TUBERCULOSIS EPIDEMIOLOGY LOCAL, STATE, NATIONAL, GLOBAL Office of Communicable Disease Epidemiology Global TB Burden, 216 estimates Total TB Estimated number of TB cases 1.4 million 14 per 1, Estimated number of deaths 1.7 million^ 6.7 million males 1,7, in males 3.7 million females 61, in women 1.4 million children 253, in children HIV associated TB 1 million (1%) 374, (22%) Multidrug resistant TB MDR/RR 49, (4.1% of new TB) 6, (incl. RR TB) 24, (14%) ^Includes HIV/TB deaths Global tuberculosis report 217. Geneva: World Health Organization 1
Global Impact of TB Deaths Global tuberculosis report 217. Geneva: World Health Organization Washington State Department of Health 3 Global tuberculosis report 217. Geneva: World Health Organization Washington State Department of Health 4 2
Washington State Department of Health 5 Washington State Department of Health 6 3
Global tuberculosis report 217. Geneva: World Health Organization Washington State Department of Health 7 Washington State Department of Health 8 4
Washington State Department of Health 9 Global tuberculosis report 217. Geneva: World Health Organization Washington State Department of Health 1 5
Washington State Department of Health 11 Washington State Department of Health 12 6
Global tuberculosis report 217. Geneva: World Health Organization Washington State Department of Health 14 7
Washington State Department of Health 15 3, Reported Tuberculosis (TB) Cases United States, 1982 216* No. of cases 25, 2, 15, 1, 5, 1982 1984 1986 1988 199 1992 1994 1996 1998 2 22 24 26 28 21 212 214 216 Year *As of June 21, 217. 8
TB Case Rates,* United States, 216 NYC DC *Cases per 1,; as of June 21, 217. DC, District of Columbia; NYC, New York City (excluded from New York state) 2.9 (216 national average) >2.9 TB Case Rates,* U.S. Affiliated Pacific Islands, 216 United States overall Hawaii 2.9 8.3 American Samoa Guam Northern Mariana Islands Palau Federated States of Micronesia Marshall Islands 1.8 46.1 5.5 98.4 12.3 243.9 5 1 15 2 25 3 *Cases per 1, population; as of June 21, 217. 9
TB Case Rates* by Age Group, United States, 1993 216 Cases per 1, population 2 15 1 5 Age (yrs.) 4 5 14 15 24 25 44 45 64 65 1994 1996 1998 2 22 24 26 28 21 212 214 216 *Cases per 1, population; as of June 21, 217. TB Case Rates by Age Group and Sex, United States, 216* Cases per 1, population 7 6 5 4 3 2 1 Male Female <5 5 14 15 24 25 44 45 64 65 *Cases per 1, population; as of June 21, 217. 1
TB Case Rates by Race/Ethnicity,* United States, 23 216 Cases per 1, population 35 3 25 2 15 1 5 American Indian/Alaska Native Asian Black/African American Native Hawaiian/Other Pacific Islander White Hispanic/Latino 23 24 25 26 27 28 29 21 211 212 213 214 215 216 * All races are non Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin. As of June 21, 217. Number of TB Cases Among U.S. Born versus Non U.S. Born Persons, United States, 1993 216* 2, U.S. born Non U.S. born 15, No. of cases 1, 5, *As of June 21, 217. 1994 1996 1998 2 22 24 26 28 21 212 214 216 Year 11
Trends in TB Cases Among Non U.S. Born Persons, United States, 1993 216* No. of cases Percentage Number of cases Percentage of total cases 9, 8 8, 7 7, 6 6, 5 5, 4 4, 3, 3 2, 2 1, 1 1994 1996 1998 2 22 24 26 28 21 212 214 216 Year *As of June 21, 217. TB Case Rates Among U.S. Born versus Non U.S. Born Persons, United States, 1993 216* Cases per 1, population 4 35 3 25 2 15 1 5 U.S. overall U.S. born Non U.S. born 1994 1996 1998 2 22 24 26 28 21 212 214 216 Year *As of June 21, 217. 12
Reported TB Cases by Origin and Race/Ethnicity*, United States, 216 Multiple race 1% Hispanic/Latino 21% U.S. born persons Non U.S. born persons American Indian/Alaska Native 4% Asian 5% Hispanic/Latino 31% Asian 48% White 31% Black/African American 37% Native Hawaiian/Pacific Islander 1% Multiple race 1% White 5% Native Hawaiian/ Pacific Islander 1% Black/African American 14% * All races are non Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin. Percentages are rounded; as of June 21, 217. American Indian/Alaska Native accounted for <1% of cases among non U.S. born persons and are not shown. Countries of Birth Among Non U.S. Born Persons Reported with TB, United States, 216 Mexico 19% Other countries 4% Philippines 12% Haiti 3% Guatemala 3% China 6% Vietnam 8% India 9% *Percentages are rounded; as of June 21, 217. 13
Percentage of Non U.S. Born Persons with TB, by Time of Residence in U.S. Before Diagnosis, 216* 1 Unknown 12 mos. 1 4 years 5 9 years 1 19 years 2 years 8 Percentage 6 4 2 Mexico Philippines India All other non U.S. born * As of June 21, 217. Non U.S. born persons for whom information on length of residence in the United States before diagnosis is unknown or missing. Primary Anti TB Drug Resistance, United States, 1993 216* 1 Isoniazid MDR TB Resistant (%) 8 6 4 2 1994 1996 1998 2 22 24 26 28 21 212 214 216 Year * As of June 21, 217. 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. 14
