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For more information, contact

Division of Tuberculosis Elimination Nat�onal Center for HIV/AIDS, V�ral Hepat�t�s, STD, and TB Prevent�on

Coord�nat�ng Center for Infect�ous D�seasesCenters for D�sease Control and Prevent�on

1600 Cl�fton Road NEMS E-10

Atlanta, GA 30333Phone: (404) 639-8120Fax: (404) 639-8959

E-ma�l: TBInfo@cdc.govWeb address: http://www.cdc.gov/tb/

Tuberculosis Information Management System (TIMS)

TIMS Help Desk: (404) 639-8444

Suggested Citation: CDC. Reported Tuberculosis in the United States, 2006. Atlanta, GA: U.S. Department of Health and Human Serv�ces, CDC, September 2007.

All mater�al �n th�s report �s �n the publ�c doma�n and may be reproduced or cop�ed w�thout perm�s-s�on. However, c�tat�on as to source �s requested.

Ordering InformationCop�es of Reported Tuberculosis in the United States, 2006, are ava�lable from the D�v�s�on of Tuberculos�s El�m�nat�on’s onl�ne order�ng system at http://www.cdc.gov/tb/.

This report is also accessible via Internet at http://www.cdc.gov/tb/

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Centers for Disease Control and Prevention ..........................................Julie L. Gerberding, M.D., M.P.H. Director

Coordinating Center for Infectious Diseases ...................................................Mitchell L. Cohen, M.D. Director

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention ..Kevin Fenton, M.D., Ph.D. Director

Division of Tuberculosis Elimination ........................................................Kenneth G. Castro, M.D. Director

Surveillance, Epidemiology, and Outbreak Investigations Branch .......... Thomas R. Navin, M.D. Chief

Surveillance Team .................................................. Valerie Robison, D.D.S., M.P.H., Ph.D. Team Leader

Field Services and Evaluation Branch ..............................................................Kashef Ijaz, M.D. Chief

Data Management and Statistics Branch ....................................José E. Becerra, M.D., M.P.H. Chief

Reported Tuberculosis in the United States, 2006Centers for D�sease Control and Prevent�onCoord�nat�ng Center for Infect�ous D�seases

Nat�onal Center for HIV, STD, and TB Prevent�onD�v�s�on of Tuberculos�s El�m�nat�on

September 2007

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Acknowledgments

This report was prepared by

Surveillance TeamSurveillance, Epidemiology, and Outbreak Investigations Branch

Division of Tuberculosis EliminationNational Center for HIV/AIDS, Virgal Hepatitis, STD, and TB Prevention

Coordinating Center for Infectious DiseasesCenters for Disease Control and Prevention

Valer�e Rob�son, D.D.S., M.P.H., Ph.D.Sandy Althomsons, M.A., M.H.S.1

Robert Pratt, B.S.1

Ryan MacLaren Wallace, M.P.H.Elv�n Magee, M.P.H., M.S.

Lor� Armstrong, Ph.D.Carla W�nston, Ph.D.

L�l�a P. Manangan, R.N., M.P.H. Glenda T. Newell

Em�ly G. Cap�louto

Others contributing to the production of this publication Office of the Director

Ph�l�p LoBue, M.D., FACP, FCCP

Data Management and Statistics BranchThe Tuberculosis Information Management System

Development and Support TeamsSandy Pr�ce, P.M.P.1

Bruce Bradley, M.P.A.Stacey Parker1

Cr�st�na Cooper, M.B.A.1

Jayasree Gop�nath, M.C.A.1

Surveillance, Epidemiology, and Outbreak Investigations BranchAnn Buff, M.D., M.P.H.

National Center for Health Marketing, Division of Creative ServicesBrenda Holmes

Field Services and Evaluation Branch

We also acknowledge and thankAll state and local health departments throughout the Un�ted States whose staff collected and reported

the data used �n th�s publ�cat�on.Cover �llustrat�on by L�a Dav�s, age 10, Atlanta, Georg�a, w�nner of art contest follow�ng a TB

educat�on program �n a fourth-grade elementary school classroom.

