Mexican and Central American TB cases in California

Transcription

1 Mexican and Central American TB cases in California Neha Shah, MD MPH Division of Tuberculosis Elimination Centers for Disease Control and Prevention California Department of Health Tuberculosis Control Branch California TB Controllers Association Annual Meeting May 15, 2011 Los Angeles, CA

2 BACKGROUND

3 US TB cases among Mexican-born individuals Approximately 1 million persons cross the U.S.-Mexico border daily Among foreign-born TB cases in the US in 2011, 37% were from Mexico 1 Ways TB is transmitted across the border into the US Individuals with active TB migrate to the US Individuals with latent TB infection reactivate after arrival Most Mexican Born (MB) TB cases in US reported by the four border states: TX, NM, AZ and CA 2 1. Trends in Tuberculosis United States, 2011 Centers for Disease Control and Prevention, MMWR March 23, Tuberculosis along the US Mexico Border Work Group, Centers for Disease Control and Prevention, Preventing and controlling tuberculosis in the US Mexico border. MMWR Recomm Rep 50: 1 27

4 California MB TB Cases In 2011, 78% of California TB cases were foreign-born (n=1783) Mexican-born accounted for the largest proportion of foreign-born cases (28%, n=495) Philippines (21%, n=374) Vietnam (13%, n=239) China (7%, n=121) India (5%, n=89)

5 Unique Challenges with MB TB Cases Frequent border crossings complicate case management and continuity of care Potential differences in treatment regimens Movement within the US Difficulty in locating cases Potential for creating MDR and XDR TB due to treatment interruptions

6 CALIFORNIA TB CASES AMONG MEXICAN AND CENTRAL AMERICAN BORN INDIVIDUALS

7 TB Cases in California reported California TB cases 165 missing data on FB status (77%) TB cases among foreign born individuals 8092 (37%) MB/CAB TB cases (63%) all other FB TB cases

8 60 Reported TB Cases in California by Country of Birth, CA/MB Other FB US Born Percent Year Counted

9 Demographic characteristics of CAB/MB and all other FB TB cases in California, MB/CAB All other FB n % n % RR (95% CI) Sex (Male) n = 8090 n = (1.16, 1.21) Age n = 8090 n = (1.88, 2.67) (1.39, 1.47) (0.82, 0.90) (0.52, 0.58) Median Age T test <.0001 Time in US n = 7787 n = Less than 6 months (0.67, 0.77) 6mos 1 year (1.13, 1.28) 1 5 years (1.14, 1.29) 5+ years (0.98, 1.02)* Median Time in US T test <.0001 Migrant worker n = 7084 n = (21.44, 47.11) * RR not significant at 95%

10 TB risk factors of CAB/MB and all other FB TB cases in California, MB/CAB All other FB RR (95% CI) n % n % Homeless n= 8005 n = (4.39, 6.15) Corrections n= 8074 n = (6.78, 10.92) Long term care facility n= 8077 n = (0.47, 0.78) Any substance abuse n= 7848 n = (4.07, 4.92)

11 TB Clinical Characteristics of CAB/MB and all other FB TB cases in California, MB/CAB All other FB n % n % RR (95% CI) Previous TB Diagnosis n= 8014 n = (0.48, 0.61) HIV/AIDS match n= 8089 n = (4.50, 6.05) Site of Disease n= 8086 n = Pulmonary (0.95, 0.99) Extrapulmonary (0.91, 1.02)* Both (1.32, 1.59) Sputum Smear Positive n= 6118 n = (1.26, 1.34) Cavity n= 5638 n = (1.30, 1.46) * RR not significant at 95%

12 TB Outcomes of CAB/MB and all other FB TB cases in California, ₁ MB/CAB All other FB RR (95% CI) n % n % Start 4 drug Tx n = 7349 n = (0.97, 0.99) Outcome n = 7236 n = Completed (ever) (0.95, 0.98) <366 days (0.95, 0.98) Moved (1.30, 1.70) Lost (2.40, 3.68) Uncooperative/ Refused (0.42, 1.02)* Died (0.79, 0.99) ₁ Most recent complete follow-up 2 data * RR not significant at 95%

13 RESULTS NEW 2010 RVCT VARIABLES

14 MB/CAB compared to all other FB using New 2010 Variables Reason for evaluation Immigration medical exam (MB/CAB: 1.1%, FB: 6.0%, p<.0001) Targeted testing (MB/CAB: 3.0%, FB: 0.6%, p<.0001) Immigration Status at First Entry Other: (MB/CAB: 32.3%, FB: 7.8%, p<.0001) Unknown: (MB/CAB: 38.98%, FB: 22.3%, p<.0001) Immigrant visa (MB/CAB: 22.5%, FB: 50.38%, p<.0001) Diabetes (MB/CAB: 24.4%, FB: 22.5%, p<.3582)

15 2010 US Born Pediatric Cases Cohort: US born cases aged < 15 whose guardians are foreign-born (N = 65) MB/CAB: 47 (72%) Other FB: 18 (28%) Extrapulmonary disease: MB/CAB: 18 (38%) Other FB: 2 (11%) PZA mono-resistance MB/CAB: 12 (80% of 15 culture positive cases with susceptibility) Other FB: 0 (of 6 culture positive cases with susceptibility) Outcomes 1 child of MB/CAB guardians was dead at diagnosis 1 child of MB/CAB guardians was lost prior to completion All other cases completed treatment or are still on treatment

16 CONCLUSIONS

17 Conclusion Mexican/Central American-born TB cases have higher likelihood of: Being younger and migrant workers Higher proportion of pediatric cases among MB/CAB than other FB Having risk factors of homeless, corrections, substance abuse or living with HIV Having smear positivity or cavitary disease by the time they are diagnosed Moving or being lost prior to completion of therapy

18 Discussion MB/CAB TB cases may disproportionately influence funding formula in future Completion of therapy Higher proportion lost or moved Less likely to complete within 12 months Case management Sputum conversion Need strong, stable binational programs Increased collaboration with our Mexico partners with protocol development on how to share data across the border

19 Acknowledgements Katherine Robsky Janice Westenhouse Saul Kanowitz Tambi Shaw Martin Clinis Pennan Barry Jenny Flood Phil Lowenthal Melissa Ehman Kathy Moser

20 THANK YOU QUESTIONS? The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.