Tuberculosis

World TB Day: U.S. Cases Hit New Low, Integration with HIV Care Needed Worldwide

The number of new tuberculosis (TB) cases in the U.S. fell below 10,000 in 2012 -- the lowest rate since tallying began in the early 1950s, according to a Centers for Disease Control and Prevention(CDC) report released ahead of World TB Day on March 24. But the news is not all good, as novel treatments and better integration of care are needed on a global basis.

As described in the March 22, 2013, Morbidity and Mortality Weekly Report, a total of 9951 new TB cases were reported in the U.S. in 2012, for an incidence rate of 3.2 cases per 100,000 persons. This represents a 6.1% decrease from 2011, and is the 20th consecutive year of declining rates, according to the CDC.

While more than 40% of U.S. counties did not report a single new TB case during 2010-2012, there were notable regional variations. The San Francisco Department of Public Health, for example, announced that the city's TB rate rose for the second year in a row.

The CDC figures, derived from the National Tuberculosis Surveillance System, show that foreign-born persons living in the U.S. were 11.5 times more likely to be diagnosed with TB than people born in the U.S. TB rates among Asians, Hispanics/Latinos, and blacks were 25.0, 6.6, and 7.3 times as high, respectively, as the rate for whites.

"Although the number of cases dropped below 10,000 for the first time since standardized national reporting of TB began in 1953, a number of challenges remain that slow progress toward the goal of TB elimination in the U.S.," the CDC authors wrote. "Initiatives to increase TB awareness and testing and treatment of latent infection and disease will be critical to TB elimination efforts, especially among foreign-born populations, racial/ethnic minorities, and other groups that are disproportionately affected."

This is even more true outside the U.S., as TB rates are much higher in many other parts of the world including Africa, Asia, and Eastern Europe, with multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) disease a growing concern.

The World Health Organization (WHO) and the Global Fund to Fight AIDS, TB and Malaria said in a statement last week that at least US$1.6 billion in international funding is needed for treatment and prevention of the disease.

"We are treading water at a time when we desperately need to scale up our response to MDR-TB," said WHO Director-General Margaret Chan. “We have gained a lot of ground in TB control through international collaboration, but it can easily be lost if we do not act now.”

In a World TB Day statement, UNAIDS Executive Director Michel Sidibé emphasize the need for integrations of HIV and TB services, as TB is the leading cause of death for people with HIV worldwide.

"Every day more than 1000 people living with HIV die of tuberculosis. This is unacceptable," he stated. "Today we have the knowledge and the power to stop HIV and TB in their tracks. By integrating HIV and TB services and systems, we can save millions of lives and millions of dollars...Any time wasted will be precious lives lost."

3/27/12

Reference

R Miramontes, R Pratt, SF Price, et al. Trends in Tuberculosis -- United States, 2012. Morbidity and Mortality Weekly Report 62(11):201-205. March 22, 2013.

Other Sources

San Francisco Department of Public Health. TB Rates in San Francisco on the rise for second year. Media advisory. March 18, 2013.

World Health Organization. World Health Organization and Global Fund cite tuberculosis threat. Press release. March 18, 2013.

UNAIDS. UNAIDS calls for Zero parallel systems for HIV and TB. Press release. March 24, 2013.