Current Issues:
MDH TB Program
MDH TB Advisory Committee
March 24, 2011
Deb Sodt
What we are doing well





Sputum cultures for respiratory TB
cases
Starting therapy w/in 7 days
(sputum smear+)
Using 4-drug therapy
Using Directly Observed Therapy
Drug susceptibility testing
What we are doing well, cont’d





Negative sputum cultures w/in 60
days for people with pulmonary TB
HIV testing
Genotyping
Contact Investigations
Reporting TB data
What we need to improve

Finish TB treatment within 1 year
(goal 90%)
• 2008: 89%
• 2009: 87%


Evaluating immigrants and refugees
with TB Class B conditions within 30
days
Treating Class B immigrants and
refugees for LTBI
US Tuberculosis Case Reports
and Federal Funding 1967 - 1999
Institute of Medicine
Tuberculosis Cases by Method of Case
Identification, Minnesota, 2006-2010
How Identified
Presented with symptoms
2006
No. (%)
2007
No. ( %)
2009
2008
No. ( %) No. ( %)
2010
No. (%)
170 (78) 193 (81) 163 (77) 131 (81) 113 (84)
TB contact investigation
10 ( 5)
15 ( 6)
27 (13)
10 ( 6)
1 ( 1)
Refugee health exam (domestic)
17 ( 8)
13 ( 5)
6 ( 3)
1 ( 1)
1 ( 1)
Pre-immigration exam (overseas)
5 ( 2)
7 ( 3)
4 ( 2)
3 ( 2)
1 ( 1)
15 ( 7)
10 ( 4)
11 ( 5)
16 (10)
19 (14)
Other*
Total
217 (100)
238 (100) 211 (100) 161 (100) 135 (100)
* e.g., occupational screening, other targeted tuberculin skin testing, etc.
Completeness of Medical Evaluation of TB Class B1 Arrivals to
MN by Visa Status Upon Arrival, 2007–June 2010
Indicator
2007
2008
2009
Jan. – June
2010
Ratio of Class B1
refugee/immigrant arrivals
2.5:1
0.9:1
0.6:1
0.7:1
96%
(261/271)
95%
(89/94)
97%
(71/73)
100%
(54/54)
75%
(82/109)
74%
(84/114)
63%
(73/116)
69%
(52/75)
90%
(343/380)
83%
(173/208)
76%
(144/189)
82%
(106/129)
TB Class B1 refugee
arrivals evaluated
TB Class B1 immigrant
arrivals evaluated
Total Class B arrivals
evaluated
Future TB Cases?
Active TB disease
Latent TB infection
Current Issues


TB blood tests (IGRAs)
TB in correctional facilities
• Additional cases connected to the 2008
outbreak at Ramsey County Correctional
Facility
• Webinars for correctional facility staff



Electronic disease surveillance system
(Is MDH legally liable for supplying INH
without requiring written proof from
providers or public health nurses that
patient is monitored monthly?)
What will be the effects of cuts in health
and social services?
Future questions

Are TB cases becoming more complex?

How can we find active TB cases earlier?

What are the most effective ways to get
more people tested and treated for LTBI
when we have few resources?
Evaluation Project for 2011
Barriers to medical evaluation
of immigrants with TB Class
B1 conditions.
Completeness of Medical Evaluation of TB Class B1 Arrivals to
MN by Visa Status Upon Arrival, 2007–June 2010
Indicator
2007
2008
2009
Jan. – June
2010
Ratio of Class B1
refugee/immigrant arrivals
2.5:1
0.9:1
0.6:1
0.7:1
96%
(261/271)
95%
(89/94)
97%
(71/73)
100%
(54/54)
75%
(82/109)
74%
(84/114)
63%
(73/116)
69%
(52/75)
90%
(343/380)
83%
(173/208)
76%
(144/189)
82%
(106/129)
TB Class B1 refugee
arrivals evaluated
TB Class B1 immigrant
arrivals evaluated
Total Class B arrivals
evaluated
Only 68% of immigrants
with a “TB Class
Condition” identified
overseas receive a medical
evaluation after coming to
Minnesota.
Why?
Now that TB is
decreasing, how can
we help providers,
the community and
policy makers in
Minnesota
“Think TB”?
Suggestions for
ways MDH staff can
be more visible?
Emerging issues?
THANK YOU!