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The Epidemiology of Tuberculosis in Minnesota, 2008-2012

The Epidemiology of Tuberculosis in Minnesota, 2008-2012. Minnesota Department of Health Tuberculosis Prevention and Control Program (651) 201-5414 Tuberculosis surveillance data for Minnesota are available on the Web at: www.health.state.mn.us/tb.

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The Epidemiology of Tuberculosis in Minnesota, 2008-2012

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  1. The Epidemiology of Tuberculosis in Minnesota, 2008-2012 Minnesota Department of Health Tuberculosis Prevention and Control Program (651) 201-5414 Tuberculosis surveillance data for Minnesota are available on the Web at: www.health.state.mn.us/tb

  2. Tuberculosis Morbidity, Minnesota, 2008-2012 Year No. Cases Rate* • 2008 211 4.0 • 2009 161 3.1 • 135 2.5 • 137 2.6 • 2012 162 3.0 * Cases per 100,000 population. Rates were calculated using state population estimates from the U.S. Census Bureau.

  3. Tuberculosis Incidence Rates per 100,000 Population, United States and Minnesota, 1998-2012

  4. Percentage of Foreign-Born Tuberculosis Cases, United States and Minnesota, 2003-2012 Percentage of Cases Year of Diagnosis

  5. Number of Tuberculosis Cases by Placeof Birth, Minnesota, 2003-2012

  6. Tuberculosis Morbidity and Mortality, Minnesota, 2008-2012 Year No. Cases No. Deaths* (%) • 2008 211 3 (1%) • 2009 161 1 (1%) • 135 3 (2%) • 137 9 (7%) • 162 4 (2%) *Represents only deaths due to TB disease or TB drug-induced toxicity

  7. Number of Cases and Incidence of Tuberculosis by Location of Residence, Minnesota, 2008-2012 2010 No. (rate)* 2012 No. (rate)* 2009 No. (rate)* 2011 No. (rate)* 2008 No. (rate)* Location of Residence 67 (5.8) 34 (6.7) 16 (1.3) 6 (4.2) 12 (0.5) 135 (2.5) 71 (6.1) 39 (7.6) 27 (2.2) 3 (2.1) 22 (1.0) 162 (3.0) 59 (5.0) 31 (6.0) 12 (0.7) 9 (6.2) 26 (1.1) 137 (2.6) Hennepin County Ramsey County Suburban Twin Cities Metro† Olmsted County Other Counties Total 61 (5.3) 41 (8.1) 26 (2.2) 8 (5.6) 25 (1.1) 161 (3.1) 97 (8.5) 44 (8.8) 23 (2.0) 4 (2.8) 43 (1.9) 211 (4.0) * Rate per 100,000 population. Rates were calculated using population estimates from U.S. Census Bureau data. † Anoka, Carver, Dakota, Scott, and Washington counties

  8. Tuberculosis Disease: Minnesota, 2012 Hennepin: 71 Ramsey: 39 Suburban metro: 27 Greater MN: 25 Total: 162

  9. Tuberculosis Disease: Minnesota, 2008-2012 Hennepin: 355 Ramsey: 189 Suburban metro: 104 Greater MN: 158 Total: 806

  10. Number of Cases of Tuberculosis by Location of Residence, Minnesota, 2008-2012 2012 No. (%) 2009 No. ( %) 2010 No. (%) 2011 No. (%) 2008 No. ( %) Location of Residence Hennepin County Ramsey County Suburban Twin Cities Metro* Olmsted County Other Counties Total 71 (44) 39 (24) 27 (17) 3 ( 2) 22 (13) 162 (100) 97 (46) 44 (21) 23 (11) 4 ( 2) 43 (20) 211 (100) 61 (38) 41 (25) 26 (16) 8 ( 5) 25 (16) 161 (100) 67 (50) 34 (25) 16 (12) 6 ( 4) 12 ( 9) 135 (100) 59 (43) 31 (22) 12 ( 9) 9 ( 7) 26 (19) 137 (100) * Anoka, Carver, Dakota, Scott, and Washington counties

