TB Infection Epidemiology in Washington State

TB Infection Epidemiology in Washington State


so I will skip their cutie slides
quickly here so I have some disclosures and my objectives have been posted in
queue different locations so we’ll start here so we’re to talk about TB infection
and epidemiology TB infection and Washington today and I guess I first
just want to thank everyone for all the work that you do because we’re able to
talk about TB infection because of the work we do around TB cases and really
initiating treatment early and doing thorough content investigation so if it
wasn’t for that we actually wouldn’t even eat here today and I think you
probably all very familiar with the infographic there on the left this is
our to the iceberg infographic as you know tip of the iceberg really is
our TB cases when we talk about TV infections everything ever needs the
water so really a massive amount we know that you know around a quarter of the
world’s population is infected in TV according to most recent models and that
comes down to around 13 million people in the United States and we now have new
numbers that show us for a 200,000 people in Washington are actually
infected with TB so where did that come from so last year an epidemiologist
Marion cidade from CDC published his paper and it’s the simple estimates for
local prevalence of Ltd eye infection in the United States for 2011 2015 and in
addition to publishing this paper she actually talked with all the different
states in the US and provided kind of some state specific numbers and actually
county level specific numbers so we have for everyone in Washington we have
county specific LTI numbers in both the US for and people for not us born and
also so if you’re if you’re participating not from Washington today
this is actually available in your state as well so she did this for Alaska Idaho
Oregon so work with your programs or if your will be welcome to work with me to
get this information or reach out to Mariam Haddad herself and I’m sure she’d
be happy to get you that information so I’m going to show you why can I talk
about her methods I’ll show you this because it’s a little prettier to look
at so this is actually again these are the cannula
estimates for the entire United States and what she did was she took genotyping
data and said that if you are somebody with a unique genotype
you probably got infected a long time ago maybe it’s a child before you came
to the United States and you when you develop TB disease that’s that’s why
you’re unique because you match people who were back in the Philippines or back
in Vietnam you don’t match to anyone here you didn’t get TV from someone in
the US if you were recent transmission so maybe you match several other people
they were actually thrown out of this and not really considered to be someone
who was in that LTI state for a long period of time so then with that Jun
typing information they also then applied what’s called the annual risk
for progression so this was something that’s established in other papers and
she used annual risk for progression to be 0.1% if you use slightly different
numbers so you get obviously pretty big ranges we’re looking at big numbers
across the u.s. and say applied that to get those unique cases those ones that
they thought actually been effective really a long time and they did a back
calculation we’re gonna kind of look at it a little bit here this is this comes
directly from what’s called the tuberculosis genotyping information
management system this is something that we have access to
I know King County does here in Washington and are interested by getting
direct access to this as well please let us know it’s something I know that Shawn
and Brian is interested in doing and what it can do is it can show you of
your cases that have ultra positive what those genotypes are and it actually has
this report in here that actually will give you an estimate of your recent
transmission and there’s a lot of little caveats because again this is a model
these are estimates there’s a lot of little limitations to these numbers but
again it’s kind of our best guess estimate so I’m gonna focus your
attention there on the bottom line which is the Washington so this is for 2016 to
2017 we had 319 cases that were ultra positive and genotyped
of those they actually calculated around 23 orally said
two points 7.2% were attributed to recent transmission meaning that around
93% of our genotype cases were thought to be basically from LT bi that lawns
and yields behind the community so when Miriam took her calculation she provided
us with three different maps and here’s the first one and this is looking at
both our us born and our non-us foreign individuals divided into four categories
so we can see again the darkest color is over 3% population with TB infection all
the way down to zero or less than one percent here and this is actually in
line with Ann Haynes estimate so our overall state L TDI prevalence rate was
2.9 percent and the natural estimate is 3.1 so we’re a little bit under what
that national estimate is and if you break it down try it by US foreign and
non-us born again it’s 0.7 percent for non-us born in Washington and eighteen
point seven percent of people born outside the United States are estimated
to have TB infection Washington so the next figure again you notice that the
bar on the bottom there actually changed so we’re looking at a smaller scale now
and this is just looking at people who are born United States and looking at
transmission again the the underlying numbers here come from our genotyping
data which shows us who has a unique genotype and then they did that that
calculation looking at just point one percent of the total population of that
County to determine what they thought the rates were so the median for
Washington was actually zero point six percent and it ranged from zero point
zero to two point six so a little bit smaller numbers for sure and this one I
think is maybe my favorite nunim was interesting and this is looking at those
who were born outside the United States only and so again our scale has changed
at the bottom so we have ranging from zero to over 15% the median was twelve
point two and you can see again who wear dark
counties are there I think I’ve reached out to a couple of you to talk about
kind of this and I we actually have specific numbers we have for us for
non-us born and confined for every single County so if you’re interested in
getting those numbers please reach out to me and I would love to get them for
you they also then of course apply that to your population you can actually
count so maybe if you’re trying to go to your board or something you can actually
tell them this is the estimate of else behind our community just I think pretty
exciting and you know we know that Washington is home to a very large of
its population and you look at immigration numbers for Washington our
top countries are Mexico, Philippines India, China, and Vietnam. Then if you
compare that to our actual cases so this is a from Sean MacBride RFP looking at
our cases 25 to 26 17 and you’ll see almost the exact same cases for a TB
disease so again we think about our population not or in the United States
these are really at the countries that we’re looking at. That doesn’t mean that
somebody who’s coming maybe from a new crane or something we don’t have to
worry about TV but when you’re think seeing these countries it’s important to
think TV okay I think um I just wanted to share with you a couple of tools
really quickly this tool here that’s on our website was adapted from the
California Department of Health that helps us look at who to test for lcbi in
our community it focuses again on birth or travel and rest of the country an
elevated TB rate for least one month immunosuppression both current and plans
and close contacts this was all based on on epidemiology so when we’re thinking
about TV again we are really using our technology to inform those decisions
again we’ve been talking mostly today about these people who are born outside
the United States and it’s kind of tiny aside there the other tool I wanted to
point you to in terms of trying to learn more about your community is really um I
picked so can here this is the American FactFinder you can go on you can google
American FactFinder you’ll see a little it’ll come up with a
search box and you can type in wherever you want there at Spokane County
or I mean obviously do it for an anchorage anywhere you want and then
I’ve said the left there I had the option to choose origin language and
then it came up with what might what they’re calling for more population is
and several different categories that you can choose from in that area there
and then it really so it’s going to give you a lot of information you know sex
age it’s going to give you you know employment status education status and
it goes on and on and it breaks it down by and see on the right side they’re
people who are born in the u.s. u.s. people were in the US and actually
breaks it up even further it’s they’re really kind of learn about your
community and I think this is a great resource for us all to kind of look to
when we’re trying to determine you know who do we need to be screening in our
community so again please reach out to me if you’re looking for specific
numbers for your county I’d be happy to send those to you I might actually be
around to send it to you even if you don’t ask me for them so you have that
information going forward you can use that kind of when you’re making
decisions about how to prioritize within your community

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