Tuberculosis in the United States

National Tuberculosis Surveillance System Highlights from 2011

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

Reported TB Cases United States, 19822011*

Year
*Updated as of June 25, 2012.

TB Morbidity United States, 20062011

No.
13,727
13,278 12,895 11,528 11,171

Rate*
4.6
4.4 4.2 3.8 3.6

10,528

3.4

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

TB Case Rates,* United States, 2011

D.C.

< 3.4 (2011 national average) >3.4

TB Case Rates* by Age Group United States, 19932011

Cases per 100,000

15.0

10.0
5.0 0.0

0- 14

15 - 24

25 - 44

45-65

>65

* Updated as of June 25, 2012.

Reported TB Cases by Age Group, United States, 2011

65 yrs (21%)

45-64 yrs (31%)

24-44 yrs (32%)

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

Cases per 100,000

6.0
5.0 4.0

3.0
2.0 1.0

0.0
Under 5 5 - 14 15 - 24 Male 24 - 44 45-64 65 Female

TB Case Rates by Race/Ethnicity* United States, 20032011**

25.0 20.0

15.0
10.0 5.0 0.0
2003 2004 2005 2006 2007 2008 2009 2010 2011 Hispanic or Latino Asian Native Hawaiian or Other Pacific Islander
*All races are non-Hispanic. **Updated as of June 25, 2012.

American Indian or Alaska Native Black or African American White

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

40.0
30.0 20.0 10.0 0.0 Under 5 5 - 14 15 - 24 24 - 44 45-64 65
Hispanic or Latino Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Black or African American White

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

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

American Indian or Alaska Native (1%) Native Hawaiian or Other Pacific Islander (1%)

Asian (30%)

White (16%)

*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, 19932011*

No. of Cases

U.S.-born
*Updated as of June 25, 2012.

Foreign-born

No. of Cases 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0

Trends in TB Cases in Foreign-born Persons United States, 1991 2011*

Percentage 70 60 50 40 30 20

10
0

Number of Cases
*Updated as of June 25, 2012.

Percentage of Total Cases

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

Foreign-born**
White (5%) Hispanic or Latino (34%)

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

Native Hawaiian or Other Pacific Islander (2%)

Black or African American (39%)

Asian (46%)

*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*

2001

2011

DC

DC

*Updated as of June 25, 2012.

>50% 25%49% <25%

TB Case Rates in U.S.-born vs. Foreign-born Persons, United States, 1993 2011*
40.0
Cases per 100,000

35.0 30.0

25.0
20.0 15.0 10.0

5.0
0.0

U.S. Overall
*Updated as of June 25, 2012.

U.S.-born

Foreign-born

TB Case Rates in U.S.-born vs. Foreign-born Persons, United States*, 1993 2011**
100.0
Cases per 100,000

10.0

1.0

U.S. Overall

U.S.-born

Foreign-born

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

Countries of Birth of Foreign-born Persons Reported with TB, United States, 2011
Mexico
(22%)

Other Countries 39% Philippines

Haiti
(3%) Guatemala China (3%) (6%)

Vietnam India
(8%)
(8%)

Percent of Foreign-born with TB by Time of Residence in U.S. Prior to Diagnosis, 2011

0
Mexico Philippines Unknown* <1 year Vietnam 1-4 years 5 years All Foreign-born

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

Primary Anti-TB Drug Resistance United States, 1993 2011*

% Resistant

Isoniazid

MDR TB

*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

No. of Cases

Primary MDR TB United States, 1993 2011*

Percentage

500 400 300 200

100
0 0

No. of Cases

Percentage

*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 Isoniazid Resistance in U.S.-born vs. Foreign-born Persons United States, 1993 2011*
14 12
% Resistant

10
8 6 4 2 0

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

Foreign-born

Primary MDR TB in U.S.-born vs. Foreign-born Persons United States, 1993 2011*
3

% Resistant

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.

XDR TB Case Count Defined on Initial DST* by Year, 1993 2011**

4
2 0

* 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

Year of Diagnosis

Reporting of HIV Test Results in Persons with TB by Age Group United States, 1993 2011*
100 90 80 70 60 50 40 30 20 10 0

% with Test Results

All Ages

Aged 25 - 44

*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.

Estimated HIV Coinfection in Persons Reported with TB, United States, 1993 2011*
30 25 % Coinfection 20 15

10
5 0

Aged 25-44

All Ages

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

TB Cases by Residence in Correctional Facilities, Age 15, United States, 1993-2011*

800
600 400 200 0

4.0%
3.0% 2.0% 1.0% 0.0%

No. of Cases
*Updated as of June 25, 2012 Note: Resident of correctional facility at time of TB diagnosis

Percent of Total Cases

TB Cases Reported as Homeless in the 12 Months Prior to Diagnosis, Age 15, United States, 1993-2011*
1600 1400 1200 8.0% 7.0% 6.0%

1000
800 600 400

5.0%
4.0% 3.0% 2.0%

200
0

1.0%
0.0%

No. of Cases
*Updated as of June 25, 2012 Note: Homeless within past 12 months of TB diagnosis

Percent of Total Cases

Mode of Treatment Administration in Persons Reported with TB United States, 1993 2009*
100
Percentage**

80 60 40 20 0

DOT only

DOT + SA

SA only

*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)

Completion of TB Therapy United States, 1993 2009*

60 40 20 0

Completed

Completed in 1 year or less

* 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.