Minnesota Department of Health Tuberculosis Prevention and Control Program (651) Tuberculosis surveillance data for Minnesota are available

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1 Minnesota Department of Health Tuberculosis Prevention and Control Program (651) Tuberculosis surveillance data for Minnesota are available on the Web at:

2 Year No. Cases Rate* * Cases per 100,000 population. Rates were calculated using state population estimates from the U.S. Census Bureau.

3

4 Percentage of Cases Year of Diagnosis

5

6 Year No. Cases No. Deaths* (%) (2%) (7%) (2%) (1%) (2%) *Represents only deaths due to TB disease or TB drug-induced toxicity

7 Location of Residence 2010 No. (rate)* 2011 No. (rate)* 2012 No. (rate)* 2013 No. (rate)* 2014 No. (rate)* Hennepin County 67 (5.8) 59 (5.0) 71 (6.1) 51 (4.3) 51 (4.3) Ramsey County 34 (6.7) 31 (6.0) 39 (7.6) 39 (7.5) 26 (4.9) Suburban Twin Cities Metro 16 (1.3) 12 (0.7) 27 (2.2) 20 (1.6) 24 (2.0) Olmsted County 6 (4.2) 9 (6.2) 3 (2.1) 10 (6.8) 16 (10.7) Other counties 12 (0.5) 26 (1.1) 22 (1.0) 31 (1.3) 30 (1.3) Total 135 (2.5) 137 (2.6) 162 (3.0) 151 (2.8) 147 (2.7) * Rate per 100,000 population. Rates were calculated using population estimates from U.S. Census Bureau data. Anoka, Carver, Dakota, Scott, and Washington counties

8 Location of Residence 2010 No. (rate)* 2011 No. (rate)* 2012 No. (rate)* 2013 No. (rate)* 2014 No. (rate)* Hennepin County 67 (50) 59 (43) 71 (44) 51 (34) 51 (35) Ramsey County 34 (25) 31 (22) 39 (24) 39 (26) 26 (18) Suburban Twin Cities Metro 16 (12) 12 ( 9) 27 (17) 20 (13) 24 (16) Olmsted County 6 ( 4) 9 ( 7) 3 ( 2) 10 ( 7) 16 (11) Other counties 12 ( 9) 26 (19) 22 (13) 31 (21) 30 (20) Total 135 (100) 137 (100) 162 (100) 151 (100) 147 (100) * Rate per 100,000 population. Rates were calculated using population estimates from U.S. Census Bureau data. Anoka, Carver, Dakota, Scott, and Washington counties

9 Hennepin: 51 Ramsey: 26 Suburban metro: 24 Greater MN: 46 Total: 147

10 Hennepin: 299 Ramsey: 169 Suburban metro: 99 Greater MN: 165 Total: 732

11 Percentage of Cases Place of Birth

12 N = 732

13 Cases per 100,000 * Race categories do not include persons of Hispanic/Latino origin. Rates were calculated using population estimates from the U.S. Census Bureau. ** The 2014 patient with multiple races is not represented in this graph.

14 Race / Ethnicity* Foreign-Born Cases No. (%) U.S.-Born Cases No. (%) White 15 (2) 59 (42) Black 308 (52) 35 (25) Asian 211 (36) 14 (10) Native American / Alaska Native 0 17 (12) Multi-racial 0 1 (<1) Hispanic/Latino 59 (10) 13 (9) Total 593 (100) 139 (100) *Race categories do not include persons of Hispanic/Latino origin. Includes U.S.-born children of foreign-born parents

15

16 Risk Category* 2010 (N=135) No. (%) 2011 (N=137) No. (%) 2012 (N=162) No. (%) 2013 (N=151) No. (%) 2014 (N=147) No. (%) Cumulative (N=732) No. (%) Foreign-born 110 (81) 116 (85) 136 (84) 123 (81) 108 (73) 593 (81) Substance abuse 7 (5) 7 (5) 7 (4) 9 (6) 7 (5) 37 (5) Homeless 3 (2) 2 (1) 2 (1) 4 (3) 7 (5) 18 (2) HIV-infected 6 (4) 3 (2) 6 (4) 4 (3) 4 (3) 23 (3) Other medical condition** 23 (17) 27 (20) 20 (12) 35 (23) 37 (25) 142 (19) Incarcerated 4 (3) 2 (1) 0 (0) 0 (0) 1 (1) 7 (1) Long-term care resident 3 (2) 2 (1) 1 (1) 2 (1) 0 (0) 8 (1) * Risk categories are not mutually exclusive Alcohol abuse and/or illicit drug use ** Conditions or therapies that increase risk for progression from latent TB infection to active TB disease, not including HIV/AIDS

17 N=732 * Risk categories are not mutually exclusive Alcohol abuse and/or illicit drug use ** Conditions or therapies that increase risk for progression from latent TB infection to active TB disease, not including HIV/AIDS

