CDC Features - World TB Day 2012: Stop TB in My Lifetime

CDC Features - World TB Day 2012: Stop TB in My Lifetime

World TB Day 2012: Stop TB in My Lifetime

Each year, CDC and others recognize World TB Day on March 24. Tuberculosis (TB) is one of the world's deadliest diseases. Learn more about TB risk factors that can increase the chance of developing TB disease.

Tuberculosis, also called TB, is one of the world's deadliest diseases and has been affecting people for thousands of years. It's estimated that 2 billion people — one third of the people in the world — are infected with M. tuberculosis. Each year, nearly 9 million people in the world become sick with TB disease, and almost 1.5 million deaths are attributed to TB. While the number of TB cases in the United States has been declining since 1993, there remains a higher-than-normal burden of TB among racial and ethnic minorities. This is due to unequal distribution of TB risk factors that can increase the chance of developing the disease.

World TB Day

World TB Day is observed annually on March 24 to educate the public that TB remains a problem in much of the world, with much more needed to prevent, control, and eventually eliminate this devastating disease. This day provides an opportunity to raise awareness about TB-related problems and solutions, and to support worldwide TB-control efforts. This year, CDC is joining the global Stop TB Partnership in adopting the theme, "Stop TB in my lifetime." People are encouraged to imagine a world free of TB and to state what changes they expect in their lifetimes such as a better TB test, faster treatment, or no more TB deaths.

What CDC is Doing

Researchers in CDC's Division of Tuberculosis Elimination and their partners in the TB Trials Consortium are at the forefront of the research that is striving to make the world free of TB. They recently completed a 10-year study of an innovative preventive therapy regimen that will dramatically shorten treatment for persons with latent (inactive) TB infections. This course of preventive therapy is referred to as the 12-dose regimen and contains two very effective TB drugs, isoniazid and rifapentine. It is given once weekly for 12 weeks under directly observed therapy, which means that the swallowing of each dose of medicine is observed by a health worker.
The concept of TB preventive therapy involves treating people who are infected with TB but who are not clinically ill.  Doing so can prevent those infected persons from progressing to TB disease. Preventive therapy not only prevents disease and disability in that one person; it also prevents the spread of infection to others, some of whom would develop TB in the future and then spread the bacteria to their close contacts. We can only reach the goal of a world free of TB by working together to detect, treat, and prevent this disease. 

Working Together to Stop TB in our Lifetime

"This is not the time to be complacent about TB diagnosis and treatment. We need to maintain a clear vision of delivering same day diagnosis and treatment, if at all possible, and strive to eliminate TB in our lifetime" (Dr. Kenneth Castro, Director, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention)

What Can You Do?

• Learn more about TB. Local and state coalitions are convening educational and awareness activities related to World TB Day to raise awareness of this deadly disease. Check out the activities and get involved.
  • World TB Day 2012 — Activities
• Promote World TB Day. Send a World TB Day e-card or add a World TB Day button to your Web site to increase awareness of this important day.

Until TB is eliminated, World TB Day won't be a celebration. But it is a valuable opportunity to educate the public about the devastation of TB and how it can be stopped.

 

More Information

World TB Day Resources

• CDC World TB Day
• CDC World TB Day Resources
• History of World TB Day
• TB Elimination: Now is the Time!
• Stop TB in My Lifetime: A Call for a World Free of TB - World TB Day 2012 Podcast
• Forging Partnerships to Eliminate Tuberculosis
• Global Stop TB Partnership – World TB Day

Additional Information About TB

• CDC Questions and Answers about TB
• Tuberculosis: General Information
• Basic Tuberculosis Facts Podcast
• List of State TB Control Offices
• Surveillance Data

State TB Control Offices

(PDF  - 300k)

