Wetmore TB Foundation
TB Education
Professional HotLine
1.Global Impact of Tuberculosis on the United States
• One third of the world's population is infected with the TB bacillus.
• There are 8 million new cases of TB each year and 3 million people die of the disease (170,000 cases are children).
• TB is the leading cause of death in HIV-infected persons.
• In 1995, 36% of new U.S. cases were in foreign-born persons.
2.TB in the United States
TB disease was once the leading cause of death in the U.S. In the 1940's, scientists discovered the first of several drugs now used to treat TB. As a result, TB slowly began to disappear in the United States with a 6% decrease per year in TB cases for more than 3 decades. But between 1985 and 1992 TB cases increased.
Reported TB Cases
United States, 1975-1995
3. Reasons for an Increase in TB cases
• Immigration from other countries -- In the United States, TB infection and disease occur often among people born in areas of the world where TB is common such as Asia, Africa, and Latin America. TB cases in foreign-born persons accounted for 60% of the increase in 1986-l992.
• HIV epidemic -- The risk of developing TB disease is about 8% to 10% each year for people who are infected with both M. tuberculosis and HIV, whereas the risk of developing disease is 10% over a lifetime for people infected only with M. tuberculosis.
• Transmission in congregate settings -- In certain settings such as nursing homes, prisons, hospitals, homeless shelters, etc., the risk of being exposed to TB is higher than in other places.
• Deterioration of the TB public health care infrastructure.
4.Reasons for a Decrease in TB cases in 1993, 1994, and 1995
• Implementation of control measures and portions of A Strategic Plan for the Elimination of Tuberculosis (1989) and the National Action Plan to Combat Multidrug-Resistant TB (1992)
• Successful use of new resources in different areas of the U.S.
5. Strengthening TB Prevention
The CDC's Division of Tuberculosis Elimination's (DTBE) primary focus has been on those persons with active TB disease -- treating and curing these individuals, and following up on their contacts. However, an estimated 10-l5 million Americans are infected, and this pool of infected persons is the source of many future cases. TB disease may be costly to treat if the individuals are infected with multidrug-resistant TB. Thus, focused screening and preventive treatment programs for high-risk groups (particularly HIV-infected persons) need to be substantially strengthened.
6. CDC's Role
The mission of DTBE is to provide leadership in preventing, controlling, and eventually eliminating tuberculosis (TB) from the Untied States, in collaboration with partners at the community, state and international levels. To accomplish its mission DTBE carries out the following activities and projects:
• Monitoring disease trends through TB surveillance
• Epidemic assistance to states and cities to help control outbreaks
• Cooperative agreements (COAGs) with 68 state and large city health departments
• Support through cooperative agreements including many activities such as improving case detection and management, funding outreach workers to provide directly observed therapy (DOT), and identifying and giving preventive treatment to persons exposed to infectious cases
• Improved laboratory capacity
• Research and evaluation methods to better diagnose and treat infection and disease -- assessing behavioral aspects of patients and provider issues and evaluating activities
• Education of TB workers, providers, patients and the public
• Collaboration efforts which include working with the National Coalition to Eliminate TB
(NCET), which represents 72 agencies, associations, and voluntary groups as well as the
National TB Controllers Association and 43 state and local TB advisory committees
• Model TB Centers in California, New York, and New Jersey
7. Preventing another Resurgence
Recent successful efforts to control TB must be sustained and increased in order to prevent another resurgence. TB control is an exercise in vigilance; the goal of controlling and eventually eliminating TB requires a targeted and continuous effort.
Public Health Service
Centers for Disease Control and Prevention
National Center for HIV, STD, and TB Prevention
Division of Tuberculosis Elimination
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