For more information, contact Division of Tuberculosis Elimination Natonal Center for HIV/AIDS, Vral Hepatts, STD, and TB Preventon Coordnatng Center for Infectous Dseases Centers for Dsease Control and Preventon 1600 Clfton Road NE MS E-10 Atlanta, GA 30333 Phone: (404) 639-8120 Fax: (404) 639-8959 E-mal: [email protected]Web 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 Servces, CDC, September 2007. All materal n ths report s n the publc doman and may be reproduced or coped wthout perms- son. However, ctaton as to source s requested. Ordering Information Copes of Reported Tuberculosis in the United States, 2006, are avalable from the Dvson of Tuberculoss Elmnaton’s onlne orderng system at http://www.cdc.gov/tb/. This report is also accessible via Internet at http://www.cdc.gov/tb/
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Reported Tuberculosis in the United States, 2006 - Preface · This report was prepared by Surveillance Team ... rac c Soc ety/CDC recommendat ons aga nst ... 7. Tuberculosis Program
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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
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
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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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
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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 ([email protected]).
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).