2018 Contact Investigations Report (ARPE Data)

Table of Contents

Appendix A. Counts and Indices for Investigation of Sputum AFB Smear-Positive TB Cases, 2014-2018

Table 1: Counts of Smear-Positive Cases and Contacts

Table 2: Reasons Contacts Stopped LTBI Treatment, Smear-Positive Cases

Table 3: Contact Investigation Evaluation Indices, Smear-Positive Cases

Figures

  1. National Objective: Increase the proportion of TB patients with positive acid-fast bacillus (AFB) sputum-smear results who have contacts elicited to 100.0% by 2025.
  2. National Objective: Increase the proportion of contacts to sputum AFB smear-positive TB cases who are examined for infection and disease to 94.0% by 2025
  3. National Objective: Increase the proportion of contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection (LTBI) who start treatment to 92.0% by 2025
  4. National Objective: For contacts to sputum AFB smear-positive TB cases who have started treatment for LTBI, increase the proportion who complete treatment to 93.0% by 2025
  5. Number of contacts to AFB smear-positive TB cases
  6. Treatment outcomes for contacts diagnosed with LTBI

Appendix B. Counts and Indices for Investigation of Sputum AFB Smear-Negative, Culture-Positive TB Cases, 2014-2018

Table 4: Counts of Smear-Negative, Culture-Positive Cases and Contacts

Table 5: Reasons Contacts Stopped LTBI Treatment – Smear-Negative, Culture-Positive Cases

Table 6: Contact Investigation Evaluation Indices – Smear-Negative, Culture-Positive Cases

Appendix C. Counts and Indices for Investigation of Other* Cases, 2014-2018

Table 7: Counts of Contacts, Other Cases

Table 8: Reasons Contacts Stopped Treatment for LTBI, Other Cases

Table 9: Contact Investigation Evaluation Indices, Other Cases

Appendix A. Counts and Indices for Investigation of Sputum AFB Smear-Positive TB Cases, 2014-20181

Table 1: Counts of Smear-Positive Cases and Contacts

Cases and Contacts 2014 2015 2016 2017 2018
Cases for investigation 3,652 3,714 3,477 3,297 3,254
Cases, no contacts 228 227 188 194 183
Number contacts 65,590 64,509 59,721 51,695 53,271
Evaluated 53,220 51,294 47,361 43,110 42,673
TB disease 406 387 339 395 328
Latent TB infection 8,897 8,126 7,166 6,450 5,610
Started treatment 6,436 5,904 5,242 5,068 4,339
Completed treatment 4,813 4,468 4,131 4,019 3,397
Unknown/Missing 353 302 238 187 394

Table 2: Reasons Contacts Stopped LTBI Treatment, Smear-Positive Cases

Reason 2014 2015 2016 2017 2018
Contacts stopping treatment (n) 1270 1134 873 862 548
Death 7 (1%) 6 (1%) 5 (1%) 6 (1%) 4 (1%)
Contact moved 105 (8%) 77 (7%) 62 (7%) 64 (7%) 38 (7%)
Active TB developed 25 (2%) 14 (1%) 17 (2%) 7 (1%) 4 (1%)
Adverse effect of medication 99 (8%) 107 (9%) 103 (12%) 52 (6%) 44 (8%)
Contact chose to stop 509 (40%) 444 (39%) 335 (38%) 283 (33%) 245 (45%)
Contact is lost to follow-up 451 (36%) 418 (37%) 291 (33%) 391 (45%) 161 (29%)
Provider decision 74 (6%) 68 (6%) 60 (7%) 59 (7%) 52 (9%)

Table 3: Contact Investigation Evaluation Indices, Smear-Positive Cases

Evaluation Indices (%) 2014 2015 2016 2017 2018
Contact Elicitation (%) 93.8% 93.9% 94.6% 94.1% 94.4%
Contacts Per Case (N, Average) 18.0 17.4 17.2 15.7 16.4
Contact Evaluation (%) 81.1% 79.5% 79.3% 83.4% 80.1%
TB Disease (%) 0.8% 0.8% 0.7% 0.9% 0.8%
Latent TB Infection (%) 16.7% 15.8% 15.1% 15.0% 13.1%
LTBI Treatment Initiated (%) 72.3% 72.7% 73.2% 78.6% 77.3%
LTBI Treatment Completed (%) 74.8% 75.7% 78.8% 79.3% 78.3%

1 Reporting jurisdictions: 50 U.S. states, Washington D.C., Puerto Rico and eight large city jurisdictions (Los Angeles, CA, San Francisco, CA, San Diego, CA, Chicago, IL, Baltimore, MD, New York City, NY, Philadelphia, PA, Houston, TX). Data shown in tables and figures is up to date as of 10 Dec 2020. Missouri did not report in 2017 and 2018, and Kansas did not report in 2016 -2018. Iowa, Nebraska, and Virgin Islands did not report in 2018.

