PREVENTING RELAPSE

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PREVENTING RELAPSE. Lee B. Reichman, MD, MPH Northeast TB Controllers Meeting October 24, 2006 Princeton, New Jersey. Reported TB Cases United States, 1982 – 2005. No. of Cases. 1982. 1987. 1991. 1995. 1999. 2005. Year. Trends in Tuberculosis – United States, 2005. - PowerPoint PPT Presentation

Transcript of PREVENTING RELAPSE

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PREVENTING RELAPSEPREVENTING RELAPSE

Lee B. Reichman, MD, MPH

Northeast TB Controllers Meeting

October 24, 2006

Princeton, New Jersey

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Reported TB Cases United States, 1982–2005

Reported TB Cases United States, 1982–2005

10,000

15,000

20,000

25,000

Year

1982 1987 1991 1995 1999 2005

No

. of

Ca

ses

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Trends in Tuberculosis – United States, 2005

Trends in Tuberculosis – United States, 2005

• Deceleration of the decline in the overall national TB rate, the persistent disparities in TB rates between U.S.-born and foreign-born persons and between whites and racial/ethnic minorities, and the increase in MDR TB cases all threaten progress toward the goal of TB elimination in the United States

• Effective TB control and prevention in the United States require sufficient resources, continued collaborative measures with other countries to reduce TB globally, and interventions targeted to U.S. populations with the highest TB rates

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The U-Shaped Curve of ConcernThe U-Shaped Curve of Concern

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Tuberculosis: No Longer a Problem?

Tuberculosis: No Longer a Problem?

CDC TB Related News Items Weekly Update6 month sample: October 1, 2003 - March 31, 2004

• 117 articles from 33 states on all aspects of TB

• 76 reports of TB outbreaks: (almost 1 every 2-3 days)– Schools and colleges 38– Prisons 8– Hospital/Nursing Home 7– Workplace 16– Homeless 7

- J. Seggerson, NCET WIRE, April 2004

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Federal News RadioFederal News Radio

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CNNCNN

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NBC 4NBC 4

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ResultsResults

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TB OnboardTB Onboard

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XDRTBXDRTB

• 1539 Patients with Isolates sent

• 544 Culture-Positive for M.Tb– 35% of total

• 221 Resistant to Isoniazid & Rifampin (MDR TB)– 40% of M.Tb and 14% of total

• 53 Resistant to all tested drugs (XDR TB)– 24% of MDR TB, 10% MTB and 3% of total

-G. Friedland, Int Conf on AIDS, 2006

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XDRTB PatientsPrior TB Treatment or Hospitalization

XDRTB PatientsPrior TB Treatment or Hospitalization

Characteristics XDR TB Patients n (%)

Prior TB Treatment:

No prior TB treatment 26 (51%)

Cure or completed treatment 14 (28%)

Default or Treatment Failure 7 (14%)

Prior Hospitalization: 32 (64%)

-G. Friedland, Int Conf on AIDS, 2006

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XDRTB MortalityXDRTB Mortality

• 52 of 53 (98%) of XDR patients have died

• Median survival from date sputum collected was 16 days (IQR 2-210 days)

– No significant difference by HIV status, previous or use of ARVs

-G. Friedland, Int Conf on AIDS, 2006

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The New York TimesSeptember 14, 2006

The New York TimesSeptember 14, 2006

EDITORIAL: Extreme TuberculosisMore funding is needed to catch up with new, extensivelydrug-resistant strains of tuberculosis.

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Patient Involvement in Medical Care Patient Involvement in Medical Care

• Patients and their families have become increasingly involved—and influential—in all aspects of medical care

• In the mid-eighties, as the first anti-viral drugs for treating AIDS were being developed, activists demanded to participate in the design of clinical trials directed by the National Institutes of Health and pharmaceutical companies

• Inspired by the activists’ example, breast cancer patient-advocacy groups made similar requests

• The AIDS groups interrupted meetings and staged “die-ins” at the N.I.H.

• Eventually, the physicians in charge of planning the clinical trials agreed to their demands

• Laypeople now routinely sit on committees on the N.I.H. and on hospitals’ institutional review boards, which assess the ethicality and scientific merit of clinical trials

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The Patient’s Charter for Tuberculosis Care

The Patient’s Charter for Tuberculosis Care

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The Patient’s Charter for Tuberculosis Care

The Patient’s Charter for Tuberculosis Care

• Initiated and developed by patients from around the world

• Outlines rights and responsibilities of people with tuberculosis

• Sets out the ways in which patients, the community, health providers (both private and public), and governments can work as partners in a positive and open relationship

• Practices principle of Greater Involvement of People with Tuberculosis

• Affirms that empowerment is catalyst for effective collaboration with health providers and authorities

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Patient’s RightsPatient’s Rights

You have the right to:

Care;

Dignity;

Information;

Choice;

Confidence;

Justice;

Organization;

Security

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Patient’s ResponsibilitiesPatient’s Responsibilities

You have the responsibility to:

Share information;

Follow treatment;

Contribute to Community Health

Show Solidarity

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Deaths Due To:Deaths Due To:

TB (annually)

2 - 3,000,000

SARS

813

Angola Marburg Hemorrhagic Fever

329

Avian Influenza

144

Anthrax

5

Mad Cow Disease

1 (Cow)

Smallpox

0

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Reichman’s Prediction Reichman’s Prediction • The continued rise of the TB in the world and the leveling off of

tuberculosis in the US portends a significant global resurgence of TB followed by a frightening resurgence of MDRTB still diagnosed and treated with old tools

• The resurgence will continue unabated followed by subsequent transmission to healthcare workers and through that vector to the community at large

• Subsequent global re-establishment of control of tuberculosis will then entail more staggering costs, both in cash and hysteria than has ever been contemplated

• New drugs and New Diagnostics and an effective vaccine will enhance the TB community’s success in turning this around which once again will depend on energizing others to make our case

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