ALABAMA Alabama Department of Public Health RSA Tower, Suite 1450 201 Monroe Street Montgomery, AL 36130-3017 Tel: 334-206-5330 Fax: 334-206-5931 ALASKA Alaska Department of Health & Social Services 3601 “C” Street, Suite 540 Anchorage, AK 99503-5949 Tel: 907-269-8000 Fax: 907-562-7802 ARIZONA Arizona Department of Health Services 150 North 18th Avenue Phoenix, AZ 85007-3237 Tel: 602-364-4750 Fax: 602-364-3267 ARKANSAS Arkansas Department of Health 4815 West Markham St. Slot 45 Little Rock, AR 72203 Tel: 501-661-2152 Fax: 501-661-2759 CALIFORNIA California Department of Public Health 850 Marina Bay Parkway Building P, 2nd Floor Richmond, CA 94804-6403 Tel: 510-620-3000 Fax: 510-620-3034 COLORADO Colorado Department of Public Health & Environment TB Program 4300 Cherry Creek Drive South Denver, CO 80246-1530 Tel: 303-692-2638 Fax: 303-759-5538 CONNECTICUT Connecticut Department of Public Health 410 Capitol Avenue, MS-11TUB Hartford, CT 06134 Tel: 860-509-7722 Fax: 860-509-7743 DISTRICT of COLUMBIA District of Columbia Department of Health 1900 Massachusetts Ave SE Bldg. 15 Washington, D.C. 20003 Tel: 202-698-4040 Fax: 202-724-2363 DELAWARE Delaware Department of Health & Social Services TB Control Program Thomas Collins Bldg, Suite 12, D620P 540 S. Dupont Hwy Dover, DE 19901 Tel: 302-744-1050 Fax: 302-739-2548 FLORIDA Florida Department of Health 4052 Bald Cypress Way, BIN #A20 Prather Building, Room 240-N Tallahassee, FL 32399-1717 Tel: 850-245-4350 Fax: 850-921-9906 GEORGIA Georgia Department of Public Health Tuberculosis Program 2 Peachtree St., NW, Suite 12-493 Atlanta, GA 30303-2588 Tel: 404-657-2634 Fax: 404 463-3460 HAWAII Hawaii Department of Health 1700 Lanakila Avenue Honolulu, HI 96817-2199 Tel: 808-832-5737 Fax: 808-832-5846 IDAHO Idaho Department of Health & Welfare 450 West State Street, 4th Floor Boise, ID 83720-0036 Tel: 208-334-5939 Fax: 208-332-7307 ILLINOIS Illinois Department of Public Health 525 West Jefferson Street, 1st Floor Springfield, IL 62761-0001 Tel: 217-785-5371 Fax: 217-524-4515 INDIANA Indiana Department of Health 2 North Meridian Street, 6th Floor Indianapolis, IN 46204 Tel: 317-233-7545 Fax: 317-233-7747 IOWA Iowa Department of Public Health Lucas State Office Building 321 East 12th Street Des Moines, IA 50319-0075 Tel: 515-281-7504 Fax: 515-281-4570 KANSAS Kansas Department of Health & Environment 1000 Southwest Jackson Street Suite 210 Topeka, KS 66612 Tel: 785-296-8893 Fax: 785-291-3732 KENTUCKY Kentucky Department for Public Health 275 East Main Street Frankfort, KY 40621 Tel: 502-564-7243 Fax: 502-564-0542 LOUISIANA Louisiana Department of Health & Hospitals Office of Public Health – TB Control 1010 Common Street, Suite 1134 New Orleans, LA 70112 Tel: 504-568-5015 Fax: 504-568-5016 MAINE Maine Department of Human Services 286 Water Streeet, 8th Floor SHS #1 Augusta, Maine 04333 Tel: 207-287-5194 Fax: 1-800-293-7534 MARYLAND Maryland Department of Health 500 North Calver Street, 5th Floor Baltimore, MD 21202 Tel: 410-767-6698 Fax: 410-383-1762 MASSACHUSETTS Massachusetts Department of Public Health 305 South Street Boston, MA 02130-3515 Tel: 617-983-6970 Fax: 617-983-6990 MICHIGAN Michigan Department of Community Health Capitol View Building 201 Townsend Street, 5th Floor Lansing, MI 48913 Tel: 517-335-8165 Fax: 517-335-8263 MINNESOTA Minnesota Department of Health Freeman Office Building 625 N. Robert St. (street address) P.O. Box 64975 (mailing address) St. Paul, MN 55164-0975 Tel: 651-201-5414 Fax: 651-201-5500 MISSISSIPPI Mississippi State Department of Health P.O. Box 1700 Jackson, MS 39215-1700 Tel: 601-576-7700 Fax: 601-576-7520 MISSOURI Missouri Department of Health 930 Wildwood Drive Jefferson City, MO 65109 Tel: 573-751-6113 Fax: 573-526-0235 MONTANA Montana Department of Public Health and Human Services Cogswell Building, Room C216 1400 Broadway Avenue Helena, MT 59620 Tel: 406-444-0275 Fax: 406-444-0272 NEBRASKA Nebraska Department of Health & Human Services 301 Centennial Mall South, 3rd Floor Lincoln, NE 68509 Tel: 402-471-2937 Fax: 402-471-3601 NEVADA Nevada State Health Division, Tuberculosis Program Bureau of Health Statistics, Planning and Emergency Response Office of Epidemiology 4150 Technology Way, Suite 201 Carson City, NV 89706 Phone: 775-684-5982 Fax: 775-684-5999 NEW HAMPSHIRE New Hampshire Department of Health & Human Services Health & Welfare Building 29 Hazen Drive Concord NH 03301-6504 Tel: 603-271-4496 Fax: 603-271-0545