Figures

1. National Objective: Increase the proportion of TB patients with positive acid-fast bacillus (AFB) sputum-smear results who have contacts elicited to 100.0% by 2025.

Objective: Increase the proportion of TB patients with positive acid-fast bacillus (AFB) sputum-smear results who have contacts elicited to 100.0% by 2025.

Indicator: Percent of sputum AFB smear-positive TB cases with contacts elicited

Cohort: Sputum AFB smear-positive TB cases counted in the cohort period of interest. Records with missing or incomplete data where exclusion criteria cannot be assessed are included in the analytic cohort.

Data Sources: ARPEs (Contacts) fields, a1 (Sputum smear+ Cases for Investigation), b1 (Sputum smear+ Cases with No Contacts).

Sputum AFB smear-positive TB Cases with contacts elicited = Number of sputum AFB smear-positive TB cases for investigation – Number of sputum AFB smear-positive TB cases with no contacts.

Calculation: [(Number of sputum AFB smear-positive TB cases with contacts elicited) / Cohort] x 100

2. National Objective: Increase the proportion of contacts to sputum AFB smear-positive TB cases who are examined for infection and disease to 94.0% by 2025.

Objective: Increase the proportion of contacts to sputum AFB smear-positive TB cases who are examined for infection and disease to 94.0% by 2025.

Contacts are counted as evaluated if they have been tested and examined to the point where a final determination of diagnosis is either latent TB infection or TB disease.

Indicator: Percent of contacts to sputum AFB smear-positive TB cases examined for infection and disease

Cohort: Contacts to sputum AFB smear-positive TB cases counted in the cohort period of interest. Records with missing or incomplete data where exclusion criteria cannot be assessed are included in the analytic cohort.

Data Sources: ARPEs (Contacts) fields, c1 (Number of Contacts to Sputum smear+ Cases), d1 (Contacts to Sputum smear+ Cases Evaluated).

Calculation: [Number of contacts to sputum AFB smear-positive TB cases evaluated / Cohort] x 100

3. National Objective: Increase the proportion of contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection (LTBI) who start treatment to 92.0% by 2025.

Objective: Increase the proportion of contacts to sputum acid-fast bacillus (AFB) smear-positive TB cases diagnosed with latent TB infection (LTBI) who start treatment to 92.0% by 2025.

Indicator: Percent of contacts to sputum AFB smear-positive TB cases diagnosed with LTBI who started treatment NOTE: Contacts are counted as having started treatment after taking the first dose of a treatment course.

Cohort: Contacts to sputum AFB smear-positive TB cases who have newly diagnosed LTBI, counted in the cohort period of interest. Records with missing or incomplete data where exclusion criteria cannot be assessed are included in the analytic cohort.

Data Sources: ARPEs (Contacts) fields, f1 (Contacts to Sputum smear+ Cases with Latent TB Infection), g1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Started Treatment).

Calculation: [Number of contacts diagnosed with LTBI who started treatment / Cohort] x 100

4. National Objective: For contacts to sputum AFB smear-positive TB cases who have started treatment for LTBI, increase the proportion who complete treatment to 93.0% by 2025.

Objective: For contacts to sputum AFB smear-positive TB cases who have started treatment for LTBI, increase the proportion who complete treatment to 93.0% by 2025.

Indicator: Percent of contacts to sputum AFB smear-positive TB cases who completed treatment

Cohort: Contacts to sputum AFB smear-positive TB cases with newly diagnosed LTBI and have started treatment, counted in the cohort period of interest. Records with missing or incomplete data where exclusion criteria cannot be assessed are included in the analytic cohort.

Data Sources: ARPEs (Contacts) fields, g1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Started Treatment), h1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Completed Treatment).

Calculation: [Number of contacts diagnosed with LTBI who completed treatment / Cohort] x 100

5. Number of contacts to AFB smear-positive TB cases

Number of Contacts to Sputum Acid-Fast Bacillus (AFB) Smear-Positive TB Cases, by Examination and Treatment Disposition, United States 2018

6. Treatment outcomes for contacts diagnosed with LTBI

Treatment Outcomes for Contacts to Sputum Acid-Fast Bacillus Smear-Positive TB Cases Diagnosed with Latent TB Infection (LTBI), United States 2018

Appendix B. Counts and Indices for Investigation of Sputum AFB Smear-Negative, Culture-Positive TB Cases, 2014-2018

Table 4: Counts of Smear-Negative, Culture-Positive Cases and Contacts

Cases and Contacts 2014 2015 2016 2017 2018
Cases, no contacts 245 260 401 255 243
Number contacts 14,847 17,680 13,914 12,659 11,501
    Evaluated 12,393 13,235 11,460 10,707 9,465
    TB disease 65 78 60 66 67
    Latent TB infection 1,683 1,609 1,493 1,169 1,191
      Started treatment 1,088 1,015 965 834 877
      Completed treatment 783 737 765 664 677
      Unknown/Missing 66 74 4 34 37

