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Return to 2000 Surveillance Slides Main Menu 2000 Surveillance SlidesThis is an archived document. The links and content are no longer being updated. Tuberculosis in the United States National Surveillance System Highlights from 2000 Slide 1 (title slide): Tuberculosis in the United States: National Surveillance System, Highlights from 2000. Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention. This slide set provides highlights from the data collected through the national TB surveillance system in 2000. Since 1953, through the cooperation of state and local health departments, CDC has collected information on the numbers of reported TB cases in the United States. The data presented here were primarily collected via the expanded TB case report introduced in 1993. Currently, individual TB case reports (Report of Verified Case of Tuberculosis, or RVCT) are submitted electronically via the Tuberculosis Information Management System (TIMS), a comprehensive CDC software system for TB surveillance, patient management, and program evaluation. Slide 2: Reported TB Cases, United States, 1980-2000. The resurgence of TB in the mid 1980s was marked by several years of slowly increasing case counts followed by a substantial rise for several years. The total number of TB cases peaked in 1992. Since 1992, the total number of TB cases has decreased 5%-7% annually. 2000 marks the eighth year of decline in the total number of TB cases reported in the US since the peak of the resurgence. In 2000, a total of 16,377 TB cases were reported from the 50 states and the District of Columbia. This represents a 7% decrease from 1999 and a 39% decline from 1992. Slide 3: TB Morbidity, United States, 1996-2000. This slide provides the total number of reported US TB cases and the associated TB case rates for each of the past 5 years. Rate is defined as cases per 100,000. Year 1996, cases 21,337, rate 8.0. Year 1997, cases 19,851, rate 7.4. Year 1998, cases 18,361, rate 6.8. Year 1999, cases 17,531, rate 6.4. Year 2000, cases 16,377, rate 5.8. Slide 4: TB Case Rates, 2000. This map shows TB case rates for 2000. Twenty-two states had a case rate of less than or equal to 3.5 TB cases per 100,000, the interim goal for the year 2000 established by the Advisory Council for the Elimination of Tuberculosis. This group of states has remained fairly constant over the last decade, although five states joined the group in 2000 (CT, MI, NM, OR, PA). States with a case rate above the national average include the seven states that reported at least 500 cases in 2000: CA, TX, IL, GA, FL, NY, and NJ. These seven states accounted for nearly 60% of the national total and have experienced substantial overall decreases in cases and case rates since 1992. Slide 5: Reported TB Cases by Age Group, United States, 2000. This pie chart shows the age distribution of persons reported with TB in 2000. Approximately 5% occurred in children under 15 years of age, 75% in 15- to 64-year-olds, and 20% in persons at least 65 years old. All five age groups on this chart have shown substantial decreases in numbers since 1992. The largest declines occurred in children under 15 years of age, adults aged 25- to 44 years old and those 65 years and older, each group having had a decrease of at least 40%. Slide 6: TB Case Rates by Age Group and Sex, United States, 2000. This slide graphs the TB case rates by age group and sex. It highlights the increasing risk with increasing age, ranging from a low of less than 2 per 100,000 in children to a high of approximately 15 per 100,000 in men over 65 years old. The rates in adult men are twice those in women. Slide 7: Reported TB Cases by Race/Ethnicity, 2000. In 2000, approximately 75% of all reported TB cases occurred in racial and ethnic minorities, including 32% in non-Hispanic blacks, 23% in Hispanics, 21% in Asians and Pacific Islanders, and 1% in American Indians and Alaskan Natives. Approximately 22% of all reported cases occurred in non-Hispanic whites. Several important factors likely contribute to the disproportionate burden of TB in minorities. In foreign-born persons from countries where TB is common, active TB disease may result from infection acquired in the country of origin. In racial and ethnic minorities, unequal distribution of TB risk factors, such as HIV infection, may also contribute to increased exposure to TB or to risk of developing active TB once infected with M. tuberculosis. However, much of the increased risk of TB in minorities has been linked to lower socioeconomic status and the effects of crowding, particularly among US-born persons. Slide 8: TB Case Rates by Age Group and Race/Ethnicity, United States, 2000. This slide presents TB case rates in 2000 by age group and race/ethnicity. Risk increased with age across racial and ethnic groups, and case rates were consistently higher in minority racial and ethnic groups compared with non-Hispanic whites. Case rates in Asians and Pacific Islanders were the highest, particularly in adult age groups. The impact of birth outside the United States is a consideration in interpreting rate variations by race/ethnicity. For example, approximately 95% of cases in the Asian/Pacific Islander group occurred in foreign-born persons, compared with 70% of cases in Hispanics and 20% of cases in non-Hispanic blacks. Slide 9: Number of TB Cases in US-born
