Tuberculosis Services Branch
Adolfo Valadez, MD, MPH
Assistant Commissioner
Division for Prevention and Preparedness Services
Tuberculosis (TB) in Texas
In 2010,there were 1385 cases of tuberculosis (TB) reported
in Texas
In 2010, the rates of TB (overall, by race/ethnicity, border):
• Overall rate of 6 per 100,000 population
• Rates are higher along the border
In 2010, among the reported TB cases:
• 51.3% were among Hispanics,
• 18.4% were among African Americans,
• 14.8% were among Whites,
• 14.85 were among Asians, and
• 0.7% were among persons of unknown ethnicity.
1,800
9
1,600
8
1,400
7
1,200
6
1,000
5
800
4
600
3
400
2
200
1
0
0
2000
2001
2002
2003
2004
2005
Cases
2006
2007
2008
2009
2010
Rates
*Cases per 100,000 population. Population estimates from the Texas State Data Center, Office of the State Demographer as
of July 1, 2011
The number of reported TB cases declined 7% from 2000 to 2010.
Rate*
Cases
TB Cases and Incidence Rates
Texas, 2000-2010
TB Incidence Rates,
Texas 2010
Collin
Tarrant
Dallas
El Paso
Travis
Harris
Bexar
State Rate:
5.5/100,000
Webb
Hidalgo
Cameron
TB Incidence Rate:
Border vs. Non-Border
Texas, 2001-2010
14
12.5
12.2
12.8
12.7
12.6
12
11.5
12.7
11.5
12
9.9
Rate*
10
8
6
6.9
6.3
4
6.7
6.4
5.9
5.9
5.6
5.3
5.3
4.9
2008
2009
2010
2
0
2001
2002
2003
2004
2005
2006
2007
Year
Texas Border
Texas Non-Border
*Cases per 100,000 population. Population estimates from Texas Vital Web Population Data:
www.ehdp.com/vn/ro/txu1/pt1/dgw/en_US/index.htm as of July 1, 2011
* Excludes
TDCJ cases
Program Mission and Goal
• Mission: Prevent, treat and control the
spread of tuberculosis in Texas.
• Goal: Reduce the number of new
tuberculosis infections, and assure access to
care and treatment for persons infected with
tuberculosis and others diagnosed with active
tuberculosis disease.
Program Responsibilities
• Provide funding to health service regions and
local health departments to support TB
prevention and control activities.
• Provide TB medications to public health
clinics that treat patients with TB disease and
persons with latent TB Infection (LTBI).
• Provide TB testing supplies for public health
use.
Program Responsibilities
• Assure persons diagnosed with TB disease
including contacts to a known case are
successfully evaluated and complete
appropriate treatment.
• Contact investigation and outbreak response.
• Support public health laboratory testing within
available resources.
TB/HIV/STD/Viral Hepatitis Unit
TB Program Activities
• TB Prevention & Control
• Medication and Testing Supplies
• Laboratory Services
• Case Management
• Standards of Care
• Contract Administration
• Services delivered primarily by local health departments
• Program Evaluation
• Data Analysis
• Site Reviews
DSHS Health Service Region
TB Activities
• Provide TB prevention and Control Activities in Areas
without Local Health Departments (LHDs)
• Conduct Case Investigations
• Administer Medications via Directly Observed
Therapy (DOT)
• Provide Case Management
• Provide Oversight and Technical Assistance to LHDs
• Conduct Site Reviews
• Conduct Data Analysis
Partners
The DSHS Tuberculosis Services Branch works with
many external partners to prevent and control
tuberculosis in Texas. These partners include:
•
•
•
•
•
•
•
•
•
•
•
U.S.-Mexico Border Health Commission
Centers for Disease Control and Prevention (CDC)
Texas Association of Local Health Officials (TALHO)
American Thoracic Society (ATS)
Pan American Health Organization (PAHO)
Texas Center for Infectious Disease (TCID)
RESULTS
Rotary International
International Union Against TB and Lung Disease (IUATLD)
Texas Medical Association (TMA)
National TB Controllers Association (NTCA)
TB Surveillance
TB Surveillance and Case Reporting are done
by the TB/HIV/STD Epidemiology and
Surveillance Branch that is in the same Unit as
the TB Services Branch.
