tuberculosis in new york state in new york state ... table 1. tuberculosis cases and rates ......

TUBERCULOSIS IN

NEW YORK STATE2014

AnnualStatisticalReport

BureauofTuberculosisControl

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TABLE OF CONTENTS

TableofContents

ListofFigures......................................................................................................................................................3

ListofTables.........................................................................................................................................................4

ExecutiveSummary..........................................................................................................................................5

TuberculosisCasesandRates....................................................................................................................6

GeographicDistribution.............................................................................................................................10

DemographicCharacteristics..................................................................................................................12

TuberculosisintheForeign‐Born.........................................................................................................19

HIVCo‐Infection..............................................................................................................................................23

ReasonsforEvaluation................................................................................................................................26

RiskFactors........................................................................................................................................................27

DrugResistance...............................................................................................................................................31

Genotyping.........................................................................................................................................................33

SiteofDisease...................................................................................................................................................34

CompletionofTherapy................................................................................................................................36

ContactstoInfectiousTuberculosisCases.......................................................................................38

DirectlyObservedTherapy.......................................................................................................................40

ContactInformation......................................................................................................................................41

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LIST OF FIGURES

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Figure1.TuberculosisCasesandRates,NewYorkState,1960‐2014

Figure2.TuberculosisCaseRates,NewYorkStateandtheUnitedStates,1960‐2014

Figure3.NumberandPercentofDeathsamongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),1993‐2014

Figure4.DistributionofTuberculosisCases,NewYorkState,2014

Figure5.NumberandPercentofTuberculosisCasesbyRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Figure6.Race/EthnicityofTuberculosisCases,NewYorkState,2014

Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Figure8.TuberculosisCasesandRatesbyAgeandGender,NewYorkState(ExclusiveofNewYorkCity),2014

Figure9.TuberculosisCasesbyAgeandRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2014

Figure10.TuberculosisCasesbyAgeandRace/Ethnicity,NewYorkCity,2014

Figure11a.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),1985‐2014

Figure11b.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkCity,1985‐2014

Figure12.HIVStatusforTuberculosisCases,NewYorkState,2014

Figure13.NumberandPercentofTuberculosisCasesWhoHaveBeenTestedforHIV,NewYorkState(ExclusiveofNewYorkCity),2005‐2014

Figure14.TuberculosisCasesandRatesamongDOCCSInmates,NewYorkState(ExclusiveofNewYorkCity),1986‐2014

Figure15.NumberandPercentofMultidrug‐ResistantTuberculosisCases,NewYorkState,2010‐2014

Figure16.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState,2014

Figure17.PercentofTuberculosisPatientsWhoCompletedTreatmentwithin12Months,NewYorkState(ExclusiveofNewYorkCity),2004‐2013

Figure18.NumberandPercentofContactstoInfectiousTuberculosisCasesPlacedonTreatmentforLatentTuberculosisInfectionandCompleted,NewYorkState(ExclusiveofNewYorkCity),2004‐2013

Figure19.NumberandPercentofTuberculosisCasesReceivingAnyDirectlyObservedTherapy,NewYorkState(ExclusiveofNewYorkCity),1991‐2014

LIST OF TABLES

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Table1.TuberculosisCasesandRates,NewYorkState,1960‐2014

Table2.TuberculosisCasesandRatesbyCounty,NewYorkState,2010‐2014

Table3.TuberculosisCasesandRatesbyGender,AgeandRace/Ethnicity,NewYorkState,2014

Table4.TuberculosisCasesbyCountryofOrigin,NewYorkState,2014

Table5.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2014

Table6.LengthofTimeForeign‐BornTuberculosisCaseswereintheUnitedStatesPriortoDiagnosis,NewYorkState(ExclusiveofNewYorkCity),2014

Table7a.HIVStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table7b.HIVStatusforTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2014

Table8a.PrimaryReasonforEvaluationofTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table8b.PrimaryReasonforEvaluationofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2014

Table9a.AdditionalRiskFactorsAmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table9b.AdditionalRiskFactorsAmongTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2014

Table10.High‐RiskCongregateSettingattheTimeofDiagnosisforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table11.HomelessnessAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table12.SubstanceAbuseAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table13a.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table13b.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2012‐2014

Table14.TuberculosisGenotypingSummaryforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table15.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Table16.Extra‐PulmonarySitesofDiseaseforTuberculosisCases,NewYorkState,2014

Table17a.TreatmentStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2009‐2013

Table17b.TreatmentStatusforTuberculosisCasesReportedin2013,NewYorkState(ExclusiveofNewYorkCity)

Table18.NumberandPercentofInfectiousTuberculosisCaseswithContactsIdentified,NewYorkState(ExclusiveofNewYorkCity),2004‐2013

Table19.NumberandPercentofContactstoInfectiousTuberculosisCasesEvaluatedforLatentTuberculosisInfection,NewYorkState(ExclusiveofNewYorkCity),2004‐2013

EXECUTIVE SUMMARY

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ExecutiveSummary

MORBIDITY & MORTALITY

From2013to2014,tuberculosis(TB)morbiditydecreasedinNewYorkState.The2014totalof787cases(585casesinNewYorkCity,202casesintheremainderofNewYorkState)representsa9.9percentdecreasefromthe873casesreportedin2013.Thenationasawholeexperienceda1.6percentdeclineinmorbidity.Sincethemostrecentpeakepidemicin1992with4,574cases,therewasan82.8percentdecreaseinNewYorkStatecomparedtoanationaldeclineof64.7percent.

InNewYorkState(exclusiveofNewYorkCity),thenumberofTBcasesdecreased6.9percentfrom217casesin2013to202casesin2014.ThenumberofTBcasesinNewYorkCitydecreasedby10.8percentfrom656casesin2013to585casesin2014.In2014,thenationasawholereported9,412cases,down1.8percentfromthe9,588casesreportedin2013.

NewYorkStaterankedsixthnationallyforTBmorbiditywithanincidencerateof4.1per100,000populationin2014.ThisrateisinfluencedbyNewYorkCity,whichhadaTBcaserateof7.2per100,000.Incontrast,NewYorkState(exclusiveofNewYorkCity)reportedanincidencerateof1.8per100,000.

GEOGRAPHIC DISTRIBUTION

Threecounties–Nassau,SuffolkandWestchester–reportednearlyhalfoftheTBcasesinNewYorkState(exclusiveofNewYorkCity)in2014.

RACE‐ETHNICITY

In2014,AsianscontinuedtohaveoneofthehighestincidenceratesofTBstatewide(24.0per100,000).White,non‐Hispanicshadthelowestincidencerateof0.6per100,000.

FOREIGN‐BORN

Statewide,theproportionofforeign‐borncasesin2014remainednearlythesameasin2013at82.7percent(N=651),withpeopleborninChinacomprisingthegreatestnumberofforeign‐bornTBcases(N=132).InNewYorkState(exclusiveofNewYorkCity),peopleborninIndiacomprisedthegreatestnumberofTBcases(N=23).

DRUG SUSCEPTIBILITY

Amongindividualswithdrugsusceptibilitiesreportedin2014,thenumberofmultidrug‐resistant(MDRTB)casesinNewYorkCitywasnine,asmallincreasefromthesevencasesseenin2013.InNewYorkState(exclusiveofNewYorkCity),thenumberofMDRTBcaseswastwo,whichwasthesamenumberseenin2013.

TB IN THE PRISONS

Since1991,thenumberofTBcasesamongtheNewYorkStateDepartmentofCorrectionsandCommunitySupervision(DOCCS)inmatepopulationhadbeencontinuallydeclining,andin2011and2012nonewcaseswerereported.However,in2013,threenewDOCCScaseswerereported.In2014,thisnumberdroppedtoonecase.