NEW JERSEY New Jersey Department of Health and Senior Services 135 East State Street, 1st Floor P.O. Box 369 Trenton, NJ 08625-0369 Tel: 609-826-4878 Fax: 609-826-4879 NEW MEXICO New Mexico Department of Health 1190 Saint Francis Drive, Room S1150 Santa Fe, NM 87502 Tel: 505-827-2471 Fax: 505-827-0163 NEW YORK New York State Department of Health Empire State Plaza Corning Tower, Room 840 Albany, NY 12237-0669 Tel: 518-474-7000 Fax: 518-473-6164 NORTH CAROLINA North Carolina Department of Health & Human Services 1200 Front Street, Suite 101 Raleigh, NC 27609 Tel: 919-733-7286 Fax: 919-733-0084 NORTH DAKOTA North Dakota Department of Health State Capitol 600 East Boulevard, Dept. 301 Bismarck, ND 58505-0200 Tel: 701-328-2377 Fax: 701-328-2499 OHIO Ohio Department of Health Bureau of Infectious Disease and Control 35 E. Chestnut St., 7th floor Columbus, OH 43215 Tel: 614-466-2381 Fax: 614-387-2132 OKLAHOMA Oklahoma State Department of Health 1000 NE 10th Street, Room 608 Oklahoma City, OK 73117-1299 Tel: 405-271-4060 Fax: 405-271-6680 OREGON Oregon Public Health Division 800 NE Oregon, Suite 1105 Portland, OR 97232 Tel: 971-673-0174 Fax: 971-673-0178 PENNSYLVANIA Pennsylvania Department of Health TB Control Program Health and Welfare Building, Room 1013 625 and Forester Street Harrisburg, PA 17120 Tel: 717-787-6267 Fax: 717-772-4309 RHODE ISLAND Rhode Island Department of Health 3 Capitol Hill, Room 106 Providence, RI 02908 Tel: 401-222-2577 Fax: 401-222-2488 SOUTH CAROLINA South Carolina Department of Health and Environmental Control Mills/Jarrett Complex, Box 101106 1751 Calhoun Street Columbia, SC 29201 Tel: 803-898-0558 Fax: 803-898–0685 SOUTH DAKOTA South Dakota Department of Health 615 East 4th Street Pierre, SD 57501 Tel: 605-773-4784 Fax: 605-773-5509 TENNESSEE Tennessee Department of Health Cordell Hull Building, 1st Floor 425 5th Avenue North Nashville, TN 37243-0001 Tel: 615-741-7247 Fax: 615-253-1370 TEXAS Texas Department of State Health Services 1100 West 49th Street Austin, TX 78756 Tel: 512-458-7455 Fax: 512-458-7601 UTAH Utah Department of Health, TB Control and Bureau of Epidemiology Box 142105 Salt Lake City, UT 84114-2105 Tel: 801-538-6191 Fax: 801-538-9913 VERMONT Vermont Department of