«Annual Tuberculosis Surveillance Report COOK COUNTY DEPARTMENT OF PUBLIC HEALTH Terry Mason, MD, FACS Chief Operating Ofﬁcer, Cook County ...»
COOK COUNTY DEPARTMENT OF PUBLIC HEALTH
Terry Mason, MD, FACS
Chief Operating Ofﬁcer, Cook County Department of Public Health
Demian Christiansen, DSc, MPH
Communicable Disease Control Unit
All materials contained in this report are in the public domain and may be used and reprinted without
special permission; citation as to source, however, is appreciated.
Suggested Citation Cook County Department of Public Health. Annual Tuberculosis Surveillance Report, 2014. Oak Forest, IL, 2015.
Cook County Department of Public Health Protecting the Health and Environment of Suburban Cook County Afﬁliate, Cook County Health and Hospitals System John Jay Shannon, MD CEO, Cook County Health and Hospitals System Honorable Toni Preckwinkle President, Cook County Board of Commissioners President, Cook County Board of Health Communicable Disease Control Unit Cook County Department of Public Health 7665 W. Jackson Blvd.
Forest Park, IL 60130 CONTENTS ACRONYMS, ABBREVIATIONS & DEFINITIONS
LIST OF TABLESTable 1. Number and Rate (per 100,000 population) of Reported Tuberculosis Cases by Selected
Public Health Jurisdictions, 1993-2014
Table 2. Number and Percentage of Reported Tuberculosis Cases by Selected Characteristics, Suburban Cook County, 2005-2014
Table 3. Tuberculosis Cases by Most Frequently Reported Countries of Origin, Suburban Cook County, 2005-2014
Table 4. Number and Proportion of Reported Tuberculosis Cases by Site of Disease and Laboratory Results, Suburban Cook County, 2014
Table 5. Tuberculosis Susceptibility Results by Birthplace, Suburban Cook County, 2014.
.............10 Table 6. Trends in the Number of Reported Tuberculosis Cases, HIV Testing and Coinfection with HIV, Suburban Cook County, 2005-2014
Table 7. Reported Tuberculosis Cases and Rates (per 100,000 population) by Municipality, Suburban Cook County, 2014
LIST OF FIGURESFigure 1. Rates of Reported Tuberculosis Cases by Selected Jurisdictions, 1993-2014
Figure 2. Proportion of Reported Tuberculosis Cases by Birthplace, Suburban Cook County, 2005-2014
Figure 3. Reported TB Cases by Birthplace and Race/Ethnicity, Suburban Cook County, 2014.
.......9 Figure 4. Number of Years Living in the United States Prior to Receiving a Diagnosis of Tuberculosis Disease, Suburban Cook County, 2014
Figure 5. Mode of Treatment Administration in Reported Tuberculosis Cases, Suburban Cook County, 2005-2014
Figure 6. Completion of Tuberculosis Therapy, Suburban Cook County, 2003-2012
ACRONYMS, ABBREVIATIONS & DEFINITIONSActive TB: (see TB Disease) AIDS: Acquired immunodeﬁciency syndrome.
BCG: Bacille Calmette Guérin, a vaccination given to persons, usually infants, in countries where TB is common. BCG is NOT used in the United States.
DOT: Directly Observed Therapy. Health department staff watch patients take anti-TB medications.
Extrapulmonary TB: A person with Mycobacterium tuberculosis infection outside of the lungs, the pleural space, and the larynx (voice box). A person with extrapulmonary disease can also have pulmonary TB (see below).
HIV: Human immunodeﬁciency virus.
I-NEDSS: 1Illinois-National Electronic Disease Surveillance System. I-NEDSS is a web-based application that establishes a secure and real-time communication link between hospitals, laboratories and other health care providers with state and local health department staff for the purposes of reporting and managing communicable disease information.
LTBI: Latent Tuberculosis Infection; a person with TB infection who is not contagious.
MDR-TB: Multi-drug resistant TB. MDR-TB is deﬁned as TB resistant to isoniazid and rifampin.
Pulmonary TB: A person with Mycobacterium tuberculosis infection of the lungs, pleural space or the larynx (voice box). A person with pulmonary TB can also have extrapulmonary TB.
QFT-G: QuantiFERON-TB Gold Test, a blood test used to detect Mycobacterium tuberculosis. This test cannot distinguish persons with LTBI from persons with TB disease. QFT-G can, however, differentiate between persons with TB infection or disease and those who received BCG vaccine.
