World TB Day 2012: Stop TB in My LifetimeTuberculosis, 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 DayWorld 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 DoingResearchers 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.
- 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.
More InformationWorld 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
- 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
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|Alabama Department of Public Health |
RSA Tower, Suite 1450
201 Monroe Street
Montgomery, AL 36130-3017
ALASKAAlaska Department of Health & Social Services
3601 “C” Street, Suite 540
Anchorage, AK 99503-5949
ARIZONAArizona Department of Health Services
150 North 18th Avenue
Phoenix, AZ 85007-3237
ARKANSASArkansas Department of Health
4815 West Markham St.
Little Rock, AR 72203
CALIFORNIACalifornia Department of Public Health
850 Marina Bay Parkway
Building P, 2nd Floor
Richmond, CA 94804-6403
COLORADOColorado Department of Public Health & Environment TB Program
4300 Cherry Creek Drive South
Denver, CO 80246-1530
CONNECTICUTConnecticut Department of Public Health
410 Capitol Avenue, MS-11TUB
Hartford, CT 06134
DISTRICT of COLUMBIADistrict of Columbia Department of Health
1900 Massachusetts Ave SE
Washington, D.C. 20003
DELAWAREDelaware Department of Health & Social Services
TB Control Program
Thomas Collins Bldg,
Suite 12, D620P
540 S. Dupont Hwy
Dover, DE 19901
FLORIDAFlorida Department of Health
4052 Bald Cypress Way, BIN #A20
Prather Building, Room 240-N
Tallahassee, FL 32399-1717
GEORGIAGeorgia Department of Public Health Tuberculosis Program
2 Peachtree St., NW, Suite 12-493
Atlanta, GA 30303-2588
Fax: 404 463-3460
HAWAIIHawaii Department of Health
1700 Lanakila Avenue
Honolulu, HI 96817-2199
IDAHOIdaho Department of Health & Welfare
450 West State Street, 4th Floor
Boise, ID 83720-0036
ILLINOISIllinois Department of Public Health
525 West Jefferson Street, 1st Floor
Springfield, IL 62761-0001
INDIANAIndiana Department of Health
2 North Meridian Street, 6th Floor
Indianapolis, IN 46204
IOWAIowa Department of Public Health
Lucas State Office Building
321 East 12th Street
Des Moines, IA 50319-0075
KANSASKansas Department of Health & Environment
1000 Southwest Jackson Street Suite 210
Topeka, KS 66612
KENTUCKYKentucky Department for Public Health
275 East Main Street
Frankfort, KY 40621
LOUISIANALouisiana Department of Health & Hospitals Office of Public Health – TB Control
1010 Common Street,
New Orleans, LA 70112
MAINEMaine Department of Human Services
286 Water Streeet, 8th Floor
Augusta, Maine 04333
MARYLANDMaryland Department of Health
500 North Calver Street, 5th Floor
Baltimore, MD 21202
MASSACHUSETTSMassachusetts Department of Public Health
305 South Street
Boston, MA 02130-3515
MICHIGANMichigan Department of Community Health
Capitol View Building
201 Townsend Street, 5th Floor
Lansing, MI 48913
MINNESOTAMinnesota Department of Health
Freeman Office Building
625 N. Robert St. (street address)
P.O. Box 64975 (mailing address)
St. Paul, MN 55164-0975
MISSISSIPPIMississippi State Department of Health
P.O. Box 1700
Jackson, MS 39215-1700
MISSOURIMissouri Department of Health
930 Wildwood Drive
Jefferson City, MO 65109
MONTANAMontana Department of Public Health and Human Services
Cogswell Building, Room C216
1400 Broadway Avenue
Helena, MT 59620
NEBRASKANebraska Department of Health & Human Services
301 Centennial Mall South, 3rd Floor
Lincoln, NE 68509
NEVADANevada 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
NEW HAMPSHIRENew Hampshire Department of Health & Human Services
Health & Welfare Building
29 Hazen Drive
Concord NH 03301-6504
NEW JERSEYNew Jersey Department of Health and Senior Services
135 East State Street, 1st Floor
P.O. Box 369
Trenton, NJ 08625-0369
NEW MEXICONew Mexico Department of Health
1190 Saint Francis Drive, Room S1150
Santa Fe, NM 87502
NEW YORKNew York State Department of Health
Empire State Plaza
Corning Tower, Room 840
Albany, NY 12237-0669
NORTH CAROLINANorth Carolina Department of Health & Human Services
1200 Front Street, Suite 101
Raleigh, NC 27609
