State Public Health Officials Continue to See Record Low Numbers of Tuberculosis Cases in Massachusetts
Rise in multi-drug resistant cases underscores need for heightened vigilance among providers, continued funding for laboratory surveillance and treatment
BOSTON — The Department of Public Health (DPH) today announced that in 2013 Massachusetts continued to see a decline in tuberculosis (TB) cases, with 201 confirmed last year. The state saw 215 the year before, following a record low of 196 in 2011.
By coordinating medical care and local public health activity, following up with close contacts of active cases where transmission may have occurred, and through the work of the state’s TB nurses and community health workers, Massachusetts has dramatically reduced the incidence of active TB over the past decade. This ongoing work will help Massachusetts battle the drug-resistant forms of TB.
“We owe great thanks to the medical community, local public health officials, and the staff at the Hinton State Laboratory Institute for their work in containing TB,” said DPH Commissioner Cheryl Bartlett, RN, who joined other health officials and providers at a State House event held by the Medical Advisory Committee for the Elimination of Tuberculosis to commemorate March 24 as World Tuberculosis Day. “The dramatic increase in multi-drug resistant-TB cases is very concerning, and requires the state and local health departments to maintain their vigilance on all TB cases to contain the spread of these serious infections.”
TB surveillance became part of the state’s groundbreaking integrated surveillance and case management system, MAVEN (Massachusetts Virtual Epidemiologic Network) in 2007. Developed during the Patrick Administration, MAVEN synthesizes, sorts, and coordinates laboratory reports, clinical disease reports, epidemiologic investigation data, and disease case management data, making these data available to state and local disease trackers. MAVEN includes our electronic laboratory reporting (ELR) system, which was rolled out to the Commonwealth’s 73 acute care hospital laboratories in 2013 and collected over 6.5 million laboratory reports last year alone. Electronic receipt and sorting of laboratory reports greatly enhances the timeliness, completeness, and efficiency of managing this vast amount of data, putting Massachusetts way ahead of other states on these measures.
DPH reported a record number of multi-drug resistant tuberculosis (MDR-TB) cases in 2013, mirroring national and worldwide trends. Of a total of 201 active (mostly infectious) TB cases reported statewide, a total of seven cases were resistant to the two antibiotics most commonly used to treat TB. These MDR-TB cases are more difficult to treat, requiring up to two years of intensive medical care to cure.
“The rise in multi-drug resistant tuberculosis in Massachusetts comes at the same time that we’re seeing record low numbers of infectious TB cases here,” said State Epidemiologist Dr. Alfred DeMaria, Jr. “It will take a continued, concentrated partnership between clinical providers, local health departments, state public health nurses, community health workers, and epidemiologists to diagnose cases, manage treatment, and investigate contacts for possible exposure in order to limit the spread of MDR-TB.”
The Hinton State Laboratory continues to play a critical role in tracking and containing the spread of MDR-TB cases throughout Massachusetts. In 2012, the Hinton Lab adopted a new, FDA-approved test that detects drug resistance in TB cases days sooner than previous tests, aiding clinicians in proper treatment with other drugs. Through sophisticated testing, the Hinton lab is able to quickly and accurately determine patterns of drug resistance among newly diagnosed active TB cases, allowing the proper drugs to be prescribed to treat the patient.
Tuberculosis is a serious disease caused by bacteria that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body such as the brain, kidneys or spine. In most cases, TB is treatable; however TB can be deadly, and may remain transmissible, without proper treatment.
The Centers for Disease Control and Prevention (CDC) estimates that the cost of treating a single MDR-TB case, including hospitalizations that often accompany their care, averages $134,000 per patient. The medication cost alone is over 60 times greater to treat MDR-TB than non-resistant forms of the disease, averaging $30,000 per patient.
The current rise in MDR-TB in Massachusetts parallels national and global trends. In 2012, one case of MDR-TB was detected in Massachusetts and 86 nationwide. Drug resistance is generally only detected among active TB cases (persons with the symptoms of tuberculosis, including a persistent cough.
More information about tuberculosis diagnosis and treatment can be found at www.cdc.gov/tb. Further details on the DPH Tuberculosis program can be found at www.mass.gov/eohhs/gov/departments/dph/programs/id/tb .
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