Georgia program and data summary. Tuberculosis

2008 Georgia Program and Data Summary:
TUBERCULOSIS
Tuberculosis (TB) is an infectious disease caused by the germ Mycobacterium tuberculosis or tubercle bacilli. It usually affects the lungs but can affect any part of the body. TB is curable, but can be fatal if not treated appropriately.
WHAT IS TUBERCULOSIS (TB)?
TB is an infectious bacterial disease that is spread from person to person through the air. It usually affects the lungs (pulmonary TB), but can affect any part of the body. TB is transmitted when persons with pulmonary or laryngeal TB cough, sneeze, speak, or sing, and expel droplet nuclei containing tubercle bacilli. A susceptible person may inhale the tubercle bacilli and get infected.
WHAT ARE THE SIGNS AND SYMPTOMS OF TB?
The most common symptoms of pulmonary TB include a persistent, productive cough lasting more than 2-3 weeks, coughing up blood, fever, night sweats, weakness, and weight loss.
WHAT CAN BE DONE TO PREVENT THE SPREAD OF TB?
The best way to stop TB transmission is immediate respiratory isolation of infectious TB patients at home or at a health care facility and starting effective TB therapy. Infectiousness declines rapidly after adequate therapy is started and the patient adheres to the prescribed TB treatment. TB patients must cover their mouths and noses when coughing, and take the prescribed medicines as directed by their health provider.
WHO IS AT RISK FOR TB?
Anyone can get TB, but some people are at higher risk: Close contacts of a person with infectious TB HIV infected individuals Immunosuppressed persons, e.g., on prolonged corticosteroid therapy or taking tumor necrosis factor blockers Foreign-born persons from countries where TB is common Injecting drug users Residents and employees of homeless shelters, nursing homes, jails, and prisons Mycobacterial laboratory personnel and health care workers who serve high-risk clients Persons with diabetes mellitus, silicosis, end stage renal disease, gastrectomy, jejunoileal bypass, leukemia, lymphoma, or cancer of the head or neck
These persons should receive a TB skin test to screen for active TB or latent TB infection.
What is the difference between active TB disease and latent TB infection (LTBI)? In active TB disease, the person is symptomatic and TB bacilli are actively multiplying and attacking different parts of the body. Persons with active TB disease can infect other people.
Latent TB infection is a condition in which tubercle bacilli are present in the body but are inactive because the immune system can fight the bacteria to stop it from multiplying. Persons with LTBI have no symptoms and are not contagious, but may develop TB disease later in life if they do not receive treatment for LTBI.
Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-2634 gaepinfo@dhr.state.ga.us http://health.state.ga.us

PROGRAM OVERVIEW
The mission of the Georgia TB Prevention and Control Program is to control TB transmission, prevent illness, and ensure TB treatment completion. This is accomplished by the following:
1. Identifying and treating persons who have active TB disease, 2. Finding, screening and treating infected contacts, and 3. Screening high-risk populations
The Georgia TB Program is funded by the state of Georgia and the U.S. Centers for Disease Control and Prevention.
WHAT DOES THE TB PROGRAM DO?
Conducts case reviews to ensure that all TB cases in Georgia are evaluated and treated Provides individualized case management to TB patients that includes social services,
incentives and enablers to complete treatment, and directly observed therapy (DOT) Identifies, locates, and evaluates persons exposed to TB Provides tuberculin skin testing, bacteriology, radiologic services, and anti-TB medications to
persons who have active TB and their contacts Provides education and treatment to contacts with latent TB infection (LTBI) to prevent future
illness Maintains statewide TB surveillance system and ensures complete, accurate, and timely
reporting of newly diagnosed and suspected TB cases Provides QA/QI oversight and builds capacity of health districts, hospitals, and health providers
to identify, treat, and control transmission of TB through education, training, and technical assistance
WHAT PROGRAM SERVICES ARE AVAILABLE?
Medical consultation Nurse case management Free laboratory diagnostic testing Free TB and LTBI medications Directly observed therapy Contact investigation Outbreak and cluster investigation Surveillance and Epidemiology Education and Training Incentives and enablers to patients to complete TB and LTBI therapy
WHERE ARE SERVICES LOCATED? In every county health department and district health office statewide
WHO IS ELIGIBLE FOR PROGRAM SERVICES? TB Program services are provided at no charge to TB suspects, TB cases, and contacts of TB cases, regardless of their ability to pay.
Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-2634 gaepinfo@dhr.state.ga.us http://health.state.ga.us

TB cases are decreasing in Georgia due to successful Public Health interventions
In 2007, 473 TB cases were reported in Georgia a 48% decrease from the early 1990s when 800-900 cases were reported every year.
Georgia had the 9th highest TB case rate (5 per 100,000) among the 50 states in 2007.
Fulton, DeKalb, Gwinnett, and Cobb Counties accounted for 49% of reported TB cases.