1 CDC Informat�on Technology Support Contractor

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�x

PrefaceReports of tuberculos�s (TB) cases are subm�t-ted to the D�v�s�on of TB El�m�nat�on (DTBE), Centers for D�sease Control and Prevent�on (CDC), by 60 report�ng areas (the 50 states, the D�str�ct of Columb�a, New York C�ty, Puerto R�co, and seven other jur�sd�ct�ons �n the Pacific and Caribbean). In January 1993, an expanded system was developed to collect ad-d�t�onal �nformat�on for each reported TB case �n order to better mon�tor trends �n TB and TB control. A software package (SURVS-TB) for data entry, analys�s, and transm�ss�on of case reports to CDC was des�gned and �mplemented as part of the expanded TB surve�llance system. In 1998, the Tuberculos�s Informat�on Manage-ment System (TIMS) replaced SURVS-TB.

Th�s publ�cat�on, Reported Tuberculosis in the United States, 2006, presents summary data for TB cases reported to DTBE, verified, and counted �n 2006. It �s s�m�lar to prev�ous publ�cat�ons (see page x�, #19) and conta�ns s�x major sections. The first section presents trends �n the overall TB case counts and case rates by selected demograph�c and cl�n�cal character�s-t�cs. The second sect�on presents overall case counts and case rates for the Un�ted States by selected demograph�c character�st�cs for 2006. In the th�rd sect�on, TB case counts and case rates are presented by state and other jur�sd�c-t�ons w�th tables of selected demograph�c and cl�n�cal character�st�cs. In the fourth sect�on, data collected as part of the expanded system (e.g., �n�t�al drug res�stance, HIV status) are presented by report�ng area. Select tables report data from the Pacific and Caribbean jurisdictions. The fifth section provides TB case counts and case rates by metropol�tan stat�st�cal areas (MSAs: see Techn�cal Notes, page 9, for further deta�ls) w�th tables of selected demo-graph�c and cl�n�cal character�st�cs. F�nally, the sixth section presents figures from the annual surve�llance sl�de set, wh�ch emphas�ze key recent trends �n TB ep�dem�ology �n the Un�ted States. The sl�des w�th accompany�ng text can also be v�ewed and downloaded from the

D�v�s�on home page, wh�ch �s access�ble v�a the Internet at http://www.cdc.gov/tb/.

To help �nterpret the data, an Execut�ve Com-mentary (page 3) and Techn�cal Notes (page 9) have been �ncluded. In add�t�on, the current case definition (MMWR 1997;46 [No. RR 10]:40-41) and “Recommendat�ons for Count�ng Reported Tuberculos�s Cases” are prov�ded �n Append�ces A and B, respect�vely (page 119). The recommen-dat�ons for count�ng TB cases, wh�ch update the original January 1977 recommendations, were first publ�shed �n Reported Tuberculosis in the United States, 1996.

After the publ�cat�on of updated Guidelines for Targeted Tuberculin Testing and Treatment of La-tent Tuberculosis Infection �n Apr�l 2000,1 DTBE began rece�v�ng reports of ser�ous adverse events (�.e., hosp�tal�zat�on or death) related to the use of a 2-month course of r�famp�n and pyraz�nam�de (RZ) for treatment of latent tuberculos�s �nfect�on (TLTBI). Subsequently, DTBE requested and rece�ved reports and conducted on-s�te �nvest�ga-t�ons of l�ver �njury �n persons on TLTBI, and treatment gu�del�nes were rev�sed accord�ngly.2

Severe adverse events among persons rece�v�ng TLTBI cont�nue to be a publ�c health concern, and data on the annual number and trends of such events are needed. To th�s end, DTBE organ�zed a work�ng group on TLTBI adverse events �n Sep-tember 2003. Th�s work�ng group was charged w�th the development of a nat�onal surve�llance system w�th the follow�ng object�ves:

• To assist public health officials, policy makers, and healthcare prov�ders �n the prevent�on of adverse events, and

• To serve as the bas�s for per�od�c evalua-t�on of gu�del�nes for TLTBI and rev�s�on of these gu�del�nes as needed.

Development of the Nat�onal System for Severe Adverse Events Assoc�ated w�th Treatment of LTBI has been �mplemented, and w�ll �nclude

x

formal collaborat�ons among CDC, FDA, and other part�c�pat�ng agenc�es to ensure �nter-agency notification of serious adverse events. Mechan�sms for qual�ty assurance and t�mely d�ssem�nat�on of data are also under develop-ment.

