Tuberculosis: The Provincial Picture

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Tuberculosis The Provincial Picture

• Update from Provincial Tuberculosis Program
• Geetika Verma, MD, MPH

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Objectives

• Review of Alberta s tuberculosis epidemiology
• Tuberculosis in Alberta in recent years
• Future directions
• Program transition
• Areas for growth
• Performance indicators
• Quantiferon roll-out
• Education

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Rates of TB in Alberta and Canada, 1992-2002
Source Health Canada, Public Health Agency of
Canada. Tuberculosis in Canada 2002. 2004. 31
Jan. 2005. 26 May 2005. lthttp//www.phac-aspc.gc.c
a/publicat/tbcan02/index.htmlgt.
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Number of cases in AB, 1989-2004
Source Alberta Tuberculosis Registry, Alberta
Health and Wellness
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Cases by former health regions
First Nations have been included in the nine
Health Regions Source Alberta Tuberculosis
Registry, Alberta Health and Wellness
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Cases by ethnicity
Includes Canadian-born Registered and
Non-Registered Treaty Indians, Métis, and Inuit
Includes three Treaty Indians born in the USA
Source Alberta Tuberculosis Registry, Alberta
Health and Wellness
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Top ten countries of origin
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Cases by disease site
CNS 1.7
Source Alberta Tuberculosis Registry, Alberta
Health and Wellness
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Source Alberta Tuberculosis Registry, Alberta
Health and Wellness
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Drug Resistance 2000-2004

• Only 4 Canadian-born patients had resistance to
  one or more first line drugs, with one case of
  MDRTB during this time period
• Among FB, there were 54 patients with drug
  resistance, and 2 cases of MDRTB
• Drug resistance rates among culture positive
  patients were
• 5.7- Canadian-born nonaboriginal
• 2.1 - Canadian-born Aboriginal
• 17.9- foreign-born

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Tuberculosis in Alberta The Current Picture
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2007

• 2007 was our nadir year with a rate of
  3.28/100,000- successfully halving our 1994 rate
• Total cases 112
• Pediatric cases 6
• Resistance 6 (no MDR)
• 12 deaths (3 attributable to TB)
• 10 HIV co-infected
• resistance to one or more drugs including
  streptomycin

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2007 Cases by ethnicity
Eleven (of fifteen) patients lived on reserve
most of the time
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Top five countries of origin, 2007
Philippines 15
India 12
Vietnam 9
China 6
Ethiopia 6
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Cases by site, 2007
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2008

• Total cases 168
• Pediatric cases 7 (4.2)
• 64 respiratory smear positive (38.1)
• Drug resistance 20 (11.9)
• HIV coinfection 10 (6.0)
• Deaths 13 (4 attributable to TB)
• Resistance to any first line drug, excluding
  streptomycin

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2008 Cases by ethnicity
eight (of fifteen) patients lived on reserve
most of the time
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Top five countries of origin, 2008
India 23
Philippines 19
China 14
Ethiopia 14
Pakistan 8
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2009 Preliminary Count

• Total cases 179
• Calgary 66
• Edmonton 72
• Rural 41
• Numbers not finalized

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Surveillance
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Surveillance
Source Alberta Tuberculosis Registry, Alberta
Health and Wellness
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Source Alberta Tuberculosis Registry, Alberta
Health and Wellness
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Number of people completing preventative therapy
2000-2004
Source Alberta Tuberculosis Registry, Alberta
Health and Wellness
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Preventative Therapy- 2009

• Total number of recommendations for preventative
  therapy in the province was 1328
• Calgary 239
• Edmonton 552
• Provincial TB control 537
• First Nations- 92
• Includes corrections - 97

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Program Performance and Initiatives
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Performance indicators

• Active disease
• Bacteriologic confirmation
• Initiation of multiple drug therapy
• Timeliness of treatment onset
• HIV screening among active cases
• Prophylactic therapy
• Proportion of those offered PT who accept and
  complete treatment

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2007-2008 Performance Indicators for Active
Disease
2007 2008 2000-2004 Target
Bacteriologic confirmation 100/112 (89.3) 138/167 (82.6) 88.5 90
HIV testing 107/112 (95.5) 160/167 (95.8) Increased from lt50 2000 to 87 2004 88.7
Initiation of a Multiple Drug Regimen 103/112 (92.0) 159/167 (95.2) 93.0 100
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Quantiferon in the province

• Centres offered Calgary, Edmonton
• Pilot sites Red Deer, Standoff

Positive Negative Total
Calgary 95 98 194
Edmonton 227 664 898
Other 36 71 107
Total 358 833 1199
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Quantiferon roll-out

• Supported by Alberta Health and Wellness
• Make QFT available to multiple hospital
  laboratories across the province
• All QFT assays will be performed through the
  provincial laboratory
• All QFT will be ordered by a TB physician in the
  province

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Looking ahead

• Lessons to be learned from complex outbreaks
• Education for primary care physicians in the
  province
• Tuberculosis among recent immigrants