TB in Alameda County & Zika Update

Transcription

1 Alameda County BOS Health Committee TB in Alameda County & Zika Update Monday, January 9, 2017 Erica Pan, MD MPH FAAP Deputy Health Officer Director, Division of Communicable Disease Control & Prevention

2 Overview What is TB? TB patients in Alameda County TB public health functions Control & Prevention Strengths, Opportunities and Gaps Zika Update

3 TB Basics What is TB? A slow-growing bacteria: Mycobacterium tuberculosis How? Spreads through the air Where? Most commonly the lungs, but can cause disease in any part of the body Treatment? Multiple drugs for >=6 mos

4 Alameda County TB cases, cases of TB disease 6.5% of 2,137 CA cases 9.5 cases /100,000 residents 73% higher than CA rate (5.5 cases/100,000) 4 th highest rate in CA 10% resistant to at least 1 drug 3 Multi-Drug Resistant cases

5 Number of Cases Rate per 100,000 Annual TB Cases # Cases Alameda County California U.S.

6 Medical Consultation TB Control Case management Directly Observed Therapy (DOT) Laboratory testing Approve hospital discharges Reporting & surveillance Isolation

7 TB Prevention Contact investigation Outbreak investigation Immigrant evaluation Outreach training & education Latent TB infection Treatment is Prevention

8 Social and health care access Incentives and enablers Assess reasons for non-adherence Referrals to social services Referrals to health care insurance eligibility screening TB Enhanced Medical Care Access Program contracts Problem-solve high co-pays Assist with housing

9 TB contact investigation For every case identify contacts for 3 months prior to symptoms Households, workplace or school, social contacts Prioritize high risk contacts for evaluation Perform on-site testing for high risk group settings, e.g., high school, church Treat high risk contacts to prevent disease Recent high school investigation (Oakland) ~300 contacts On-site testing for >270 At least 4 on-site visits I feel like we're in good hands. a high school parent on KTVU 9/19/16

10 Strengths TB control program staff Dedicated to TB patients and program Knowledge and experience in TB control Longstanding relationships with community providers Established safety net of providers

11 Progress & future directions Improve access to TB care TB control MD providing direct clinical service Collaborate with AHS, Community Health Care Network & UCSF Benioff Oakland Children s Video DOT Collaboration - CDPH, Francis Curry TB Center Develop & improve electronic information systems & charting

12 Challenges & Gaps Access to care No Public Health TB Clinic Decentralized TB expertise & services Social resources Housing options for infectious patients Mental health, drug rehabilitation needs Data collection & analysis resources Paper based systems Data entry & analysis support (0.25 FTE Epi) Prevention resources & staffing Contact investigations New immigrants Latent TB infection follow up

13 Summary Alameda County TB Control Ranks 4 th in TB case rates in CA Unique barriers to timely, affordable access to TB care Opportunities for improved collaboration & technology use Gaps to address to achieve vision: Improve access & centralization of TB care Increase prevention capacity Using data to guide program improvement Outreach & education Staffing challenges

14 TB Control Section Amit Chitnis, MD TB Controller Susan Sawley, PHN, BSN TB Control Unit Manager Division of Communicable Disease Control & Prevention Alameda County Public Health Department

15 Updates Nationally/Globally WHO announces shift from PH Emergency to long term response (11/18/16) Local Transmission in TX (11/29/16) Shifting areas in Miami, FL but initial areas controlled Increasing availability of testing at private labs Travel advisories issued for holiday travelers Zika Response and Preparedness Appropriations Act of 2016

16 As of 12/30/16 Zika in California Cases of Zika in Bay Area Counties Cases* Alameda 31 Berkeley 3 Contra Costa 23 Marin 8 Napa 3 San Francisco 28 San Joaquin 7 San Mateo 12 Santa Clara 29 Solano 2 Sonoma 11 Bay Area Subtotal 157 Total CA 451 Hayward (5/2015; none since) Mosquitoes Detection Menlo Park Atherton Aedes aegypti Aedes albopictus 70 pregnant, 3 infants. 3 sexually transmitted *Returning travelers and their sexual partners or infants. *Unincorporated Census-Designated Places

17 Alameda County Ongoing test requests: as of 12/23/ received, 686 approved Zika Health Advisories (6) Ongoing enhanced mosquito surveillance Shift from Infectious Disease Emergency to long term response Awaiting local funding allocation need an additional RN Work with health care community & limited public outreach Operation Zika 2016 As of 12/23/16

18

19

20 SUPPLEMENTAL SLIDES

21 Alameda County TB Control TB Controller: Dr. Amit Chitnis TB Control Nurse Manager: Susan Sawley Nurse Team Leader: Michelle Levy, 1 vacant Communicable Disease Surveillance Epidemiologist: Rita Shiau (0.25 FTE) Medical Social Worker: Dennis Mallilin Specialist Clerks: Loriezel Joson & Maly Sok CHOW II: Andrew Chin TB PHNs: Gwen Alcazar Jennifer Bruns Priscilla Chang Kim Ha Stella Szeto Robert Fischer Renee Lucas Reiko Senteno TB DOT Workers: Zeny Castanares Jenny Hung Amelia Quiroz Patty Phung Leonor Rodriguez Ashok Tangri

22 Acknowledgments for TB slides DCDCP Amit Chitnis, MD, MPH Susan Sawley, PHN, BSN Rita Shiau, MPH Sandra Huang, MD CAPE Matt Beyers, MSCRP, MA

23 Alameda County TB rates by zip code,

24 Risk factors for infection and disease, 2015 TB cases Risk Factor #/139 total cases (%) Diabetes 30 (22) End-stage Renal Disease 7 (5) HIV coinfected 6 (4) Other immunosuppression 8 (6) Excessive ETOH 8 (6) Non-IDU drug use 4 (3) IDU 1 (1) Homeless 3 (2) Correctional Facility 1 (1) LTC Facility 5 (4) Deaths: 7/139 (5%) 2015 cases

25 Payors for TB cases & suspects, 2013 Payor Percent (n=135) Private (incl. Kaiser) 19 Medi-Cal 27 Medicare 4 HealthPAC 9 Other (likely Health PAC) 21 No insurance 13 Missing 7

26 TB laboratory services Alameda County Public Health Laboratory (ACPHL) services: Acid Fast Bacilili (AFB) smear & cultures Drug susceptibility testing (DST) MTB PCR by GeneXpert MTB/Rif IGRA (Quantiferon) Expert consultation Liaison to CDPH & other labs for specialized testing