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No. 2, 2006

HIGHLIGHTS FROM STATE AND LOCAL PROGRAMS 

No Reported TB Cases in Wyoming in 2005

After more than 12 years of concentrating on providing tuberculin skin tests (TSTs) and preventive therapy for those considered to be at increased risk for TB disease or latent TB infection (LTBI), or those required by OSHA to be tested for LTBI, Wyoming found and counted no cases of active TB during calendar year 2005. Wyoming is the only state that has achieved this result, and in fact has done it twice. The state reported zero cases in 1989 as well as in 2005, and thus is the only one of the 50 states to report zero cases since nationwide TB morbidity data were collected.

It didn’t happen by accident. Wyoming’s TB control program has been essentially 100% federally funded by annual cooperative agreements from DTBE since 1993. With an average of only four cases of active TB per year for 2000–2004, Wyoming has been able to focus on other important aspects of TB prevention and control: (1) finding and skin testing contacts of infectious TB patients, (2) skin testing members of high-risk populations to find those with LTBI, and (3) offering preventive therapy to those who are infected with M. tuberculosis. From 2000 to 2004, an average of 19,131 high-risk people were tuberculin skin tested using PPD supplied by the state’s TB control program. The table below is representative of the magnitude of our effort and progress.

Wyoming is a large, low-density state with a population of about 510,000, and a number of populations at high risk for infection with M. tuberculosis. Given the existence of the many at-risk populations within the state (e.g., the homeless, Native Americans, migrant workers, inmates within a state prison system and 23 county detention centers, and the elderly), it is remarkable that no countable active cases were encountered during 2005. However, during 2005, the Wyoming TB control program provided care for five “suspects” for whom active TB was subsequently ruled out, one elderly individual whom we believe had active TB but which could not be proven, and one Alabama TB case. Wyoming’s public health TB program made the effort and absorbed the costs of laboratory testing, medications, and public health nursing personnel associated with initiation of contact investigation, case management, and directly observed therapy, even though none of these “suspects” resulted in having active TB, and the Alabama case appears in that state’s reported morbidity. The basic infrastructure costs of Wyoming’s TB surveillance, prevention, control, and laboratory work remained, and the costs for the treatment of several suspects and of one case from another state were added, even as Wyoming’s case count reached zero in 2005.

Wyoming’s success can be attributed to the cooperation of its many partners involved in TB prevention and control. Our intramural partners include public health nurses, county health officers, disease intervention specialists, the public health TB laboratory, the state’s substance abuse program, and the HIV/AIDS program. Our external partners include the Wyoming TB Advisory Committee, clinics providing health care for the homeless, hospital-based infection control staff, nursing homes, Indian Health Service (IHS) public health staff on the Wind River Reservation, Wyoming Department of Corrections and the medical staff of its correctional facilities, those private providers who consult with the TB control program on the testing and care of their patients, DTBE staff, and others.

The lesson appears to be that persistence will be rewarded in the end. The caution is that in an environment with no or few active TB cases, suspicion for TB infection and disease can easily diminish. It will be Wyoming’s challenge to maintain the focus on TB prevention and control in an arena demanding resources for other public health priorities.

—N. Alexander Bowler, MPH, CHE
Wyoming TB Program

Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

 
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