A MESSAGE FROM LARIMER COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENT TB PROGRAM TO COMMEMORATE WORLD TB DAY 2017 Information included in this document is taken from a paper produced by STOP TB USA called “Common Sense-Routinely Treating TB Infection Could Avert More than 1 Million Cases of TB Disease in the United States”, and from INFECTIOUS DISEASES IN CHILDREN, February 2017; “The new face of an old disease: TB over 3 decades”. World TB Day is March 24, 2017. It is celebrated worldwide to bring attention to the fact that TB is now the single greatest infectious disease killer in the world: 10.4 million people became sick with TB disease in 2015 and 1.8 million deaths occurred in the same year. There is a worldwide effort to eliminate tuberculosis disease by 2026 – 2030. There were increasing numbers of tuberculosis disease in the 1980s in part due to the onset of HIV infection and increases in immigrant populations. Tuberculosis disease in the United States decreased annually from 26,673 cases in 1992 to 9,406 cases in 2014 due to a commitment by federal agencies and state health departments. However in 2015, the number of cases in the U.S. increased for the first time since 1992 to 9,557.
Current TB statistics for Larimer County 4 - Number of persons with TB disease in 2016 2 – Number of those people who died secondary to late diagnosis or undetected TB disease 341 - Number of high risk persons tested for TB 42 - Number of persons found to have latent TB infection 35 - Number of persons who initiated treatment for latent TB infection 4 - Number of potential TB cases prevented through treatment of latent TB infection
In 2015, two third of the reported cases of TB disease in the United States were among foreign born individuals. Statistics show that between 20-30% of the 1 million legal immigrants to the U.S. each year, are likely infected with TB in its dormant or latent form. People with TB infection are at risk of progressing to TB disease at some point in their lives. According to Jeffrey Starke, M.D., professor of pediatrics at Baylor College of Medicine and director of the Children’s Tuberculosis Clinic at Texas Children’s Hospital, speaking in Infectious Diseases in Children, February, 2017, “If we really want to eliminate TB in this country, we have to address not just TB disease but we have to address TB infection”. Furthermore, in the same article, Dr. David Cohn, M.D., professor of medicine at the University of Colorado Denver and previous director of the Denver Metro TB Clinic, cited the inability to treat TB infection as one of the greatest failures of TB control over the past 30 years, not just in the U.S., but globally. A study in the New England Journal of Medicine found that more than 80% of cases of TB disease in the U.S. arise from a past TB infection that remained dormant or latent for a time, but then reactivated and progressed to TB disease. If those persons with TB infection had been identified and treated with antibiotics to kill the TB bacteria, nearly all of them would have been prevented from developing TB disease.
What are we doing in Larimer County to address this need to eliminate TB disease by finding and treating TB infection?
The Larimer County Department of Health and Environment (LCDHE) TB Program is participating in a statewide initiative to eliminate TB disease by increasing the testing of individuals at risk for tuberculosis and treating them for TB infection if indicated before TB disease can develop.
Our efforts are based on our goal to honor people’s right to know their TB status. According to Stop TB USA, people have a right to know if they’re living with TB infection that could one day-suddenly and without warning-progress to become active, transmissible TB disease. “Treating TB infection stops the TB bacteria in its tracks-before it has a chance to develop into TB disease, before it has the chance to spread to other people, before the possibility of developing drug resistance and before the possibility of death. Treating TB infection is the safest, cheapest, and most effective way to prevent progression to TB disease”. This is being accomplished by: • Outreach efforts to local community medical providers: 1. To follow the 2016 U.S Preventive Services Task Force guidelines recommending testing for TB infection in populations at increased risk. Risk Assessment Tool also has been provided. 2. To Think TB as a differential diagnosis when symptoms are consistent with tuberculosis disease. 3. To refer all suspect TB cases to local public health as mandated by state statute. Laboratory confirmation should not delay reporting to public health. • Outreach to area medical providers, health care agencies who employ health care workers, local universities whose students are from TB endemic countries, with information regarding role of Health Department in TB screening and treatment. • To at risk community members: Providing testing opportunities, recommendations for treatment if indicated based on their risk of progressing from infection to TB disease, and their options for treatment.
TB is Preventable Elimination of TB disease requires elevating the priority we place on identifying and treating TB infection. In 2000, the Institute of Medicine published a 250 page report of TB in the U.S.. It concluded that finding and treating the roughly 11 million people in the U.S. with TB infection, 5-10% of whom could develop TB disease, could avoid between 550,000 and 1.1 million future cases of TB disease. Larimer County Department of Health and Environment TB Program is committed to continuing efforts to raise medical provider and community awareness of the risk posed by untreated TB infection and to encourage clinicians to provide their patients with an assessment of their risks, thus empowering high risk individuals with the tools to prevent TB disease and its spread.
