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Sarah Phillips MPH Candidate

Beijing Strain of Tuberculosis in the State of Florida from 2008 - 2011: an Analysis of Clinical Data. Sarah Phillips MPH Candidate. I have no conflicts of interest. Disclosures. Background | TB in the World. Background | TB in the World. 1/3 of the world has TB.

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Sarah Phillips MPH Candidate

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  1. Beijing Strain of Tuberculosis in the State of Florida from 2008 - 2011: an Analysis of Clinical Data Sarah Phillips MPH Candidate

  2. I have no conflicts of interest Disclosures

  3. Background | TB in the World

  4. Background | TB in the World 1/3 of the world has TB

  5. Background | TB in the World Nine million convert from latent infection to active disease annually

  6. Background | Trends in TB: Foreign vs US –born persons * Source: National TB Surveillance System * Per 100,000 population.

  7. M. tuberculosis evolutionary scenario (out of Mesopotamia) Background | Origin and Spread ofTB Wirth T, Hildebrand F, Allix-Béguec C, Wölbeling F, et al. (2008) Origin, Spread and Demography of the Mycobacterium tuberculosis Complex. PLoSPathog 4(9): e1000160. doi:10.1371/journal.ppat.1000160 http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1000160

  8. Time to the most recent common ancestor (TMRCA), time elapsed since the last expansion began (ta) and growth rate estimates based on the MSVAR software Background | Strains of TB Wirth T, Hildebrand F, Allix-Béguec C, Wölbeling F, et al. (2008) Origin, Spread and Demography of the Mycobacterium tuberculosis Complex. PLoSPathog 4(9): e1000160. doi:10.1371/journal.ppat.1000160 http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1000160

  9. Background | The Beijing Strain of TB

  10. Research | Rationale Current literature on the Beijing strain indicates variation among clinical features in different populations, sometimes finding no difference between strains1 and other times finding significant differences in incidence of fever, pulmonary cavitation, night sweats, and duration of cough2 1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374453/ 2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1552074/

  11. Research | Rationale Make informed recommendations regarding vulnerable populations The purpose of this study was to identify cases of TB in the state of Florida caused by the Beijing strain of Mycobacterium tuberculosis and determine key etiological properties in its clinical presentation at diagnosis

  12. Research | Question Objective To determine whether there is a delay in diagnosis of TB among cases of the Beijing strain as evidenced by indication of more advanced disease at diagnosis Exposure of Interest Beijing spoligotype Primary Outcome of Interest X-ray cavitation Hypothesis Positive X-ray cavitation at diagnosis of tuberculosis will be positively correlated with the Beijing spoligotype

  13. Data | Source & Methods Every case was de-identified and completely confidential TB Cases: Health Management System (HMS) & the Tuberculosis Information Management System (TIMS) Cases in Florida from 2008 to 2011 n=1540 Sputum and Culture Data: Florida Bureau of Laboratories Fully HIPAA compliant disease registries: Florida Department of Health Statistical Software: SAS 9.3

  14. Data | Source & Methods Data Analysis Frequency Statistics Univariate Analysis 95% Confidence Intervals and p-values (α=0.05) Multivariate Logistic Regression Odds Ratios, beta coefficients

  15. Data | Source & Methods Study approved by UF IRB and by the FDOH We conducted a retrospective cross-sectional study of culture-confirmed M. TB cases gathered by physician visits Our sample included de-identified demographic, epidemiological, and laboratory from 2008 to 2011 Strain information was determined by spoligotyping, which is both sensitive and specific for the Beijing family

  16. Dataset | Variables 1587 total observations (n = 1540)

  17. Demographics | Race (n = 1540)

  18. Demographics | Race (n = 1540) 1:32 1:14 1:11 1:4

  19. Demographics | Race (n = 1540)

  20. Demographics | Age (n = 1540)

  21. Demographics | Age (n = 1540) 1:12 1:18 1:14 1:10

  22. Demographics | Age (n = 1540)

  23. Demographics | Sex (n = 1540)

  24. Demographics | Sex (n = 1540) 1:13 1:15

  25. Results | Genotyping Lineage (n = 106) (n = 1434)

  26. Results| Variable ORs and 95% CIsin a Univariate Analysis

  27. Results | X-ray Cavitation OR = 0.70 95% Confidence Interval (0.42, 1.17) P-Value > 0.05 Note: 251 missing

  28. Results | Origin OR = 1.21 95% Confidence Interval (0.89, 1.65) P-Value > 0.05 Note: 89 missing

  29. Results | Age OR = 1.33 95% Confidence Interval (0.77, 2.29) P-Value > 0.05

  30. Results | Previous TB OR = 1.48 95% Confidence Interval (0.52, 4.24) P-Value > 0.05

  31. Results | Multidrug Resistance OR = 2.12 95% Confidence Interval (0.45, 10.05) P-Value > 0.05 Note: 29 missing

  32. Results | Race OR = 2.43 95% Confidence Interval (1.40, 4.24) P-Value < 0.002

  33. Results | Race OR = 0.34 95% Confidence Interval (0.19, 0.60) P-Value < 0.001 Note: missing

  34. Results| Variable ORs and 95% CIsin a Multivariate Analysis

  35. Results| Variable ORs and 95% CIsin a Multivariate Analysis

  36. Results | Geographical Clustering: Beijing vs Non-Beijing

  37. Results | Geographical Clustering: Beijing vs Non-Beijing

  38. Results | Geographical Clustering:Foreign vs US -Born

  39. Results | Geographical Clustering:Foreign vs US -Born

  40. Discussion • How this study compares with others of the Beijing strain • Strengths and limitations • Generalizability • Recommendations for future research

  41. Discussion • How this study compares with others of the Beijing strain • Strengths and limitations • Generalizability • Recommendations for future research

  42. Discussion • How this study compares with others of the Beijing strain • Strengths and limitations • Generalizability • Recommendations for future research

  43. Discussion • How this study compares with others of the Beijing strain • Strengths and limitations • Generalizability • Recommendations for future research

  44. Conclusion The purpose of this study was to identify cases of TB in the state of Florida caused by the Beijing strain of Mycobacterium tuberculosis and determine key etiological propertiesin its clinical presentation at diagnosis

  45. Conclusion The purpose of this study was to identify cases of TB in the state of Florida caused by the Beijing strain of Mycobacterium tuberculosis and determine key etiological propertiesin its clinical presentation at diagnosis In addition to naming the Asian race a significant risk factor, we identified the Black race as a significant protective factor against having the Beijing TB strain and discovered high rates of geographical clustering of Beijing cases

  46. Conclusion The purpose of this study was to identify cases of TB in the state of Florida caused by the Beijing strain of Mycobacterium tuberculosis and determine key etiological propertiesin its clinical presentation at diagnosis While we failed to reject our null hypothesis, we can now contribute to the limited but sorely needed data on clinical presentation of Beijing spoligotype TB cases

  47. Beijing in the World 18 Studies of Beijing Prevalence

  48. Beijing in the World 19 Studies of Beijing Prevalence

  49. My mentors: Dr. Lauzardo and Jennifer Hosford The entire SNTC Staff Acknowledgements My advisor: Dr. Cottler Our internship coordinator: Slande The UF College of Public Health and Health Professions

  50. Thank you for your time and attention Feel free to contact me with questions regarding my internship or special project! email: sarahphillips@ufl.edu

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