Tuberculosis in El Paso, Texas

Jorge C. Magaña, M.D., F.A.A.P.Director

El Paso City-County Health & Environmental District

What is TB?• TB, or tuberculosis, is caused by bacteria called

Mycobacterium tuberculosis.• The bacteria can attack any part of your body,

most commonly the lungs. • People with TB disease can be treated and

cured.• When people become exposed to TB, but do not

develop the disease, they are considered to have Latent TB Infection (LTBI).

What is Latent Infection?• Most people who breathe in TB bacteria and

become infected are able to fight the bacteria to stop them from growing.

• The bacteria become inactive, but remain alive in the body & can become active later.

• Many people who have latent TB infection never develop TB disease & the TB bacteria remain inactive for a lifetime.

• In other people, especially those who have weak immune systems, the bacteria become active and cause TB disease.

TB Cases Texas

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Year 2003 Year 2004

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Changing Epidemiology of TB

Between 1985 and 1992, cases of TB in the U. S. increased by 20 percent. Resurgence of TB disease was fueled by:

•Onset of TB epidemic

•Increases in TB cases among foreign-born persons

•Outbreaks in congregate settings (correctional facilities and homeless shelters)

•Appearance and transmission of deadly multidrugresistant (MDR) TB strains

Today’s Trends• 1992-2001, the incidence of TB decreased by 40%. • 2001, the ninth consecutive year of decline, the TB

incidence rate was 5.6 cases per 100,000, the lowest ever recorded in this country.

• Reduction is attributed to more effective TB-control programs that emphasize:

1. prompt identification of persons with TB2. prompt initiation of appropriate therapy3. Efforts to assure that therapy will be completed.

TB MorbidityUnited States, 1999-2003

Year Cases Rate*1999 17,531 6.42000 16,377 5.82001 15,989 5.62002 15,075 5.22003 14,874 5.1

*Cases per 100,000

Populations Most Affected by TB

• Recent success in TB control in the U.S. tempered by burden of TB among foreign-born persons

• Case rate among foreign-born persons is now at least eight times higher than among U.S.-born persons.

• 1991, 73 percent of reported TB cases were among U.S.-born persons (8.2 cases per 100,000) while 27 percent were in foreign-born persons (33.9 per 100,000).

• 2001, there was an equal distribution (50 percent) in the number of TB cases among these two groups.

• During 1997 through 2001, the top five countries of origin of TB cases among foreign-born persons were Mexico, the Philippines, Vietnam, India, and China

Active TB Patients El Paso County

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Challenges to TB Elimination

• Retreat of TB into high-risk populations at the margins of society where it can resist detection

• Persistence and growth of the global TB epidemic

• Limitations of current control measures • Recognition of the need for new tests and

treatments, plus an improved vaccine • Changes in the health care system that make

the current context for TB elimination very different from that of a decade ago

Priorities• Identify & treat all active TB Patients by Directly

Observed Therapy• Epidemiological investigation & contact

identification to focus on initiating & completing treatment on contacts.

• Treatment of Latent TB patients with limitation of DOT to contacts (recently infected), children, immununocompromised patients and clients with multiple or complex health problems.

Risk Factors TB Cases El Paso County 2000-2002

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US-Mexico Binational TB Referral and Case Management

• Bi-national patients are co-managed with “JUNTOS”& TB Net

• Binational TB Card Project: Educate key audiences about the continuity of care and expected treatment outcome improvements for TB patients crossing U.S.-Mexico border

• U.S. states of California and Texas, Mexican states of Baja California, Sonora, Chihuahua, Coahuila, Nuevo Leon, and Tamaulipas

Where We Are Now ?• TB remains a threat to the health and

well-being of people around the world.• Among infectious diseases, TB remains

2ndleading killer of adults in the world,more than 2 million TB-related deaths each year.

• Until TB is controlled, we muse use every available opportunity to educate the public about the devastation TB can spread and how it can be stopped