) Program...

2016 WI TB Update WI TB Program

Wisconsin Department of Health Services

Julie Tans-Kersten, MS, BSMT (ASCP) Wisconsin TB Program Northeast TB Summit, Kimberly WI November 3, 2016

Wisconsin Tuberculosis (TB) Program Update

1



Outline

• TB in Wisconsin

o Epidemiology

o Demographics

• Latent Tuberculosis Infection (LTBI) treatment in Wisconsin

• Wisconsin TB Program ongoing activities

2



TB IN WISCONSIN

3



Reported TB Cases

United States, 1982–2014

Wisconsin, 1982–2014

0

5,000

10,000

15,000

20,000

25,000

30,000

No

. of

case

s

Year 0

50

100

150

200

250

No

. of

case

s

Year

4



Douglas Bayfield

Ashland

Saywer

Washburn

Burnett

Polk

Barron Rusk

Price

Iron

Vilas

Oneida

Lincoln

Taylor

Chippewa St. Croix

Pierce

Dunn

Pepin

Eau Claire

Buffalo

Tre

mpe

alea

u

Jackson

Monroe

Clark Marathon

Wood Portage

Juneau

Adams

Sauk

LaCrosse

Vernon

Crawford Richland

Grant

LaFayette Green Rock

Dane

Iowa

Columbia Dodge

Jefferson Waukesha

Walworth

Kenosha

Racine

Oza

ukee

Sheboygan Fond du Lac Green

Lake

Marquette

Waushara

Win

neba

go

Cal

umet

Manitowoc

Kew

aune

e

Brown Outagamie

Waupaca

Shawano

Menominee

Oconto Langlade

Forest Marinette

Florence

Door

Milw

auke

e

Was

hing

ton

Western Region

Northeastern Region

Southeastern Region

Southern Region

Northern Region City of Milwaukee 17

Northshore 2

Cudahy 1

Greenfield 1

Franklin 1

West Allis 1

7

3

1

1

1

2

2

2

2 1

1

1

1

23

3

2

1

1

*Preliminary as of November 1, 2015. WI TB Program.

2015 TB Cases by Region

6



Douglas Bayfield

Ashland

Saywer

Washburn

Burnett

Polk Barron

Rusk

Price

Iron

Vilas

Oneida

Lincoln

Taylor

Chippewa St. Croix

Pierce

Dunn

Pepin

Eau Claire

Buffalo

Tre

mpe

alea

u Jackson

Monroe

Clark Marathon

Wood Portage

Juneau

Adams

Sauk

La Crosse

Vernon

Crawford Richland

Grant

LaFayette Green Rock

Dane

Iowa

Columbia Dodge

Jefferson Waukesha

Walworth

Kenosha

Racine

Oza

ukee

Sheboygan Fond du Lac Green

Lake

Marquette

Waushara Winnebago

Cal

umet

Manitowoc

Kew

aune

e

Brown Outagamie

Waupaca

Shawano

Menominee

Oconto Langlade

Forest Marinette

Florence

Door

Milw

auke

e

Was

hing

ton

0.51-1.0

1.1-1.5

1.6-2.0

>2.0

≤ 0.50

10 year average TB rates 2005-2015

*rate = number of cases per 100,000

TB Case Rates,* Wisconsin, 2005-2014

7



Reported TB Cases by Age Group United States, 2014 Wisconsin, 2005-2014

<15 yrs (5%)

15-24 yrs

(10%)

25-44 yrs

(30%) 45-64

yrs (31%)

≥ 65 yrs (24%)

<15 (7%)

15-24 (13%)

25-44 (34%)

45-64 (24%)

>65 (22%)

8



TB Cases by Residence in Correctional Facilities, Age ≥15

United States, 1993-2014 Wisconsin, 2005-2014

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0

200

400

600

800

1000

1200

19

93

19

95

19

97

19

99

20

01

20

03

20

05

20

07

20

09

20

11

20

13

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

0

0.5

1

1.5

2

2.5

3

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

No. of Cases No. of Cases Percentage Percentage

9



TB Cases Reported as Homeless in the 12 Months Prior to Diagnosis, Age ≥15

United States, 1993-2014 Wisconsin, 2005-2014 No. of Cases No. of Cases Percentage Percentage

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

0

200

400

600

800

1000

1200

1400

1600

19

93

19

95

19

97

19

99

20

01

20

03

20

05

20

07

20

09

20

11

20

13

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

0

1

2

3

4

5

6

7

10



Number of TB Cases in U.S.-born vs. Foreign-born Persons


0

5,000

10,000

15,000

20,000

Nu

mb

er

of

Cas

es

U.S.-born Foreign-born

0

10

20

30

40

50

60

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

Nu

mb

er

of

Cas

es

Year

US-Born Foreign-Born

11



Countries of Birth of Foreign-born Persons Reported with TB

United States, 2014 Wisconsin, 2005-2014

• Mexico (21%)