TUBERCULOSIS CASES AND RATES

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Table1.TuberculosisCasesandRates,*NewYorkState,1960‐2014

No. Rate No. Rate No. Rate1960 2,376 26.4 4,699 60.4 7,075 42.21961 2,052 22.3 4,360 56.3 6,412 37.81962 2,005 21.4 4,437 56.7 6,442 37.51963 1,865 19.6 4,891 61.7 6,756 38.71964 1,715 17.8 4,207 52.7 5,922 33.61965 1,627 16.6 4,242 53.0 5,869 33.01966 1,633 16.5 3,663 45.7 5,296 29.51967 1,527 15.2 3,542 44.4 5,069 28.11968 1,475 14.5 3,224 40.5 4,699 25.91969 1,384 13.5 2,951 37.4 4,335 23.91970 1,275 12.3 2,590 32.8 3,865 21.21971 1,180 11.3 2,572 32.5 3,752 20.41972 1,176 11.2 2,275 29.0 3,451 18.81973 1,009 9.6 2,101 27.4 3,110 17.11974** 844 8.1 2,022 26.6 2,866 15.91975 1,041 9.9 2,893 38.6 3,934 21.81976 916 8.7 2,156 29.0 3,072 17.11977 829 7.9 1,605 22.0 2,434 13.61978 753 7.1 1,307 18.2 2,060 11.61979 699 6.6 1,530 21.5 2,229 12.61980 780 7.4 1,514 21.4 2,294 13.11981 641 6.1 1,582 22.4 2,223 12.71982 674 6.4 1,594 22.5 2,268 12.91983 658 6.2 1,651 23.1 2,309 13.11984 616 5.8 1,630 22.6 2,246 12.71985 638 6.0 1,843 25.5 2,481 13.91986 615 5.8 2,223 30.6 2,838 15.91987 615 5.8 2,197 30.1 2,812 15.71988 688 6.5 2,317 31.8 3,005 16.81989 657 6.2 2,545 34.8 3,202 17.81990 656 6.1 3,520 48.1 4,176 23.21991 748 7.0 3,673 50.2 4,421 24.61992 763 7.2 3,811 52.0 4,574 25.41993 717 6.7 3,235 44.2 3,952 22.01994 641 6.0 2,995 40.9 3,636 20.21995 621 5.8 2,445 33.4 3,066 17.01996 535 5.0 2,053 28.0 2,588 14.41997 535 5.0 1,730 23.6 2,265 12.61998 442 4.1 1,558 21.3 2,000 11.11999 377 3.5 1,460 19.9 1,837 10.22000 412 3.8 1,332 16.6 1,744 9.22001 415 3.8 1,261 15.7 1,676 8.82002 350 3.2 1,084 13.5 1,434 7.62003 340 3.1 1,140 14.2 1,480 7.82004 324 3.0 1,039 13.0 1,363 7.22005 305 2.8 984 12.3 1,289 6.82006 317 2.9 954 11.9 1,271 6.72007 261 2.4 914 11.4 1,175 6.22008 305 2.8 895 11.2 1,200 6.32009 246 2.2 760 9.5 1,006 5.32010 243 2.2 711 8.7 954 4.92011 221 2.0 689 8.4 910 4.72012 215 1.9 651 8.0 866 4.52013 217 1.9 656 8.0 873 4.52014 202 1.8 585 7.2 787 4.1

YearNewYorkState NewYorkCity NewYorkState

(ExclusiveofNewYorkCity) (Total)

*RatecalculationsarebasedonUnitedStatesdecennialCensusdata;per100,000population**Figuresafter1974reflectanationallyrevisedcasedefinitionthatincludesreactivatedcasesSource:NewYorkStateDepartmentofHealthBureauofTuberculosisControl


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From2013to2014,TBcasesandratescontinuedtodeclinestatewide.In2014,atotalof787caseswerereportedinNewYorkState,representinga9.9percentdecreasefromthe873casesreportedin2013andan88.9percentdecreasefromthe7,075casesreportedin1960.Nearlythree‐quartersofthestate’sTBmorbidityisconcentratedinNewYorkCity.

In2014,NewYorkCityreported74.3percent(N=585)ofthetotalcasesdespitehavingonly42percentofthestatepopulation.Therestofthestatereported202cases,whichwasa6.9percentdecreasecomparedtothe217reportedin2013.

TherateofTBinNewYorkStateisgreatlyinfluencedbythehighmorbidityinNewYorkCity.OutsideofNewYorkCity,theratein2014was1.8per100,000population,butNewYorkCityreportedarateof7.2per100,000,resultinginanoverallrateof4.1per100,000populationforthewholestate.

Figure1.TuberculosisCasesandRates,*NewYorkState,1960‐2014

Overthelast50years,therehavebeentwopeaksinTBmorbiditywherethenumberandrateofTBsubstantiallyincreased.Thepeakin1975canbeexplainedbyachangeinthecasedefinitiontoincludereactivatedTBcases.Theincreasethatbeganinthemid‐1980sandextendedthroughtheearly1990swasdrivenmainlybytheresurgenceofTBcasesinNewYorkCity.Thisrisewaslargelyduetotwofactors.OnewastheHIV/AIDSepidemicthatstartedintheearly1980s.TheotherwasthereductionofTBcontrolresourcescombinedwiththeriseinhighriskpopulationssuchasforeign‐bornandhomeless.


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Figure2.TuberculosisCaseRates,*NewYorkStateandtheUnitedStates,1960‐2014

Historically,TBcaseratesinNewYorkState(exclusiveofNewYorkCity)havebeenlowerthanthenationalaverage,whilecaseratesinNewYorkCityhaveexceedednationalrates.In2014,thenationalcaseratewas3.0per100,000populationandrangedfrom0.3to9.6per100,000populationacrossallthestates.NewYorkStaterankedthirdbasedonthenumberofcases(N=787)andsixthbasedonincidencerate(4.1per100,000population),buttheserankingswerelargelyinfluencedbyNewYorkCitywhich,byitself,wouldhaverankedfourthnationallybasedonnumberofcases(N=585)andthirdbasedonincidencerate(7.2per100,000population).


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Figure3.NumberandPercentofDeathsAmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),1993‐2014

ThenumberandpercentofdeathsamongTBcasesinNewYorkState(exclusiveofNewYorkCity)decreasedconsiderablyfollowingthelastepidemicthatpeakedintheearly1990s.Thisdropinmortalityslowedby1997andhasvariedeachyearsince2000.ThedeathsportrayedinFigure3werenotallTB‐related.

AmongthereportedTBcasesinNewYorkState(exclusiveofNewYorkCity),therewere17totaldeathsin2014.ThecauseofdeathwasTB‐relatedforsixcases,oneofwhichwasdiagnosedatdeathbeforetreatmentcouldbestarted.Oftheremainingfivecases,fourwereover60yearsofagewithothercomorbiditiessuchasHIV,diabetes,immunosuppression(otherthanHIV/AIDS),andend‐stagerenalfailure.


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Table2.TuberculosisCasesandRates*byCounty,NewYorkState,2010‐2014

No. Rate No. Rate No. Rate No. Rate No. RateAlbany 10 3.3 8 2.6 6 2.0 5 1.6 7 2.3Allegany 1 2.0 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Broome 1 0.5 1 0.5 5 2.5 1 0.5 0 ‐‐‐Cattaraugus 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Cayuga 0 ‐‐‐ 1 1.2 0 ‐‐‐ 1 1.2 2 2.5Chautauqua 1 0.7 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Chemung 0 ‐‐‐ 0 ‐‐‐ 1 1.1 1 1.1 0 ‐‐‐Chenango 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Clinton 0 ‐‐‐ 0 ‐‐‐ 2 2.4 1 1.2 0 ‐‐‐Columbia 1 1.6 0 ‐‐‐ 2 3.2 0 ‐‐‐ 2 3.2Cortland 0 ‐‐‐ 0 ‐‐‐ 1 2.0 0 ‐‐‐ 0 ‐‐‐Delaware 0 ‐‐‐ 1 2.1 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Dutchess 9 3.0 3 1.0 4 1.3 4 1.3 7 2.4Erie 11 1.2 14 1.5 19 2.1 21 2.3 16 1.7Essex 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 2.5Franklin 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Fulton 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 1.8 0 ‐‐‐Genesee 1 1.7 2 3.3 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Greene 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 3 6.1 0 ‐‐‐Hamilton 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Herkimer 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 1.5 0 ‐‐‐Jefferson 0 ‐‐‐ 1 0.9 0 ‐‐‐ 2 1.7 1 0.9Lewis 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Livingston 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 2 3.1 0 ‐‐‐Madison 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Monroe 16 2.1 19 2.6 14 1.9 22 3.0 20 2.7Montgomery 1 2.0 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Nassau 48 3.6 33 2.5 36 2.7 40 3.0 33 2.5Niagara 0 ‐‐‐ 1 0.5 2 0.9 3 1.4 3 1.4Oneida 7 3.0 8 3.4 5 2.1 8 3.4 3 1.3Onondaga 13 2.8 8 1.7 11 2.4 9 1.9 10 2.1Ontario 1 0.9 3 2.8 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Orange 5 1.3 9 2.4 6 1.6 9 2.4 8 2.1Orleans 1 2.3 1 2.3 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Oswego 0 ‐‐‐ 0 ‐‐‐ 3 2.5 0 ‐‐‐ 1 0.8Otsego 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Putnam 0 ‐‐‐ 4 4.0 0 ‐‐‐ 0 ‐‐‐ 2 2.0Rensselaer 3 1.9 2 1.3 3 1.9 1 0.6 2 1.3Rockland 21 6.7 10 3.2 11 3.5 15 4.8 11 3.5Saratoga 2 0.9 0 ‐‐‐ 1 0.5 2 0.9 1 0.5Schenectady 5 3.2 3 1.9 3 1.9 3 1.9 3 1.9Schoharie 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Schuyler 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Seneca 0 ‐‐‐ 0 ‐‐‐ 2 5.7 0 ‐‐‐ 0 ‐‐‐St.Lawrence 0 ‐‐‐ 0 ‐‐‐ 1 0.9 1 0.9 0 ‐‐‐Steuben 3 3.0 0 ‐‐‐ 0 ‐‐‐ 1 1.0 0 ‐‐‐Suffolk 40 2.7 43 2.9 33 2.2 22 1.5 35 2.3Sullivan 1 1.3 1 1.3 0 ‐‐‐ 1 1.3 1 1.3Tioga 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Tompkins 0 ‐‐‐ 3 3.0 4 3.9 1 1.0 4 3.9Ulster 1 0.5 1 0.5 3 1.6 4 2.2 0 ‐‐‐Warren 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Washington 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 1.6 1 1.6Wayne 1 1.1 3 3.2 0 ‐‐‐ 1 1.1 1 1.1Westchester 37 3.9 38 4.0 35 3.7 30 3.2 27 2.8Wyoming 1 2.4 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Yates 1 3.9 0 ‐‐‐ 2 7.9 0 ‐‐‐ 0 ‐‐‐

