of Tuberculosis Internationally Tuberculosis Control In Vulnerable Groups Bulletin of the World Health Organization TB is an in important public health problem in industrialized countries Most cases occur in minority groups ID: 596146
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Slide1
The Effects
of Tuberculosis InternationallySlide2
Tuberculosis Control In Vulnerable Groups
Bulletin of the World Health Organization
TB is an in important public health problem in industrialized countries
Most cases occur in minority groups
Immigrants who arrive from high
endemicitySlide3
WHO Bulletin
Association between TB and poverty is mediated by ;
Overcrowding
Poorly ventilated housing
Malnutrition
Smoking
Stress
Social deprivationSlide4
Displaced populations
Large groups of refugees affects TB control in receiving country.
Poor living conditions and overcrowding in refugee settlements increase the risk of TBSlide5
MMWR March 20, 2014
Morbidity and Mortality Weekly Report
Cases and rates of TB continue to fall in the US
Foreign – Born and racial/ethnic minorities are keeping TB elimination out of reach
TB rate for foreign born individuals is 13 times higher than among individuals born in the US.
The proportion of TB cases in foreign-born group continues to increase.Slide6
New
TB Screening
CDC recommendations for overseas tuberculosis screening of immigrants and refugees has improved diagnosis prior to
arrival
Sputum more sensitive screening
Chest x-ray
$15 million decrease in US Health Care costsSlide7
TB
screening overseas
Guidelines require testing of children ages 2 – 14 who are arriving from countries with high rates of TB
The 2007 guidelines are require the use of DOT Direct Observed Therapy. This is considered the gold standardSlide8
Incidence
The four greatest immigrant magnet states have over half the TB cases in the U.S.
1992 27 % TB cases in the U.S. are foreign born: Hawaii 83% of cases
Washington State 48% of
cases California
61% of cases
The Queens, New York, Health Dept. 81% of new TB cases in 2001 to immigrantsSlide9
Impact on the Unites States
Immigrants/refugees,
these groups intend to reside
in
the U.S.
Nonimmigrant
visitors students
, exchange
visitors temporary
workers, tourists,
business
travelers.
Only immigrants and refugees are screened.Slide10
Positive Patient
Recently a visiting student from Singapore tested positive for active TB
Required hospitalization
Collection of Sputum
Medication
Contact investigation
work
, church, family Slide11
Basic principles of TB Control
Early and accurate detection, diagnosis and reporting of TB cases leading to initiation and completion of treatment
Identification of contacts of patients with infectious TB
Identification of those patients with LTBI and at risk for progression to TB
diseaseSlide12
Delays in Obtaining Health Care
Homeless patients
Fear of Immigration authorities
Those who speak language other than English
Cultural
factors, social
stigma of TBSlide13
Importance of Tb Training and Education
Deficiencies in clinical knowledge and practice
Staffing and workforce
concerns
New guidelines and
recommendations
Education of new contributors to TB control
Diminished teaching about TB in medical and nursing schoolsSlide14
Civil Surgeon
Licensed physicians conduct health screening including LTBI and active TB on foreign born persons living in the US for permanent residency
Civil surgeons receive immigration-focused training Slide15
Drug –resistant TB
Refers to an isolate of M. Tuberculosis that is resistant to one of the first-line
antiTB
drugs:
Isonaizid
Rifampin
Pyrazinsmide
Ethambutol
StreptomycinSlide16
Multidrug-resistant TB
MDR-TB
Multidrug resistant TB refers to an isolate of
M.Tuberculosis
that is resistant to at least isoniazid and rifampin and possibly additional agentsSlide17
Extensive Drug Resistant
XDR-TB
This refers to an isolate of
M.Tuberculosis
that is resistant to at least Isoniazid, rifampin and
fluroquinolones
as well as either aminoglycosides (
amikacin
, kanamycin or
capreomycin
or bothSlide18
Totally drug-resistant TB
TDR-TB refers to an isolate of
M.tuberculosis
resistant to all locally tested medicationsSlide19
Primary Drug Resistance
Primary drug resistance is said to occur in a patient who has never received
ant-TB therapySlide20
Secondary drug Resistance
Secondary drug resistance refers to the development of resistance during or following chemotherapy in patients who had previously had drug-susceptible TBSlide21
CDC’s Do Not Board and/or Lookout
L
ists
E
xplained
U.S. Federally
Quarantinable
Communicable
Diseases
Cholera
Viral
hemorrhagic fevers
Diphtheria
Sever
acute respiratory
(SARS
)
Infectious TB
Plague
Influenza
novel
or
reemerging
influenza causing
or with potential
to cause
a pandemic
Smallpox
Yellow feverSlide22
Definitions
Do Not Board (DNB) List
Travel restriction tool: Prevents people who meet specific criteria from obtaining a boarding pass for any flight inbound to, outbound from, or within the United States
Implented
by the TSA
Does
NOT prevent
passengers from
boarding ships, trains, or
busesSlide23
DNB/LO at a Glance
DNB LO
Boarding pass denied
Traveler evaluated
For
any flight inbound to,
evaluated when
Outbound from, or within
entering
US at
US
a border
Implemented by TSA Enforced
by
Customs
and Border ProtectionSlide24
NOTE
People on the Do Not Board list are not part of the No Fly List
The Do Not Board list is designed to protect the public’s health
The No Fly list is intended for law enforcement purposes, such as terrorist threats.Slide25
Criteria for DNB/LO Removal
Removal
is
f
acilitated
when
person
is
d
etermined
to
b
e NONINFECTIOUSSlide26
Wall Street Journal
October 29, 2014
Few diseases need new medicines as much as tuberculosis.
Some medications are 40 years old
Funding for R&D rose annually
2005-2012
Most cuts came from private sector donors
Bedaquiline
,
Johnson
& Johnson
Awaiting regulatory approval outside US where 450,000 annual drug resistant TB occurSlide27
Delamanid
Otsuka Pharmaceutical failed to get approval
f
rom European Union committee in July
Pfizer
Astra-Zeneca
Bill & Melinda Gates
President Obama
in 2014
budget proposed a 19% cut to
$191
MillionSlide28
Goal
Currently, most cases are diagnosed via the longtime sputum smear microscopy method.
Doctors need a test that can be used to diagnose patients in the examination room and begin treatment right away.