18 Cases (N=732) Medical conditions** No. (%) Diabetes 81 (11) End stage renal disease 19 (3) Weight loss/undernutrition/malabsorption 6 (1) Other: silicosis, hematologic disease 3 (<1) Other immunosuppressive condition or immunosuppressive therapy*** 56 (8) *Conditions or therapies that increase risk for progression from latent TB infection to active TB disease, not including HIV/AIDS **Patients could have > 1 medical condition ***Includes TNF α antagonist therapy and post-organ transplantation

19 * Risk categories are not mutually exclusive ** Conditions or therapies risk for progression to active TB disease, not HIV Alcohol abuse and/or illicit drug use

20 HIV Status Foreign-Born Cases No. (%) U.S.-Born Cases No. (%) Total No. (%) Negative 546 (92) 126 (91) 672 (92) Positive 21 (4) 2 (1) 23 (3) Refused 4 (1) 2 (1) 6 (1) Not Offered 22 (4) 9 (6) 31 (4) Total 593 (100) 139 (100) 732 (100)

21 Percent co-infected No. of TB- HIV cases in MN:

22 No. of eligible TB cases* Percent of eligible TB cases with HIV result * Alive at diagnosis

23 School/Setting No. (%) Preschool 2 (<1) Elementary 36 (5) Secondary 31 (4) Post-secondary 51 (7) Other* 52 (7) None 560 (77) Total 732 (100) *Includes: daycare, ESL/ELL, and other schools

24 Number of Cases Year * Other includes: Eastern Europe, North Africa/Middle East, and Western Europe

25 Number of Cases Region of Birth * Other includes: Eastern Europe, North Africa/Middle East, and Western Europe

26 N = 593

27 N = 593

28 * Per results of pre-immigration screening performed overseas N = 71

29 N = 593

30 % of foreign-born cases N = Technical instructions for overseas exams revised

31 N = 732

32 * Includes cases with or without concurrent pulmonary disease

33 Site of disease** Cases (N=356) No. (%) Lymphatic 192 (54) Musculoskeletal 51 (14) Pleural 40 (11) Peritoneal 22 (6) Genitourinary 14 (4) Brain 14 (4) Meningeal 11 (3) Other 26 (7) * Includes TB cases with or without concurrent pulmonary disease ** Patients may have multiple extrapulmonary sites of disease

34 N = 460 * From initial chest x-ray or chest CT scan

35 N = 460 *53% of pulmonary cases without sputum smear results were under 15 years of age

36 N = 732

37 N = 732 *Based on the public health surveillance definition for TB [CDC. (2009, June) CDC Tuberculosis Surveillance Data Training: Report of Verified Case of Tuberculosis (RVCT) Instruction Manual. Atlanta, GA: U.S. Department of Health and Human Services, CDC. (Appendix A - Tuberculosis Case Definition for Public Health Surveillance)]

38 Year Cases With Susceptibility Results* Any Drug Resistance No. (%) INH- Resistant** No. (%) MDR-TB No. (%) (12) 5 (5) 0 (0) (22) 12 (12) 3 (3) (19) 12 (10) 1 (1) (21) 13 (21) 0 (0) (24) 19 (18) 1 (1) Total (19) 61 (11) 5 (1) * Culture-confirmed cases with drug susceptibility results available Resistance to at least one first-line anti-tb drug [i.e., isoniazid (INH), rifampin, pyrazinamide (PZA), or ethambutol] ** INH-resistant cases may also be resistant to other drugs Multi-drug resistant TB, defined as resistance to at least INH and rifampin

39 Place of birth Cases With Susceptibility Results* Any Drug Resistance No. (%) INH- Resistant** No. (%) MDR-TB No. (%) Foreign-Born Cases (21) 53 (12) 4 (1) U.S.-Born Cases (14) 8 (8) 1 (1) Total (19) 61 (11) 5 (1) * Culture-confirmed cases with drug susceptibility results available Resistance to at least one first-line anti-tb drug [i.e., isoniazid (INH), rifampin, pyrazinamide (PZA), or ethambutol] ** INH-resistant cases may also be resistant to other drugs Multi-drug resistant TB, defined as resistance to at least INH and rifampin

40 N = 732 Overseas TB class follow-up 2% * Other includes: other immigration exam 1.3%, and employment screening (including health care worker screening) 1.6%

41 90%

42 90% Type of provider N=722 started on treatment * DOT = Directly Observed Therapy

43 Year Started Treatment* Completed Within 12 mos.** No. (%) Completed Overall** No. (%) (91) 115 (99) (95) 97 (96) (95) 130 (98) (93) 123 (98) Total (93) 465 (98) * Patients for whom < 12 months of therapy is indicated. This excludes: patients with rifampin resistance, meningeal TB, TB in bone or skeletal system, TB in CNS, children 14 years of age or younger with disseminated TB, patients who died or moved out of US within 366 days of starting treatment. ** Treatment completion data as of 9/14/2015

44 * Some patients are managed by multiple providers throughout disease course

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