According to the Centers for Disease Control and prevention (CDC), there were 13,293 reported cases of
tuberculosis
in 2007, a decline by 4.2% compared to 2006. Overall, the TB incidence
rate has decreased from 7.3%, as seen in the 1990s, to 3.8% during the
first seven years of this decade. However, this rate of decline appears
to be slowing, and the ultimate goal of eliminating TB in the US is
still elusive. Slightly more than one per cent (1.1%) of those patients
with TB has multidrug-resistant tuberculosis (MDR TB). In 2008, the
World Health Organization (WHO) reported that MDR TB was at the highest
rate ever.
While tuberculosis is still relatively rare in this country, it is a
large health issue among at-risk groups. The rate is almost ten times
higher in foreign-born persons living in the US as opposed to US-born
individuals. Among those TB-positive patients in 2007 who were also
tested for HIV,
11.3% were HIV-positive. HIV is now recognized as a key risk factor in
the progression from latent to full TB infection; thus the CDC has
recommended HIV testing for all TB patients.
Current guidelines call for targeted screening among such groups.
Adults who are part of or have been exposed to those who fall into high
risk groups should also be considered for screening.
The infection may be detected via a tuberculin skin test
and/or a blood test. The CDC notes that more data are needed on the
blood test’s effectiveness in children and those with HIV or acquired
immunodeficiency syndrome (AIDS). Although the CDC discourages routine
screening of low-risk populations, students are often required to be
tested before the first day of school, most health care workers are
routinely tested for possible exposure, persons who have had contact
with an individual who has suspected or confirmed TB, and persons with
or at risk for HIV infection are the CDC’s highest screening priority.
If an adult has been exposed to a high-risk adult, he or she should
be tested. The American Academy of Family Physicians’ high-risk
category includes the following:
- Those with close contact to a person with known or suspected TB
- Health care workers
- Immigrants from countries with a high rate of this disease (generally, less industrialized, developing nations)
- People with HIV
- Alcoholics
- Users of injection drugs or other illicit substances
- Residents
of long-term care facilities (such as nursing homes, mental health
facilities, prisons, AIDS care facilities, and homeless shelters)
- Those considered medically underserved from a low-income environment
Others vulnerable to infection:
- The elderly and individuals whose immune systems are
impaired, including persons whose medical conditions or therapies put
them at greater risk.
- Persons who live in unclean or crowded places and those without healthy food.
- Infants, children, and adolescents: if they are exposed to high-risk adults, they should be tested.
Links
Centers for Disease Control and Prevention: TB Fact sheet
Sources
US Centers for Disease Control and Prevention. QuantiFERON-TB Gold Test
(fact sheet). Last modified 16 Nov 2007. Available on the Internet at
http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm through http://www.cdc.gov. Accessed 6 Dec 2007.
US Centers for Disease Control and Prevention. Trends in Tuberculosis –
United States, 2007. Available on the Internet at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm through http://www.cdc.gov.
New Jersey Medical School and National Tuberculosis Center, University
of Medicine and Dentistry of New Jersey. History of TB: the recent TB
epidemic. 26 Feb 2001. Available on the Internet at
http://www.umdnj.edu/globaltb/tbhistory.htm through http://www.umdnj.edu. Accessed 26 Jul 2004 and 6 Dec 2007.
D’Alessandro D and Huth L. Children’s Virtual Hospital and The
University of Iowa. Pediatrics common questions, quick answers: TB
(tuberculosis). Last revised Apr 2002. Available on the Internet at
http://lib.cpums.edu.cn/jiepou/tupu/atlas/www.vh.org/pediatric/patient/pediatrics/cqqa/tb.html
through http://lib.cpums.edu.cn. Accessed 26 Jul 2004 and 6 Dec 2007.
Screening for tuberculosis and tuberculosis infection in high-risk
populations: recommendations of the advisory council for the
elimination of tuberculosis. 8 Sep 1995. MMWR 44(RR11);18-34. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/00038873.htm through http://www.cdc.gov. Accessed 21 Jul 2004 and 28 Jan 2008.
Targeted tuberculin testing and treatment of latent tuberculosis
infection (American Thoracic Society/CDC statement). 9 Jun 2000. US
Centers for Disease Control and Prevention. MMWR 49(RR06);1-54. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4906a1.htm through http://www.cdc.gov. Accessed 21 Jul 2004 and 6 Dec 2007.
University of Iowa Health Care. Tuberculosis. Last modified 19 Oct
2006. Available on the Internet at
http://
www.uihealthcare.com/topics/infectiousdiseases/infe4731.html
through http://
www.uihealthcare.com. Last accessed 6 Dec 2007.
Tuberculosis. In: Caring for Your Baby and Young Child: Birth to Age 5.
1999. Bantam. Excerpt on the Internet at
http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ1BN54FDC&sub_cat=573
through http://www.medem.com. Accessed 26 Jul 2004 and 6 Dec 2007.