vs. Foreign-born Persons, United States, 1992-2000 Slide 10: Percentage of TB Cases Among Foreign-born Persons. The percentage of each state’s total number of TB cases that occurred in foreign-born persons is highlighted for 1992 and 2000 in these two side-by-side maps. The number of states with at least 50% of cases in the foreign-born increased from 4 in 1992 to 21 in 2000. The percentage was at least 70% in five states: CA, HI, MA, MN, and NH. Slide 11: Countries of Birth for Foreign-born Persons Reported with TB, United States, 2000. This slide provides the overall distribution of countries of birth for foreign-born persons reported with TB. The countries have remained relatively constant since 1986, when information on country of birth was reported by all areas submitting reports to CDC. Seven countries account for nearly 2/3 of the total, with persons from Mexico accounting for nearly 1/4 and persons from the Philippines and Vietnam each accounting for approximately 10%. Persons from India, China, Haiti, and South Korea each account for approximately 5%, and more than 140 other countries each account for 2% or less of the total. Slide 12: TB Case Rates in US-born vs. Foreign-born Persons, United States, 1992-2000. TB case rates in foreign-born persons remain substantially higher than those in the US-born population. From 1992 through 2000, the case rate in US-born persons decreased from 8 per 100,000 to 4, whereas the rate in foreign-born persons decreased from 34 per 100,000 to 26. Slide 13: Length of US Residence Prior to TB Diagnosis, United States, 2000. The length of US residence among foreign-born persons prior to their TB diagnosis in 2000 is shown in these stacked bars. Overall, approximately 25% had been in the US for less than 1 year, 25% between 1 and 4 years, and 50% for at least 5 years. The distribution is also shown for the top three countries of birth: Philippines, Mexico, and Vietnam. Among persons born in the Philippines, 26% had been in the U.S. for less than 1 year, 13% between 1 and 4 years, and 61% for at least 5 years. Among persons born in Mexico, 24% had been in the U.S. for less than 1 year, 23% between 1 and 4 years, and 53% for at least 5 years. Among persons born in Vietnam, 13% had been in the U.S. for less than 1 year, 19% between 1 and 4 years, and 68% for at least 5 years. Slide 14: Primary Anti-TB Drug Resistance, United States, 1993-2000. Primary drug resistance is estimated for the previous 8 years. The graph starts in 1993 because this is the year in which the individual TB case reports submitted to the national surveillance system began collecting information on initial susceptibility test results (for isolates) from patients with culture-positive TB. Data were available for more than 85% of culture-positive cases for each year. Primary resistance was estimated by using data from persons with no reported prior TB episode. Resistance to at least isoniazid remained between 7 and 8%. However, resistance to at least isoniazid and rifampin (or multidrug-resistant TB [MDR TB]) decreased from 2.5% in 1993 to 1.1% in 2000, representing an actual decrease from more than 400 MDR TB cases to fewer than 150 in 2000. Slide 15: Primary MDR TB in US-born vs. Foreign-born Persons, United States, 1993-2000 This graph highlights primary MDR TB in US-born versus foreign-born persons. Although the percentage of MDR TB was more than 2% in each group in 1993, the percentage of MDR TB in the US-born continued to decrease to less than 1% (0.6% in 2000), whereas the percentage in foreign-born persons has remained above 1%. As a result, the proportion of primary MDR TB cases reported in foreign-born persons increased from approximately 25% in 1993 to 70% in 2000. Slide 16: Estimated HIV Coinfection in Persons Reported with TB, United States, 1993-1999. This slide provides minimum estimates of HIV coinfection among persons reported with TB from 1993 through 1999. Since HIV was added to the individual TB case report in 1993, incomplete reporting has provided a challenge to calculating reliable estimates. Results from the cross-matching of TB and AIDS registries have been used to supplement reported HIV test results. For all ages, the estimated percentage of HIV coinfection in persons reported with TB decreased from 15% to 10% overall and from nearly 30% to less than 20% in persons aged 25 to 44 during this period. Slide 17: Mode of Treatment Administration in Persons Reported with TB, United States, 1993-1998. In 1993, the individual TB case report began collecting information on mode of treatment administration. This slide is based on data received at CDC by April 2001. Treatment administered under only directly observed therapy (DOT) increased from approximately 20% in 1993 to more than 50% in 1998, the latest year with available data. The proportion of patients who received at least some portion of their treatment under DOT (based on combining treatment received only under DOT and that for which some portion was self-administered), also increased. In 1998, the proportion of patients who received at least some portion of their treatment under DOT was approximately 75%. Slide 18: Completion of TB Therapy, United States, 1993-1998. The individual TB case report began collecting information on completion of therapy in 1993. This slide is based on data received at CDC by April 2001. Patients with an initial isolate resistant to rifampin and children with meningeal, bone or joint, or miliary disease were excluded from the calculations. Overall completion remained at approximately 90%; however, completion of therapy in 1 year or less increased from <65% in 1993 to nearly 80% in 1998. The current national program goal is completion of therapy in 1 year or less in 90% of patients. CDC is working with state and local health departments to evaluate reasons for apparently delayed completion of therapy, which may vary by jurisdiction. Last Reviewed: 05/18/2008
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