Bronx 116 8.4 102 7.4 101 7.3 91 6.6 99 7.1Kings 233 9.3 214 8.5 190 7.6 197 7.9 192 7.7NewYork 90 5.7 109 6.9 93 5.9 102 6.4 72 4.5Queens 259 11.6 250 11.2 244 10.9 242 10.8 212 9.5Richmond 13 2.8 14 3.0 23 4.9 24 5.1 10 2.1

STATETOTAL 954 4.9 910 4.7 866 4.5 873 4.5 787 4.1

1.9 202 1.8

8.0 585 7.2NewYorkCityTotal 711 8.7 689 8.4 651 8.0 656

2011 2012 2013

221

2014

2.0 215 1.9 217NewYorkStateTotal(ExclusiveofNewYorkCity)

243 2.2

County 2010

*Ratecalculationsarebasedon2010UnitedStatesCensusdata;per100,000population

Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl


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TBmorbidityisnotevenlydistributedacrossNYSandvariesgreatlybetweencounties.In2014,allfiveboroughsofNewYorkCityand25(43.9%)ofthe57upstatecountiesreportedatleastoneTBcase.Highernumbersofcaseswereseeninthemetropolitanareas.Asinpreviousyears,nearlyhalfofallTBmorbidityreportedforNYS(exclusiveofNewYorkCity)wasconcentratedinNassau,SuffolkandWestchestercounties(47.0%,N=95/202).

Figure4.DistributionofTuberculosisCasesinNewYorkState,2014

DEMOGRAPHIC CHARACTERISTICS

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Table3.TuberculosisCasesandRates*byGender,Age,**andRace/Ethnicity,NewYorkState,2014

ForNewYorkStateasawhole,theincidencerateformaleswas1.7timesthatoffemales(5.2per100,000and3.0per100,000,respectively)in2014.ThisgenderdisparitywasgreatestinNewYorkCitywheremaleshadarate2.0timesgreaterthanfemales(9.6comparedto4.9per100,000).MalesinNewYorkCityalsohadacaserate4.6timesthatofmalesintherestofthestate(9.6comparedto2.1per100,000).

TBcasesinthe65yearsandolderagegrouphadthehighestincidencerateinNewYorkCity,aswellastherestofthestate(13.6per100,000and3.1per100,000,respectively).Statewide,thelowestrateswereseenamongthehighriskpediatricpopulation(<15yearsold),withthoseinthe5‐9yearoldagegroupcontributingonlythreecasesforarateof0.6per100,000inNewYorkCityand0.3per100,000forthewholestate.

In2014,thehighestincidencerateforTBwasseenamongAsiansinNewYorkState(24.0per100,000).Inpreviousyears,therateforAsianswasconsiderablyhigherinNewYorkCitycomparedtotherestofthestate,butin2014therateforAsiansoutsideofNewYorkCityslightlyexceededthatfoundwithinthecity(24.3per100,000and23.8per100,000,respectively).

No. Rate No. Rate No. RateMale 116 2.1 373 9.6 489 5.2Female 86 1.5 212 4.9 298 3.0Under5years 6 0.9 4 0.8 10 0.95‐9 0 ‐‐‐ 3 0.6 3 0.310‐14 1 0.1 7 1.5 8 0.715‐19 4 0.5 21 3.9 25 1.820‐24 18 2.3 49 7.6 67 4.725‐34 32 2.5 104 7.5 136 5.135‐44 33 2.3 85 7.4 118 4.545‐54 29 1.6 79 7.1 108 3.855‐64 28 2.0 98 11.0 126 5.565+ 51 3.1 135 13.6 186 7.1White,non‐Hispanic 35 0.4 36 1.3 71 0.6Black,non‐Hispanic 22 2.4 128 6.9 150 5.4Hispanic 49 4.5 146 6.2 195 5.7Asian 92 24.3 245 23.8 337 24.0PacificIslander 1 39.6 0 ‐‐‐ 1 18.8MultipleRaces 1 0.6 23 15.5 24 7.4Other/Unknown 2 8.4 7 12.1 9 11.0

202 1.8 585 7.2 787 4.1

Gender

AgeGroup

Race/Ethnicity

TOTALCASES

DemographicCharacteristicsNewYorkState NewYorkCity NewYorkState

(ExclusiveofNewYorkCity) (Total)

*Ratecalculationsarebasedon2010UnitedStatesCensusdata;per100,000population**Agecalculationsarebasedondateofbirthandreportdate



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Figure5.NumberandPercentofTuberculosisCasesbyRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Overthelastfiveyears,themajorityofTBcasesreportedinNewYorkState(exclusiveofNewYorkCity)havebeenofAsianandHispanicdescent.Between2010and2011,theproportionofAsianswithTBincreasedfrom28.4percentto32.6percent,surpassingtheproportionofHispaniccases,whichdecreasedfrom34.2percentto29.0percent.Inthefollowingyears,Asianshavecontinuedtorepresentalargerpercentageofreportedcasesthananyotherracial/ethnicgroup,especiallyin2014whenthepercentageofAsiancasesdramaticallyincreasedto45.5percent(N=92/202).


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Figure6.Race/EthnicityofTuberculosisCases,NewYorkState,2014

InNewYorkState(exclusiveofNewYorkCity),45.5percent(N=92/202)ofreportedcasesin2014wereAsianandanadditional24.3percent(N=49/202)wereHispanic.SimilarpercentageswereseeninNewYorkCity,whereAsianscontributed41.9percent(N=245/585)ofthecasesandHispanicsrepresented25.0percent(N=146/585).Incontrast,theproportionofwhite,non‐HispanicswasnearlythreetimeslowerinNewYorkCitycomparedtotheremainderofthestate(6.2%and17.3%,respectively).


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Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Overthelastfiveyears,maleshaveconsistentlycomprisedahigherproportionofcasescomparedtofemalesinNewYorkState(exclusiveofNewYorkCity).In2014,57.4percent(N=116/202)ofreportedcasesweremale.


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Figure8.TuberculosisCasesandRates*byAge**andGender,NewYorkState(ExclusiveofNewYorkCity),2014

In2014,thedifferenceinTBmorbiditybetweenmalesandfemalesinNewYorkState

(exclusiveofNewYorkCity)varieddependingonage.ThedistributionandrateofmalesandfemalesacrossagegroupswasrelativelyevenamongTBcasesunder35yearsofage,butforcases35yearsofageorolder,thenumberandrateformalesgreatlyexceededthatoffemales.ThelargestgendergapinTBmorbiditywasseeninthe45‐54yearoldagegroupwherethecaserateformaleswas3.7timesthatoffemales(2.6per100,000formales;0.7per100,000forfemales).Additionally,thenumberofmalecaseswasfourtimesgreaterthanthenumberoffemalecasesinthisagegroup(N=24formales;N=6forfemales).


