Tuberculosis Trends and Recommendations: Disproportionate Decline of Tuberculosis in United States Populations and Recommendations to Eliminate These Disparities

Many people believe that tuberculosis (TB), like smallpox, is a disease of the past, and they are surprised to learn that tuberculosis still exists in the United States. On a global basis, TB continues to be the leading cause of death for adults from an infectious disease. Despite a steady decrease in the annual rate of TB cases since 1992, TB is a major public health threat in the United States, largely due to immigration from high-burden countries. As reported by the Center for Disease Control and Prevention (CDC), in 2008 a total of 12,898 incident TB cases were reported; the TB case rate declined 3.8% from the 2007 case rate to 4.2 cases per 100,000 population, the lowest rate recorded since reporting began in 1953. However, since 2000, the U.S. rate of decline has slowed considerably, and we are still far from meeting the goal of TB elimination. Although TB rates have fallen dramatically in the U.S.-born population, rates in the foreign-born population have declined much more slowly, and they now account for 59% of total incident cases of TB in the United States. Further, Multi-drug Resistant Tuberculosis (MDR TB) continues to be a public health concern and has been shown to also disproportionately affect foreign-born persons in the United States. Increased travel and immigration of persons from countries with a high tuberculosis burden are certain to bring new challenges to public health. Future efforts to curtail the incidence of TB will require vigilant public health efforts that include: education of patients and health care personnel; identification of routes and mechanisms of transmission; and assuring adequate treatment among infected individuals, and adequate prophylactic regimens among those with latent infection. An understanding of TB epidemiology coupled with increasing awareness about TB disparities will contribute to more effective targeting of prevention and control efforts.