At present, DTBE urges health departments, hosp�ces, hosp�tals, ja�ls, pr�sons, and pr�vate medical offices to report all severe adverse events (e.g., l�ver �njury, metabol�c ac�dos�s, anaphylax�s, se�zure, severe dermat�t�s) lead�ng to hosp�tal�zat�on or death of a person rece�v�ng TLTBI that occurred after January 1, 2004, to DTBE by telephone (404-639-8401) or e-ma�l (LManangan@cdc.gov).

References

1. ATS/CDC. Targeted tubercul�n test�ng and treatment of latent tuberculos�s �nfect�on. Am J Resp�r Cr�t Care Med 2000;161:S221–S247.

2. Amer�can Thorac�c Soc�ety/CDC. Update: Adverse event data and rev�sed Amer�can Tho-rac�c Soc�ety/CDC recommendat�ons aga�nst the use of r�famp�n and pyraz�nam�de for treat-ment of latent tuberculos�s �nfect�on—Un�ted States, 2003. MMWR 2003;52(31):735–9.

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Previous Statistical Reports in this Series:

1. Special Tuberculosis Projects, 1961–1965. Atlanta: CDC; 1966. 2. Special Tuberculosis Projects, December 1965. Atlanta: CDC; 1966. 3. Special Tuberculosis Projects, June 1966. Atlanta: CDC; 1967. 4. Special Tuberculosis Projects, December 1966. Atlanta: CDC; 1967. 5. Summary Report. Atlanta: CDC; 1967. 6. Special Tuberculosis Projects, June 1967. Atlanta: CDC; 1968. 7. Tuberculosis Program Reports, December 1967. Atlanta: CDC; 1968. 8. Tubercul�n test�ng dur�ng 1966–1967 school year. In: Tuberculosis Program Reports. Atlanta: CDC; 1968. 9. Tuberculosis Program Reports: S�x Month Per�od End�ng June 1968. Atlanta: CDC; 1969.10. Program Performance Analyses, June–December 1968. In: Tuberculosis Program Reports. Atlanta: CDC; 1970.11. Tubercul�n test�ng data, 1967–1968 school year. In: Tuberculosis Program Reports. Atlanta: CDC; 1970.12. The project years, 1961–1969, In: Tuberculosis Program Reports. Atlanta: CDC; 1970.13. Tuberculos�s programs (for years 1970–1973). In: Tuberculosis Program Reports. Atlanta: CDC; 1971–1974.14. Reported Tuberculosis Data (for years 1962–1973). Atlanta: CDC; 1963–1974.15. Tuberculosis Statistics: States and Cities (for years 1974–1985). Atlanta: CDC; 1971–1986.16. Tuberculosis in the United States (for years 1974–1986). Atlanta: CDC; 1976–1987.17. Tuberculos�s program management �n the Un�ted States, 1984. In: Tuberculosis Program Reports. Atlanta: CDC; 1986.18. Tuberculosis Statistics in the United States (for years 1987–1992). Atlanta: CDC: 1989–1993.19. Reported Tuberculosis in the United States (for years 1993–2005). Atlanta: CDC: 1994–2006.

Reports from 1999 through 2006 are available on the Internet athttp://www.cdc.gov/tb/surv/default.htm.

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State TB Stat�st�cs on the Internet*

