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Tuberculosis in the United States

National Tuberculosis Surveillance SystemHighlights from 2011

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

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Reported TB CasesUnited States, 19822011*

*Updated as of June 25, 2012.

0

5,000

10,000

15,000

20,000

25,000

30,000

No.o

f

Cases

Year

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Year No. Rate*

2006 13,727 4.6

2007 13,278 4.4

2008 12,895 4.2

2009 11,528 3.8

2010 11,171 3.6

2011 10,528 3.4

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

TB MorbidityUnited States, 20062011

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TB Case Rates,* United States, 2011

*Cases per 100,000.

< 3.4 (2011 national average)

>3.4

D.C.

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TB Case Rates* by Age GroupUnited States, 19932011

* Updated as of June 25, 2012.

0.0

5.0

10.0

15.0

20.0

0- 14 15 - 24 25 - 44 45-65 >65

Casesper100,0

00

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Reported TB Cases by Age Group,United States, 2011

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

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Under 5 5 - 14 15 - 24 24 - 44 45-64 65

Male Female

Casesper1

00,0

00

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

*All races are non-Hispanic.

**Updated as of June 25, 2012.

Casesper100,0

00

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2003 2004 2005 2006 2007 2008 2009 2010 2011

Hispanic or Latino American Indian or Alaska Native

Asian Black or African American

Native Hawaiian or Other Pacific Islander White

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

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

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Under 5 5 - 14 15 - 24 24 - 44 45-64 65

Hispanic or Latino American Indian or Alaska Native

Asian Black or African American

Native Hawaiian or Other Pacific Islander White

Casesp

er100,0

00

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

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

Hispanic orLatino(29%)

Native Hawaiianor Other Pacific

Islander

(1%)White(16%)

Asian(30%)

American Indianor Alaska Native

(1%)

Black or AfricanAmerican

(23%)

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Number of TB Cases inU.S.-born vs. Foreign-born Persons

United States, 19932011*

0

5,000

10,000

15,000

20,000

U.S.-born Foreign-born

*Updated as of June 25, 2012.

No.o

fCases

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

*Updated as of June 25, 2012.

No. of Cases Percentage

0

10

20

30

40

50

60

70

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

Number of Cases Percentage of Total Cases

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

*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.

Hispanicor Latino

(19%)AmericanIndian or

Alaska

Native(3%)

Asian(3%)

Black orAfrican

American(39%)

NativeHawaiian

or OtherPacific

Islander(2%)

White(33%)

Hispanicor Latino

(34%)

Asian(46%)

Black orAfrican

American(13%)

White(5%)

U.S.-born Foreign-born**

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>50%

25%49%

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TB Case Rates in U.S.-born vs. Foreign-bornPersons, United States, 1993 2011*

*Updated as of June 25, 2012.

Casesp

er100,0

00

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

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TB Case Rates in U.S.-born vs. Foreign-bornPersons, United States*, 1993 2011**

*Includes the same data as slide 15, but rates presented on a logarithmic scale.

**Updated as of June 25, 2012.

Casesp

er100,0

00

1.0

10.0

100.0

U.S. Overall U.S.-born Foreign-born

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Countries of Birth of Foreign-born PersonsReported with TB, United States, 2011

Mexico(22%)

Philippines(11%)

India(8%)

Vietnam(8%)

China(6%)

Guatemala(3%)

Haiti(3%)

OtherCountries

39%

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

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

unknown or missing

0

20

40

60

80

100

Mexico Philippines Vietnam All Foreign-born

Unknown*

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Primary Anti-TB Drug ResistanceUnited States, 1993 2011*

*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

%R

esistant

0

5

10

Isoniazid MDR TB

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Primary MDR TBUnited States, 1993 2011*

*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.

No. of Cases Percentage

0

1

2

3

0

100

200

300

400

500

No. of Cases Percentage

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Primary Isoniazid Resistance inU.S.-born vs. Foreign-born Persons

United States, 1993 2011*

*Updated as of June 25, 2012.

Note: Based on initial isolates from persons with no prior history of TB.

%Re

sistant

0

2

4

6

8

10

12

14

U.S.-born Foreign-born

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*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 MDR TB inU.S.-born vs. Foreign-born Persons

United States, 1993 2011*

%Re

sistant

0

1

2

3

U.S.-born Foreign-born

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

* 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

CaseC

ount

Year of Diagnosis

0

2

4

6

8

10

12

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Reporting of HIV Test Resultsin Persons with TB by Age Group

United States, 1993 2011*

*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.

%w

ithTestResults

0

10

20

30

4050

60

70

80

90

100

All Ages Aged 25 - 44

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Estimated HIV Coinfection in PersonsReported with TB, United States, 1993 2011*

*Updated as of June 25, 2012

Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group

%C

oinfection

0

5

10

15

20

25

30

Aged 25-44 All Ages

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

*Updated as of June 25, 2012

Note: Resident of correctional facility at time of TB diagnosis

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

0

200

400

600

800

1000

1200

No. of Cases Percent of Total Cases

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TB Cases Reported as Homeless in the12 Months Prior to Diagnosis,

Age 15, United States, 1993-2011*

*Updated as of June 25, 2012

Note: Homeless within past 12 months of TB diagnosis

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

0

200

400

600

800

1000

1200

1400

1600

No. of Cases Percent of Total Cases

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Mode of Treatment Administrationin Persons Reported with TBUnited States, 1993 2009*

*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)

Percentage**

0

20

40

60

80

100

DOT only DOT + SA SA only

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Completion of TB TherapyUnited States, 1993 2009*

* 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