U.S. TB Cases Decrease Overall but Continue Among Some Minorities and Some Foreign Immigrants

Today is World Tuberculosis (TB) Day which marks the day in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacteria that cause TB.

The bacteria usually attack the lungs, but can also attack any part of the body such as the kidney, spine and brain. If not treated properly, TB disease can be fatal and was once the leading cause of death in the United States. In 2012, the last year for which there is data, there were close to 10,000 people with TB in the U.S. and 65 percent were foreign born. Eradication efforts in other parts of the world lag behind the U.S., which means foreign travelers and immigrants can carry the disease here.

TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks or sings. People nearby may breathe in the bacteria and become infected.

Not everyone infected with TB bacteria becomes sick. People who are infected, but not sick, have what is called latent TB infection. They don’t feel sick and don’t have any symptoms and can’t spread the disease, but they can later develop TB disease. Most people with latent TB, however, can be treated with drugs to prevent them from developing the disease, and most people with TB can be treated and cured. The drug regimen for both usually lasts nine months and is typically done through direct observation of a health care professional—sometimes through Skype or telemedicine terminals–to be sure that a TB patient finishes the full course of medicine.

In the early 1900s, TB killed one out of every seven people living in the United States and Europe. Drug treatment began in the 1940s and cases dwindled, but control efforts such as testing foreigners coming to the US decreased in the 1970s and early 1980s, which led to an increase in the number of TB cases between 1985 and 1992.  New efforts led by the CDC, however, have led to the recent fall in cases.

Four states account for half the cases of TB in the U.S. California has the third highest number of reported cases. Several years ago, more than two dozen children in Laguna Beach were exposed to a teacher with TB and now harbor the disease though none have become ill, according to the United Nations Foundation.

According to the CDC:

·         TB is still a life-threatening problem in the United States, despite the declining number of TB cases.

·         Anyone can get TB.

·         Current efforts to find and treat latent TB infection and TB disease are not sufficient.

·         Misdiagnosis of TB still occurs and health care professionals often fail to consider TB as a diagnosis.

One key effort that seems to be having an impact on the disease is a recent CDC recommendation for overseas TB screening of immigrants and refugees. The screenings have identified hundreds of cases that otherwise would have gone undetected until people with the disease arrived in the U.S.

In 2012 overseas physicians identified more than 1,100 cases of tuberculosis, including 14 cases of multidrug-resistant TB, according to a report published by the CDC last week. “This program has been one of the largest and most successful interventions in U.S. tuberculosis control during the past decade,” said Martin Cetron, M.D., director of CDC’s Division of Global Migration and Quarantine. “In addition to creating major savings in health care costs, the program ensures that immigrants and refugees get prompt care and correct treatment, which is vital to their health, the health of their loved ones, and the U.S. communities where they settle.”

According to the CDC, more than one-third of the world’s population is thought to be infected with the bacterium that causes TB. In 2012, nearly 9 million people around the world became sick with the disease.

Currently, 65 percent of people in the United States with TB are foreign-born. The change in screening procedures is estimated to have decreased the percentage of immigrants and refugees who tested negative for TB, while abroad, but who developed TB after their arrival from 7 percent to 1 to 2 percent.

New rules also now require that children ages 2-14 coming to the US with from high rates of TB be tested before coming to the U.S., since the disease often is undetected in children.

Racial disparities persist for TB cases. Latinos, African Americans and Asians face higher tuberculosis rates—7, 7 and 26 times higher, respectively—than do whites. And because of their weakened immune systems, people infected with HIV are especially vulnerable to tuberculosis.

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