Public Health

Tuberculosis Declines In The U.S., Affecting Mostly Those Born Overseas

If you follow tuberculosis news, there isn't a lot that's uplifting. It remains a stubborn menace in much of the world, and sickened 9.4 million people and killed 1.7 million in 2009.

Two students receive a tuberculin test in New  York City, 1962. i

Two students receive a tuberculin test in New York City, 1962. Library of Congress hide caption

itoggle caption Library of Congress
Two students receive a tuberculin test in New  York City, 1962.

Two students receive a tuberculin test in New York City, 1962.

Library of Congress

But the Centers for Disease Control and Prevention had an update this week, suggesting that efforts in the U.S. to control TB are going pretty well. In the latest issue of Morbidity and Mortality Weekly Report, the CDC showed that TB rates declined 3.9 percent in 2010 from the year before, and were the lowest they've been since 1953, when it first began tracking them.

All told, there were 3.6 cases of TB per 100,000 people in the U.S. last year. A lot of the 11,181 people affected have something surprising in common: they probably didn't pick up the bug in this country.

It seems that the biggest source of new cases is foreign-born people who bring it with them from home countries or pick it up when they go home to visit. In 2010, the TB rate among foreign-born people in the United States was 11 times greater than among people born on U.S. soil.

A lot of them were minorities, too: Some 95 percent of the Asians, 75 percent of the Hispanics, 34 percent of the blacks, and 20 percent of whites with TB in 2009 were foreign-born.

These cases were also clustered in the places you'd expect to find lots of immigrants. Nearly half of all the TB cases in the country came from four states: California, Texas, New York, and Florida. Each one each reported more than 500 cases for 2010.

How does the CDC know that these folks got sick outside the US? Well, they don't exactly.

But Dr. Kenneth Castro, director of the division of TB Elimination with the Centers for Disease Control and Prevention, tells Shots he's pretty confident that's the case.

"We don't know with certainty, but everything leads us to believe they were infected in their home country," says Castro. "For one, tuberculosis is very uncommon in our country contrasted with the countries of origin of these people."

Castro adds that many people who fall ill with TB in the U.S. may have had latent, or inactive TB for years, but never knew it, and so never had the chance to take drugs that would prevent the disease from getting worse.

JoAnn Carter, a board member of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international funder of public health efforts, says that the new profile of TB in America exposes the link between the global epidemic and the domestic epidemic.

"If we're not tackling this globally, we're going to see reversal of trends in this country," said Carter at a press conference Thursday.



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