tuberculosis in the united states national tuberculosis surveillance system highlights from 2012
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Tuberculosis in the United States National Tuberculosis Surveillance System Highlights from 2012. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Division of Tuberculosis Elimination. Reported TB Cases United States, 1982–2012*. No. of Cases. Year. - PowerPoint PPT PresentationTRANSCRIPT
Tuberculosis in the United States
National Tuberculosis Surveillance System
Highlights from 2012
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination
Reported TB Cases United States, 1982–2012*
*Updated as of June 10, 2013.
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
0
5,000
10,000
15,000
20,000
25,000
30,000
No.
of
Case
s
Year
Year No. Rate*
2007 13,282 4.4
2008 12,895 4.2
2009 11,520 3.8
2010 11,163 3.6
2011 10,517 3.4
2012 9,945 3.2
*Cases per 100,000. Updated as of June 10, 2013.
TB MorbidityUnited States, 2007–2012
TB Case Rates,* United States, 2012
*Cases per 100,000.
< 3.2 (2012 national average)
>3.2
D.C.
≥5010–49.9
≤9.9
Map of U.S.-Affiliated Pacific Islands by TB Case Rates,* 2012
*Cases per 100,000
Federated States of
Micronesia
Marshall Islands
Northern Mariana Islands
American Samoa
Guam
Palau
Northern Mariana Islands
Federated States of Micronesia
Guam
Marshall Islands
Palau
American Samoa
Hawaii
United States overall
0 50 100 150 200 250
40.9
162.5
42.5
211.7
9.5
1.8
8.4
3.4
TB Case Rates,* U.S.-Affiliated Pacific Islands, 2012
*Cases per 100,000
TB Case Rates* by Age Group United States, 1993–2012
* Updated as of June 10, 2013.
Case
s p
er
10
0,0
00
Age Group (years)
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0.0
5.0
10.0
15.0
20.0
0 - 14 15 -24 25 - 44 45 - 64 ≥65
Reported TB Cases by Age Group, United States, 2012
<15 yrs (5%) 15-24 yrs
(10%)
24-44 yrs (31%)45-64 yrs
(31%)
≥ 65 yrs(22%)
TB Case Rates by Age Group and Sex, United States, 2012
Case
s p
er
10
0,0
00
Under 5 5 - 14 15 - 24 25 - 44 45 - 64 ≥650.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
Male Female
TB Case Rates by Race/Ethnicity,* United States, 2003–2012**
*All races are non-Hispanic. **Updated as of June 10, 2013.
Case
s per
10
0,0
00
2003 2004 2005 2006 2007 2008 2009 2010 2011 20120.0
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, 2012
*All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.
Case
s per
100
,00
0
Under 5 5 - 14 15 - 24 24 - 44 45-64 ≥650
10
20
30
40
50
60
Hispanic or Latino
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Is-lander
White
Reported TB Cases by Race/Ethnicity,*United States, 2012
*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 Islander
(1%)White(16%)
Asian(31%)
American Indian or Alaska Native
(1%)
Black or African American
(22%)
Number of TB Cases inU.S.-born vs. Foreign-born Persons,
United States, 1993–2012*
*Updated as of June 10, 2013
No. of
Case
s
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0
5,000
10,000
15,000
20,000
U.S.-born Foreign-born
Trends in TB Cases in Foreign-born Persons,
United States, 1992 – 2012*
*Updated as of June 10, 2013
No. of Cases Percentage
19921993
19941995
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20102011
20120
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, 2012
*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(4%)
Asian(3%)
Black or African American
(37%)
Native Hawaiian or Other Pacific Is-
lander(1%)
White(35%)
His-panic or Latino(33%)
Asian(45%)
Black or African Ameri-
can(14%)
White(5%)
U.S.-born Foreign-born**
>50%25%–49%<25%
2002 2012
DC
*Updated as of June 10, 2013.
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 –
2012*
*Updated as of June 10, 2013.
Case
s per
10
0,0
00
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0.0
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 –
2012**
*Includes the same data as slide 15, but rates presented on a logarithmic scale.**Updated as of June 10, 2013.
Case
s per
10
0,0
00
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
1.0
10.0
100.0
U.S. Overall U.S.-born Foreign-born
Countries of Birth of Foreign-born Persons Reported with TB, United
States, 2012
Mexico(21%)
Philippines(12%)
India(8%)
Vietnam(7%)
China(6%)
Guatemala(3%)
Haiti(3%)
Other Countries39%
Percent of Foreign-born with TB by Time of Residence in U.S. Prior to
Diagnosis, 2012
*Foreign-born TB patients for whom information on length of residence in the U.S. prior to diagnosis is unknown or missing
Mexico Philippines India All Other Foreign-born0
10
20
30
40
50
60
70
80
90
100
Unknown* <1 year 1-4 years ≥5 years
Primary Anti-TB Drug Resistance,United States, 1993 – 2012*
*Updated as of June 10, 2013.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
esi
stant
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0123456789
10
Isoniazid MDR TB
Primary MDR TB,United States, 1993 – 2012*
*Updated as of June 10, 2013.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
19941995
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20102011
20120
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 – 2012*
*Updated as of June 10, 2013.Note: Based on initial isolates from persons with no prior history of TB.
