Epidemiology of TB in Texas 2004

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Epidemiology of TB in Texas2004

• Gail Shevick, Epidemiologist
• Infectious Disease Control Unit
• Texas Department of State Health Services
• 03/22/2005

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Objectives

• Which Geographic Regions Have the Highest Cases?
• Which Populations Have the Highest Cases in
  Texas?
• What Are the Most Common Risk Factors?

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Tuberculosis Incidence Rates,Texas and U.S.,
1994-2004
8.3 7.6 7.1 4.9
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Five Leading U.S. States by Number of TB Cases,
2004
A total of 14,511 TB cases were reported in the
U.S. during 2004. These 5 states represent 53
of the cases reported. (CA, TX, NY represent 42
of the cases.)
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Number of TB Cases Texas 1994-2004
There was a 5.6 increase in the number of cases
from 2003 to 2004. This is an 11.8 increase from
the low in year 2000.
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Geographic Distribution
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TB Cases by Geographic AreaTexas 2004
Percent of TB Cases for Selected Areas
Top 10 Counties for Cases

• Harris 472
• Dallas 256
• Bexar 114
• Tarrant 109
• Hidalgo 82
• El Paso 70
• Cameron 68
• Travis 64
• Webb 50
• Fort Bend 29

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TB Incidence Rates for Selected Geographic
Areas Texas 2004
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Tuberculosis Incidence Rates Along Texas-Mexico
Border,Texas 1994-2004
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Demographics

• Gender
• Age
• Race/ethnic group

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Tuberculosis Cases by Age Group and Sex, Texas
2004
65 Male, 35 Female Incidence rate for Males
10.0, Females 5.2
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Tuberculosis Cases and Rates by Age Group, Texas
2004
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Tuberculosis Incidence Rates By Race/Ethnic
Group,Texas, 1994-2004
Other consists of Asians, Pacific Islanders,
Native Hawaiians, American Indians, Alaskan
Natives
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TB Cases by Race/Ethnic Group Texas 2004
TB Incidence Rate
Percent of Cases
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TB Cases by Race/Ethnic Group Texas 2004
Texas Population
Texas TB Cases
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Percent of Cases by Race/Ethnic Group and Region,
Texas 1994-2004
One percent or less fell into other racial/ethnic
categories for each place.
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Risk Factors

• Those that put person at higher risk for exposure
  to or infection with TB
• Those that put a person at higher risk of
  developing the disease after infected

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Percent of TB Cases That Are Foreign Born Texas
and U.S., 1997-2004
Top countries Mexico (58), Vietnam (9),
India (5), and Philippines (3) 57 foreign
countries represented.
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Percentage of Foreign Born TB Cases by Years in
the U.S., Texas 2004
37.8 in U.S. lt5yrs, 45.7 in U.S. 10 yrs or more
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Percent of TB Cases in Each Race/Ethnic Group by
Origin, Texas 2004
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Percent of TB Cases With Selected Risk Factors,
Texas 2004
Note Individuals can have more than one risk
factor.
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Drug-Resistant TB

• Newly diagnosed cases start on 4 drugs while
  awaiting culture and susceptibility results
• INH (Isoniazid)
• RIF (Rifampin)
• PZA (Pyrazinamide)
• EMB (Ethambutol)
• Results drug-susceptible M.tb
• Remain on 2 drugs, usually INH RIF, to prevent
  emergence of resistant bacilli

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How does a Patient become Infected with
Drug-Resistant TB?

• Exposed to and become infected with a
  drug-resistant strain of TB
• Exposed to and infected with a drug-susceptible
  strain of TB and acquire drug-resistance through
• Patient prescribed inappropriate treatment
• Patient does not follow appropriate regimen

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What is Multi Drug-Resistant (MDR) TB?

• Resistant to both INH and RIF
• More difficult to treat
• More drugs are required to treat patient
• Often less effective at killing the bacilli
• Often cause more adverse reactions
• Treatment longer 2 years or more
• IS MDR TB A PROBLEM IN TEXAS???

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Number of MDRTB Cases Texas 1994-2004
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Percent of TB Cases in Each Race/Ethnic Group by
Drug Susceptibility, Texas 2004
Other includes Native Hawaiian, American Indian,
Alaskan Native, and Multiracial.
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Which Geographic Regions Have the Highest Cases?

• 5 counties Harris (472), Dallas (256), Tarrant
  (109), Bexar (114), Travis (64)
• 14 Border Counties (283) 95 of border cases
  reside in 4 counties Cameron (68), El Paso (70),
  Hidalgo (82), Webb (50)
• These areas represent 77 of cases
• Border counties represent only 17 of cases, but
  high incidence rate border (13.2) is approx.
  twice that of non-border (7.0)

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Which Populations Have the Highest Cases in Texas?

• Male or Female?
• Males 65 of cases
• Age group?
• Majority 25-54 years of age
• Race/Ethnic Group?
• Minorities
• Hispanic largest percent of cases (50)
• Highest rate Others (24.9), followed by Black
  (15.0), Hispanic (11.1)

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What Are the Most Common Risk Factors?

• Foreign birth (45)
• Low Income (43)
• Alcohol abuse (19)
• HIV/AIDS (17)
• Diabetes (15)
• Prison/Jail Inmate (12)
• Risk Factors will vary by region
• HIV/AIDS more common in larger urban areas
• Diabetes more common along border

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Thank you

• Please visit our website at
• http//www.texastb.org