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Figure9.TuberculosisCasesbyAge*andRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2014

In2014,aquarterofreportedcasesinNewYorkState(exclusiveofNewYorkCity)were65yearsofageandolder(25.2%,N=51/202).Amongthe51casesinthisagegroup,21(41.2%)wereAsianand19(37.3%)werewhite,non‐Hispanic.

ThesecondlargestnumberofTBcasesreportedin2014forNewYorkState(exclusiveofNewYorkCity)wasseeninthe35‐44yearagegroup(N=33)followedbythe25‐34yearagegroup(N=32).Overtwo‐thirds(N=22/32,68.8%)ofthecasesinthe25‐34yearagegroupwereAsianandoverhalf(N=17/33,51.5%)ofthecasesinthe35‐44yearagegroupwereHispanic.

Incontrasttothebroadagedistributionofnearlyeveryotherraceandethnicity,allofthewhite,non‐HispanicTBcaseswereatleast20yearsofage,with54.3percent(N=19/35)being65yearsofageorolder.


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Figure10.TuberculosisCasesbyAge*andRace/Ethnicity,NewYorkCity,2014

InNewYorkCity,thelargestnumberofTBcasesreportedin2014wasseeninthe65yearsofageandoldergroup(N=135).Amongthese135cases,74(54.8%)wereAsian,22(16.3%)wereblack,non‐Hispanicand20(14.8%)wereHispanic.

ThesecondlargestnumberofTBcasesinNewYorkCitywasidentifiedinthe25‐34yearagegroup(N=104).Forty‐four(42.3%)casesinthisagegroupwereAsianand30(28.8%)caseswereHispanic.

TUBERCULOSIS IN THE FOREIGN‐BORN

19

Figure11a.NumberandPercentofTuberculosisCasesbyU.S.‐Born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),1985‐2014

In2014,therewere160foreign‐borncasesinNewYorkState(exclusiveofNewYorkCity),adecreasefromthe172reportedin2013.Despitethisdecreaseinnumber,theoverallforeign‐bornpercentageremainedat79percent.Similarly,inNewYorkCity,thenumberofforeign‐bornTBcasesdecreasedfrom551in2013to491in2014,buttheoverallpercentageremainedat84percent.

Figure11b.NumberandPercentofTuberculosisCasesbyU.S.‐Born*andForeign‐BornStatus,NewYorkCity,1985‐2014


20

Table4.TuberculosisCasesbyCountryofOrigin,*NewYorkState,2014

In2014,therewere80differentcountriesrepresentedbythe787TBcasesreportedinNewYorkState,31ofwhichwererepresentedbyatleastfivecases.Similartopreviousyears,themostcommoncountryoforiginforforeign‐bornTBcasesreportedbyNewYorkState(exclusiveofNewYorkCity)wasIndia(N=23)andforNewYorkCity,themostcommoncountrywasChina(N=117).ThenumberofcasesbornintheU.S.hashistoricallybeengreaterthananyothersinglecountry,butin2014thisnumberfellbelowthatofChina(N=119andN=132,respectively).

NewYorkState NewYorkCity NewYorkState(ExclusiveofNewYorkCity) (Total)

China 15 117 132UnitedStates 41 78 119India 23 28 51Mexico 7 30 37Philippines 12 25 37Ecuador 11 24 35DominicanRepublic 1 33 34Haiti 4 26 30Nepal 7 14 21Bangladesh 1 17 18Pakistan 2 15 17Honduras 6 10 16Guyana 0 13 13Burma 5 7 12Bhutan 11 0 11Korea,South 4 7 11PuertoRico** 1 9 10Guatemala 4 5 9Peru 6 3 9ElSalvador 5 3 8Ghana 1 7 8Jamaica 1 7 8Taiwan 2 6 8Vietnam 3 5 8HongKong 0 7 7Senegal 0 7 7Colombia 2 4 6Nigeria 3 3 6Poland 1 5 6TrinidadandTobago 1 5 6Ukraine 1 5 6OtherCountries 21 59 80Unknown 0 1 1TOTALCASES 202 585 787

Country


*Onlycountriesrepresenting≥5TBcasesarenamed**PuertoRicoandotherU.S.Territoriesareconsideredseparately


21

Table5.NumberandPercentofForeign‐BornTuberculosisCasesbyCounty,NewYorkState(ExclusiveofNewYorkCity),2014

In2014,therewere160foreign‐bornTBcasesreportedinNewYorkState(exclusiveofNewYorkCity).Nearlyhalf(49.4%,N=79)ofthesecaseswereidentifiedinNassau,SuffolkandWestchesteralone.Amongtheotherhighermorbiditycountiesthatreportedatleast10foreign‐borncases,Eriereportedthelowestforeign‐bornpercentage(68.8%)whileOnondagareportedthehighestpercentage(100.0%).Intheremainingcountieswithforeign‐borncases,thenumberandpercentagevaried.

Albany 7 3 4 57.1Allegany 0 0 0 0.0Broome 0 0 0 0.0Cattaraugus 0 0 0 0.0Cayuga 2 2 0 0.0Chautauqua 0 0 0 0.0Chemung 0 0 0 0.0Chenango 0 0 0 0.0Clinton 0 0 0 0.0Columbia 2 1 1 50.0Cortland 0 0 0 0.0Delaware 0 0 0 0.0Dutchess 7 2 5 71.4Erie 16 5 11 68.8Essex 1 1 0 0.0Franklin 0 0 0 0.0Fulton 0 0 0 0.0Genesee 0 0 0 0.0Greene 0 0 0 0.0Hamilton 0 0 0 0.0Herkimer 0 0 0 0.0Jefferson 1 1 0 0.0Lewis 0 0 0 0.0Livingston 0 0 0 0.0Madison 0 0 0 0.0Monroe 20 3 17 85.0Montgomery 0 0 0 0.0Nassau 33 7 26 78.8Niagara 3 2 1 33.3Oneida 3 0 3 100.0Onondaga 10 0 10 100.0Ontario 0 0 0 0.0Orange 8 2 6 75.0Orleans 0 0 0 0.0Oswego 1 0 1 100.0Otsego 0 0 0 0.0Putnam 2 1 1 50.0Rensselaer 2 0 2 100.0Rockland 11 1 10 90.9St.Lawrence 0 0 0 0.0Saratoga 1 0 1 100.0Schenectady 3 0 3 100.0Schoharie 0 0 0 0.0Schuyler 0 0 0 0.0Seneca 0 0 0 0.0Steuben 0 0 0 0.0Suffolk 35 8 27 77.1Sullivan 1 0 1 100.0Tioga 0 0 0 0.0Tompkins 4 0 4 100.0Ulster 0 0 0 0.0Warren 0 0 0 0.0Washington 1 1 0 0.0Wayne 1 1 0 0.0Westchester 27 1 26 96.3Wyoming 0 0 0 0.0Yates 0 0 0 0.0TOTALCASES 202 42 160 79.2

County Total U.S.‐Born*Number Number

Foreign‐BornPercent

Foreign‐BornNumber

*U.S.‐born isdefined assomeone borninone ofthe50states,DistrictofColumbia, orbornoutside theUnitedStates toatleastone parentwhowasaU.S. citizen.Source:NewYorkStateDepartment ofHealth Bureau ofTuberculosisControl


22

Table6.LengthofTimeForeign‐BornTuberculosisCaseswereintheUnitedStatesPriortoDiagnosis,NewYorkState(ExclusiveofNewYorkCity),2014

InNewYorkState(exclusiveofNewYorkCity),42.5percent(N=68/160)offoreign‐bornTBcaseswerediagnosedwithinfiveyearsofenteringtheU.S.Overhalf(54.4%,N=37)ofthese68caseshadenteredtheU.S.withintwoyearspriortodiagnosis.Afterfiveyears,thenumberofnewlydiagnosedcasesdeclineasthenumberofyearsintheU.S.increases.

LengthofTimeintheUnitedStates(Years) No. %

<1 20 12.51‐5 48 30.06‐10 27 16.911‐20 29 18.121‐30 13 8.131‐40 11 6.941‐50 5 3.151‐60 4 2.5Unknown 3 1.9

HIV CO‐INFECTION

23

KnowledgeofHIVstatusisessentialforthepropermanagementofpatientswithTB.HIVinfectionimpairstheimmunesystemleavingindividualsatgreaterriskforbecominginfectedwithTBanddevelopingactivedisease.