Health PO Box 70 Drawer 41 108 Cherry Street Burlington, VT 05401 Tel: 802-863-7245 Fax: 802-863-9962 VIRGINIA Virginia Department of Health 109 Governor Street, 3rd floor Richmond, VA 23219 Tel: 804-864-7906 Fax: 804-371-0248 WASHINGTON Washington State Department of Health 111 Israel Rd, S.E. PO Box 47837 Olympia, WA 98504-7837 Tel: 360-236-3447 Fax: 360-236-3405 WEST VIRGINIA West Virginia Department of Health & Human Resources TB Control Program, Room 125 350 Capitol Street Charleston, WV 25301-1417 Tel: 304-558-3669 Fax: 304-558-1825 WISCONSIN Wisconsin Department of Health & Family Services 1 West Wilson Street, Room 318 Madison, WI 53702 Tel: 608-261-6319 Fax: 608-266-0049 WYOMING Wyoming Department of Health Qwest Building, Suite 510 6101 Yellowstone Road Cheyenne, WY 82002 Tel: 307-777-5658 Fax: 307-777-5402 or 777-5573 TERRITORIES AMERICAN SAMOA Department of Health American Samoa Government Department of Health LBJ Tropical Medical Center P.O. Box F Pago Pago, AS 96799 Tel: 011-684-633-4690 Fax: 011-684-633-5692 FEDERATED STATES OF MICRONESIA Department of Health, Education & Social Affairs Federated States of Micronesia P.O. Box PS-70 Kolonia, Pohnpei, FM 96941 Tel: 011-691-320-2619 Fax: 011-691-320-8382 GUAM Department of Public Health & Social Services National TB Control Program 123 Chalan Kareta, Route 10 Manqilao, GU 96910-2816 Tel: 011-671-735-7145, 7157, or 7131 Fax: 011-671-735-7318 NORTHERN MARIANA ISLANDS CNMI TB Control Program Department of Public Health & Commonwealth Health Center P.O. Box 500409 CK Saipan, MP 96950-0409 Tel: 011-670-236-8376 or 8377 Fax: 011-670-236-8736 PUERTO RICO Puerto Rico Department of Health P.O. Box 70184 San Juan, PR 00936 Tel: 787-274-5553 Fax: 787-274-5554 REPUBLIC OF MARSHALL ISLANDS National TB Control Program Ministry of Health P.O. Box 16 Majuro Hospital Majuro, MH 96960-0016 Tel: 011-692-625-0074 or 7321 Fax: 011-692-625-4372 or 4543 REPUBLIC OF PALAU Palau Ministry of Health Republic of Palau P.O. Box 6027 Koror, Republic of Palau 96940-0845 Tel: 011-680-488-2925 or 1360 Fax: 011-680-488-4800 VIRGIN ISLANDS Virgin Islands Department of Health Old Municipal Hospital, Bldg. 1 Knud Hansen Complex St. Thomas, VI 00802 Tel: 340-774-9000 Fax: 340-776-5466