NORTH DAKOTANorth Dakota Department of Health
600 East Boulevard, Dept. 301
Bismarck, ND 58505-0200
OHIOOhio Department of Health Bureau of Infectious Disease and Control
35 E. Chestnut St., 7th floor
Columbus, OH 43215
OKLAHOMAOklahoma State Department of Health
1000 NE 10th Street, Room 608
Oklahoma City, OK 73117-1299
OREGONOregon Public Health Division
800 NE Oregon, Suite 1105
Portland, OR 97232
PENNSYLVANIAPennsylvania Department of Health TB Control Program
Health and Welfare Building, Room 1013
625 and Forester Street
Harrisburg, PA 17120
RHODE ISLANDRhode Island Department of Health
3 Capitol Hill, Room 106
Providence, RI 02908
SOUTH CAROLINASouth Carolina Department of Health and Environmental Control
Mills/Jarrett Complex, Box 101106
1751 Calhoun Street
Columbia, SC 29201
SOUTH DAKOTASouth Dakota Department of Health
615 East 4th Street
Pierre, SD 57501
TENNESSEETennessee Department of Health
Cordell Hull Building, 1st Floor
425 5th Avenue North
Nashville, TN 37243-0001
TEXASTexas Department of State Health Services
1100 West 49th Street
Austin, TX 78756
UTAHUtah Department of Health, TB Control and Bureau of Epidemiology
Salt Lake City, UT 84114-2105
VERMONTVermont Department of Health
PO Box 70
108 Cherry Street
Burlington, VT 05401
VIRGINIAVirginia Department of Health
109 Governor Street, 3rd floor
Richmond, VA 23219
WASHINGTONWashington State Department of Health
111 Israel Rd, S.E.
PO Box 47837
Olympia, WA 98504-7837
WEST VIRGINIAWest Virginia Department of Health & Human Resources
TB Control Program, Room 125
350 Capitol Street
Charleston, WV 25301-1417
WISCONSINWisconsin Department of Health & Family Services
1 West Wilson Street, Room 318
Madison, WI 53702
WYOMINGWyoming Department of Health
Qwest Building, Suite 510
6101 Yellowstone Road
Cheyenne, WY 82002
Fax: 307-777-5402 or 777-5573
AMERICAN SAMOADepartment of Health
American Samoa Government
Department of Health
LBJ Tropical Medical Center
P.O. Box F
Pago Pago, AS 96799
FEDERATED STATES OF MICRONESIADepartment of Health, Education & Social Affairs
Federated States of Micronesia
P.O. Box PS-70
Kolonia, Pohnpei, FM 96941
GUAMDepartment 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
NORTHERN MARIANA ISLANDSCNMI 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
PUERTO RICOPuerto Rico Department of Health
P.O. Box 70184
San Juan, PR 00936
REPUBLIC OF MARSHALL ISLANDSNational TB Control Program
Ministry of Health
P.O. Box 16
Majuro, MH 96960-0016
Tel: 011-692-625-0074 or 7321
Fax: 011-692-625-4372 or 4543
REPUBLIC OF PALAUPalau Ministry of Health
Republic of Palau
P.O. Box 6027
Koror, Republic of Palau 96940-0845
Tel: 011-680-488-2925 or 1360
VIRGIN ISLANDSVirgin Islands Department of Health
Old Municipal Hospital, Bldg. 1
Knud Hansen Complex
St. Thomas, VI 00802
Trends in Tuberculosis — United States, 2011
WeeklyMarch 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 byRoque 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, firstname.lastname@example.org, 404-718-8633.
Editorial NoteDespite 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.
AcknowledgmentsState and local TB control officials.
- 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.
- CDC. Decrease in reported tuberculosis cases—United States, 2009. MMWR 2010;59:289–94.
- US Census Bureau. Current estimates data. Available at http://www.census.gov/popest/data/national/totals/2011/index.html. Accessed February 2, 2012.
- CDC. A strategic plan for the elimination of tuberculosis in the United States. MMWR 1989;38(No. S-3).
- Hill AN, Becerra JE, Castro KG. Modelling tuberculosis trends in the USA. Epidemiol Infect 2012:1–11.
- Cegielski JP, Griffith DE, McGaha PK, et al. Eliminating tuberculosis, one neighborhood at a time. Am J Public Health 2012 (In press).
- 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.
- 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.
- CDC. Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR 2011;60:1650–3.
- CDC. Treatment of tuberculosis. American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR 2003;52(No. RR-11).
† 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.