AL http://www.adph.org/tb/AK http://www.ep�.hss.state.ak.us/�d/tb.stmAR NoneAZ http://www.hs.state.az.us/phs/o�ds/stats/�ndex.htm#TBStatsCA http://www.dhs.ca.gov/ps/dcdc/TBCB/publ�cat�ons.html CO http://www.cdphe.state.co.us/dc/tb/tbhome.html CT http://www.dph.state.ct.us/BCH/�nfect�ousd�se/tubercul.htm DC NoneDE http://www.dhss.delaware.gov/dph/dpc/tuberculos�s.html FL http://www.doh.state.fl.us/disease_ctrl/tb/ GA http://health.state.ga.us/ep�/tuber.aspHI http://www.hawa��.gov/health/tbIA http://www.idph.state.ia.us/adper/tb_control.asp ID NoneIL http://www.�dph.state.�l.us/health/�nfect/reportd�s/tb.htmIN http://www.�n.gov/�sdh/programs/tb KS http://www.kdhe.state.ks.us/tb/statistical_information.html KY http://chfs.ky.gov/dph/tb.htm LA http://www.oph.dhh.state.la.us/tuberculos�s/�ndex.html MA http://www.mass.gov/dph/cdc/tb/�ndex.htm MD http://www.edcp.org/tb/�ndex.html ME http://www.ma�ne.gov/dhs/boh/ddc/tuberculos�s.htm MI http://www.m�ch�gantb.org MN http://www.health.state.mn.us/tb MO http://dhss.mo.gov/Tuberculos�s/MT http://www.dphhs.state.mt.us/hpsd/Commun�cable-d�sease/commun-d�sease-�ndex.htm MS NoneND http://www.health.state.nd.us/d�sease/tb/ NC http://www.ep�.state.nc.us/ep�/tb NE http://www.hhs.state.ne.us/cod/Tuberculos�s/tb�ndex.htm NH http://www.dhhs.state.nh.us/DHHS/BCDCS/LIBRARY/Data-Stat�st�cal+Report/tb-count�es.htm NJ NoneNM NoneNYC http://www.nyc.gov/html/doh/html/tb/tb.shtmlNV http://health2k.state.nv.us/tuberculos�s/Trends.htmNY NoneOH http://www2.odh.ohio.gov/Data/Inf_Dis/TB/tb1.htm OK http://www.health.ok.gov/program/tb/�ndex.html OR http://egov.oregon.gov/dhs/ph/tb/�ndex.shtml PA http://www.health.state.pa.us/PHP/TB/tb.htm RI http://www.health.r�.gov/d�sease/commun�cable/tb/�ndex.php PR http://www.salud.gov.pr/PDFs/Impresos/estF�nalesTB-2003.pdf SC http://www.dhec.sc.gov/health/d�sease/tb SD http://www.state.sd.us/doh/TB/stat�st�cs.htm TN http://www2.state.tn.us/health/CEDS/tb/�ndex.htm TX http://www.tdh.state.tx.us/tb UT http://health.utah.gov/els/h�va�ds/tb/tbrefugee.htmlVA http://www.vdh.v�rg�n�a.gov/std/tb�ndex.asp VT NoneWA http://www.doh.wa.gov/cfh/tb WI http://www.dhfs.w�scons�n.gov/tbWV http://www.wvdhhr.org/�dep/dsdc.aspWY http://wdh.state.wy.us/tb/�ndex.asp

*As reported to CDC by U.S. reporting area TB programs as of July 2007. Includes responses from the reporting areas of New York City (NYC) and Puerto Rico (PR).

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Contents

Acknowledgments ............................................................................................................................... v��

Preface .................................................................................................................................................. �x

Prev�ous Stat�st�cal Reports �n Th�s Ser�es .......................................................................................... x�

State TB Stat�st�cs on the Internet ....................................................................................................... x��

Execut�ve Commentary ..........................................................................................................................3

Techn�cal Notes ......................................................................................................................................9

Morbidity Trend Tables, United StatesTable 1. Tuberculos�s Cases, Case Rates per 100,000 Populat�on, Deaths, and Death Rates per

100,000 Populat�on, and Percent Change: Un�ted States, 1953–2006 ...........................................15

Table 2. Tuberculos�s Cases, Percentages, and Case Rates per 100,000 Populat�on by H�span�c

Ethn�c�ty and non-H�span�c Race: Un�ted States, 1993–2006 .......................................................16

Table 3. Tuberculos�s Cases, Percentages, and Case Rates per 100,000 Populat�on by Race Only:

Un�ted States, 1993–2006 ..............................................................................................................17

Table 4. Tuberculos�s Cases, Percentages, and Case Rates per 100,000 Populat�on by Age

Group: Un�ted States, 1993–2006 ..................................................................................................18

Table 5. Tuberculos�s Cases, Percentages, and Case Rates per 100,000 Populat�on by Or�g�n of

B�rth: Un�ted States, 1993–2006 ....................................................................................................18

Table 6. Tuberculos�s Cases and Percentages Among Fore�gn-born Persons by the Top 30

Countr�es of Or�g�n of B�rth: Un�ted States, 2002–2006 ...............................................................19