Figure12.HIVStatusforTuberculosisCases,NewYorkState,2014

Eighty‐fivepercent(N=172/202)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)and80percentofcasesinNewYorkCityhadaknownHIVstatusin2014.Theco‐infectionrateforTBcasesinNewYorkState(exclusiveofNewYorkCity)wasthreepercent(N=6/202),whichwaslessthanhalfofthatseeninNewYorkCity(6.7%,N=39/585).IndividualsmissingHIVtestinginformationandthosewhowerenotofferedorhadrefusedtestingwereconsideredtohaveanunknownstatus.

HIV CO‐INFECTION

24

Figure13.NumberandPercentofTuberculosisCasesWhoHaveBeenTestedforHIV,NewYorkState(ExclusiveofNewYorkCity),2005‐2014

InNewYorkState(exclusiveofNewYorkCity),theproportionofTBcaseswithaknownHIVstatushasincreasedoverthelast10years.In2014,85.1percent(N=172/202)ofTBcaseshadadocumentedHIVresult,whichwasanincreaseof18.9percentcomparedtothe66.2percent(N=202/305)seenin2005.

In2014,only16.7percent(N=1/6)ofTBcasesunderfiveyearsoldhadaknownHIVstatusinNewYorkState(exclusiveofNewYorkCity).TheproportionofcaseswithaknownHIVstatuswasalsorelativelylowinthe55‐64yearagegroup(71.4%,N=20/28)andthe65yearsandolderagegroup(80.4%,N=41/51).

HIV CO‐INFECTION

25

Table7a.HIVStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

In2014,only15percent(N=30/202)ofTBcasesinNewYorkState(excludingNewYork

City)hadanunknownHIVstatus(refused,notofferedormissing/unknown).Thiswasthelowestpercentageseenoverthelastfiveyears.Thepercentageof2014casesnotofferedanHIVtestdropped41.7percentcomparedto2013(3.5%and6.0%,respectively).Thisdeclinewasevenmoresubstantialwhencomparedto2010‐2012.

Table7b.HIVStatusforTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2014

Therewere16femaleTBcases(18.6%,N=16/86)and14malecases(12.1%,N=14/116)reportedinNewYorkState(exclusiveofNewYorkCity)whodidnothaveaknownHIVstatusin2014.NearlyfourpercentmorefemalecasesrefusedtestingcomparedtomaleTBcases(11.6%and7.8%,respectively).

No. % No. % No. % No. % No. %Negative 179 73.7 166 75.1 157 73.0 167 77.0 166 82.2Positive 16 6.6 10 4.5 6 2.8 14 6.5 6 3.0Refused 28 11.5 23 10.4 25 11.6 19 8.8 19 9.4NotOffered 17 7.0 20 9.0 23 10.7 13 6.0 7 3.5Missing/Unknown 3 1.2 2 0.9 4 1.9 4 1.8 4 2.0

TOTALCASES

2013 2014

243 221 215 217 202

2010 2011 2012HIVTest


No. % No. % No. %Negative 99 85.3 67 77.9 166 82.2Positive 3 2.6 3 3.5 6 3.0Refused 9 7.8 10 11.6 19 9.4NotOffered 3 2.6 4 4.7 7 3.5Missing/Unknown 2 1.7 2 2.3 4 2.0

TOTALCASES

HIVTest Male Female Total

116 86 202Source:NewYorkStateDepartmentof Health


REASONS FOR EVALUATION

26

Table8a.PrimaryReasonforEvaluationofTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

In2014,57.4percent(N=116/202)ofcasesinNewYorkState(exclusiveofNewYorkCity)wereevaluatedasaresultofpresentingwithTBsymptomsandanotherone‐thirdofcaseseitherhadanabnormalchestradiograph(N=42/202,20.8%)oranincidentallabresult(N=23/202,11.4%).Overthepastfiveyears,thesehavecontinuedtobethethreemostfrequentlyreportedreasonsforevaluation.

Table8b.PrimaryReasonforEvaluationofTuberculosisCasesbyU.S.‐born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2014

Nearly62percent(N=99/160)offoreign‐borncasesinNewYorkState(exclusiveofNewYorkCity),underwentTBevaluationduetoTBsymptomscomparedto40.5percent(N=17/42)ofU.S.‐borncasesin2014.AsidefromTBsymptoms,thereasonsforevaluationvariedmorewidelyforforeign‐borncasesthanforU.S.‐borncases.

No. % No. % No. % No. % No. %TBSymptoms 115 47.3 116 52.5 110 51.2 111 51.2 116 57.4AbnormalChestRadiograph 70 28.8 54 24.4 54 25.1 48 22.1 42 20.8IncidentalLabResult 35 14.4 28 12.7 35 16.3 35 16.1 23 11.4ContactInvestigation 4 1.6 10 4.5 4 1.9 6 2.8 9 4.5TargetedTesting 1 0.4 5 2.3 2 0.9 1 0.5 4 2.0ImmigrationMedicalExam 6 2.5 4 1.8 3 1.4 6 2.8 3 1.5Employment/AdministrativeTesting 2 0.8 0 0.0 1 0.5 2 0.9 1 0.5HealthCareWorker 1 0.4 0 0.0 1 0.5 0 0.0 1 0.5Unknown 9 3.7 4 1.8 5 2.3 8 3.7 3 1.5

TOTALCASES

2011 2012 2013 2014

221 215 217 202

PrimaryReasonforEvaluation 2010

243Source:NewYorkStateDepartmentofHealth


No. % No. % No. %TBSymptoms 17 40.5 99 61.9 116 57.4AbnormalChestRadiograph 13 31.0 29 18.1 42 20.8IncidentalLabResult 7 16.7 16 10.0 23 11.4ContactInvestigation 4 9.5 5 3.1 9 4.5TargetedTesting 0 0.0 4 2.5 4 2.0ImmigrationMedicalExam 0 0.0 3 1.9 3 1.5Employment/AdministrativeTesting 0 0.0 1 0.6 1 0.5HealthCareWorker 0 0.0 1 0.6 1 0.5Unknown 1 2.4 2 1.3 3 1.5

TOTALCASES

PrimaryReasonforEvaluation U.S.‐Born Foreign‐Born Total

42 160 202Source:NewYorkStateDepartmentofHealth

BureauofTuberculosisControl*U.S.‐bornisdefinedassomeoneborninoneofthe50states,DistrictofColumbia,orbornoutsidetheUnitedStatestoatleastoneparentwhowasaU.S.citizen

RISK FACTORS

27

Asidefromthecommonlycollectedriskfactors,suchasHIVstatus,drug/alcoholusage,occupationandcountryofbirth,thereareadditionalmedicalandexposureriskfactorsthatareassociatedwithTB.Medicalriskfactorsareconditionsthatweakenanindividual’simmunedefensesagainstTBandmaycomplicatethemanagementofthedisease.ExposureriskfactorsarethosethatplaceanindividualatincreasedriskofTBtransmission.

Table9a.AdditionalRiskFactors*AmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

AlthoughthemajorityofTBcasesinNewYorkState(exclusiveofNewYorkCity)didn’thaveadditionalriskfactors,between33and42percentofthosediagnosedinthelastfiveyearshadatleastone.Amongthesecases,mostfactorsweremedicalriskfactors,withdiabetes,immunosuppression(notHIV/AIDS)andincompletelatenttuberculosisinfection(LTBI)therapybeingmostcommon.

TheproportionofTBcaseswithdiabeteshassteadilyincreasedsince2010.In2014nearly15percent(N=30/202)ofcasesinNewYorkState(exclusiveofNewYorkCity)haddiabetes.Another8.4percent(N=17/202)ofcasesin2014hadbeenincontactwithaninfectiousTBpatientwithinthelasttwoyears.

Table9b.AdditionalRiskFactors*AmongTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2014

In2014,diabeteswasmorecommonlyidentifiedamongfemalesthanmales(N=14,16.3%forfemales;N=16,13.8%formales),aswasbeingarecentcontacttoaninfectiousTBcase(N=9,10.5%forfemales;N=8,6.9%formales).