Figure 3. TB Case Rates by Health Districts Georgia, 2007

1-2

Gordon

2-0

1-1 Bartow

Polk Paulding 3-1
Haralson

3-2 3-4

3-5

3-3

Rockdale

10-0

Case rates/100,000 population:
<= 3.5 (national target) 3.6 to 5.0 > 5.0 (state average)

4-0

6-0

5-2

7-0
8-2
Seminole Decatur

5-1 9-1
9-2 8-1

Majority of TB cases were male (65%) and Black, non-Hispanic (51%). The highest proportion of TB cases by age group (36%) occurred among persons 25-44 years old.
High-risk populations: 41% of TB cases were foreign-born, 18% were drug abusers, 14% were HIV-positive, 7% were homeless, 6% were prisoners, 2% were in nursing homes.

Public Health Departments monitor TB treatment by directly observed th
TB treatment takes at least 6-9 months to complete (1,2). In 2007, 92% of TB cases reported in 2006 completed TB treatment and 82% completed within 12 months.
Ensuring treatment completion prevents drugresistant TB strains from emerging.

Two multidrug-resistant (resistant to at least isoniazid and rifampin) cases were reported.
Number of TB Cases and TB Case Rates Georgia,1982-2007

82% received treatment exclusively by directly-observed therapy (DOT) from Public Health Department staff who watch patients take every dose of their medications to make sure patients complete their treatment and are cured.

1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Percent

Number of Cases
1000 900 800 700 600 500 400 300 200 100 0

Year Number Case Rate

Rate/100,000
16 14 12 10 8 6 4 2 0

Timely TB Treatment Completion and Directly Observed Therapy (DOT)
Georgia, 1993-2006

90

80

70

60

50

40

30

20

10

DOT became standard of care

0

1993 1995 1997 1999 2001 2003

Year

Completion in 12 months Totally DOT
2005

Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-2634 gaepinfo@dhr.state.ga.us http://health.state.ga.us

Public Health Departments conduct contact investigations to prevent the

Web-based Resources for TB Information: Georgia TB Program:

spread of TB in the community

http://www.health.state.ga.us/programs/tb/i

ndex.asp Southeast National TB Center:

To screen for TB infection among contacts to a TB case, public health staff ask if contacts have

http://sntc.medicine.ufl.edu/ CDC Division of TB Elimination:

TB-like symptoms, administer a TB skin test (TST), and if the TST is positive, a chest x-ray is done

http://www.cdc.gov/tb/default.htm World Health Organization:

(3,4).

http://www.who.int/topics/tuberculosis/en/

7,222 contacts to TB cases reported in 2006 were evaluated by public health departments to determine if they were infected with TB.
1,284 (18%) of contacts to TB cases were found to have latent TB infection and were given treatment to prevent development of active TB.
69 (1%) of contacts to TB cases developed active TB and were given anti-TB medications by directly observed therapy.
Education and Training Opportunities

References: 1. Georgia Department of Human Resources, Division of Public Health, Georgia TB Reference Guide, 2005. 2. CDC. Treatment of Tuberculosis. MMWR 2003; 52 (No. RR-11). 3. CDC. Guidelines for the Investigation of Persons with Infectious TB: Recommendations from the National TB Controllers Association and CDC. MMWR 2005; 54 (No. RR-15, 1-37). 4. CDC. Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection. MMWR 2000; 49 (No. RR-6).

All TB educational activities are posted on the Georgia Division of Public Health Web Calendar under "Nursing" and "Epidemiology." Please check the calendar frequently for updated information. Call the TB Nurses at 404-657-2634 for more information.

The Georgia State TB Program can provide speakers for your events and facility. Call the TB Nurses at 404-657-2634 to discuss the needs of your facility and staff.

The following classes are offered to public health districts upon request:

TB Contact Investigation Directly Observed Therapy (DOT) TB Case Management Outreach Worker Training TB Update and TB Skin Test Certification

Date Updated: September 2008 Publication Number: DPH08.310W

Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-2634 gaepinfo@dhr.state.ga.us http://health.state.ga.us