Estimated HIV Coinfection Among Persons Reported with TB, United States, 1993 216* Coinfection (%) 7 6 5 4 3 2 1 All ages Ages 25 44 yrs 1994 1996 1998 2 22 24 26 28 21 212 214 216 Year * As of June 21, 217. Note: Minimum estimates are based on reported HIV positive status among all TB patients in the age group. Reporting of HIV Test Results Among Persons with TB, by Age Group, United States, 1993 216* With test results (%) 1 8 6 4 2 All ages Ages 25 44 yrs 1994 1996 1998 2 22 24 26 28 21 212 214 216 * As of June 21, 217. Note: Includes persons with positive, negative, or indeterminate human immunodeficiency virus (HIV) test results and persons from California with codiagnosis of TB and acquired immunodeficiency syndrome (AIDS). Rhode Island did not report HIV test results for years 1993 1997. HIV test results for Vermont are not included for years 27 213. HIV test results for California are not included for years 25 21. Year 15
TB Cases Reported Among Homeless Persons During the 12 Months Before Diagnosis, Ages 15 Years, United States, 1993 216* No. of cases 1,5 No. of cases Percentage of total cases Percentage 8 1, 5 1994 1996 1998 2 22 24 26 28 21 212 214 216 Year 6 4 2 * As of June 21, 217. Note: Homeless during the 12 months before TB diagnosis. Definition for Tuberculosis Genotyping in the United States Spoligotype: 3771 Initial 12 locus MIRU VNTR * : 223325173533 Sequentially assigned for each unique spoligotype and initial 12 locus MIRU VNTR combination PCRType: PCR2 + Additional 12 locus MIRU VNTR (MIRU2): 444534423428 Sequentially assigned for each unique spoligotype and 24 locus MIRU VNTR combination GENType: G1 * Mycobacterial interspersed repetitive unit variable number tandem repeat. The complete set of 24 loci is referred to as 24 locus MIRU VNTR and is used for GENType designation for genotype in the United States. 16
National Tuberculosis Genotyping Surveillance Coverage * by Year: United States, 24 216 Proportion of culture confirmed TB cases genotyped (%) 1 9 8 7 6 5 4 3 2 1 91.6 94.2 94.9 95.9 96.7 97.1 96.4 86.9 8.8 81.6 68.4 7.1 52.6 24 25 26 27 28 29 21 211 212 213 214 215 216 National Goal, 94% * The proportion of positive cultures with at least one genotyped isolate. Includes 5 states and the District of Columbia. For the year 22, the national goal for TB genotyping surveillance coverage will change to 1%. Number of County Based Tuberculosis Genotype Clusters * by Cluster Size, United States, 214 216 1, 878 Number of Clusters 8 6 4 2 2 case cluster 263 3 case cluster 15 4 case cluster 43 25 26 14 1 5 case cluster 6 case cluster 7 case cluster 8 case cluster 9 case cluster 37 1 case cluster Number of Persons in Cluster * Genotype cluster is defined as two or more cases with matching spoligotype and 24 locus MIRU VNTR (GENType) within a county during the specified 3 year time period. 17
Washington State Department of Health 35 Washington State Department of Health 36 18
Modeling Tuberculosis Trends in the USA, A. N. H ILL, J. E. BECERRA AND K. G. CASTRO. Epidemiol. Infect. (212), 14, 1862 1872 Washington State Department of Health 37 https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6711a2 H.PDF Washington State Department of Health 38 19
Incidence by Origin 1 WA; 27-216 1 U.S. Born includes birth within the continental U.S. or U.S. territory. Proportional Disease Burden by Origin 1 WA; 29-217 1 U.S. Born includes birth within the continental U.S. or a U.S. territory. 2
Average Incidence by Race/Ethnicity 1 WA; 215-217 1 AIAN - American Indian or Alaskan Native; NHPI - Native Hawaiian or Other Pacific Islander. Disease Burden by Race/Ethnicity 1 WA; 215-217 1 AIAN - American Indian or Alaskan Native; NHPI - Native Hawaiian or Other Pacific Islander. 21
Proportional Disease Burden by Race/Ethnicity and Origin 1 WA; 215-217 1 AIAN - American Indian or Alaskan Native; NHPI - Native Hawaiian or Other Pacific Islander. 2 U.S. Born includes birth within the continental U.S. or a U.S. territory Average Incidence by Age/Gender WA; 215-217 22
TB Case Counts and Rates, 216 Curry Center Intensive Participants Case Count Rate (per 1,) Arizona 188 2.7 California 262 5.3 Canada 1738 5.2 Colorado 64 1.2 Delaware 16 1.7 Georgia 32 2.9 Jamaica 13 4.5 Montana 4.4 New Mexico 39 1.9 Oregon 7 1.7 Centers for Disease Control and Prevention (CDC). Reported Tuberculosis in the United States, 216. Atlanta, GA Country Profiles 216: World Health Organization Washington State Department of Health 45 Washington State Department of Health 46 23