The Association of Asian Pacific Community Health Organizations (AAPCHO) co-hosted a World TB Day webinar for TB elimination partners and public health TB program staff entitled The Tuberculosis Epidemic: Impact in California and Strategies to Reach Elimination on April 8th.
The meeting opened with introductions from co-host representatives, the current CTCA President and Orange County TB Program Manager Angelito Bravo, MD, and Joe Lee the Director of Strategic Initiatives and Partnerships at AAPCHO. For our first presentation, we heard from Jackie Cuen, CTCA TB Patient Peer Support Navigator, as she shared her story of TB diagnosis and treatment in San Diego County. After we heard from Jackie, we heard about the number and distribution of TB cases in California in 2020.
AAPCHO representative, Joe Lee, provided a comprehensive overview of their TB elimination strategies and efforts, explaining that AAPCHO provides advocacy, collaboration, and leadership to drive health equity for Asian Americans, Native Hawaiian and Pacific Islanders (AANHPI) who have been marginalized and minoritized. AAPCHO is addressing TB because, nationwide, nearly 35% of all TB cases reported each year in the U.S. are among the AANHPI communities. TB impacts the over 50 ethnic subgroups with more than 100 languages spoken differently. AAPCHO is closely examining which subgroups are most disproportionately impacted to better target their enhanced prevention services. AAPCHO created the TB Elimination Alliance (TEA), a coalition funded by the CDC to eliminate TB and LTBI inequities among AANHPI populations, through education, awareness raising, innovation to achieve health communities free of TB.
We are excited to continue to build on this partnership and work together to achieve TB elimination.
This webinar was recorded and can be accessed here.
Each year in March, the number of TB cases diagnosed the year before are reported to the public. Tracking TB diagnoses and subpopulations affected disproportionately directs public health department efforts statewide to allocate resources and strategies to prevent and control TB.
Below is a summary of TB by the numbers in California 2020:
There are more than 2 million Californians living with latent TB infection (LTBI). LTBI is when the TB bacteria are found in the body but not causing symptoms, illness and cannot be spread to others.
85% of those diagnosed with TB disease in California in 2020 developed TB from LTBI.
84% of those diagnosed with TB disease in California in 2020 were born outside of the U.S.
52% of those diagnosed with TB disease in California in 2020 were born in Asia.
40% of adult TB cases had diabetes, end stage renal disease, HIV infection, or another health condition that increases the likelihood that LTBI will progress to TB disease.
Only 20% of those with LTBI are aware that they are living with LTBI.
11 (1.0%) of those diagnosed with TB in California in 2020 had multidrug resistant (MDR) TB.
California has not seen an increase in MDR TB diagnoses since routine testing for TB drug sensitivity began in 1993.
If you want to know more about TB in your area, contact us.
Social Media and Light Up in Red Campaigns Updated and Relaunched
CTCA Communications Committee (CC) World TB Day (WTBD) 2021 preparations focused on simplifying the 3rd generation WTBD Toolkit. The Social Media Campaign was updated and focused on Twitter posts and the development of a guide for creating TikTok TB educational videos. Additionally, the Light Up the World in Red materials were updated.
The CTCA CC enthusiastically embraced a new CC member’s TikTok ideas and research. After several presentations to key CTCA committees, planning got underway. A CTCA TikTok Channel (EndTBCalifornia) was created and linked to the www.ctca.org homepage. A video theme was created, a magic wand challenge, asking participants to answer the question, “if you could make any fact about tuberculosis common knowledge to the public, what would you choose?”
Messages and instructions were created and distributed to California TB Controllers and communication staff by CTCA CC members in advance to assist with planning for individual video production and posting to TikTok on World TB Day. The CTCA CC shifted from planning to production as people volunteered to review the instructions and create demonstration videos. All of the resources are posted to the World TB Day page on www.ctca.org. This is a communication strategy we hope to continue to build on.
If you could make any fact about tuberculosis common knowledge to the public, what would you choose?
CTCA is excited to announce the arrival of Ryan Clary, a seasoned coalition consultant, with a background in infectious disease control efforts. He will be helping to grow the Coalition for a TB-Free California. Ryan joins us with a lot of experience in Hep C, HIV and AIDS coalition development and support. We are thrilled to have his help reaching out to partner organizations to remove barriers to TB diagnosis and preventive treatment to protect Californians from the threat of TB disease.
With Ryan’s help, we’ll work to bring together additional partners who are leading and serving those populations disproportionately impacted by TB in California. We want to bring COVID-19 innovations in public health to TB care and prevention efforts, to eliminate the threat of TB.