  11. Tuberculosis Cases by Age Group and Place of Birth, Minnesota, 2008-2012 Percentage of Cases Place of Birth

  12. Number of Cases and Incidence of Tuberculosis by Race/Ethnicity, Minnesota, 2008-2012 2012 No. (rate)† 2009 No. (rate)† 2008 No. (rate)† 2010 No. (rate)† 2011 No. (rate)† Race/Ethnicity* 16 ( 0.4) 112 (47.9) 48 (25.2) 4 ( 6.9) 0 ( 0.0) 31 (14.2) 211 (4.0) White Black Asian American Indian Multi-racial Hispanic/Latino Total 19 ( 0.4) 80 (32.3) 43 (21.5) 2 ( 2.9) 0 ( 0.0) 17 ( 7.5) 161 (3.1) 11 ( 0.2) 66 (26.7) 41 (20.5) 4 ( 5.8) 0 ( 0.0) 13 ( 5.7) 135 (2.5) 13 ( 0.3) 66 (23.0) 40 (18.0) 3 ( 4.4) 0 ( 0.0) 15 ( 5.8) 137 (2.6) 12 ( 0.3) 90 (29.4) 42 (17.8) 2 ( 3.1) 0 ( 0.0) 16 ( 6.2) 162 (3.0) * Race categories do not include persons of Hispanic/Latino origin. † Rate per 100,000 population. Rates were calculated using mid-year population estimates from the U.S. Census Bureau.

  13. Tuberculosis Cases by Race/Ethnicity and Place of Birth, Minnesota, 2008-2012 U.S.-Born Cases† Foreign-Born Cases No. (%) No. (%) Race/Ethnicity* White Black Asian American Indian Multi-racial Hispanic/Latino Total 16 ( 2) 358 (55) 200 (31) 0 ( 0) 0 ( 0) 72 (11) 646 (100) 55 (34) 56 (35) 14 ( 9) 15 ( 9) 0 ( 0) 20 (13) 160 (100) *Race categories do not include persons of Hispanic/Latino origin. †Includes U.S.-born children of foreign-born parents

  14. Cases of Tuberculosis by Risk Category,Minnesota, 2008-2012 2009 (N=161) No. (%) 2008 (N=211) No. (%) Cumulative (N=806) No. (%) 2010 (N=135) No. (%) 2011 (N=137) No. (%) 2012 (N=162) No. (%) Risk Category* 116 (85) 7 ( 5) 2 ( 1) 3 ( 2) 27 (20) 2 ( 1) 2 ( 1) 136 (84) 7 ( 4) 2 ( 1) 6 ( 4) 20 (12) 0 ( 0) 1 ( 1) Foreign-born Substance abuse† Homeless HIV-infected Other medical condition** Inmate Long-term care resident 110 (81) 7 ( 5) 3 ( 2) 6 ( 4) 23 (17) 4 ( 3) 3 ( 2) 646 (80) 52 ( 6) 22 ( 3) 33 ( 4) 116 (14) 14 ( 2) 10 ( 1) 155 (73) 21 (10) 11 ( 5) 11 ( 5) 23 (11) 5 ( 2) 3 ( 1) 129 (80) 10 ( 6) 4 ( 2) 7 ( 4) 23 (14) 3 ( 2) 1 ( 1) * Risk categories are not mutually exclusive † Alcohol abuse and/or illicit drug use ** Silicosis, diabetes, prolonged corticosteroid therapy or other immunosuppressive therapy, hematologic/ reticuloendothelial disease, end-stage renal disease, substantial weight loss (not TB-related) or undernutrition

  15. Tuberculosis Cases by Risk Category*, Minnesota, 2008-2012 * Risk categories are not mutually exclusive. † Alcohol abuse and/or illicit drug use ** Conditions or therapies that increase risk for progression from latent TB infection to active TB disease

  16. Tuberculosis Cases With Other Medical Conditions, by Type of Condition, Minnesota, 2008-2012 Cases (N=806) No. ( %) Medical conditions* 65 ( 8) 41 ( 5) 13 ( 2) 2 (<1) 6 ( 1) 1 (<1) Diabetes Other Immunosuppressive Therapy End Stage Renal Disease Prolonged Corticosteroid Therapy Weight loss/Undernutrition Hematologic/Reticuloendothelial Disease *Patients could have > 1 medical condition.