CDC | TB | State TB Control Offices

Trends in Tuberculosis — United States, 2011

Weekly

March 23, 2012 / 61(11);181-185
Trends in Tuberculosis — United States, 2011


In 2011, a total of 10,521 new tuberculosis (TB) cases were reported in the United States, an incidence of 3.4 cases per 100,000 population, which is 6.4% lower than the rate in 2010. This is the lowest rate recorded since national reporting began in 1953 (1). The percentage decline is greater than the average 3.8% decline per year observed from 2000 to 2008 but not as large as the record decline of 11.4% from 2008 to 2009 (2). This report summarizes 2011 TB surveillance data reported to CDC's National Tuberculosis Surveillance System. Although TB cases and rates decreased among foreign-born and U.S.-born persons, foreign-born persons and racial/ethnic minorities continue to be affected disproportionately. The rate of incident TB cases (representing new infection and reactivation of latent infection) among foreign-born persons in the United States was 12 times greater than among U.S.-born persons. For the first time since the current reporting system began in 1993, non-Hispanic Asians surpassed persons of Hispanic ethnicity as the largest racial/ethnic group among TB patients in 2011. Compared with non-Hispanic whites, the TB rate among non-Hispanic Asians was 25 times greater, and rates among non-Hispanic blacks and Hispanics were eight and seven times greater, respectively. Among U.S.-born racial and ethnic groups, the greatest racial disparity in TB rates occurred among non-Hispanic blacks, whose rate was six times the rate for non-Hispanic whites. The need for continued awareness and surveillance of TB persists despite the continued decline in U.S. TB cases and rates. Initiatives to improve awareness, testing, and treatment of latent infection and TB disease in minorities and foreign-born populations might facilitate progress toward the elimination of TB in the United States.
Health departments in the 50 states and the District of Columbia electronically report to CDC verified TB cases that meet the CDC and Council of State and Territorial Epidemiologists surveillance case definition.* Reports include the patient's self-identified race, ethnicity (i.e., Hispanic or non-Hispanic), human immunodeficiency virus (HIV) status, treatment information, and drug-susceptibility test results. CDC calculates national and state TB rates overall and by racial/ethnic group, using U.S. Census Bureau population estimates (3). As of March 22, 2012, race/ethnicity intercensal population estimates were unavailable for 2011; therefore, 2010 population estimates were used as denominators to calculate 2011 case rates. The Current Population Survey provides the population denominators used to calculate TB rates and percentage changes according to national origin.† Because 2011 Current Population Survey data were available, 2011 population estimates were used for U.S.-born and foreign-born TB rates. For TB surveillance, a U.S.-born person is defined as someone born in the United States or its associated jurisdictions, or someone born in a foreign country but having at least one U.S.-citizen parent. In 2011, 0.4% of patients had unknown country of birth, and 0.7% had unknown race or ethnicity. For this report, persons of Hispanic ethnicity might be of any race; non-Hispanic persons are categorized as black, Asian, white, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, or of multiple races.
