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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.
TB Testing and Preventive Therapy in Wyoming |
Year |
No. Tested1 |
No. Positives |
No. Started on Prev. Therapy |
Prev. Therapy Completion Rate2 |
2004 |
19,126 |
272 |
163 |
92.0% |
20053 |
16,566 |
217 |
135 |
91.1% |
- No. tested=high-risk persons skin tested with PPD by
the WY TB program.
- Preventive therapy completion rate was calculated using
the formula in the CDC report, “TB Program Management Report
- Completion of Preventive Therapy.”
- Figures for 2005 are 10-month figures for 1/1/2005 to
10/31/2005.
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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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