Table 5: Reasons Contacts Stopped LTBI Treatment – Smear-Negative, Culture-Positive Cases

Reason 2014 2015 2016 2017 2018
Contacts stopping treatment (n) 239 204 196 136 162
Death 3 (1%) 0 (0%) 2 (1%) 1 (<1) 2 (1%)
Contact moved 21 (9%) 17 (8%) 20 (10%) 15 (11%) 8 (5%)
Active TB developed 1 (<1%) 1 (<1%) 1 (1%) 1 (<1%) 4 (2%)
Adverse effect of medication 22 (9%) 19 (9%) 22 (11%) 16 (12%) 17 (10%)
Contact chose to stop 108 (45%) 101 (50%) 79(40%) 43 (32%) 68 (42%)
Contact is lost to follow-up 66 (28%) 57 (28%) 50 (26%) 45 (33%) 50 (31%)
Provider decision 18 (8%) 9 (4%) 22 (11%) 15 (11%) 13 (8%)

Table 6: Contact Investigation Evaluation Indices – Smear-Negative, Culture-Positive Cases

Evaluation Indices (%) 2014 2015 2016 2017 2018
Contact Elicitation (%) 86.3% 85.9% 79.2% 85.2% 86.1%
Contacts Per Case (N, Average) 8.3 9.6 7.2 7.4 6.6
Contact Evaluation (%) 83.5% 74.9% 82.4% 84.6% 82.3%
TB Disease (%) 0.5% 0.6% 0.5% 0.6% 0.7%
Latent TB Infection (%) 13.6% 12.2% 13.0% 10.9% 12.6%
LTBI Treatment Initiated (%) 65.0% 63.1% 64.6% 71.3% 73.6%
LTBI Treatment Completed (%) 71.9% 72.6% 79.3% 79.6% 77.2%

1 Reporting jurisdictions: 50 U.S. states, Washington D.C., Puerto Rico and eight large city jurisdictions (Los Angeles, CA, San Francisco, CA, San Diego, CA, Chicago, IL, Baltimore, MD, New York City, NY, Philadelphia, PA, Houston, TX). Data shown in tables and figures is up to date as of 10 Dec 2020. Missouri did not report in 2017 and 2018, and Kansas did not report in 2016 -2018. Iowa, Nebraska, and Virgin Islands did not report in 2018.

Appendix C. Counts and Indices for Investigation of Other* Cases, 2014-2018

* Others = Contact investigations not captured in investigating sputum AFB smear-positive or sputum AFB smear-negative\culture-positive. For example: Associate-contact or source-case investigations done because of a child with TB.

Table 7: Counts of Contacts, Other Cases

Contacts 2014 2015 2016 2017 2018
Number contacts 9,824 11,753 8,119 10,028 11,317
Evaluated 8,435 9,879 6,648 8,591 10,000
TB disease 67 33 52 76 60
Latent TB infection 1,242 1,168 847 1,074 1,022
Started treatment 863 789 587 824 826
Completed treatment 643 604 454 674 675
Unknown/Missing 5 36 17 71 87

Table 8: Reasons Contacts Stopped Treatment for LTBI, Other Cases

Reason 2014 2015 2016 2017 2018
Contacts stopping treatment (n) 215 149 116 79 64
Death 3 (1%) 1 (1%) 0 (0%) 0 (0%) 1 (2%)
Contact moved 15 (7%) 11 (7%) 18 (16%) 8 (10%) 4 (6%)
Active TB developed 2 (1%) 0 (0%) 3 (3%) 4 (5%) 1 (2%)
Adverse effect of medication 20 (9%) 11 (7%) 11 (10%) 5 (6%) 8 (13%)
Contact chose to stop 96 (45%) 58 (39%) 46 (40%) 31 (39%) 18 (28%)
Contact is lost to follow-up 60 (28%) 55 (37%) 27 (23%) 26 (33%) 26 (40%)
Provider decision 19 (9%) 13 (9%) 11 (10%) 5 (6%) 6 (9%)

Table 9: Contact Investigation Evaluation Indices, Other Cases

Evaluation Indices (%) 2014 2015 2016 2017 2018
Contact Evaluation (%) 85.9% 84.1% 81.9% 85.7% 88.4%
TB Disease (%) 0.8% 0.3% 0.8% 0.9% 0.6%
Latent TB Infection (%) 14.7% 11.8% 12.7% 12.5% 10.2%
LTBI Treatment Initiated (%) 69.5% 67.6% 69.3% 76.7% 80.8%
LTBI Treatment Completed (%) 74.5% 76.6% 77.3% 81.8% 81.7%