• Philippines (12%)

• India (8%)

• Vietnam (8%)

• China (7%)

• Guatemala (3%)

• Haiti (3%)

• Other countries (39%)

• Mexico (27%)

• Hmong (Laos/Thai) (18%)

• India (14%)

• Philippines (5%)

• China (5%)

• Burma (3%)

• Somalia (3%)

• Other counties (25%)

12



Laos/Thailand 68%

Burma 12%

Somalia 12%

Nepal 3%

Cambodia 2%

Sudan 1%

Vietnam 1% Bhutan

1%

Refugee population by country of origin

TB in Wisconsin Refugee Population 2005-2014

13



Primary MDR TB


0%

1%

2%

3%

0

100

200

300

400

500

19

93

19

95

19

97

19

99

20

01

20

03

20

05

20

07

20

09

20

11

20

13

0%

2%

4%

6%

8%

10%

0

1

2

3

4

5

6

7

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

14



2014 vs 2015 TB Data

15

2014 Total case = 48

2015 Total case = 69

% # % #

Pulmonary only 60% 29 59% 41

Extra-pulmonary 23% 11 32% 22

Both pulmonary & extra-pulmonary

17% 8 9% 6

Children <15 yo 0% 0 1% 1

Foreign-born 69% 33 71% 49

US-born 31% 15 29% 20

MDR-TB cases 6% 3 6% 4

Deaths 6% 3 10% 7



TB Summary and Challenges • Two most common factors associated with TB

Disease in Wisconsin: • foreign-born

• known contact with someone with active TB disease

• Challenges • Loss of TB expertise in healthcare

• Diagnosis and treatment of TB in high-risk foreign-born populations

• Complex case management/patients with co-morbidities (diabetes, HIV, alcohol/drug use, smoking)

16



TB INFECTION TREATMENT

17



Active TB (suspect or confirmed)

1%

Medical risk factor 10%

Contact to current case of TB

12%

Population risk factor 77%

Referral Reason for LTBI Treatment, 2010-2015

18



0

200

400

600

800

1000

1200

2010 2011 2012 2013 2014 2015

Nu

mb

er

Year

WI LTBI Treatment Regimen Prescribed 2010-2015

INH Daily x9 months RIF daily x4 months 3HP MDR-LTBI Other

19



Average Completion of LTBI Treatment Prescribed

2010-2014

INH Daily x9 months

RIF daily x4 months

3HP Other

64% 75% 85% 64%

20



TB PROGRAM ACTIVITIES

21



Wisconsin Program Updates • Staffing

• TB Dispensary

• WEDSS Update

• TB Program website

• TB Program outreach

22



TB Program Staffing

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Role Name

Phone

TB Program Director

Julie Tans-Kersten 608-261-6387

TB Nurse Consultants

Judy Rabinowitz 608-266-7338

Marjorie Wall 608-266-9452

Lorna Will 608-266-3729

Office Associates for Dispensary

Joey Janz 608-266-9692

Brandon Rufer 608-266-7473



WI TB Dispensary

The Wisconsin TB Dispensary provides TB/LTBI drugs and other medical services for uninsured and under-insured patients (state funded). • Contracts with local public health departments and

pharmacies

• Approves medication orders and other services, coordinates logistics and reimbursements

Challenge: Outdated/antiquated database

Solution: Contracting with IT to build new, web-based system

24



TB Program Data Collection The Wisconsin Electronic Disease Surveillance System (WEDSS) is a is a secure, web-based system designed to facilitate reporting, investigation, and surveillance of communicable diseases in Wisconsin. Challenges: • Nurse Case Manager (NCM) module not interfacing

well with WEDSS Reporter • Unable to extract data for CDC

Solution: • Merging NCM components into Reporter module

25



Ongoing Activities • WI TB Program website:

https://www.dhs.wisconsin.gov/tb

26





Outreach Activities

• LTBI educational visits

• November 3, 2016 – Northeastern Regional TB Summit (Kimberly)

• November 17, 2016 - WI Mycobacteriology Laboratory Network meeting (Madison)

• April 2017- Madison/Dane County Regional TB Summit (Madison)

• 2017- Northwest Regional TB Summit

27



2016 NTCA Conference Denver, CO

TB Survivor Training Poster Presentation

28



THANK YOU! QUESTIONS?

Wisconsin TB Program

1 West Wilson Street, PO Box 2659

Madison, Wisconsin 53701-2659

608-261-6319 (Office)

608-266-0049 (Fax)

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