TB Along the US/Mexico Border El Paso, Texas August 22-23, 27 Border Tuberculosis Trends: Implications for Border Tuberculosis Control Miguel A. Escobedo, MD, MPH August 22, 27 1 Border Tuberculosis Trends Implications for Border Tuberculosis Control Miguel A. Escobedo, MD, MPH El Paso CDC Quarantine Station 1
Border Crossings Approximately 7, Mexican Citizens cross legally into the United States every day to shop, work, visit relatives, returning at night to their homes in Mexico. Approximately 12.5 million north n bound d legal border crossings every year in El Paso Sector alone. illegal immigrant populationp pulation estimated d at between 7 million and 9 million people about 6 percent of them from Mexico. 2
35 3 25 Estimated Mortality: England and Wales Tubercle bacillus identified 2 15 1 5 Tuberculin test Chemotherapy BCG vaccination 186 187 188 189 19 191 192 193 194 195 Journal of Infectious Diseases History of Tuberculosis in El Paso Called consumption,, closely allied with the history of physicians and hospitals in El Paso In 1881, after completion of Southern Pacific railroad, approximately 25, consumptives came to El Paso seeking a cure for TB El Paso ideal for treatment of TB and other pulmonary diseases High altitude Abundant sunshine Climate 3
Southwestern General Hospital circa 197 Photo courtesy Dr. Laurance N. Nickey TB Rates in US and MéxicoM 199-25 25 2 15 1 5 199 1991 1992 1993 1994 1995 1996 México 1997 1998 Source: Dirección General de Epidemiología / CDC 1999 Estados Unidos 2 21 22 23 24 25 4
44.3 National Rates 13.7 TB rates in MéxicoM xico 1995-25 25 31.3 18.5 14.3 25 13.7 24 2.3 14.4 23 15.1 22 33.1 16.1 21 15.8 2 17.2 1999 14.3 18.7 1998 2.7 1997 18.2 1996 18.7 1995 *Per 1, poppulation Source Sistema Único de Información para la Vigilancia Epidemiológica Dirección General de Epidemiología/SSA Rates in Northern States 26.3 25 24.6 24 26.3 23 28.2 22 3.3 21 27.7 2 25.5 1999 28. 1998 24.1 1997 27.1 1996 32.6 1995 Pulmonary Tuberculosis rates Border States, 25 National 8. average 4.7 2. 44.3 US 4.8 6.7 31.3 13.7 MX 14.3 18.5 2.3 33.1 Rates: Cases per 1, Source: CDC and Sistema Único de Información para la Vigilancia Epidemiológica (SUIVE) 5
Number T B Cases El Paso # TB C ases 1 9 8 7 6 5 4 3 68 65 71 7 56 49 Yr 21 Yr 22 Yr 23 Yr 24 Yr 25 Yr 26 Year Number TB cases year to date 27: 43 Source El Paso CCHED TB Control ece t 1% 8% 6% 4% 2% % ET Fr Brn OH HIV+ Con/Cov Risk Factor TB Cases El Paso 21-26 Source El Paso CCHED TB Control Risk Factor Diabetes Silicosis Steroid Renal Gast Res Jail IVDA Cancer INS W<1% N SyHm Cal 1 Cal 2 Cal 3 Cal 4 Cal 5 Cal 26 6
Number of TB Cases in U.S.-born vs. Foreign-born Persons United States, 1993 23 2 15 1 5 1993 1995 1997 1999 21 23 Source: CDC U.S. -born Foreign-born Trends in TB Cases in Foreign-born Persons, United States, 1986 24 1, 8, 6, 4, 2, 86 87 88 89 9 91 92 93 94 95 96 97 98 99 1 2 3 4 6 5 4 3 2 1 Source: CDC No. of Cases Percentage of Total Cases 7
Countries of Birth for Foreign-born Persons Reported with TB United States, 24 Other Countries (38%) Mexico (25%) Philippines (11%) Source: CDC S. Korea (3%) Haiti China (3%) (5%) India (7%) Viet Nam (8%) Primary MDR TB in U.S.-born vs. Foreign-born Persons, United States, 1993 24 3 2 1 1993 1995 1997 1999 21 23 Source: CDC U.S.-born Foreign-born 8
US/MX Border Binational Case Definition meets the t e U.S. or Mexican n case c definitio tion for active TB disease Optimal case manam nagement requires communication or collaboration with TB control programs or health-care providers on the opposite side of the border. The case-patient is a contact of a binational TB case or is the e TB source casec for contacts on the opposite side of the U.S.-Mexi Mexico border. Binational Active TB Case Reporting Source Until recently, Local and State TB programs were the only case reporting sources. Binational TB Treatment and Case Referral Projects are now important sources CBP at land Ports of Entry are becoming important sources ICE Immigrant Health Services detention centers are intere teresting sources Reported cases represent the tip of the ice berg 9
Binational TB case implications A missed binatinal TB case becomes a foreign born case A missed foreign born case creates future foreign born and native born cases Public Health partners can make a difference by preventing Binational TB cases from becoming foreign born and native born US cases Thank you very much Y muchas Gracias Preguntas/Questions? 1