Tuberculosis in the United States

National Tuberculosis Surveillance System

Highlights from 2011

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of Tuberculosis Elimination

Reported TB Cases United States, 1982–2011*

*Updated as of June 25, 2012.

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

0

5,000

10,000

15,000

20,000

25,000

30,000

No. o

f Cas

es

Year

Year No. Rate*2006 13,727 4.6

2007 13,278 4.4

2008 12,895 4.2

2009 11,528 3.8

2010 11,171 3.6

2011 10,528 3.4

*Cases per 100,000. Updated as of June 25, 2012.

TB MorbidityUnited States, 2006–2011

TB Case Rates,* United States, 2011

*Cases per 100,000.

< 3.4 (2011 national average)>3.4

D.C.

TB Case Rates* by Age Group United States, 1993–2011

* Updated as of June 25, 2012.

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0.0

5.0

10.0

15.0

20.0

0- 14 15 - 24 25 - 44 45-65

Cas

es p

er 1

00,0

00

Age Group (years)

Reported TB Cases by Age Group, United States, 2011

<15 yrs (5%) 15-24 yrs

(10%)

24-44 yrs (32%)45-64 yrs

(31%)

≥ 65 yrs(21%)

TB Case Rates by Age Group and Sex, United States, 2011

Under 5 5 - 14 15 - 24 24 - 44 45-64 ≥650.01.02.03.04.05.06.07.08.0

Male Female

Cas

es p

er 1

00,0

00

TB Case Rates by Race/Ethnicity* United States, 2003–2011**

*All races are non-Hispanic. **Updated as of June 25, 2012.

Cas

es p

er 1

00,0

00

2003 2004 2005 2006 2007 2008 2009 2010 20110.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Hispanic or Latino American Indian or Alaska Native Asian

Black or African American Native Hawaiian or Other Pacific Islander White

TB Case Rates by Age Group and Race/Ethnicity* United States, 2011

*All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.

Under 5 5 - 14 15 - 24 24 - 44 45-64 ≥650.0

10.0

20.0

30.0

40.0

50.0

60.0

Hispanic or Latino American Indian or Alaska Native AsianBlack or African American Native Hawaiian or Other Pacific Islander White

Cas

es p

er 1

00,0

00

Reported TB Cases by Race/Ethnicity*United States, 2011

*All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.

Hispanic or Latino(29%)

Native Hawaiian or Other Pacific Is-

lander(1%)

White(16%)Asian

(30%)

American Indian or Alaska Native

(1%)

Black or African American

(23%)

Number of TB Cases inU.S.-born vs. Foreign-born Persons

United States, 1993–2011*

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

0

5,000

10,000

15,000

20,000

U.S.-born Foreign-born

*Updated as of June 25, 2012.

No. o

f Cas

es

Trends in TB Cases in Foreign-born Persons

United States, 1991 – 2011*

*Updated as of June 25, 2012.

No. of Cases Percentage

19911992

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110

1,0002,0003,0004,0005,0006,0007,0008,0009,000

10,000

0

10

20

30

40

50

60

70

Number of Cases Percentage of Total Cases

Reported TB Cases by Origin and Race/Ethnicity,* United States, 2011

*All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.

** American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander accounted for less than 1% of foreign-born cases and are not shown.

Hispanic or Latino

(19%)American Indian or Alaska Native(3%)

Asian(3%)

Black or African American

(39%)

Native Hawaiian or Other Pacific Is-

lander(2%)

White(33%)

His-panic or Latino(34%)

Asian(46%)

Black or African Ameri-

can(13%)

White(5%)

U.S.-born Foreign-born**

>50%25%–49%<25%

2001 2011

DC

*Updated as of June 25, 2012.

Percentage of TB Cases Among Foreign-born Persons, United States*

DC

TB Case Rates in U.S.-born vs. Foreign-born Persons, United States, 1993 –

2011*

*Updated as of June 25, 2012.

Cas

es p

er 1

00,0

00

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

U.S. Overall U.S.-born Foreign-born

TB Case Rates in U.S.-born vs. Foreign-born Persons, United States*, 1993 –

2011**

*Includes the same data as slide 15, but rates presented on a logarithmic scale.**Updated as of June 25, 2012.

