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Adopt and present a resolution recognizing March 24, 2022 as World Tuberculosis Day in Solano County (Chair Vasquez)
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Published Notice Required? Yes ___ No _X _
Public Hearing Required? Yes ___ No _ X_
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board of Supervisors adopt and present a resolution recognizing March 24, 2022 as World Tuberculosis Day in Solano County.
SUMMARY:
The World Health Organization (WHO) has declared March 24th of each year as World Tuberculosis (TB) Day to commemorate the day in 1882 when the tuberculosis bacterium was discovered and to raise public awareness about the continued health, social, and economic consequences of one of the world’s deadliest infectious diseases. Each day, more than 4,100 people lose their lives to TB and close to 28,000 people fall ill to this preventable and curable disease. Global efforts to combat TB have saved an estimated 66 million lives since the year 2000. However, the COVID-19 pandemic has reversed years of progress made in the fight to end TB. For the first time in over a decade, TB deaths increased in 2020. This resolution to recognize March 24, 2022, as World TB Day in Solano County will increase awareness about TB and help decrease the spread of TB in the community through collaboration to further efforts to eliminate this preventable disease.
FINANCIAL IMPACT:
The costs associated with preparing this agenda item are nominal and are included in the department's FY2021/22 Adopted Budget. There is no additional impact to the County General Fund.
DISCUSSION:
Annually across the world, March 24th is recognized as World TB Day by the WHO. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium Tuberculosis, the bacillus that causes TB.
The purpose of World TB Day is to raise awareness about the burden of TB worldwide and the status of TB prevention and care efforts. It is also an opportunity to mobilize social and political commitment for further progress in efforts to end TB. The theme for World TB Day 2022, “Invest to End TB. Save Lives” conveys the urgent need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders. This is especially critical in the context of the COVID-19 pandemic that has put “End TB” progress at risk and reversed years of progress made in the fight to end TB. The WHO reports that “for the first time in over a decade, TB deaths increased [globally] in 2020.”
TB in Solano County & California-2020 Snapshot:
In 2020, California reported 1,704 new cases of infectious TB, a 19% decrease compared to 2,114 cases in 2019 and the biggest percent decrease since 1981; however, the TB case rate in California was 4.3 cases per 100,000 persons or nearly double the national case rate of 2.2 per 100,000 persons. Nationally, 7,174 TB cases were reported in 2020, a 19.4% decrease from 2019. Although the specific causes of the single year decline are unknown, it is likely that at least some of the decrease is related to the COVID-19 pandemic. For example, decreased detection of TB cases may have been due to fewer patients seeking care during the pandemic. Also, due to travel restrictions during the pandemic the opportunity to spread TB during travel was reduced. Finally, TB transmission may have been reduced due to masking and reduced movement outside of households.
In 2020, Solano County’s Tuberculosis (TB) Control Program saw a similar decline in TB cases; twenty-eight (28) cases of active TB disease were reported, amounting to a TB case rate of 6.4 cases per 100,000. Despite the decrease, this case rate was nearly three times the national rate and double the State rate, and Solano County’s TB case rate ranked fifth highest of all local health jurisdictions in California. Local data indicate a persistent decline in case reports and a 41.9% decline in reported cases during the past two years of the pandemic. Anecdotally, cases reported to the Solano TB Control Program in 2020/21 have tended to be diagnosed later in the course of their illness and found incidentally while the patient was undergoing work-up for another disease.
The most recent State-level data on deaths attributable to TB is from 2018. During the 2016-2018 period, 661 persons (11% of TB cases) in California died with TB. Of those, 20% died before receiving treatment. More recent data have not been verified. Solano County identified two deaths attributable to TB in 2020 and three in 2021.
Medical and societal costs of TB reached $180 million in California in 2020. The vast majority of TB cases (85%) were attributable to progression of Latent TB Infection (LTBI) to active TB while an estimated 5% of cases were in persons who arrived in California with active TB disease from outside the United States, and another 10% resulted from recent transmission.
TB can be prevented with LTBI treatment:
More than two million Californians (6% of the population) are believed to have LTBI. Without treatment, LTBI can progress to active TB.
• Most people with LTBI are not aware they have it and have not been treated.
• Most TB cases continue to occur disproportionately among racial and ethnic groups.
• Forty percent (40%) of adult TB cases had another chronic comorbidity; comorbidities such as diabetes mellitus, end stage renal disease, HIV infection, or another condition can increase the risk of progression from latent to active TB disease.
It is not yet known whether US, California, and Solano TB deaths in 2020 and 2021 will mirror the global picture. But it is well established that reduced access to TB diagnosis and treatment in the face of the COVID-19 pandemic contributed to the large decline in reported cases and delayed TB diagnoses locally.
The WHO calls out the need to step up investments in TB preventive treatment; to mobilize sufficient and sustainable financing efforts to end TB, noting that for every $1 invested, there is a return of $43; and to invest in TB research for better science, better tools, and better delivery of health care services. An investment to end TB will save millions of lives.
To eliminate TB disease, we must diagnose, treat, and prevent TB even as the response to COVID-19 continues, especially among groups at increased risk. Timely diagnosis of TB disease saves lives and prevents spread in Solano communities. The plan to eliminate TB calls for making TB prevention a routine part of medical care by finding and testing Californians who are at risk for TB, treatment of all identified cases of LTBI, and ensuring that patients, clinicians, and public health programs have the tools and resources needed to prevent TB disease and transmission.
World TB Day provides an opportunity to focus local, national, and international attention on TB infection and allows H&SS to renew its commitment to disseminate information and promote TB prevention and awareness. The Solano County TB Control Program commits to continued outreach to the Solano provider network to treat all TB-infected individuals, especially those at high-risk to progress to TB disease, and continued prevention education for Solano County residents, noting that “It’s time” to end TB in Solano County.
ALTERNATIVES:
The Board could choose not to adopt this resolution recognizing March 24, 2022, as World TB Day. This is not recommended because this resolution promotes increased awareness of the risk of TB to the Solano community and the need to keep TB in mind in the face of the pandemic.
OTHER AGENCY INVOLVEMENT:
The H&SS’s Communicable Disease Program works with health care providers locally and statewide to address TB cases in Solano County.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION