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Tuberculosis in the United States National Tuberculosis Surveillance System Highlights from 2013

Tuberculosis in the United States National Tuberculosis Surveillance System Highlights from 2013. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Division of Tuberculosis Elimination. Reported TB Cases United States, 1982–2013*. No. of Cases. Year.

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Tuberculosis in the United States National Tuberculosis Surveillance System Highlights from 2013

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  1. Tuberculosis in the United StatesNational Tuberculosis Surveillance SystemHighlights from 2013 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

  2. Reported TB Cases United States, 1982–2013* No. of Cases Year *Updated as of June 11, 2014.

  3. TB MorbidityUnited States, 2008–2013 *Cases per 100,000. Updated as of June 11, 2014.

  4. TB Case Rates,* United States, 2013 D.C. <3.0 (2013 national average) >3.0 *Cases per 100,000.

  5. Map of U.S.-Affiliated Pacific Islands by TB Case Rates,* 2013 Northern Mariana Islands • Guam • Marshall Islands • Palau • Federated States of Micronesia • American Samoa ≤9.9 10–49.9 ≥50 *Cases per 100,000

  6. TB Case Rates,* U.S.-Affiliated Pacific Islands, 2013 *Cases per 100,000

  7. TB Case Rates* by Age Group United States, 1993–2013 Cases per 100,000 Age Group (years) * Updated as of June 11, 2014.

  8. Reported TB Cases by Age Group, United States, 2013

  9. TB Case Rates by Age Group and Sex, United States, 2013 Cases per 100,000

  10. TB Case Rates by Race/Ethnicity,* United States, 2003–2013** Cases per 100,000 *All races are non-Hispanic. **Updated as of June 11, 2014.

  11. TB Case Rates by Age Group and Race/Ethnicity,*United States, 2013 Cases per 100,000 *All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.

  12. Reported TB Cases by Race/Ethnicity,*United States, 2013 *All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.

  13. Number of TB Cases inU.S.-born vs. Foreign-born Persons, United States, 1993–2013* No. of Cases *Updated as of June 11, 2014.

  14. Trends in TB Cases in Foreign-born Persons,United States, 1993 – 2013* No. of Cases Percentage *Updated as of June 11, 2014.

  15. Reported TB Cases by Origin and Race/Ethnicity,* United States, 2013 Foreign-born** U.S.-born *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.

  16. Percentage of TB Cases Among Foreign-born Persons, United States* 2003 2013 DC DC >50% 25%–49% *Updated as of June 11, 2014. <25% No cases

  17. TB Case Rates in U.S.-born vs. Foreign-born Persons, United States, 1993 – 2013* Cases per 100,000 *Updated as of June 11, 2014.

  18. TB Case Rates in U.S.-born vs. Foreign-born Persons, United States,* 1993 – 2013** Cases per 100,000 *Includes the same data as slide 15, but rates presented on a logarithmic scale. **Updated as of June 11, 2014.

  19. Countries of Birth of Foreign-born Persons Reported with TB, United States, 2013

  20. Percent of Foreign-born with TB by Time of Residence in U.S. Prior to Diagnosis, 2013 *Foreign-born TB patients for whom information on length of residence in the U.S. prior to diagnosis is unknown or missing.

  21. Primary Anti-TB Drug Resistance,United States, 1993 – 2013* % Resistant *Updated as of June 11, 2014. 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.

  22. Primary MDR TB,United States, 1993 – 2013* No. of Cases Percentage *Updated as of June 11, 2014. Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

  23. Primary Isoniazid Resistance in U.S.-born vs. Foreign-born Persons,United States, 1993 – 2013* % Resistant *Updated as of June 11, 2014. Note: Based on initial isolates from persons with no prior history of TB.

  24. Primary MDR TB in U.S.-born vs. Foreign-born PersonsUnited States, 1993 – 2013* % Resistant *Updated as of June 11, 2014. Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin.

  25. XDR TB Case Count Defined on Initial DST*by Year, 1993 – 2013** Case Count Year of Diagnosis * Drug susceptibility test. ** Updated as of June 11, 2014. 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.

  26. Reporting of HIV Test Results in Persons with TB by Age Group,United States, 1993 – 2013* % with Test Results *Updated as of June 11, 2014. 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.

  27. Estimated HIV Coinfection in Persons Reported with TB, United States, 1993 – 2013* % Coinfection *Updated as of June 11, 2014. Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group.

  28. TB Cases by Residence in Correctional Facilities, Age ≥15, United States, 1993-2013* No. of Cases Percentage *Updated as of June 11, 2014. Note: Resident of correctional facility at time of TB diagnosis.

  29. TB Cases Reported as Homeless in the 12 Months Prior to Diagnosis, Age ≥15, United States, 1993-2013* No. of Cases Percentage *Updated as of June 11, 2014. Note: Homeless within past 12 months of TB diagnosis.

  30. Mode of Treatment Administration in Persons Reported with TB,United States, 1993 – 2011* Percentage** *Updated as of June 11, 2014. Data available through 2011 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).

  31. Completion of TB Therapy,United States, 1993 – 2011* Percentage * Updated as of June 11, 2014. Data available through 2011 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.

  32. Definition for Tuberculosis Genotypingin the United States Spoligotype: 000000000003771 Initial 12-locus MIRU-VNTR1: 223325173533 Additional 12-locus MIRU-VNTR (MIRU2): 4445344234282 Sequentially assigned for each unique spoligotype and initial 12-locus MIRU-VNTR combination PCRType:PCR00002 + GENType: G00010 Sequentially assigned for each unique spoligotype and 24-locus MIRU-VNTR combination 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 United States.

  33. National Tuberculosis Genotyping Surveillance Coverage* by Year, United States**, 2004–2013 Proportion of culture confirmed TB cases genotyped (%) National Indicator 94% * The proportion of positive cultures with at least one genotyped isolate. ** Includes 50 states and the District of Columbia.

  34. Number and Percent of Unique* andCounty-GENType Clustered** Cases,United States, 2011–2013 *Unique case is a case with a spoligotype and 24-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 MIRU-VNTR (GENType) within a county during the specified 3-year time period.

  35. Number of County-based Tuberculosis Genotype Clusters* by Cluster Size, United States, 2011–2013 Number of Clusters 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.

  36. Tuberculosis Genotype Clusters by TB GIMS*Alert Levels**,United States, 2011-2013 *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.

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