TB cases in US hit all-time low; declines insufficient to meet goals

Adam MacNeil, PhD, MPH
Adam MacNeil

Tuberculosis cases in the United States in 2018 fell to the lowest level ever reported, according to preliminary surveillance data, but the rate of progress toward the goal of eliminating the disease in the U.S. has slowed, researchers reported in MMWR.

Another MMWR report highlighted small global declines in 2017 in incident cases of TB and TB deaths, demonstrating “only modest progress.”

The U.S. report by Amish Talwar, MD, MPH, of the CDC’s Division of Tuberculosis Elimination, and colleagues, described a 0.7% decrease in TB cases and a 1.3% decrease in TB incidence in 2018 compared with 2017. They noted that TB incidence declined an average of 1.6% per year during 2014-2018, a slower rate of decline compared with the 4.7% annual decline from 2010-2014.

“This decrease is consistent with the declines seen over the past several years; however, the current level of progress remains insufficient to eliminate TB in the United States in this century,” Talwar told Infectious Disease News.

The number of new TB cases reported in the U.S. in 2018 was 9,029. The researchers reported that non U.S.-born people made up two-thirds (69.5%) of the new cases, whereas U.S.-born people made up one-third (29.5%).

“Lower counts and incidences were seen in U.S.-born persons as well as in non U.S.-born persons, who continue to represent a large majority of TB cases and have an incidence greater than 14 times that of U.S.-born persons,” the researchers wrote.

Talwar added that “health care providers must recognize that in the United States, TB is not a disease of the past. Eliminating TB in the United States will require a concerted effort to enhance surveillance, detection, and treatment for latent TB infection among populations at increased risk.

“Treatment of latent TB infection is essential to controlling and eliminating TB in the United States because it substantially reduces the risk that latent TB infection will progress to TB disease. Another key is encouraging patient compliance by identifying shorter, more effective treatment regimens for TB disease and latent TB infection and less resource-intensive ways for ensuring treatment completion.”

In a separate study, CDC epidemiologist Adam MacNeil, PhD, MPH, and colleagues reported on the global epidemiology of TB.

They reported that in 2017, an estimated 10 million incident cases of TB occurred, representing a 1.8% decline from 2016, and 1.57 million TB deaths occurred, a 3.9% decline from the prior year. The highest number of TB cases and disease incidence were in Southeast Asia and Africa, with 9% of cases occurring among people infected with HIV.

“These numbers demonstrate only modest progress in reducing TB, as measured by the number of cases of disease, death, and drug resistance,” MacNeil told Infectious Disease News. “The rate of decline of these measures must improve in order to meet global TB 2020 targets.”

The researchers reported that multiple strategies are needed to reduce TB worldwide.

“These strategies include innovative approaches to case finding; scale-up of TB preventive treatment, especially among populations at high risk; use of newer TB treatment regimens; and the prevention and control of HIV infection,” MacNeil said.

The CDC observes World TB Day on March 24 as an opportunity to raise awareness of TB and treatment and prevention measures of the disease. – by Bruce Thiel

References:

Talwar A, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6811a2.

MacNeil A, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6811a3.

Disclosures: The authors report no relevant financial disclosures.

Adam MacNeil, PhD, MPH
Adam MacNeil

Tuberculosis cases in the United States in 2018 fell to the lowest level ever reported, according to preliminary surveillance data, but the rate of progress toward the goal of eliminating the disease in the U.S. has slowed, researchers reported in MMWR.

Another MMWR report highlighted small global declines in 2017 in incident cases of TB and TB deaths, demonstrating “only modest progress.”

The U.S. report by Amish Talwar, MD, MPH, of the CDC’s Division of Tuberculosis Elimination, and colleagues, described a 0.7% decrease in TB cases and a 1.3% decrease in TB incidence in 2018 compared with 2017. They noted that TB incidence declined an average of 1.6% per year during 2014-2018, a slower rate of decline compared with the 4.7% annual decline from 2010-2014.

“This decrease is consistent with the declines seen over the past several years; however, the current level of progress remains insufficient to eliminate TB in the United States in this century,” Talwar told Infectious Disease News.

The number of new TB cases reported in the U.S. in 2018 was 9,029. The researchers reported that non U.S.-born people made up two-thirds (69.5%) of the new cases, whereas U.S.-born people made up one-third (29.5%).

“Lower counts and incidences were seen in U.S.-born persons as well as in non U.S.-born persons, who continue to represent a large majority of TB cases and have an incidence greater than 14 times that of U.S.-born persons,” the researchers wrote.

Talwar added that “health care providers must recognize that in the United States, TB is not a disease of the past. Eliminating TB in the United States will require a concerted effort to enhance surveillance, detection, and treatment for latent TB infection among populations at increased risk.

“Treatment of latent TB infection is essential to controlling and eliminating TB in the United States because it substantially reduces the risk that latent TB infection will progress to TB disease. Another key is encouraging patient compliance by identifying shorter, more effective treatment regimens for TB disease and latent TB infection and less resource-intensive ways for ensuring treatment completion.”

In a separate study, CDC epidemiologist Adam MacNeil, PhD, MPH, and colleagues reported on the global epidemiology of TB.

They reported that in 2017, an estimated 10 million incident cases of TB occurred, representing a 1.8% decline from 2016, and 1.57 million TB deaths occurred, a 3.9% decline from the prior year. The highest number of TB cases and disease incidence were in Southeast Asia and Africa, with 9% of cases occurring among people infected with HIV.

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“These numbers demonstrate only modest progress in reducing TB, as measured by the number of cases of disease, death, and drug resistance,” MacNeil told Infectious Disease News. “The rate of decline of these measures must improve in order to meet global TB 2020 targets.”

The researchers reported that multiple strategies are needed to reduce TB worldwide.

“These strategies include innovative approaches to case finding; scale-up of TB preventive treatment, especially among populations at high risk; use of newer TB treatment regimens; and the prevention and control of HIV infection,” MacNeil said.

The CDC observes World TB Day on March 24 as an opportunity to raise awareness of TB and treatment and prevention measures of the disease. – by Bruce Thiel

References:

Talwar A, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6811a2.

MacNeil A, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6811a3.

Disclosures: The authors report no relevant financial disclosures.