Tuberculosis Impact in Boston Residents: 2011 · 2013-12-05 · US Born Foreign Born. Building a...

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Tuberculosis Impact in Boston Residents: 2011

BOSTON PUBLIC HEALTH COMMISSIONInfectious Disease Bureau

Communicable Disease Control Division


BOSTON PUBLIC HEALTH COMMISSION ▪ COMMUNICABLE DISEASE CONTROL DIVISION

Number of TB Cases: Boston, 1990-2011

149141

128115 108

93 8779

8977 82 75

67 64 7057 61

4961 57 58

44

0

20

40

60

80

100

120

140

160

180

200

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Num

ber o

f cases



Incidence of TB: Boston, 2000-2011

13.912.7

11.4 10.911.9

9.7 10.48.3

10.4 9.7 9.8

7.1

02468101214161820

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rate per 100

,000



Incidence of TB by Gender: Boston, 2009-2011

0

2

4

6

8

10

12

2009 2010 2011

Rate per 100

,000

Male Female



Percent of Reported TB Cases by Age Group: Boston, 2009-2011

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

< 25 years 25‐44 years 45‐64 years > 64 years

Percen

t

2009 2010 2011



Incidence of TB by Age Group:Boston, 2009-2011

0

5

10

15

20

25

30

35

2009 2010 2011

Rate per 100

,000

< 20 years 20‐29 years 30‐39 years 40‐49 years 50‐59 years 60‐69 years >= 70 years



Percent of Reported Tuberculosis Cases by Race/Ethnicity: Boston, 2009-2011

0%5%10%15%20%25%30%35%40%45%50%

2009 2010 2011

Percen

t

White Black Hispanic Asian



Incidence of TB by Race/Ethnicity: Boston, 2009-2011

05101520253035404550

2009 2010 2011

Rate per 100

,000

White Black Hispanic Asian



Incidence of TB Among the Homeless:Boston, 2009-2011

0

10

20

30

40

50

60

70

80

90

100

2009 2010 2011

Rate per 100

,000



TB Incidence by Neighborhood*, 2011

0 5 10 15 20 25 30

Rate per 100,000

* Allston/Brighton, Back Bay/Beacon Hill/North End, East Boston, Fenway, Hyde Park, Jamaica Plain, Roslindale, Roxbury, South Boston & South End: < 5 cases; Charlestown, West Roxbury: 0 cases



TB Incidence by Neighborhood*, 2010

0 5 10 15 20 25 30

Allston/Brighton

Fenway

North Dorchester

Roslindale

South Dorchester

South End

Rate per 100,000

* Back Bay/Beacon Hill/ North End, Charlestown, East Boston, Hyde Park, Jamaica Plain, Mattapan, Roxbury, & South Boston: < 5 cases; West Roxbury: 0 cases



TB Cases by Birthplace: Boston, 2009-2011

0

20

40

60

80

100

2009 2010 2011

Percen

t

US Born Foreign Born



Length of US Residence for Foreign Born TB Cases Prior to TB Diagnosis: Boston, 2009-2011

0

20

40

60

80

100

2009 2010 2011

Percen

t

<1 year 1‐5 years 6‐10 years > 10 years



Region of Birth for TB Cases: Boston, 2011

0 10 20 30 40

Africa

Asia

Carribean

Central/South America

Europe

North America

Percent



Primary Site of TB Disease: Boston, 2011

70%

5%

7%

18%

Pulmonary

Lymphatic

Pleural

Other



Sputum Smear and Culture Results for Cases with Primary Pulmonary TB: Boston, 2009-2011

0

5

10

15

20

2009 2010* 2011**

Num

ber o

f cases

Smear+/Culture+ Smear+/Culture‐ Smear‐/Culture+ Smear‐/Culture‐

*Sputum samples unavailable for 2 cases**Sputum samples unavailable for 3 cases



Drug Resistance in TB Cases:Boston, 2011

Number

Two Drugs Isoniazid, Streptomycin 1

Rifampin, Streptomycin 1



Completeness of HIV Testing* of TB Cases: Boston, 2009-2011

0102030405060708090

100

2009 2010 2011

Percen

t

*Includes cases with negative, positive and indeterminate HIV test results



Percent TB Cases with HIV Infection:* Boston, 2009-2011

0

5

10

15

20

25

30

2009 2010 2011

Percen

t

*Of those tested



What health care sites are diagnosing and initiating TB treatment for Boston cases?

2010*N=57

2011**N=42

Diagnosing site Inpatient 37(64%) 29(66%)

Outpatient 21(36%) 15(34%)

Initial treatment site*

Inpatient 20(35%) 28(67%)

TB clinic 26(46%) 10(24%)

Hospital outpatient clinic

11(19%) 2(5%)

Other ‐ 2(5%)

*1 case died prior to identification of tuberculosis**2 case died prior to identification of tuberculosis



Who do Boston TB cases identify as their primary care site?

2010N=58

2011N=44

Hospital outpatient clinic 26 (45%) 17 (39%)

Community health center 16 (28%) 13 (30%)

Private practices 2 (3%) 1 (2%)

Other sites 4 (7%) 6 (14%)

None identified 10 (17%) 7 (16%)



Boston Residents with Latent TB Infection (N=1,373) Evaluated at the BPHC TB Clinic, Incidence by Gender: 2011

0 25 50 75 100 125 150 175 200 225 250 275

Male

Female

Rate per 100,000



Boston Residents with Latent TB Infection (N=1,373) Evaluated at the BPHC TB Clinic, Incidence by Age Group: 2011

0

50

100

150

200

250

300

350

Rate per 100

,000

<10 Years 10‐19 years 20‐29 years 30‐39 years

40‐49 years 50‐59 years 60‐69 years >= 70 years



Percent of Boston Residents with Latent TB Infection (N=1,373) Evaluated at the BPHC TB Clinic by Race/Ethnicity: 2011

28%

36%

19%

9%

3% 5%

AsianBlackHispanicOtherUnknownWhite



Boston Residents with Latent TB Infection (N=1,375) Evaluated at the BPHC TB Clinic, Incidence by Neighborhood: 2011

0

100

200

300

400

500

600

700

Rate per 100,000



Help To Eliminate TB in Boston

• Evaluate any patient who has a risk factor for TB.

• Ensure that patients with evidence of latent TB infection are completely evaluated AND appropriately treated.– TB is a preventable disease.

• Consider TB as a diagnosis in persons with appropriate symptoms and risk factors.



Help to Eliminate TB in Boston

• Healthcare institutions and healthcare providers in all settings should have a TB exposure control plan in place, including routine assessment of healthcare workers in accordance with Centers for Disease Control and Prevention (CDC) guidelines.



For More Information:

BOSTON PUBLIC HEALTH COMMISSIONCommunicable Disease Control Division

1010 Massachusetts AvenueBoston, MA 02118

Phone: 617‐534‐5611Fax: 617‐534‐5905

Website: www.bphc.org

Tuberculosis Impact in Boston Residents: 2011 · 2013-12-05 · US Born Foreign Born. Building a...

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