SA: Self-adnministered anti-TB therapy. Patients are not observed taking their medications.
TB Disease: A person with TB infection who is contagious to others; a person with TB disease can have pulmonary TB, extrapulmonary TB, or both.
TST: Tuberculin Skin Test, a test whereby puriﬁed protein derivative (PPD) is injected under the skin in the forearm. Persons with TB infection react to the PPD which results in a bump (induration) where the PPD was injected. Qualiﬁed healthcare personnel can measure the size of the bump and determine whether the test is positive or negative. A positive TST can indicate active TB infection, LTBI, or prior BCG vaccination. However, the TST is not able to distinguish between these three possibilities.
XDR-TB: Extensively drug resistant TB. XDR-TB is deﬁned as MDR-TB plus TB that is resistant to any ﬂuoroquinoline plus resistance to one of the three injectable drugs (i.e., amikacin, kanamycin, or capreomycin).
OVERVIEW Epidemiologic Summary
• Sixty four (64) new cases of TB were reported in suburban Cook County in 2014. This represents a rate of 2.6 cases per 100,000 population and is an 18% decrease in cases reported since 2013 (Table 1).
• The West District had the highest TB rate (4.0 per 100,000 population) of any of the four public health districts in suburban Cook County (Table 7). The North District had the second highest TB rate (3.4 per 100,000 population; Table 7).
TB Burden in Foreign-born Persons
• The proportion of TB cases in foreign-born persons was 73% in 2014 (Figure 2).
• Three countries accounted for 68% of all foreign-born cases: Mexico (34%), the Philippines (19%) and India (15%; Table 3 and Figure 4).
• Among foreign-born persons diagnosed with TB, 74% arrived 5 or more years prior to receiving a diagnosis of TB disease (Figure 4).
• In 2014, no case of MDR-TB was identiﬁed (Table 5).
Coinfection with HIV
• Five (5) cases with TB were coinfected with HIV (Table 6); these persons are deﬁned, per AIDS case deﬁnition, as having AIDS.
Directly Observed Therapy
• In 2014, 92.5% of patients with pulmonary TB received DOT (Figure 5).
Completion of Therapy
• For TB cases diagnosed in 2012, the most recent year for which data on completion of tuberculosis therapy are available, 97.5% of persons with TB disease who were eligible* completed treatment.
• Among persons diagnosed in 2012 and who were eligible* to complete TB treatment in 12 months*, 94.3% of cases did so. This is above the Healthy People 2020 goal of 93% (Figure 6).
▲Table 2. In 2014, 56% of TB cases were male; 82% were aged 25 years or older; 34% were Asian/Paciﬁc Islanders and 33% were Hispanic/Latino. There were 4 pediatric cases (i.e. cases 15 years of age) representing 7% of all cases diagnosed in 2014 in suburban Cook County.
*Cases were also counted in persons born in Australia, Bosnia and Herzegovina, Bulgaria, Cambodia, Guatemala, Serbia, South Africa, and Tanzania.
* Eligible cases are persons who were alive at the time of TB diagnosis and did not die during therapy, and excludes persons with TB resistant to rifampin and pediatric cases (15 years) with a diagnosis of meningeal, bone/joint, or miliary TB.
TECHNICAL NOTESSurveillance Methodology Healthcare providers and laboratories in suburban Cook County are required to report the following results within 24 hours: (1) sputum or tissue smears positive for acid-fast bacilli (AFBs); (2) cultures positive for Mycobacterium tuberculosis; (3) mycobacterial drug susceptibility results; (4) any other tests positive for Mycobacterium tuberculosis. In addition, conﬁrmed TB cases must be reported to CCDPH within 7 days.
TB case reports are entered into I-NEDSS and provide the basis for the information presented in this report. This report includes all cases of tuberculosis reported during the year in which the case was conﬁrmed. Conﬁrmed TB cases who may have moved into suburban Cook County from another jurisdiction are not reﬂected in the data presented herein; such cases are counted in the jurisdiction that reported the case. Likewise, conﬁrmed TB cases reported in suburban Cook County who may have moved out of suburban Cook County are included in the data presented herein.
Reported TB Case Rates Suburban Cook County, Chicago and Illinois TB rates between 1993-1999 were calculated using 1990 census data. Suburban Cook County, Chicago and Illinois TB rates between 2000-2009 were calculated using 2000 census data. Suburban Cook County, Chicago and Illinois TB rates after 2009 were calculated using 2010 census data. National TB rates were