Cas

es p

er 1

00,0

00

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20111.0

10.0

100.0

U.S. Overall U.S.-born Foreign-born

Countries of Birth of Foreign-born Persons Reported with TB, United

States, 2011

Mexico(22%)

Philippines(11%)

India(8%)

Vietnam(8%)China

(6%)Guatemala

(3%)

Haiti(3%)

Other Countries39%

Percent of Foreign-born with TB by Time of Residence in U.S. Prior to

Diagnosis, 2011

*Foreign-born TB patients for whom information on length of residence in the U.S. prior to diagnosis is unknown or missing

Mexico Philippines Vietnam All Foreign-born0

102030405060708090

100

Unknown* <1 year 1-4 years ≥5 years

Primary Anti-TB Drug ResistanceUnited States, 1993 – 2011*

*Updated as of June 25, 2012.Note: Based on initial isolates from persons with no prior history of TB. Multidrug resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin

% R

esist

ant

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110123456789

10

Isoniazid MDR TB

Primary MDR TBUnited States, 1993 – 2011*

*Updated as of June 25, 2012.Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

No. of Cases Percentage

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110

100

200

300

400

500

0

1

2

3

No. of Cases Percentage

Primary Isoniazid Resistance in U.S.-born vs. Foreign-born Persons

United States, 1993 – 2011*

*Updated as of June 25, 2012.Note: Based on initial isolates from persons with no prior history of TB.

% R

esist

ant

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110

2

4

6

8

10

12

14

U.S.-born Foreign-born

*Updated as of June 25, 2012.Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

Primary MDR TB in U.S.-born vs. Foreign-born Persons

United States, 1993 – 2011*

% R

esist

ant

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110

1

2

3

U.S.-born Foreign-born

XDR TB Case Count Defined on Initial DST*

by Year, 1993 – 2011**

* Drug susceptibility test** Updated as of June 25, 2012.Note: Extensively drug-resistant TB (XDR TB) is defined as resistance to isoniazid and rifampin, plus resistance to any fluoroquinolone and at least one of three injectable second-line anti-TB drugs

Case

Cou

nt

Year of Diagnosis1993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20102011

0

2

4

6

8

10

12

Reporting of HIV Test Results in Persons with TB by Age Group

United States, 1993 – 2011*

*Updated as of June 25, 2012.Note: Includes TB patients with positive, negative, or indeterminate HIV test results. HIV test results not reported from California after 2004. HIV test results not reported from Rhode Island for years 1993-1997. HIV test results not reported from Vermont after 2007.

% w

ith Te

st R

esul

ts

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110

10 20 30 40 50 60 70 80 90

100

All Ages Aged 25 - 44

Estimated HIV Coinfection in Persons Reported with TB, United States, 1993 –

2011*

*Updated as of June 25, 2012Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group

% C

oinf

ectio

n

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110

5

10

15

20

25

30

Aged 25-44 All Ages

TB Cases by Residence in Correctional Facilities, Age ≥15, United States,

1993-2011*

*Updated as of June 25, 2012Note: Resident of correctional facility at time of TB diagnosis

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110

200

400

600

800

1000

1200

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

No. of Cases Percent of Total Cases

TB Cases Reported as Homeless in the 12 Months Prior to Diagnosis,

Age ≥15, United States, 1993-2011*

*Updated as of June 25, 2012Note: Homeless within past 12 months of TB diagnosis

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20110

200

400

600

800

1000

1200

1400

1600

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

No. of Cases Percent of Total Cases

Mode of Treatment Administration in Persons Reported with TBUnited States, 1993 – 2009*

*Updated as of June 25, 2012. Data available through 2009 only.**Percentage of total cases in persons alive at diagnosis, with an initial regimen of one or more drugs prescribed, and excluding cases with unknown mode of treatment administration.Directly observed therapy (DOT); Self-administered therapy (SA)

Perc

enta

ge**

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20090

20

40

60

80

100

DOT only DOT + SA SA only

Completion of TB TherapyUnited States, 1993 – 2009*

* Updated as of June 25, 2012. Data available through 2009 only.Note: Includes persons alive at diagnosis, with initial drug regimen of one or more drugs prescribed, who did not die during therapy. Excludes persons with initial isolate rifampin resistant, or patient with meningeal disease, or pediatric patient (aged <15) with miliary disease or positive blood culture.

Perc

enta

ge

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20090

20

40

60

80

100

Completed Completed in 1 year or less