Suzanne J. Keller, MADivision of Disease PreventionVirginia Department of Health

Tuberculosis in Virginia

and the United States, 2007

November 2008

Overview of Presentation

• Sketch trends in US and Virginia

• Describe the epidemiology of TB in Virginia

• Compare US and Virginia data on key variables

Key National Highlights in Tuberculosis, 2007

• 13,299 TB cases reported for a case rate of 4.4 per 100,000

• 58% of all TB cases in the US occurred among foreign-born persons

• All racial and ethnic groups except whites have case rates higher than the national average

Reported TB Cases* United States, 1982–2007

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

26,000

28,000

1983 1986 1989 1992 1995 1998 2001 2004 2007

Year

Nu

mb

er o

f C

ases

*Updated as of April 23, 2008.

Reported TB Cases Virginia 1980-2007

309

Key Virginia Highlights in Tuberculosis, 2007

• 309 cases reported in 2007 for a case rate of 4.0 per 100,000

• 74.4% of cases reported among the foreign-born

• For the second year in a row, cases among the US-born declined substantially

TB Case Rates,* United States, 2007

< 3.5 (year 2000 target)

3.6–4.4

> 4.4 (national average)

D.C.

*Cases per 100,000.

TB Case Rates by RegionVirginia, 2007

1.4

9.3

1.5 2.42.6

Total Rate: 4.5

Percent of Reported TB Cases by Age Virginia, 1998-2007

0

10

20

30

40

50

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Perc

en

t o

f C

ases

0-14 15-24 25-44 45-64 65+

Reported TB Cases by Age and SexVirginia, 2007

0

10

20

30

40

50

60

70

0-14 15-24 25-44 45-64 65+

MaleFemale

Nu

mb

er o

f C

ases

Age Group

Percent of TB Cases by Race/EthnicityVirginia, 2007

Hispanic31%

White11%

Black25%

Asian/Pacific Islander

33%

TB Cases By RegionVirginia, 2003-2007

0

20

40

60

80

100

120

140

160

180

200

Nu

mb

er o

f C

ases

Northwest Southwest Central Eastern Northern

2003

2004

2005

2006

2007

Percentage of TB Cases Among Foreign-born Persons, United States*

>50%25%–49%<25%

1997 2007

DC DC

*Updated as of April 23, 2008.

Foreign vs. US Born TB Cases Virginia 1998-2007

0

50

100

150

200

250

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Nu

mb

er

of

cases

US Born Foreign Born

Trends in TB Cases in Foreign-born Persons, United States, 1987–2007*

0

2,000

4,000

6,000

8,000

10,000

1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007010203040506070

No. of Cases Percentage of Total Cases

No. of Cases Percentage

*Updated as of April 23, 2008.

Foreign-born TB Cases Top Five Countries of Birth: US and Virginia

• Mexico

• Philippines

• Vietnam

• India

• China

• El Salvador

• Philippines

• India

• Bolivia

• Mexico

US (2007) Virginia (2007)

Estimated HIV Coinfection in Persons Reported with TB, United States,

1993–2006*

0

10

20

30

1993 1995 1997 1999 2001 2003 2005

All Ages Aged 25–44

% C

oin

fect

ion

*Updated as of April 23, 2008.

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

2006

Number of Reported TB/AIDS CasesVirginia, 2003-2007

21

15

2122

10

0

5

10

15

20

25

2003 2004 2005 2006 2007

Year

Nu

mb

er

of C

ase

s

Primary MDR TBUnited States, 1993–2007*

0

100

200

300

400

500

1993 1995 1997 1999 2001 2003 2005 2007

0

1

2

3

No. of Cases Percentage

*Updated as of April 23, 2008.

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

MDR Cases & Percent of Cases with Resistance to Any First Line Drugs:

VA, 2003-2007

21

3

55

13.8

5.1

11.212.8

10.7

0

2

4

6

8

10

12

2003 2004 2005 2006 2007

Num

ber

0

2

4

6

8

10

12

14

16

Per

cent

Thanks

National Data Slides from CDC