Table 7. Tuberculos�s Cases and Percentages Among Adult Fore�gn-born Persons by Country

of Or�g�n and Years �n the Un�ted States Before TB D�agnos�s, Top 30 Countr�es: Un�ted States,

2006 and 1996 ................................................................................................................................20

Table 8. Tuberculosis Cases and Percentages by Case Verification Criterion and Site of Disease:

Un�ted States, 1993–2006 ..............................................................................................................21

Table 9. Pulmonary Tuberculos�s Cases and Percentages by Sputum Smear and Sputum Culture

Results: Un�ted States, 1993–2006 ................................................................................................21

Table 10. Tuberculos�s Cases and Percentages, by Res�stance to INH or Mult�drug Res�stance �n

Persons w�th No Prev�ous H�story of TB, by Or�g�n of B�rth: Un�ted States, 1993–2006 ............22

Table 11. Tuberculos�s Cases and Percentages, by Res�stance to INH or Mult�drug Res�stance �n

Persons w�th Prev�ous H�story of TB, by Or�g�n of B�rth: Un�ted States, 1993–2006 ..................22

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Table 12. Percentages of TB Cases by In�t�al Drug Reg�men, Use of D�rectly Observed Therapy

(DOT), and Complet�on of Therapy (COT): Un�ted States, 1993–2006 .......................................23

Table 13. Tuberculos�s Cases and Percentages �n Persons w�th HIV Test Results and w�th HIV

Co�nfect�on, by Age Group: Un�ted States, 1993–2005 ................................................................23

Table 14. Tuberculos�s Cases and Percentages by Reason Tuberculos�s Therapy Stopped: Un�ted

States, 1993–2004 ..........................................................................................................................24

Morbidity Tables, United States, 2006Table 15. Tuberculos�s Cases by H�span�c Ethn�c�ty and Non-H�span�c Race, Sex, and Age

Group: Un�ted States, 2006 ............................................................................................................27

Table 16. Tuberculos�s Case Rates per 100,000 Populat�on by H�span�c Ethn�c�ty and Non-

H�span�c Race, Sex, and Age Group: Un�ted States, 2006 ............................................................28

Table 17. Tuberculos�s Cases �n U.S.-born Persons by H�span�c Ethn�c�ty and Non-H�span�c

Race, Sex, and Age Group: Un�ted States, 2006 ............................................................................29

Table 18. Tuberculos�s Cases �n Fore�gn-born Persons by H�span�c Ethn�c�ty and Non-H�span�c

Race, Sex, and Age Group: Un�ted States, 2006 ............................................................................30

Table 19. Tuberculos�s Cases by Country of Or�g�n: Un�ted States, 2006 ...................................32

Morbidity Tables, States, 2006Table 20. Tuberculos�s Cases and Case Rates per 100,000 Populat�on: States, 2006 and 2005 ...37

Table 21. Tuberculos�s Cases and Percentages by Age Group: Report�ng Areas, 2006 ...............38

Table 22. Tuberculos�s Cases and Percentages by H�span�c Ethn�c�ty and Non-H�span�c Race:

Report�ng Areas, 2006 ...................................................................................................................40

Table 23. Tuberculos�s Cases and Percentages, U.S.-born and Fore�gn-born Persons: States,

2006................................................................................................................................................42

Table 24. Tuberculos�s Cases and Percentages �n Fore�gn-born Persons by Country of Or�g�n:

States, 2006 ....................................................................................................................................44

Table 25. Tuberculos�s Cases and Percentages �n Fore�gn-born Persons by Number of Years �n

the Un�ted States: States, 2006 .......................................................................................................46

Table 26. Tuberculos�s Cases and Percentages by Pulmonary and Extrapulmonary D�sease:

Report�ng Areas, 2006 ...................................................................................................................47

Table 27. Extrapulmonary Tuberculos�s Cases and Percentages by S�te of D�sease: Report�ng

Areas, 2006 ....................................................................................................................................48

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Table 28. Tuberculos�s Cases and Case Rates per 100,000 Populat�on, Ranked and Grouped by

Number of Cases: States and the D�str�ct of Columb�a, 2005 and 2006 ........................................50

Morbidity Tables, Reporting Areas, 2006 and 2004Table 29. Tuberculos�s Cases and Percentages by Res�dence �n Correct�onal Fac�l�t�es, Age >15:

Report�ng Areas, 2006 ...................................................................................................................53

Table 30. Tuberculos�s Cases and Percentages by Homeless Status, Age >15: Report�ng Areas,

2006................................................................................................................................................54

Table 31. Tuberculos�s Cases and Percentages by Res�dence �n Long-term Care Fac�l�t�es, Age

>15: Report�ng Areas, 2006 ..........................................................................................................55

Table 32. Tuberculos�s Cases and Percentages by Inject�ng Drug Use, Age >15: Report�ng

Areas, 2006 ....................................................................................................................................56

Table 33. Tuberculos�s Cases and Percentages by Non�nject�ng Drug Use, Age >15: Report�ng

Areas, 2006..............................................................................................................................57

Table 34. Tuberculos�s Cases and Percentages by Excess Alcohol Use, Age >15: Report�ng

Areas, 2006 ....................................................................................................................................58

Table 35. Tuberculos�s Cases and Percentages by In�t�al Drug Reg�men: Report�ng Areas,

2006................................................................................................................................................59

Table 36. Culture-Pos�t�ve Tuberculos�s Cases and Percentages w�th Drug Suscept�b�l�ty Results,

by Res�stance to INH or Mult�drug Res�stance: Report�ng Areas, 2006 .......................................60

Table 37. Tuberculos�s Cases and Percentages Among Persons Aged 25–44 by HIV Status:

Report�ng Areas, 2006 ...................................................................................................................61

Table 38. Tuberculos�s Cases and Percentages by Occupat�on, Age >15: Report�ng Areas,

2006................................................................................................................................................62

Table 39. Tuberculos�s Cases and Percentages by Type of Health Care Prov�der: Report�ng

Areas, 2004 ....................................................................................................................................63

Table 40. Tuberculos�s Cases and Percentages by D�rectly Observed Therapy (DOT): Report�ng

Areas, 2004 ....................................................................................................................................64

Table 41. Tuberculos�s Cases and Percentages by Complet�on of Tuberculos�s Therapy (COT):

Report�ng Areas, 2004 ...................................................................................................................65

Table 42. Tuberculos�s Cases and Percentages by Reason Therapy Stopped: Report�ng Areas,

2004......................................................................................................................................... 66

Table 43. Complet�on of Tuberculos�s Therapy (COT) Cases and Percentages by H�span�c

Ethn�c�ty and Non-H�span�c Race: Report�ng Areas, 2004 ...........................................................67

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Table 44. Tuberculos�s Cases and Percentages �n Persons Complet�ng Therapy for Whom

Therapy Was Ind�cated for One Year or Less: Report�ng Areas, 2000–2004 ................................68

Morbidity Tables, Cities and Metropolitan Statistical Areas, 2006Table 45. Tuberculos�s Cases �n Selected C�t�es: 2006 and 2005 ..................................................71

Table 46. Tuberculos�s Cases and Case Rates per 100,000 Populat�on: Metropol�tan Stat�st�cal

Areas w�th >500,000 Populat�on, 2006 and 2005 ..........................................................................72

Table 47. Tuberculos�s Cases by Pulmonary and Extrapulmonary D�sease: Metropol�tan

Stat�st�cal Areas w�th >500,000 Populat�on, 2006 .........................................................................74

Table 48. Tuberculos�s Cases by Age Group: Metropol�tan Stat�st�cal Areas w�th >500,000

Populat�on, 2006 ............................................................................................................................76

Table 49. Tuberculos�s Cases by H�span�c Ethn�c�ty and Non-H�span�c Race: Metropol�tan Stat�s-

t�cal Areas w�th >500,000 Populat�on, 2006 ..................................................................................78

Table 50. Tuberculos�s Cases and Percentages, U.S.-born Persons and Fore�gn-born Persons:

Metropol�tan Stat�st�cal Areas w�th >500,000 Populat�on, 2006 ...................................................80

Surveillance Slide Set, 2006Sl�des ..............................................................................................................................................85

Text ..............................................................................................................................................111

AppendicesAppendix A: Tuberculosis Case Definition for Public Health Surveillance ................................119

Append�x B: Recommendat�ons for Count�ng Reported Tuberculos�s Cases .............................120