No. % No. % No. % No. % No. %DiabetesMellitus 24 9.9 23 10.4 23 10.7 25 11.5 30 14.9Immunosuppression(notHIV/AIDS) 19 7.8 18 8.1 15 7.0 9 4.1 11 5.4IncompleteLTBITherapy 13 5.3 13 5.9 13 6.0 9 4.1 8 4.0End‐StageRenalDisease 3 1.2 4 1.8 3 1.4 4 1.8 6 3.0Post‐OrganTransplantation 2 0.8 2 0.9 1 0.5 0 0.0 4 2.0TNF‐αAntagonistTherapy 2 0.8 0 0.0 2 0.9 2 0.9 1 0.5ContactofInfectiousTBPatient 15 6.2 12 5.4 8 3.7 13 6.0 17 8.4ContactofMDR‐TBPatient 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0MissedContact 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0

OtherRisk OtherFactors 10 4.1 12 5.4 24 11.2 16 7.4 28 13.9None NoAdditionalFactors 162 66.7 144 65.2 131 60.9 146 67.3 117 57.9

215

2012 2013 2014AdditionalRiskFactors 2010 2011

TOTALCASES 243

MedicalRisk

ExposureRisk**

217 202221*Categoriesarenotmutuallyexclusive**Withinthelast2yearsLTBI=LatentTuberculosisInfection


No. % No. % No. %DiabetesMellitus 16 13.8 14 16.3 30 14.9Immunosuppression(notHIV/AIDS) 7 6.0 4 4.7 11 5.4IncompleteLTBITherapy 5 4.3 3 3.5 8 4.0End‐StageRenalDisease 4 3.4 2 2.3 6 3.0Post‐OrganTransplantation 3 2.6 1 1.2 4 2.0TNF‐αAntagonistTherapy 1 0.9 0 0.0 1 0.5ContactofInfectiousTBPatient 8 6.9 9 10.5 17 8.4ContactofMDR‐TBPatient 0 0.0 0 0.0 0 0.0MissedContact 0 0.0 0 0.0 0 0.0

OtherRisk OtherFactors 16 13.8 12 14.0 28 13.9None NoAdditonalFactors 68 58.6 49 57.0 117 57.9

Male Female Total

MedicalRisk

ExposureRisk**

TOTALCASES 116 86 202

AdditionalRiskFactors

*Categoriesarenotmutuallyexclusive**Withinthelast2yearsLTBI=LatentTuberculosisInfection


RISK FACTORS

28

Figure14.TuberculosisCasesandRates*AmongDOCCS**Inmates,NewYorkState(ExclusiveofNewYorkCity),1986‐2014

Duringthelate1980sandearly1990s,asubstantialproportionofTBcasesreportedbyNewYorkState(exclusiveofNewYorkCity)wereintheNewYorkStateDepartmentofCorrectionsandCommunitySupervision(DOCCS)inmatepopulation.AmongtheDOCCSinmatepopulation,therehasbeenanotabledeclineincasessince1991when102newcases(176per100,000inmates)werereported.In2011and2012therewerenonewcasesreported,butin2013therewerethreenewcases(5.5per100,000inmates)andin2014therewasonenewcase(1.8per100,000inmates).

RISK FACTORS

29

ThereisanincreasedriskofTBtransmissionforresidentsandstaffofcongregatesettings(e.g.,correctionalfacilitiesandlong‐termcarefacilities)duetothecloseproximityandprolongedcontactwithothers.Residentsofcongregatesettingsmayalsohavesignificantcomorbiditiesthatamplifythisriskevenfurther.

Table10.High‐RiskCongregateSettingattheTimeofDiagnosisforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

ThenumberandpercentageofcasesdiagnosedwhileresidinginacongregatesettingvariedoverthelastfiveyearsinNewYorkState(exclusiveofNewYorkCity),butwashighestin2010(N=15,6.2%)andlowestin2012(N=5,2.3%).In2014,five(2.5%)caseswereidentifiedinacongregatesetting,threeofwhichwereinacorrectionalfacilityandtwowereinalong‐termcarefacility.

Table11.HomelessnessAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

ThehomelesspopulationisatincreasedriskofacquiringortransmittingTBtoothersashomelessnessisoftenaccompaniedbyotherriskfactorsassociatedwithTB,suchassubstanceabuse,HIVinfection,andinadequatemedicalcare.Apersonisconsideredtobehomelessiftheydon’thaveafixed,regularnighttimeresidence.Theseindividualsmayliveonthestreets,alternatebetweenmanytemporaryresidences,orresideinprivatelyorpubliclysupervisedshelters.

From2010to2014,anaverageof1.7percent(N=19/1,098)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)werehomelesswithinthe12monthspriortodiagnosis.

No. % No. % No. % No. % No. %JuvenileFacility 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5LocalJail 3 1.2 3 1.4 0 0.0 0 0.0 1 0.5StatePrison 2 0.8 0 0.0 0 0.0 3 1.4 1 0.5FederalPrison 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0OtherFacility 2 0.8 2 0.9 0 0.0 0 0.0 0 0.0Alcohol/DrugTreatment 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5Hospital‐Based 1 0.4 1 0.5 0 0.0 0 0.0 0 0.0MentalHealthResidence 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0NursingHome 2 0.8 2 0.9 3 1.4 2 0.9 1 0.5Residential 2 0.8 0 0.0 1 0.5 0 0.0 0 0.0OtherLong‐TermCare 3 1.2 1 0.5 1 0.5 2 0.9 0 0.0Unknown 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0

2014

CorrectionalFacility

Long‐TermCareFacility

TOTALCASES 243 221 215 217 202

CongregateSettingatTimeofTBDiagnosis

2010 2011 2012 2013


No. %2010 8 3.32011 3 1.42012 1 0.52013 5 2.32014 2 1.0

HomelessCasesYear

RISK FACTORS

30

SubstanceabuseweakenstheimmunesystemwhichcanleavepeoplemoreinfectiousoratgreaterriskofbecominginfectedanddevelopingactiveTB.Also,thedrugsusedtotreatTBcanbetoxictotheliversosubstanceabuse,suchasexcessalcoholuse,canincreasethedamagingeffectsoftreatment.

Table12.SubstanceAbuse*AmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

InNewYorkState(exclusiveofNewYorkCity),excessalcoholusehasbeenthemostcommonlyreportedformofsubstanceabuseamongTBcasesoverthelastfiveyears.Therewere13cases(6.4%)in2014whoreportedalcoholabuse,twoofwhichalsoreportednon‐injectiondruguse.

No. % No. % No. % No. % No. %InjectionDrugUse 4 1.6 1 0.5 0 0.0 2 0.9 1 0.5Non‐InjectionDrugUse 7 2.9 7 3.2 5 2.3 6 2.8 3 1.5ExcessAlcoholUse 20 8.2 20 9.0 10 4.7 22 10.1 13 6.4TOTALCASES

2014

202

SubstanceAbuse 2010 2011 2012 2013

243 221 215 217*Categoriesarenot mutuallyexclusive Source:NewYorkStateDepartmentofHealth


DRUG RESISTANCE

31

Thefirst‐linedrugsusedfortreatingTBdiseaseareisoniazid(INH),rifampin(RIF),pyrazinamide(PZA),ethambutol(EMB),andlesscommonlystreptomycin(SM),butthereareothersecond‐linedrugsthatcanbeusedwhennecessary.MostTBstrainsaresusceptibletoallfirst‐linedrugs,butresistancetooneormorecanoccur,whichcouldcomplicatethemanagementofthedisease.MDRTBiscausedbyaTBstrainthatisresistanttoatleastINHandRIF.ExtensivelydrugresistantTB(XDRTB)isMDRTBwithadditionalresistancetosecond‐linedrugs,suchasanyfluoroquinolone(levofloxacin,moxifloxacin,andofloxacin)andatleastoneoftheinjectabledrugs(amikacin,kanamycin,andcapreomycin).Drugsusceptibilitytestingisperformedwheneverpossibletoidentifyanydrugresistance.

Table13a.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Overthelastfiveyears,therehavebeen824culture‐confirmedTBcasesinNewYorkState(exclusiveofNewYorkCity).Drugsusceptibilityresultshavebeenreportedfor99percent(N=816/824)ofthesecases,most(N=678,83.1%)ofwhichhavebeensusceptibletoallfirst‐lineTBdrugs.Despitethishighlevelofsusceptibility,therewere138caseswithfirst‐linedrugresistancebetween2010and2014,16ofwhichhadMDRTB.