By partnering with private health care providers and other service and advocacy organizations, with a focus to improve the health and well being of those disproportionately impacted by TB, we aim to increase routine screening for TB risks, testing of those with a risk for TB, and treating those with latent TB infection (LTBI) before TB disease threatens their life and the lives of their families and friends.
TB Risk + Positive TB Test = Treatment to prevent TB disease.
TB is an old and enduring life-threatening bacterium, killing 10% of those TB makes sick. We have effective treatments, however, we are challenged by the current reactive nature of public health TB control and prevention efforts. True prevention requires finding and treating of those who are infected with TB before they are sick with TB disease to prevent illness. To do this, we need partners working to improve health outside of public health departments, statewide.
Together, we can eliminate the threat of TB and create a TB-free California for all.
Find outmode and join the Coalition for a TB-free California.
In January 2021, the CTCA Communications Committee (CC) Co-Chairs decided to launch a monthly journal club that takes place the hour before CC meetings. The journal club provides members with an opportunity to read the latest relevant publications for TB CC efforts. The initial meeting focused on the publication:
Shining a light on an invisible, dormant threat, Insights for developing a communications campaign to encourage testing and treatment of Latent Tuberculosis Infection, Fall 2020.
This report on latent TB infection (LTBI) messaging research, conducted among groups most impacted by TB in the U.S., is the first of its kind supported and released by the Centers for Disease Control and Prevention Division of TB Elimination. This report presented themes to explore further when raising awareness of the threat of TB disease, the risks for having LTBI and the ability to treat LTBI to prevent TB disease from developing.
José Rangel-Garibay, a Health Educator with the Los Angeles Department of Public Health and the mastermind of the CTCA CC Journal Club, led the next discussion about two brief articles: Public Health Messaging in an Era of Social Media and Evaluating the Potential Role of Social Media in Preventative Health Care. He demonstrated best practices for facilitating these discussions by selecting 2-5 pages to discuss, summarizing the articles, sharing their methods, target audience(s), findings/results, their limitations, potential applications for this group and any next steps. He further instructed that ideally articles would be distributed, and a volunteer facilitator secured, two weeks in advance of each meeting. Below is a list of the past articles used for the CC Journal Club:
Join the Journal Club through the Contact Us link below.
At the 2020 Fall TB Controllers Meeting in November, we briefly presented California requirements for Health Care Personnel (HCP) TB Screening and COVID-19 emergency response changes to these requirements.
Licensing and Certification and CalOSHA require routine TB screening of Health Care Personnel in California. Both have temporarily relaxed routine TB testing requirements to minimize potential exposure to COVID-19 during the extended emergency response. Our Health Care Personnel TB Screening resource page, located under “Guidance” on ctca.org, links to these posted changes. Though temporary, we hope that we can move into agreement with national guidance here in CA. The data proves this is the way to progress TB elimination efforts and protect HCP, working on the frontlines. It may be counter intuitive, but data show, routine testing does not provide any protection for HCP. Assessing risk, testing those at risk and treating TB infection provides HCP protection.
The Centers for Disease Control recommends risk-based testing of HCPl, based on specific job duties and a facility risk. CTCA waited a decade to endorse this change, after looking at HCP TB data. CTCA now enthusiastically endorses and promotes:
- TB testing at hire. IGRA for those with BCG history.
- If positive TB test plus risk for TB, and TB disease is ruled out, recommend treating for latent TB infection to prevent the development of TB disease.
Health Care Personnel TB Screening Information:
Planning for the 2020 CTCA Conference began in Fall 2019. Volunteer Planning Committee members created a full-day agenda with including new information to share with the TB public health workforce in May 2020. As conference planning progressed and then wrapped, TB program leaders were preparing for the potential impact of COVID-19. With a nationwide stay-at-home order and social distancing guidelines put in place, the conference went from postponed to the Fall in Palm Springs to an abbreviated and completely virtual event.
Two of the three plenary sessions were presented to more than 150 TB Control staff over two hours on November 12th via Zoom. Dr. Jennifer Flood, Chief of the California Department of Public Health TB Control Branch presented the 2019 California TB data, highlighting epidemiologic changes and recommending areas of focus to address the disparate impact of TB in the year ahead. And Dr. Jacek Skarbinski of Kaiser Permanente, Northern California, presented his Kaiser TB care cascade study and plan to increase IGRA testing and treatment of latent TB infection (LTBI) to prevent TB disease in their patient subpopulations at risk for developing TB disease.
