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Tuberculosis in the United States National Surveillance System Highlights from 2006 Division of Tuberculosis Elimination Centers for Disease Control and Prevention Reported TB Cases* United States, 1982–2006 No. of Cases 28,000 26,000 24,000 22,000 20,000 18,000 16,000 14,000 12,000 10,000 1982 1986 1990 1994 Year *Updated as of April 6, 2007. 1998 2002 2006 TB Morbidity United States, 2001–2006 Year Cases Rate* 2001 2002 2003 2004 2005 2006 15,945 15,056 14,838 14,502 14,080 13,779 5.6 5.2 5.1 4.9 4.7 *Cases per 100,000, updated as of April 6, 2007. 4.6 TB Case Rates,* United States, 2006 D.C. < 3.5 (year 2000 target) 3.6–4.6 > 4.6 (national average) *Cases per 100,000. TB Case Rates* by Age Group United States, 1993–2006 Cases per 100,000 20 15 10 5 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 0 <15 15–24 *Updated as of April 6, 2007. 25–44 45–64 >65 Reported TB Cases by Age Group, United States, 2006 >65 yrs (19%) 45–64 yrs (29%) <15 yrs (6%) 15–24 yrs (11%) 25–44 yrs (34%) TB Case Rates by Age Group and Sex, United States, 2006 Cases per 100,000 12 10 8 6 4 2 0 <15 yrs 15–24 yrs 25–44 yrs Male 45–64 yrs Female >65 yrs TB Case Rates by Race/Ethnicity* United States, 1993–2006** Cases per 100,000 50 40 30 20 10 0 1994 1996 1998 2000 2002 2004 Asian/Pacific Islander American Indian/Alaska Native Black or African-American Hispanic White *All races are non-Hispanic. In 2003, Asian/Pacific Islander category includes persons who reported race as Asian only and/or Native Hawaiian or Other Pacific Islander only. **Updated as of April 6, 2007. 2006 Reported TB Cases by Race/Ethnicity* United States, 2006 American Indian or Alaska Native (1%) White (17%) Native Hawaiian or Other Pacific Islander (<1%) Hispanic or Latino (30%) Asian (24%) Black or African-American (27%) *All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases. TB Case Rates by Age Group and Race/Ethnicity,* United States, 2006 Cases per 100,000 100 80 60 40 20 0 <5 5–14 15–24 25–44 45–64 >65 Age Group (yrs) American Indian/Alaska Native Asian Hispanic or Latino Black or African-American White Native Hawaiian/Other Pacific Islander *All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases. Number of TB Cases in U.S.-born vs. Foreign-born Persons United States, 1993–2006* No. of Cases 20000 15000 10000 5000 0 1994 1996 1998 2000 U.S.-born *Updated as of April 6, 2007. 2002 Foreign-born 2004 2006 Trends in TB Cases in Foreign-born Persons, United States, 1986–2006* No. of Cases Percentage 10,000 60 50 40 8,000 6,000 30 20 10 0 4,000 2,000 0 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 No. of Cases *Updated as of April 6, 2007. Percentage of Total Cases Reported TB Cases by Origin and Race/Ethnicity,* United States, 2006 U.S.-born Foreign-born** American Indian or Alaska Native (3%) Asian (2%) White (33%) Native Hawaiian/Other Pacific Islander (<1%) Hispanic or Latino (17%) White (5%) Hispanic or Latino (39%) Asian (40%) Black or African American (44%) Black or African American (14%) *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. Percentage of TB Cases Among Foreign-born Persons, United States* 1996 2006 DC DC >50% 25%–49% <25% *Updated as of April 6, 2007. TB Case Rates in U.S.-born vs. Foreign-born Persons United States, 1993–2006* Cases per 100,000 40 30 20 10 0 1994 1996 1998 U.S. Overall *Updated as of April 6,2007. 2000 U.S.-born 2002 2004 Foreign-born 2006 TB Case Rates in U.S.-born vs. Foreign-born Persons United States,* 1993–2006** Cases per 100,000 100 10 1 1994 1996 1998 U.S. Overall 2000 U.S.-born 2002 2004 Foreign-born *Includes the same data as slide 15, but rates presented on a logarithmic scale. **Updated as of April 6, 2007. 2006 Countries of Birth of Foreign-born Persons Reported with TB United States, 2006 Mexico (25%) Other Countries (38%) Philippines (11%) Guatemala (3%) Haiti (3%) China (5%) India (7%) Viet Nam (8%) Percent of Foreign-born with TB by Time of Residence in U.S. Prior to Diagnosis,* 2006 100% 80% 60% 40% 20% 0% All Mexico <1 yr Philippines 1–4 yrs >5 yrs *Data exclude foreign-born TB patients for when length of residence in the U.S. prior to diagnosis was unknown. Viet Nam Primary Anti-TB Drug Resistance United States, 1993–2006* % Resistant 10 5 0 1994 1996 1998 Isoniazid 2000 2002 2004 MDR TB *Updated as of April 6, 2007. Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin. 2006 Primary MDR TB United States, 1993–2006* No. of Cases Percentage 500 400 300 200 100 0 3 2 1 0 93 94 95 96 97 98 99 00 01 02 03 04 05 06 No. of Cases Percentage *Updated as of April 6, 2007. 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 Isoniazid Resistance in U.S.-born vs. Foreign-born Persons United States, 1993–2006* % Resistant 14 12 10 8 6 4 2 0 1994 1996 1998 U.S.-born 2000 2002 2004 Foreign-born *Updated as of April 6, 2007. Note: Based on initial isolates from persons with no prior history of TB. 2006 Primary MDR TB in U.S.-born vs. Foreign-born Persons, United States, 1993–2006* % Resistant 3 2 1 0 1994 1996 1998 U.S.-born 2000 2002 Foreign-born *Updated as of April 6, 2007. Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin. 2004 2006 XDR TB Counted Cases † defined on Initial DST by Year, 1993–2006* Case Count 12 10 8 6 4 2 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 0 Year of Diagnosis *Reported incident cases as of 7/18/07 † Drug Susceptibility Test Reporting of HIV Test Results in Persons with TB by Age Group United States, 1993–2005* % with Test Results 80 60 40 20 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 0 All Ages Aged 25–44 *Updated as of April 6, 2007. Note: Includes TB patients with positive, negative, or indeterminate HIV test results. Persons from California reported with AIDS only through 2004. (HIV test results are not reported from California) Estimated HIV Coinfection in Persons Reported with TB, United States, 1993–2005* % Coinfection 30 20 10 0 1993 1995 1997 1999 All Ages 2001 Aged 25–44 *Updated as of April 6, 2007. Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group. 2003 2005 Mode of Treatment Administration in Persons Reported with TB United States, 1993–2004* 100% 80% 60% 40% 20% 0% 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 DOT only DOT + SA SA only *Updated as of April 6, 2007. Directly observed therapy (DOT); Self-administered therapy (SA) Completion of TB Therapy United States, 1993–2004* ** 80 60 40 20 Completed 04 20 03 20 02 20 01 20 00 20 99 19 98 19 97 19 96 19 95 19 94 19 93 0 19 Percentage 100 Completed in 1 yr or less *Updated as of April 6, 2007. **Healthy People 2010 target: 90% completed in 1 yr or less. Note: Persons with initial isolate resistant to rifampin and children under 15 years old with meningeal, bone or joint, or miliary disease excluded.