  17. Tuberculosis Cases by HIV Status andPlace of Birth, Minnesota, 2008-2012 Foreign-Born Cases U.S.-Born Cases Total No. (%) No. (%) No. (%) HIV Status Negative Positive Refused Not Offered Unknown Total 573 (89) 28 ( 4) 11 ( 2) 34 ( 5) 0 ( 0) 646 (100) 129 (81) 5 ( 3) 3 ( 2) 22 (14) 1 (<1) 160 (100) 702 (87) 33 ( 4) 14 ( 2) 56 ( 7) 1 (<1) 806 (100)

  18. Tuberculosis Cases by Student Status at Time of Diagnosis, Minnesota, 2008-2012 School No. (%) Preschool 1 (<1) Elementary 40 ( 5) Secondary 51 ( 6) Post-secondary 48 ( 6) Other 49 ( 6) Not a student 617 (77) Total 806 (100)

  19. Foreign-Born Tuberculosis Cases by Region of Birth and Year of Diagnosis, Minnesota, 2008-2012 Number of Cases Region of Birth * “Other” includes: Eastern Europe, Latin America/Caribbean, Western Europe

  20. Foreign-Born Tuberculosis Cases by Country of Birth, Minnesota, 2008-2012 N = 646

  21. Foreign-Born Tuberculosis Cases byVisa Status Upon Arrival in the U.S., Minnesota, 2008-2012 N = 646

  22. “TB Class” Notifications* Among Foreign-Born Tuberculosis Cases Who Arrived in the U.S. as Immigrants/Refugees Within 1 Year Prior to Diagnosis, Minnesota, 2008-2012 N = 81 * Per results of pre-immigration screening performed overseas

  23. Foreign-Born Tuberculosis Cases by IntervalBetween Arrival in U.S. and Diagnosis ofTuberculosis, Minnesota, 2008-2012 N = 646

  24. Foreign-Born Tuberculosis Cases by IntervalBetween Arrival in U.S. and Diagnosis ofTuberculosis by Year, Minnesota, 2008-2012 % of foreign-born cases

  25. Tuberculosis Cases by Site of Disease*, Minnesota, 2008-2012 N = 806

  26. Tuberculosis Cases by Site of Disease and Place of Birth, Minnesota, 2008-2012 * Includes cases with both extrapulmonary and pulmonary sites of disease

  27. Extrapulmonary* Tuberculosis Cases by Site of Disease, Minnesota, 2008-2012 Cases (N=491) No. ( %) Sites of Disease Lymphatic Bone/joint Pleural Peritoneal Genitourinary Meningeal Other 243 (49) 45 ( 9) 41 ( 8) 27 ( 5) 19 ( 4) 16 ( 3) 58 (12) * Includes TB cases with or without concurrent pulmonary disease; patients may have multiple extrapulmonary sites of disease

  28. Tuberculosis Cases by Gender andPlace of Birth, Minnesota, 2008-2012

  29. Tuberculosis Cases with Pulmonary Involvement by Chest Imaging* Result, Minnesota, 2008-2012 N = 491 * Chest x-ray or chest CT scan results

  30. Tuberculosis Cases with Pulmonary Involvement by Sputum AFB Smear Result,Minnesota, 2008-2012 N = 491 *67% of cases without sputum smear results were under 15 years of age

  31. Tuberculosis Cases by Mycobacterial Culture Result, Minnesota, 2008-2012 N = 806

  32. Tuberculosis Cases by Case Verification Criteria*, Minnesota, 2009-2012 N = 595 *Based on the public health surveillance definition for TB [CDC. (2009, June) CDC Tuberculosis Surveillance Data Training: Report of Verified Case of Tuberculosis (RVCT) Instruction Manual. Atlanta, GA: U.S. Department of Health and Human Services, CDC. (Appendix A - Tuberculosis Case Definition for Public Health Surveillance)]

