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Colorado Department of Public Health and Environment
Tuberculosis Prevention and Control Program
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History of TB
On March 24th, 1882, Dr. Robert Koch announced the discovery of
Myco-bacterium tuberculosis
This discovery was the most important step taken toward the elimination of TB.
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World TB Day
March 24th
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The 22 Countries listed account for
80% of the TB Cases in the World
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Global TB
One-third of the world's population, is currently infected with TB
over 90% in developing countries
More than 8.4 million people become sick with active TB each year About 2 million people die each year from TBTB is the leading infectious killer among people living with HIV/AIDS
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Figure 1. TB in Colorado: 1999-2008Cases of Active TB by Year of Report
88
104
97
111
101
138
127
111
103
124
50
70
90
110
130
150
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
# o
f c
as
es
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TB in Colorado: 2001-2008TB Incidence Rates by Nativity
0.0
5.0
10.0
15.0
20.0
25.0
2001 2002 2003 2004 2005 2006 2007 2008
Ca
se
s p
er
10
0,0
00
po
pu
lati
on
Foreign-born case rate U.S.-born case rate
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Patient country of origin
Country # of cases Country # of casesAfghanistan 1 Laos 1Bhutan 2 Liberia 1Burma 2 Madagascar 1Cambodia 1 Mexico 22China 2 Mongolia 1Cuba 1 Morocco 1El Salvador 2 Nepal 3Eritrea 1 Peru 2Ethiopia 4 Phillipines 3Honduras 1 Rwanda 1Hungary 1 Somalia 5India 5 U.S. 30Kenya 1 Vietnam 7
Korea 1 Total 103
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TB in Colorado: 2008Cases by Race/Ethnicity (n=103)
White15%
Black19%
Multiple0%
Hispanic34%
Amer Ind/AK native
3%
Asian29%
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TB in Colorado: 2008Case rates (per 100,000) by race/ethnicity
Race/ethnicity # cases Pop est. Rate
White 15 3,506,772 0.4
Black 20 187,959 10.6
Hispanic 35 997,062 3.5
Asian/Pacific Islander 30 125,778 23.8
Amer Ind/AK native 3 36,957 8.1
Multiple race 0 79,888 0.0
TOTAL 103 4,934,416 2.0
2007
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CDPHE TB Program receives funds from
Centers for Disease Control and PreventionState General FundsPublic Health and Human Services Block Grant
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CDC funding formula
Incident cases – 30%U.S.-born minorities and foreign-born persons – 35%Persons co-infected with HIV – 5%Persons with MDR TB – 5%Substance abusers – 5%Homeless – 5%Persons with smear or culture positive pulmonary TB – 15%
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The Role of Public Health in TB Prevention and Control
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Role of public health
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Public health structureCounties receive funding from CDPHE to provide TB services
Active TB diseaseEvaluation of Class B TB Immigrants and Refugees Contact investigationsTreatment for latent TB infection (in partnership with private providers)
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Local health agencies
Denver Public Health has a TB clinic that serves 7 metro counties
70-80% of cases
Outlying counties work directly with the private providers to assure appropriate diagnosis, treatment, monitoring, and follow-up of active and latent TBProvide DOTPerform contact investigations
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CDPHE TB Program
Provide consultation and technical assistance
active diseaselatent diseasecontact investigationsoutbreaks
Conducts case management oversight of active TB cases in outlying counties
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CDPHE Funding Formula for Local Health Departments
Average number of cases (5 years)Number of TB suspects started on treatmentNumber of patients started on LTBI treatment
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TB Program Funding Formula
2004
2005
2006
2007
2008
5 yr avg 5 yr x 25
suspect(4 drug
tx started)
suspect x10 LTBI TX
5 yr x 25 plus other % of total % x total $ Total adj 07-08 diff
County A 13 6 17 14 15 13 325 5 50 111 - -$ County B 0 1 0 0 0 0.2 5 1 10 3 18 0.4% 4,160 4,200 -$ 4,200$ County C 18 17 22 17 14 17.6 440 5 50 196 - -$ County D 0 0 0 0 0 0 0 0 0 - -$ County E 0 0 0 1 0 0.2 5 0 0 5 0.1% 1,155 -$
0 0 0 0 0 0 0 0 0 0.0% - -$ 2 3 7 5 7 4.8 120 4 40 8 - -$ 0 1 0 0 0 0.2 5 0 1 - -$ 0 0 0 0 0 0 0 0 4 4 0.1% 924 -$ -$ 0 0 1 0 2 0.6 15 0 0 15 0.3% 3,466 3,600 -$ 3,600$ 0 0 0 0 0 0 0 0 0 0 0.0% - -$ 1 0 0 0 0 0.2 5 0 0 5 0.1% 1,155 -$ -$ 0 0 0 1 0 0.2 5 1 10 2 17 0.4% 3,928 4,200 4,200$
47 42 40 37 24 38 950 10 100 389 - -$ 0 0 0 0 0 0 0 0 0 0 0.0% - -$ 3 0 1 2 3 1.8 45 0 16 - -$ 0 1 0 1 0.5 12.5 0 15 27.5 0.6% 6,355 6,400 4,000$ 2,400$ 9 9 10 7 10 9 225 2 20 77 322 7.3% 74,410 82,500 70,000$ 12,500$ 0 0 0 0 0 0 0 0 0 0.0% - -$ 0 1 0 1 0 0.4 10 1 10 7 27 0.6% 6,239 6,400 3,000$ 3,400$ 0 0 2 2 1 1 25 2 20 24 69 1.6% 15,945 16,000 4,500$ 11,500$ 2 1 2 0 1.25 31.25 0 1 32.25 0.7% 7,453 7,500 7,500$
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CDPHE TB Contracts
CDPHE currently contracts with 20 local health departmentsContract period July 1, 2009 through June 30, 2010Contracts include the ability to charge for DOT and Diagnostic testing (xrays).
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TB resources
CDC Division of TB Elimination web sitehttp://www.cdc.gov/nchstp/tb/default.htmInteractive Core Curriculum on Tuberculosis: What the Clinician Should KnowSelf Study Modules on Tuberculosis
CDPHE TB Program web sitehttp://www.cdphe.state.co.us/dc/TB/tbhome.html
CDPHE TB Program – 303.692.2638
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