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1882. Tuberculosis in the Department of Veterans Affairs: Missed Opportunities for Prevention

BACKGROUND: US and global elimination of tuberculosis (TB) is an important goal. Despite decreased incidence, CDC predicts elimination of TB in the US will not occur in the 21st century without improved detection and treatment of latent TB infection (LTBI). We describe the current burden of active T...

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Autores principales: Oda, Gina, Lucero-Obusan, Cynthia, Schirmer, Patricia, Holodniy, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808874/
http://dx.doi.org/10.1093/ofid/ofz359.112
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author Oda, Gina
Lucero-Obusan, Cynthia
Schirmer, Patricia
Holodniy, Mark
author_facet Oda, Gina
Lucero-Obusan, Cynthia
Schirmer, Patricia
Holodniy, Mark
author_sort Oda, Gina
collection PubMed
description BACKGROUND: US and global elimination of tuberculosis (TB) is an important goal. Despite decreased incidence, CDC predicts elimination of TB in the US will not occur in the 21st century without improved detection and treatment of latent TB infection (LTBI). We describe the current burden of active TB infection and LTBI testing and treatment among patients within the Department of Veterans Affairs (VA). METHODS: Using the 2009 CDC case definition for laboratory-confirmed TB, we queried VA data sources from January 2010 to December 2018 for Mycobacterium tuberculosis detected via culture or nucleic acid amplification test (NAAT) from specimens from all body sites. For all TB patients, we extracted demographic, ICD-9 and ICD-10 risk factor, and LTBI testing and treatment data. RESULTS: Between 2010 and 2018, the average annual incidence of TB was 1.7 cases per 100,000 unique users of VA care (ranging from a high of 2.8 in 2010 to low of 0.8 in 2018). For 899 identified cases, demographic factors associated with highest TB rates were age between 45 and 64, Asian race, and residence in District of Columbia (Table 1). The most frequently occurring risk factors were substance abuse, diabetes, and homelessness. Of 90 patients with susceptibility documentation, 14 (15%) had resistance to 1 or more anti-TB drug (1 with multi-drug-resistant TB). Fifteen patients (1.7%) died within 7 days of their TB diagnosis; in all but 2 cases, TB was the primary cause of death (Table 2). Figure 1 depicts screening and treatment for LTBI among patients with TB. Only 228/899 (25.4%) TB patients had LTBI screening ≥ 3 months prior to diagnosis. Of the 347 TB patients never screened for LTBI, 264 (76%) had ≥ 1 documented TB risk factor. Among 228 patients screened for LTBI >3 months prior to active disease, 69 (30%) screened positive; however, only 24 (35%) had LTBI treatment initiated. CONCLUSION: Although rates of TB infection are decreasing, VHA providers would benefit from education on recognizing patients with risk factors which place them at high risk for TB who should be screened for LTBI. CDC recommends preventive treatment of patients who screen positive for LTBI, and provider collaboration with local public health departments to provide directly observed therapy in cases where adherence may be in question. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All Authors: No reported Disclosures.
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spelling pubmed-68088742019-10-28 1882. Tuberculosis in the Department of Veterans Affairs: Missed Opportunities for Prevention Oda, Gina Lucero-Obusan, Cynthia Schirmer, Patricia Holodniy, Mark Open Forum Infect Dis Abstracts BACKGROUND: US and global elimination of tuberculosis (TB) is an important goal. Despite decreased incidence, CDC predicts elimination of TB in the US will not occur in the 21st century without improved detection and treatment of latent TB infection (LTBI). We describe the current burden of active TB infection and LTBI testing and treatment among patients within the Department of Veterans Affairs (VA). METHODS: Using the 2009 CDC case definition for laboratory-confirmed TB, we queried VA data sources from January 2010 to December 2018 for Mycobacterium tuberculosis detected via culture or nucleic acid amplification test (NAAT) from specimens from all body sites. For all TB patients, we extracted demographic, ICD-9 and ICD-10 risk factor, and LTBI testing and treatment data. RESULTS: Between 2010 and 2018, the average annual incidence of TB was 1.7 cases per 100,000 unique users of VA care (ranging from a high of 2.8 in 2010 to low of 0.8 in 2018). For 899 identified cases, demographic factors associated with highest TB rates were age between 45 and 64, Asian race, and residence in District of Columbia (Table 1). The most frequently occurring risk factors were substance abuse, diabetes, and homelessness. Of 90 patients with susceptibility documentation, 14 (15%) had resistance to 1 or more anti-TB drug (1 with multi-drug-resistant TB). Fifteen patients (1.7%) died within 7 days of their TB diagnosis; in all but 2 cases, TB was the primary cause of death (Table 2). Figure 1 depicts screening and treatment for LTBI among patients with TB. Only 228/899 (25.4%) TB patients had LTBI screening ≥ 3 months prior to diagnosis. Of the 347 TB patients never screened for LTBI, 264 (76%) had ≥ 1 documented TB risk factor. Among 228 patients screened for LTBI >3 months prior to active disease, 69 (30%) screened positive; however, only 24 (35%) had LTBI treatment initiated. CONCLUSION: Although rates of TB infection are decreasing, VHA providers would benefit from education on recognizing patients with risk factors which place them at high risk for TB who should be screened for LTBI. CDC recommends preventive treatment of patients who screen positive for LTBI, and provider collaboration with local public health departments to provide directly observed therapy in cases where adherence may be in question. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All Authors: No reported Disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6808874/ http://dx.doi.org/10.1093/ofid/ofz359.112 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Oda, Gina
Lucero-Obusan, Cynthia
Schirmer, Patricia
Holodniy, Mark
1882. Tuberculosis in the Department of Veterans Affairs: Missed Opportunities for Prevention
title 1882. Tuberculosis in the Department of Veterans Affairs: Missed Opportunities for Prevention
title_full 1882. Tuberculosis in the Department of Veterans Affairs: Missed Opportunities for Prevention
title_fullStr 1882. Tuberculosis in the Department of Veterans Affairs: Missed Opportunities for Prevention
title_full_unstemmed 1882. Tuberculosis in the Department of Veterans Affairs: Missed Opportunities for Prevention
title_short 1882. Tuberculosis in the Department of Veterans Affairs: Missed Opportunities for Prevention
title_sort 1882. tuberculosis in the department of veterans affairs: missed opportunities for prevention
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808874/
http://dx.doi.org/10.1093/ofid/ofz359.112
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