We are grateful for our two presenters who gave our community the opportunity to focus on TB and the strides being made toward TB elimination in California, all during the extended COVID-19 response.
Less than a week later, more than 100 attendees gathered for the Fall 2020 TB Controllers Meeting, which was also held for two hours on Zoom. The meeting focused on COVID-19 innovations in public health and how to leverage these advancements for TB elimination efforts after the COVID-19 emergency response concludes.
Report on Tuberculosis in California, 2019
TB Patient Peer Support Navigator, Jackie (she/her), will pilot a peer support outreach effort for CTCA in partnership with the San Diego County Tuberculosis Control and Refugee Health Program. An expert in her own experience with TB and fluent in Spanish and English, Jackie is eager to offer support to TB patients.
Jackie joined the San Diego TB Survivor group in 2019 and was excited to see how she could get more involved. She was introduced to, and joined, We Are TB, a national volunteer membership organization made up of former and current TB patients and their family members, working together to offer peer support to TB patients and provide education to the general public and policy leaders about the ongoing impact of TB in the U.S.
Unfortunately, most Americans believe that tuberculosis (TB) is a disease of the past. Each year, approximately 2,000 Californians and 10,000 in the U.S. are diagnosed with TB. In California 2.5 million are estimated to be living with TB infection, the latent (inactive) form of TB. At any point, TB infection can make a person sick and be contagious, a threat to family and friends. Educating medical providers and community members with risks for TB that TB is a dangerous threat in the U.S. is an ongoing challenge.
Jackie will provide peer support or connect those seeking support with We Are TB volunteers with similar TB experiences, if preferred. For example, parents of children diagnosed with TB or women diagnosed while pregnant, may prefer support from someone with a similar experience with TB. In addition to offering peer support, she provides an important perspective to TB elimination planning and can educate the public about the impact and persistence of TB in California.
Learn more from Jackie about her TB journey. Watch her video featured on our Peer Support page.
The CTCA Executive Committee’s top priority this year is to provide the CA public health TB care and prevention community opportunities to come together to focus on TB and have an opportunity to connect with one another during this extended emergency COVID-19 response.
On November 12th (1-3 PM PST) we’ll share two hours from our planned 2020 Spring Conference opening plenary session: Our state TB epidemiology update, California, TB Elimination Landscape, presented by leaders from the California Department of Public Health TB Control Branch, followed by an innovative TB elimination strategy presented by Jacek Skarbinski, MD, at Kaiser Permanente, Northern California, Moving TB prevention cascade forward in a large primary care setting.
Two hours of CMEs/CEUs will be available for those who attend the full program on November 12th and complete the evaluation that will be emailed to those registered by 11/6/20. This evaluation must be completed by 11/27.
We are excited to come together and focus on TB during this ongoing COVID-19 response. We hope you will be able to join us. Again, there is no cost to attend either of these meetings, and all are welcome. You must pre-register. The deadline for registration is 11/6/20.
Presentations and recordings from previous CTCA conferences can be found on our Events Archives page linked here.
Tuberculosis (TB) and COVID-19, a growing concern, July 28, 2020
While we focus on the new threat, an old one may be gaining strength. With medical providers focusing on COVID-19 and patients delaying care, infectious disease experts in California are concerned that TB is going undiagnosed. Concerns are growing that TB could be spreading among those with COVID-19, undetected. When HIV/AIDS emerged in the U.S., TB surged in those communities heavily impacted.
TB has been with us for over 9,000 years, and it is estimated that one third of the world’s population is living with latent TB infection (LTBI). Approximately 2.4 million Californians are currently living with LTBI. People can live with LTBI for years, even decades before developing TB disease.
LTBI is not contagious and is much easier to treat than TB disease. Treating LTBI before people get sick with TB disease and spread TB in their communities is a new focus of TB experts in the U.S.
Each year more than 2,000 people are diagnosed with TB disease in California. TB disease is both preventable and curable, and yet people still die with TB. Approximately 10% of people with TB disease in California, died with TB.
Dr. Robert Benjamin, longtime CTCA member and dedicated TB MD in California, suggested a new slogan for TB care and prevention staff in public health departments, now focusing on COVID-19: Not All Coughs Are COVID. We want to urge the medical community and the general public to remember that one third of the world’s population is infected with TB, and Not All Coughs Are COVID.
Know the risks for TB. If you have one, contact your medical provider to be tested. If you have a positive TB test, talk with your medical provider about taking a short course drug treatment to prevent TB disease. You are not just protecting yourself, you are protecting the future of your family and those around you.
We can’t forget about TB. It doesn’t forget about us.