% R
esi
stant
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0
2
4
6
8
10
12
14
U.S.-born Foreign-born
*Updated as of June 10, 2013.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 – 2012*
% R
esi
stant
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0
1
2
3
U.S.-born Foreign-born
XDR TB Case Count Defined on Initial DST*
by Year, 1993 – 2012**
* Drug susceptibility test** Updated as of June 10, 2013.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
Count
Year of Diagnosis1993
19941995
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20102011
20120
2
4
6
8
10
12
Reporting of HIV Test Results in Persons with TB by Age Group,
United States, 1993 – 2012*
*Updated as of June 10, 2013.Note: Includes persons with positive, negative, or indeterminate HIV test results and persons from California with co-diagnosis of TB and AIDS. Rhode Island did not report HIV test results for years 1993–1997. HIV test results for Vermont are not included for years 2007–2010. HIV test results for California are not included for years 2005 - 2010
% w
ith T
est
Resu
lts
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0102030405060708090
100
All Ages Aged 25 - 44
Estimated HIV Coinfection in Persons Reported with TB, United States, 1993 –
2012*
*Updated as of June 10, 2013Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group
% C
oin
fect
ion
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0
10
20
30
40
50
60
70
Aged 25-44 All Ages
TB Cases by Residence in Correctional Facilities, Age ≥15, United States,
1993-2012*
*Updated as of June 10, 2013Note: Resident of correctional facility at time of TB diagnosis
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0
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, 1993-2012*
*Updated as of June 10, 2013Note: Homeless within past 12 months of TB diagnosis
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0
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 TB,United States, 1993 – 2010*
*Updated as of June 10, 2013. Data available through 2010 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
20092010
0
20
40
60
80
100
DOT only DOT + SA SA only
Completion of TB Therapy,United States, 1993 – 2010*
* Updated as of June 10, 2013. Data available through 2010 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
20092010
0
20
40
60
80
100
Completed in 1 year or less Completed
Initial 12-locus MIRU-VNTR1: 223325173533
Spoligotype: 000000000003771
PCRType:PCR00002
Additional 12-locus MIRU-VNTR (MIRU2): 4445344234282
+
GENType:G00010
Sequentially assigned for each unique spoligotype and initial 12-locus MIRU-VNTR combination
Sequentially assigned for each unique spoligotype and 24-locus MIRU-VNTR combination
Definition for Tuberculosis Genotypingin the United States
1 Mycobacterial interspersed repetitive unit–variable number tandem repeat 2 The complete set of 24 loci is referred to as 24-locus MIRU-VNTR and is used for GENType designation for genotype in the U.S.
2004 2005 2006 2007 2008 2009 2010 2011 20120%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
52.6%
68.5% 70.1%
80.9% 81.6%86.8%
91.3% 93.5% 93.5%
National Tuberculosis Genotyping Surveillance Coverage* by Year, United
States, 2004–2012
* The proportion of positive cultures with at least one genotyped isolate
Natio
nal
Ind
icato
r9
4%
Pro
port
ion o
f cu
lture
confirm
ed T
B c
ase
s genoty
ped (
%)
Number and Percent of Unique* andCounty-GENType Clustered** Cases,
United States, 2010–2012
17,669 (79%)
4,585 (21)%
Unique Clustered*Unique case is a case with a spoligotype and 24-locus locus MIRU-VNTR (GENType) that does not match any other case in that county during the specified 3-year time period** Two or more cases with matching spoligotype and 24-locus locus MIRU-VNTR (GENType) within a county during the specified 3-year time period
Number of County-based Tuberculosis Genotype Clusters* by Cluster Size, United
States, 2010–2012
* 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
0
200
400
600
800
1000996
257 250
30 9
Num
ber
of
Case
s in
a C
lust
er
Tuberculosis Genotype Clusters by TB GIMS* Alert Levels**, United States, 2010-2012
*Tuberculosis Genotyping Information Management System**Alert level is determined by the log likelihood ratio statistic (LLR) for a given cluster, identifying higher than expected geospatial concentrations for a TB genotype cluster in a specific county, compared to the national distribution of that genotype; TB GIMS generates alert level notifications based on this statistic: “No alert” is indicated if LLR is between 0–5, “medium” is for LLR of 5.1–10 and “high” alert is for clusters with LLR >10
High Alert, 112 (7%)
Medium Alert, 361 (23%)
No Alert, 1,069 (69%)