  33. Tuberculosis Cases by Drug Susceptibility Patterns and Year, Minnesota, 2008-2012 Cases With Susceptibility Results* Any Drug Resistance† No. (%) INH- Resistant** No. (%) MDR-TB‡ No. (%) Year • (11) 12 (10) 5 ( 5) 12 (12) 12 (10) 58 (10) 2008 2009 2010 2011 2012 Total 149 120 109 101 124 603 • (15) • 20 (17) • 13 (12) • 22 (22) • 24 (19) • 102 (17) 2 (1) 2 (2) 0 (0) 3 (3) 1 (1) 8 (1) § * Culture-confirmed cases with drug susceptibility results available † Resistance to at least one first-line anti-TB drug [i.e., isoniazid (INH), rifampin, pyrazinamide (PZA), or ethambutol] ** INH-resistant cases may also be resistant to other drugs ‡ Multi-drug resistant TB, defined as resistance to at least INH and rifampin § One of these cases was resistant to INH, rifampin, PZA, and ethambutol

  34. Tuberculosis Cases by Drug Susceptibility Patterns and Place of Birth, Minnesota, 2008-2012 Cases With Any Drug INH- ** ‡ MDR-TB Resistant Susceptibility Resistance† Place of Birth Results* No. (%) No. (%) No. (%) 94 (19) 54 (11) 7 ( 1) Foreign-Born Cases 495 U.S.-Born Cases 9 ( 8) 5 ( 5) 1 ( 1) 108 ( 1) § Total 603 103 (17) 59 (10) 8 * Culture-confirmed cases with drug susceptibility results available † Resistance to at least one first-line anti-TB drug [i.e., isoniazid (INH), rifampin, pyrazinamide (PZA), or ethambutol] ** INH-resistant cases may also be resistant to other drugs. ‡ Multi-drug resistant TB, defined as resistance to at least INH and rifampin § One of these cases was resistant to INH, rifampin, PZA, and ethambutol.

  35. Isoniazid Resistance Among Tuberculosis Cases by Place of Birth, Minnesota, 2003-2012 Percentage* * Percentage among culture-confirmed cases with isoniazid susceptibility results available by place of birth

  36. Tuberculosis Cases by Method of Case Identification, Minnesota, 2008-2012 2010 No. (%) 2012 No. ( %) 2009 No. ( %) 2008 No. ( %) 2011 No. (%) How Identified Presented with symptoms TB contact investigation Refugee health exam (domestic) Pre-immigration exam (overseas) Other* Total 128 (79) 10 ( 6) 10 ( 6) 3 ( 2) 11 ( 7) 163 (77) 27 (13) 6 ( 3) 5 ( 2) 9 ( 5) 211 (100) 131 (81) 10 ( 6) 1 ( 1) 3 ( 2) 17 (11) 161 (100) 113 (84) 1 ( 1) 1 ( 1) 1 ( 1) 19 (14) 135 (100) 109 (80) 6 ( 4) 2 ( 1) 2 ( 1) 18 (13) 137 (100) 162 (100) * e.g., occupational screening, other targeted TB testing, etc.

  37. Tuberculosis Cases by Method of Case Identification, Minnesota, 2009-2012 N = 595 * “Other” includes: pre-immigration exam (overseas) – 1.5%, other immigration exam – 1%, and employment screening – 1%

  38. Tuberculosis Cases by Mode of Treatment Administration*, Minnesota, 2008-2012

  39. Tuberculosis Cases by Mode of Treatment Administration* and Type of Health CareProvider, Minnesota, 2008-2012 N=796 Type of provider * DOT = Directly Observed Therapy SA = Self-administered

  40. Completion and Length of Therapy Among Tuberculosis Cases, Minnesota, 2011 Completed Within 12 mos.** Completed Overall** Started Treatment* No. (%) No. (%) 113 106 (94) 108 (96) * Patients for whom < 12 months of therapy is indicated . This excludes: patients with rifampin resistance or meningeal TB, children 14 years of age or younger with disseminated TB, patients who died, and those who moved outside of the U.S. during treatment. ** Treatment completion data as of 7/28/2013

  41. Tuberculosis Cases by Type(s) of Provider*, Minnesota, 2009-2012 N=796 * Some patients are managed by multiple providers throughout disease course

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