Compared with the national TB case rate of 3.4 cases per 100,000 population, TB rates in reporting areas ranged widely, from 0.7 in Maine to 9.3 in Alaska (median: 2.4) (Figure 1). Thirty-four states had lower rates in 2011 than in 2010; 16 states and the District of Columbia had higher rates. As in 2010, four states (California, Florida, New York, and Texas) continued to report more than 500 cases each in 2011. Combined, these four states accounted for 5,299 TB cases or approximately half (50.4%) of all TB cases reported in 2011.
Among U.S.-born persons, the number and rate of TB cases declined in 2011. The 3,929 TB cases in U.S.-born persons (37.5% of all cases in persons with known national origin) represented a 9.9% decrease compared with 2010 and a 77.5% decrease compared with 1993 (Figure 2). The rate of 1.5 TB cases per 100,000 population among U.S.-born persons represented a 10.3% decrease since 2010 and an 80.1% decrease since 1993.
The difference between the proportion of U.S.-born and foreign-born persons with TB continued to increase, although the number and rate of TB cases among foreign-born persons in the United States declined in 2011. A total of 6,546 TB cases were reported among foreign-born persons (62.5% of all cases in persons with known national origin), a 3.0% decrease from 2010. The 17.3 per 100,000 population TB rate among foreign-born persons was a 4.8% decrease since 2010 and a 49.0% decrease since 1993. In 2011, 54.1% of foreign-born persons with TB originated from five countries: Mexico (n = 1,392 [21.3%]), the Philippines (n = 750 [11.5%]), Vietnam (n = 537 [8.2%]), India (n = 498 [7.6%]), and China (n = 365 [5.6%]).
During the past 12 years, the proportion of TB cases occurring in Asians has increased steadily, from 20.5% in 2000 to 29.9% in 2011. More TB cases were reported among Asians than any other racial/ethnic group in the United States in 2011 (Table). From 2010 to 2011, TB rates decreased most for blacks, then Hispanics, whites, and Asians. Among persons with TB, 95.4% of Asians, 73.9% of Hispanics, 36.4% of blacks, and 20.9% of whites were foreign-born. Among U.S.-born persons, blacks were the racial/ethnic group with the greatest percentage of TB cases (38.6%) and the largest disparity compared with U.S.-born whites.
HIV test result reporting improved in 2011, with 81% of cases reported having a known HIV status. Among persons with TB who had a known HIV test result, 7.9% were coinfected with HIV. Vermont data were not available.§
A total of 109 cases of multidrug-resistant TB (MDR TB)¶ were reported in 2010, the most recent year for which complete drug-susceptibility data were available. Drug-susceptibility test results for isoniazid and rifampin were reported for 97.5% and 97.1% of culture-confirmed TB cases in 2009 and 2010, respectively. Among these cases, the percentage of MDR TB for 2010 (1.3% [109 of 8,422]) was unchanged from the percentage for 2009 (1.3%). The percentage of MDR TB cases among persons without a previous history of TB has remained stable at approximately 1.0% since 1997. For persons with a previous history of TB, the percentage with MDR TB in 2010 was approximately four times greater than among persons not previously treated for TB. In 2010, foreign-born persons accounted for 90 (82.6%) of the 109 MDR TB cases. Four cases of extensively drug-resistant TB** (all occurring in foreign-born persons) have been reported for 2011.