In2014,susceptibilityresultswerereportedfor163ofthe164caseswithcultureconfirmedTBinNewYorkState(exclusiveofNewYorkCity).Nearly88percent(N=29/33)ofU.S‐borncasesand84.6percent(N=110/130)offoreign‐borncasesweresusceptibletoallfirst‐linedrugs.Amongthetwoforeign‐borncaseswithMDRTB,onewasXDRandhadresistancetoallfirst‐linedrugsaswellasmanysecond‐linedrugs.

Table13b.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2012‐2014

No. % No. % No. % No. % No. % No. %45 116 30 127 34 130

43 95.6 115 99.1 30 100.0 127 100.0 33 97.1 130 100.0

Susceptibletoallfirst‐linedrugs 36 83.7 97 84.3 28 93.3 106 83.5 29 87.9 110 84.6

INHandRIFresistance(MDRTB) 2 4.7 1 0.9 0 0.0 2 1.6 0 0.0 2* 1.5

INHresistanceonly 2 4.7 9 7.8 0 0.0 6 4.7 2 6.1 9 6.9

RIFresistanceonly 0 0.0 0 0.0 0 0.0 1 0.8 0 0.0 0 0.0

ResistanceotherthanINHandRIF 3 7.0 8 7.0 2 6.7 12 9.4 2 6.1 9 6.9

U.S.‐Born Foreign‐Born U.S.‐Born Foreign‐Born U.S.‐Born Foreign‐BornFirst‐LineDrugSusceptibilityResults

2012 2013 2014

PositiveCulture

SusceptibilityTestReported

SusceptibilityTestResults


INH=Isoniazid;RIF=Rifampin;MDRTB=Multidrug‐resistantTB*1casehadextensivelydrugresistantTB(XDRTB)

No. % No. % No. % No. % No. %

170 172 161 157 164

169 99.4 169 98.3 158 98.1 157 100.0 163 99.4

Susceptibletoallfirst‐linedrugs 136 80.5 136 80.5 133 84.2 134 85.4 139 85.3

INHandRIFresistant(MDRTB) 3 1.8 6 3.6 3 1.9 2 1.3 2* 1.2

INHresistant,RIFsusceptible 13 7.7 12 7.1 11 7.0 6 3.8 11 6.7

RIFresistant,INHsusceptible 4 2.4 1 0.6 0 0.0 1 0.6 0 0.0

ResistanceotherthanINHandRIF 13 7.7 14 8.3 11 7.0 14 8.9 11 6.7

PositiveCulture

SusceptibilityTestReported

SusceptibilityTestResults

First‐LineDrugSusceptibilityResults 2010 2011 2012 2013 2014


INH=Isoniazid;RIF=Rifampin;MDRTB=Multidrug‐resistantTB*1casehadextensivelydrugresistantTB(XDRTB)

DRUG RESISTANCE

32

Figure15.NumberandPercentofMultidrug‐ResistantTuberculosisCases,NewYorkState,2010‐2014

Overthelastfiveyears,thenumberofMDRTBcaseswasclosetothreetimeshigherinNewYorkCitycomparedtotheremainderofthestate(N=59andN=16,respectively).Despitethislargedifferenceinnumber,theproportionofMDRTBcaseswascomparable.

GENOTYPING

33

Table14.TuberculosisGenotypingSummaryforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

NewYorkStaterequiresthatallinitialpositiveculturesbesubmittedforgenotyping.Beginningin2004,realtimespoligotypingandsubsequentrestrictionfragmentlengthpolymorphism(RFLP)testingwereperformedattheDepartment’sWadsworthCenterforLaboratoriesandResearch,butasof2009RFLPwasdiscontinued.Inaddition,theCDC‐sponsoredNationalTuberculosisGenotypingregionallabinMichiganhasperformedmycobacterialinterspersedrepetitiveunit(MIRU)andspoligotyping,bothofwhichareneededforagenotypetobeconsideredcomplete.

In2014,97percent(N=162/167)ofisolatesinNewYorkState(exclusiveofNewYorkCity)wereavailableforgenotyping,aslightdecreasefromthe100percent(N=158/158)in2013.Ofthese162isolates,95.1percent(N=154)hadacompletegenotype(spoligotypeandMIRUresult).AnadditionalsixisolatesonlyhadaspoligotypeoraMIRUresultavailable,so98.8percentofcaseshadatleastsomegenotypeinformationavailable.

No. % No. % No. % No. % No. %

172 177 163 161 170

TotalFalsePositives 2 5 2 3 3Controlstrain 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Contamination 1 0.6 2 1.1 1 0.6 0 0.0 0 0.0M.bovisBCG 1 0.6 3 1.7 1 0.6 3 1.9 3 1.8

TotalTruePositives 170 172 161 158 167IsolatesAvailable 170 172 155 158 162

CompleteGenotype* 166 97.6 155 90.1 142 91.6 128 81.0 154 95.1IncompleteGenotype 167 98.2 167 97.1 154 99.4 151 95.6 160 98.8

NoResult 3 1.8 5 2.9 1 0.6 6 3.8 2 1.2

FalsePositives

TruePositives

InitialPositiveCultures

2014Genotyping 20112010 2012 2013


*CompletegenotypemeanshavingbothaspoligotypeandMIRUresultMIRU=mycobacterialinterspersedrepetitiveunit

SITE OF DISEASE

34

TheprimarysiteofdiseaseformostTBcasesispulmonary,butextrapulmonaryinvolvementalsooccurs.TBisspreadfrompersontopersonthroughairbornetransmission,socaseswithpulmonaryinvolvementhavethegreatestpotentialtoinfectothers.

Table15.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014

Inthelastfiveyears,theproportionofTBcaseswithpulmonarydiseaserangedfrom70to

78percentinNewYorkState(exclusiveofNewYorkCity).ThelowestproportionofcaseswithpulmonaryTBwasobservedin2013(69.1%)andthehighestwasseenin2014(77.8%).

Figure16.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState,2014

ForNewYorkStateasawhole,632(80.3%)TBcaseswerereportedwithpulmonarydiseasein2014.Amongthese632pulmonarycases,128alsohaddiseaseinoneormoreextra‐pulmonarysites.

No. % No. % No. % No. % No. %Pulmonary 148 60.9 141 63.8 126 58.6 119 54.8 129 63.9Extrapulmonary 58 23.9 54 24.4 65 30.2 67 30.9 45 22.3Both 37 15.2 26 11.8 24 11.2 31 14.3 28 13.9

TOTALCASES

PrimarySiteofDisease 2010 2013 2014

243 221 215 217 202

2011 2012


SITE OF DISEASE

35

Table16.Extra‐PulmonarySitesofDisease*forTuberculosisCases,NewYorkState,2014

Amongthe283casesinNewYorkStatewithatleastoneextra‐pulmonarysiteofdisease,themostcommonsitesofdiseasein2014werelymphatic(N=121),pleural(N=74)andbone/joint(N=24).While224casesonlyhadoneextra‐pulmonarysiteofdisease,59hadmultiplesitesidentified.

NewYorkState NewYorkCity NewYorkState(ExclusiveofNewYorkCity) (Total)

Lymphatic 38 83 121Pleural 12 62 74Bone/Joint 7 17 24Meningeal 3 14 17Genitourinary 6 10 16Peritoneal 5 10 15Laryngeal 1 1 2Other 6 31 37

Extra‐PulmonarySiteofDisease


*Categoriesarenotmutuallyexclusive

COMPLETION OF THERAPY

36

Table17a.TreatmentStatusforTuberculosisCases,*NewYorkState(ExclusiveofNewYorkCity),2009‐2013

InNewYorkState(exclusiveofNewYorkCity),theaveragetreatmentcompletionratefor

TBcaseswhowerealiveatdiagnosisandstartedtreatmentbetween2009and2013(themostrecentyearforwhichcompletioninformationisavailable)was89.9percent(N=1,004/1,118).Thehighestcompletionpercentageof92.5percent(N=221/239)wasseenin2010,followedby91.1percent(195/214)in2013.

Table17b.TreatmentStatusforTuberculosisCases*Reportedin2013,NewYorkState(ExclusiveofNewYorkCity)

In2013,thetwoMDRcasesreportedinNewYorkState(ExclusiveofNewYorkCity)

completedtreatment.