TB Appropriations
TB Services Branch Budget
Successes
TB Prevention & Control in Texas
• TB morbidity in Texas is at its lowest level since record
keeping began over 40 years ago.
• Texas participated in the Tuberculosis Epidemiologic
Research Consortium, a CDC funded 10-year initiative
that translated the following research into practice:
• Implementing blood assay testing, (i.e. QuantiFERON
or T-Spot TB) to efficiently screen for the presence
of TB.
• Identifying genetically linked cases through DNA
genotyping.
TB Prevention & Control in Texas
• The Heartland National Tuberculosis Training Center
in San Antonio serves as one of four regional training
medical and consultation centers in the US. Since
2006 through mid-2011, it has provided more than
4,500 Texas consults.
• The Texas Center for Infectious Disease is the only
TB hospital in the United States. Patients requiring
court-ordered management are sequestered to this
hospital for TB treatment.
Other Successes
• Ongoing bi-national collaboration with Mexico on
the treatment of TB with a focus on complicated
multi-drug resistant TB.
• Specialized pediatric TB consultations through
Texas Children’s Hospital.
• Texas maintains a national and international
presence in TB prevention and control efforts by
holding leadership positions in TB committees
and associations.
Challenges
Current Funding Issues
• Federal funding rescission (reduction in CDC
funds)
• Loss of TB research consortium funds
• Reduction in state General Revenue funds
• Some local health departments discontinuing
or reducing TB services because of
inadequate funding
Uncertainties
• The future of federal funding
• Potential changes related to the Patient
Protection and Affordable Care Act and its
impact on public health delivery systems
• Sustainable general revenue funding
• A sustained competent workforce in light of
an aging workforce
Outbreak & Large Scale TB
Investigations - 2011
• One large TB outbreak with multiple cases traceable
to a single index case.
• Health Service Region 2/3 (Dallas-Ft. Worth area) currently
has 3 investigations related to this outbreak in Ennis, Red
Oak and Tarleton State University.
• There are 11 cases of confirmed TB and 1 suspected case
• 13 other large scale contact investigations in
congregate settings (workplace, school, etc.)
involving more than 100 contacts.
• To date about 4,500 persons tested in the outbreak
and contact investigations with almost 500 (11%)
infected with TB (mostly latent TB infections).
Outbreak & Large Scale TB
Investigations
• Within these investigations, the percentage of
contacts found to be infected varies by location and
duration of exposure.
• Estimated cost for Ennis outbreak: $1,062,247 (staff
time & travel, testing & diagnostics, treatment)
• Social media (Facebook) used to reach out to
possible contacts who left the school.
• Average cost per large scale investigation: $14,500
or $188,500 total for the 13 investigations
Texas TB Strategic Planning
Process
Members
Role
• Provide strategic direction and oversight
• Provide input and advice throughout project life cycle
• Monitor progress and milestone achievement
•
•
•
•
Dr. Adolfo Valadez (Chair)
Dr. James Morgan (Regional / Local)
Ms. Janna Zumbrun (Infectious Disease Prev.)
Mr. Felipe Rocha (TB Branch)
Input Opportunities
1
Stakeholder Input
Sessions
2
Blue Ribbon
Expert Panel
3
TB Focused Work
Groups
1.
2.
3.
4.
5.
San Antonio
Dallas
Houston
Harlingen
Austin
1. Clinical decisionmaking
2. Treatment
3. Testing
4. Screening
1.
2.
3.
4.
Outbreak response
Funding
Data
Internally facing
activities
Start: February 23
End: March 30
Output
Texas TB
Strategic
Plan
Due: June 1,
2012
2012 to 2017
Convene: No later
than week of
April 2 – 6
Varies by work group
Completed
and
Ongoing
Action
Plan
Due: Varies by
goal and
objective
Questions?
Contact:
Adolfo Valadez, M.D., M.P.H.
Assistant Commissioner
Division for Prevention and Preparedness Services
512/458-7729
adolfo.valadez@dshs.state.tx.us