Reported by

Roque Miramontes, MPH, Robert Pratt, Sandy F. Price, Carla Jeffries, MPH, Thomas R. Navin, MD, Div of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Gloria E. Oramasionwu, MD, EIS Officer, CDC. Corresponding contributor: Gloria E. Oramasionwu, iyo8@cdc.gov, 404-718-8633.

Editorial Note

Despite the continued decline in U.S. TB cases and rates since 1993, the 6.4% decline from 2010 to 2011 to a rate of 3.4 per 100,000 falls short of the 2010 goal of TB elimination (less than one case per 1,000,000) set in 1989 (4). If current efforts are not improved or expanded, TB elimination is unlikely before the year 2100 (5).
In 2011, Asians became the largest single racial/ethnic group represented among TB cases, with a case rate 25 times that of non-Hispanic whites. Although the case rate among Asians declined in 2011 compared with 2010, this 0.6% decline was smaller than among any other racial/ethnic group. This finding underscores the need for increased TB awareness and prevention programs in Asian communities. A decrease in TB rates was associated with one such program, implemented in predominantly black and Hispanic neighborhoods in Texas, which raised TB awareness in the community while also treating anyone found to have latent TB infection (LTBI) (6). Moreover, because 95% of Asians with TB in 2011 were foreign-born, further support of global TB control will be important for reducing TB rates.
Addressing the increasing difference between TB rates in foreign-born and U.S.-born persons is critical for TB elimination. Most foreign-born persons with TB (78.8%) had their TB diagnosed after being in the United States for more than 2 years,†† consistent with reactivation of LTBI acquired abroad. Therefore, treating LTBI will be critical for accelerating the TB decline among foreign-born persons (5). In 2007, CDC published technical instructions for TB screening in prospective immigrants to the United States (7). As more high-TB burden countries adopt these technical instructions, screening and treating immigrants should improve. Persons screened overseas and found to have LTBI should receive preventive TB treatment upon arrival in the United States. A new, shorter regimen for LTBI requiring just 12 once-weekly drug administrations has been recommended by CDC and might result in better adherence to LTBI treatment in foreign-born and U.S.-born populations (8,9).
Approximately 81% of TB cases in 2011 had known HIV status at TB diagnosis. This increase (66.3% in 2010) is attributed to increased reporting from selected regions. The American Thoracic Society and the Infectious Disease Society of America recommend that all TB patients be counseled and tested for HIV (10).
This analysis is limited to reporting provisional TB cases and case rates for 2011. Case rates are based on estimates of population denominators from either 2010 or 2011. CDC's annual TB surveillance report will provide final TB case rates based on updated denominators later this year.
Progress toward TB elimination in the United States will require ongoing surveillance and improved TB control and prevention activities. Sustained focus on domestic TB control activities and further support of global TB control initiatives is important to address persistent disparities between non-Hispanic whites and racial/ethnic minorities and between U.S.-born and foreign-born persons.

Acknowledgments

State and local TB control officials.

References

1. CDC. Reported tuberculosis in the United States, 2010. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Available at http://www.cdc.gov/tb/statistics/reports/2010/default.htm. Accessed February 21, 2012.
2. CDC. Decrease in reported tuberculosis cases—United States, 2009. MMWR 2010;59:289–94.
3. US Census Bureau. Current estimates data. Available at http://www.census.gov/popest/data/national/totals/2011/index.html. Accessed February 2, 2012.
4. CDC. A strategic plan for the elimination of tuberculosis in the United States. MMWR 1989;38(No. S-3).
5. Hill AN, Becerra JE, Castro KG. Modelling tuberculosis trends in the USA. Epidemiol Infect 2012:1–11.
6. Cegielski JP, Griffith DE, McGaha PK, et al. Eliminating tuberculosis, one neighborhood at a time. Am J Public Health 2012 (In press).
7. CDC. CDC immigration requirements: technical instructions for tuberculosis screening and treatment. Using cultures and directly observed therapy. US Department of Health and Human Services, CDC; 2009. Available at http://www.cdc.gov/immigrantrefugeehealth/pdf/tuberculosis-ti-2009.pdf . Accessed February 16, 2012.
8. Sterling TR, Villarino ME, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med 2011;365:2155–66.
9. CDC. Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR 2011;60:1650–3.
10. CDC. Treatment of tuberculosis. American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR 2003;52(No. RR-11).

* Available at http://www.cdc.gov/osels/ph_surveillance/nndss/casedef/tuberculosis_current.htm.

† Additional information available at http://dataferrett.census.gov.

§ Vermont no longer reports HIV status of TB patients to CDC.

¶ Defined by the World Health Organization as a case of TB in a person with a Mycobacterium tuberculosis isolate resistant to at least isoniazid and rifampin. Additional information available at http://whqlibdoc.who.int/publications/2010/9789241599191_eng.pdf .

** Defined by the World Health Organization as a case of TB in a person with an M. tuberculosis isolate with resistance to at least isoniazid and rifampin among first-line anti-TB drugs, resistance to any fluoroquinolone (e.g., ciprofloaxacin or ofloxacin), and resistance to at least one second-line injectable drug (e.g., amikacin, capreomycin, or kanamycin). Additional information available at http://whqlibdoc.who.int/publications/2010/9789241599191_eng.pdf .

†† The percentage of foreign-born persons with TB residing in the United States for more than 2 years was based on provisional 2011 National Tuberculosis Surveillance System data accessed on February 22, 2012. 

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