No. % No. % No. % No. % No. %Complete 202 84.5 221 92.5 197 90.4 189 90.9 195 91.1

Died 18 7.5 13 5.4 15 6.9 8 3.8 10 4.7Uncooperative/Refused 3 1.3 0 0.0 2 0.9 0 0.0 3 1.4Lost 4 1.7 1 0.4 0 0.0 1 0.5 1 0.5AdverseTreatmentEvent 2 0.8 1 0.4 1 0.5 2 1.0 2 0.9

Other 10 4.2 3 1.3 3 1.4 8 3.8 3 1.4

TOTALCASES 208

TreatmentStatus 2009 2010 2011 2012

239 239 218

2013

214Source:NewYorkStateDepartment ofHealth

Bureau ofTuberculosisControl*Excludes patients found nottohave TB,those reportedatdeath andthosewhoneverstartedtreatment

No. % No. % No. %Complete 193 91.0 2 100.0 195 91.1Died 10 4.7 0 0.0 10 4.7Uncooperative/Refused 3 1.4 0 0.0 3 1.4Lost 1 0.5 0 0.0 1 0.5AdverseTreatmentEvent 2 0.9 0 0.0 2 0.9Other 3 1.4 0 0.0 3 1.4

TOTALCASES

Total

2142212

TreatmentStatus Non‐MDRTB MDRTB

*ExcludespatientsfoundnottohaveTB,those reportedatdeathandthosewhoneverstartedtreatmentMDRTB=Multidrug‐resistantTB


COMPLETION OF THERAPY

37

Figure17.PercentofTuberculosisCasesWhoCompletedTreatmentWithin12Months,*byU.S.‐Born**andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2004‐2013

For2013(themostrecentyearforwhichcompleteinformationisavailable),87.8percent(N=156/180)ofpatientsinNewYorkState(exclusiveofNewYorkCity)eligible^tocompletetreatmentwithin12months,didso.Thisdecreasecomparedtorecentprioryearswasduetoseveralpatientsin2013havingcomplicatedclinicalpresentationsandadversereactionstotreatment.Anadditional9.4percent(N=17/180)ofpatientscompletedtreatmentinmorethan12monthsforanoverallcompletionrateof97.2percent.Alargerpercentageofforeign‐borncasescompletedtherapywithin12monthscomparedtoU.S.‐borncasesin2013(88.9%and83.3%,respectively).^Patientswithrifampinresistance,thosewithmeningealTB,andchildrenunder15whohavedisseminatedTB(miliaryTBorevidenceofmiliaryTBonchestradiograph,orapositivebloodculture)areineligibletocompletewithin12monthssotheyareexcluded.Thosewhowereneverstartedontreatment,weredeadatdiagnosis,orwhodiedwhileontreatmentarealsoexcluded.EffectiveJanuary2009,theCDCrevisedthedefinitionofwhoiseligibletocompletetreatmenttoalsoexcludepatientswhomovedoutofthecountrywhileontreatment.

CONTACTS TO INFECTIOUS TUBERCULOSIS CASES

38

PeoplewhocomeinclosecontactwithaninfectiousTBcaseforaprolongedperiodoftimeareathighriskofbecominginfected.SinceTBisspreadpersontopersonbybreathinginairborneparticlesfromanotherinfectedindividual,pulmonaryTBcaseswhoareexhibitingsymptoms,suchascoughing,aremostlikelytotransmitTBtoothers.Fornewlydiagnosedcases,investigationsareconductedtoidentifyclosecontactswhomayhavebeeninfected.Oncecontactsareidentified,theyarenotifiedoftheirexposureandeffortsaremadetogeteachindividualevaluated.Uponevaluation,ifacontacthasapositivetuberculinskintest(TST)orapositiveInterferon‐GammaReleaseAssay,furtherevaluationisdonetodetermineiftheinfectionisactiveTBdiseaseorLTBI.Treatmentoptionsforeitherconditionarethendiscussed.IndividualswhohavebeenrecentlyinfectedhaveagreaterriskoftheirinfectiondevelopingintoactiveTBdiseasesoitisimportantforLTBIpatientstocompletetreatment.

Table18.NumberandPercentofInfectiousTuberculosisCaseswithContactsIdentified,NewYorkState(ExclusiveofNewYorkCity),2004‐2013

In2013,themostrecentyearforwhichcompleteinformationisavailable,98.4percent(N=62/63)ofinfectiousTBcasesinNewYorkState(exclusiveofNewYorkCity)hadcontactsidentified.Thisexceedsthestateobjectiveof96.5percent.TheoneinfectiousTBcasewithoutcontactsidentifiedwasinterviewedanditwasdeterminedthatthepatientdidnotcomeinprolongedcontactwithanyotherindividualswhileexperiencingsymptoms.

Table19.NumberandPercentofContactstoInfectiousTuberculosisCasesEvaluatedforLatentTuberculosisInfection,NewYorkState(ExclusiveofNewYorkCity),2004‐2013

Eighty‐threepercent(N=1,215/1,462)ofcontactstoinfectiouscasesinNewYorkState(exclusiveofNewYorkCity)wereevaluatedforLTBIin2013(themostrecentyearforwhichcompleteinformationisavailable).Thisisadeclineof2.6percentcomparedtothe85.7percentwhowereevaluatedin2012.Commonreasonsfornotevaluatingcontactsincludetheinabilitytolocatetheindividualandthecontactrefusingevaluation.

YearTotal

InfectiousCases

No. %2004 98 96 98.0

2005 104 103 99.0

2006 97 92 94.8

2007 78 76 97.4

2008 92 90 97.8

2009 66 65 98.5

2010 73 72 98.6

2011 80 78 97.5

2012 75 75 100.0

2013 63 62 98.4

InfectiousCaseswithContactsIdentified

YearTotal

ContactsIdentified

No. %2004 3,994 3,178 79.6

2005 1,865 1,665 89.3

2006 2,970 2,506 84.4

2007 4,050 3,322 82.0

2008 3,549 2,647 74.6

2009 1,768 1,447 81.8

2010 2,253 2,027 89.9

2011 3,662 3,049 83.3

2012 1,851 1,587 85.7

2013 1,462 1,215 83.1

ContactsEvaluated

CONTACTS TO INFECTIOUS TUBERCULOSIS CASES

39

Figure18.NumberandPercentofContactstoInfectiousTuberculosisCasesPlacedonTreatmentforLatentTuberculosisInfectionandCompleted,NewYorkState(ExclusiveofNewYorkCity),2004‐2013

AmongthecontactstoinfectiouscasesinNewYorkState(exclusiveofNewYorkCity)whowereevaluatedin2013(themostrecentyearforwhichcompleteinformationisavailable),198(16.3%)werediagnosedwithLTBIandwerecandidatesfortreatment.Eightypercent(N=159/198)ofthesecontactswerestartedonatreatmentregimenand73.6percent(N=117/159)ofthosewhostartedtreatmentcompletedtheprescribedregimen.

DIRECTLY OBSERVED THERAPY

40

Figure19.NumberandPercentofTuberculosisCases*ReceivingAnyDirectlyObservedTherapy,NewYorkState(ExclusiveofNewYorkCity),1991‐2014

InNewYorkState(exclusiveofNewYorkCity)theproportionofcasesreceivingdirectlyobservedtherapy(DOT)hasbeenincreasingsincetheearly1990swhenitwasfirstactivelypromotedbytheNewYorkStateDepartmentofHealth,localhealthunits,andothers.In1991,45.2percent(N=297/657)ofTBcasesontreatmentreceivedatleastpartoftheirtherapyasDOT.Sincethen,theproportionofcasesreceivingaportionoftheirtreatmentasDOThasmorethandoubledto95.9percent(N=189/197)in2014.

CONTACT INFORMATION

41

NewYorkStateDepartmentofHealthBureauofTuberculosisControl

NewYorkStateDepartmentofHealthBureauofTuberculosisControlEmpireStatePlazaCorningTower,Room565Albany,NY12237

Tel(518)474‐7000MainFax(518)473‐6164ConfidentialFax(518)408‐[email protected]

Formoreinformation:www.health.ny.gov/diseases/communicable/tuberculosis

NewYorkCityDepartmentofHealthandMentalHygieneBureauofTuberculosisControl

NewYorkCityDepartmentofHealth&MentalHygieneBureauofTuberculosisControl42‐0928thStreet,CN72BLongIslandCity,NY11101Tel(844)713‐0559(TBHotline)Fax(844)713‐0557/0558Formoreinformation:www1.nyc.gov/site/doh/health/health‐topics/tuberculosis.page

tuberculosis in new york state in new york state ... table 1. tuberculosis cases and rates ......

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