COMMENTARY

What Do We Know About TB in the United States Today?

John G. Bartlett, MD

Disclosures

September 01, 2009

Although newly diagnosed tuberculosis (TB) in the United States is at the lowest level since recording started in 1953, risk factors can help practitioners guide their TB testing efforts. This viewpoint discusses an epidemiologic report from the Centers for Disease Control and Prevention (CDC) summarizing incident TB cases for 2008 in the United States.

Trends in Tuberculosis -- United States, 2008

Pratt R, Robinson V, Navin T, et al
MMWR. 2009;58:249-253

Article Summary

This is the CDC report for tuberculosis in the United States for 2008. Results showed a total of 12,898 incident cases for 2008, a total of 4.2 cases/100,000. This represents the lowest recorded rate since national recording began in 1953. It also represents a rate decline of 3.8% compared to 2007. The following observations are components of this CDC report:

  • The rate of TB was 10 times greater in foreign-born persons compared to US-born persons. Foreign-born persons accounted for 59% of all cases;

  • TB rates in Hispanics and blacks were about 8 times higher than those in whites and rates in Asians were nearly 23 times higher;

  • Four countries accounted for 50% of foreign-born cases: Mexico, Philippines, India, and Vietnam;

  • Of the 7652 TB cases with known HIV serologic tests, 802 (10.5%) had this infection;

  • There were 125 cases of multiple-drug-resistant TB in 2007 accounting for 1.2% of the 10,190 with sensitivity tested; this is similar to the data for 2006;

  • Extremely drug-resistant TB was reported with 4 cases in 2008 compared to 2 in 2007 and 4 in 2006; and

  • Data for completion of the 6 to 9 months of recommended treatment is available for 2005 and showed completion of treatment in 83%.

Viewpoint

Although everyone is potentially at risk for tuberculosis, some individuals are at substantially increased risk. TB rates in Asians are 23 times higher and in Hispanics and blacks 8 times higher than in whites. Having been born in a foreign country accounted for most (59%) of the all cases reported, and those born in Mexico, the Philippines, India, and Vietnam accounted for about a third of all cases. The rate of TB in HIV-infected individuals is estimated to be over 10%. Multiple-drug-resistant TB and extremely drug-resistant TB remain near 2006 levels. Finally, completion rates for recommended TB therapy are not 100%.

Abstract

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