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Efforts to
eliminate Tuberculosis in U.S. by 2010 fall
far short of benchmarks
Newswise — The U.S. is
likely to fall far short of its benchmark
goals toward eliminating tuberculosis as a
public health problem, according to data
from a nationwide survey.
Latent TB infection (LTBI)
prevalence in the 1999-2000 U.S. population
(excluding homeless and incarcerated
individuals) was found to be 4.2 percent,
according to the survey.
The current infection rate
would have to be 1 percent and decreasing if
the U.S. were on course to reach its goal of
TB incidence of less than one per million by
2010. These are the first survey-based
national LBTI estimates since 1971-1972.
The findings were
published in the first issue for February of
the American Journal of Respiratory and
Critical Care Medicine, published by the
American Thoracic Society.
“Persons with LTBI are not
infectious and cannot transmit TB to others,
and only 5-10 percent of individuals with
LTBI will go on to develop active TB, which
is infectious.
"But
because the risk of progression to TB can be
substantially reduced by preventive
treatment, it is crucial that LTBI by
detected and treated,” said lead author
Diane Bennett, M.D., M.P.H., of the Centers
for Disease Control and Prevention.
The National Health and
Nutritional Examination Survey (NHANES), a
cross-sectional series of nationally
representative health examination surveys,
suggests that of the 11,213,000 with LTBI in
the overall U.S. population, only one in
four had been diagnosed, and only 13 percent
had been prescribed treatment.
"The LTBI rates among
non-Hispanic whites, 1.9 percent, is close
to that required for TB elimination, but the
far higher rates among all other groups make
U.S. TB elimination by 2010 unlikely," wrote
Dr. Bennett and senior author Kenneth
Castro, M.D., M.P.H.
In this study, researchers
used data from 1999-2000 on 7,386
participants with TB skin test results.
They intentionally
over-sampled people with low income,
adolescents, people over age 60,
African-Americans, and Mexican-Americans so
as to allow for separate analyses of these
groups.
The survey estimated that
approximately 11 million individuals had
LTBI in 1999-2000. While that represents a
marked decline from the early 1970s, it also
masks the shifting demographics of those who
have LTBI.
Latent TB infections among
individuals living below the poverty level,
at 6.1 percent, were significantly higher
than the 3.3 percent among individuals
living above the poverty level.
Because the data excludes
homeless and incarcerated individuals, who
make up much of the U.S. population living
below the poverty line, the association may
be even stronger than suggested.
Race and ethnicity were
also associated with LTBI, even after
accounting for socioeconomic status.
“Among individuals born in
the United States, higher LTBI rates were
seen among non-Hispanic blacks and Mexican
Americans compared with non-Hispanic
whites,” wrote Dr. Bennett.
Most striking, however,
was the rate of infection among foreign-born
individuals.
In this survey, 18.7
percent of foreign-born individuals were
infected with TB, compared to 1.8 percent of
those born in the U.S. In 1999-2000, 6.9
million of the individuals with LTBI were
foreign-born, as compared with 4.1 million
U.S.-born; only 12 percent of the
foreign-born and 16 percent of the U.S.-born
had received treatment.
“The higher LTBI rates
among some subgroups suggest that specific
public health actions should be taken for
and with immigrant communities, racial
minorities and individuals living in
poverty,” Dr. Bennett said.
“While LTBI is not
infectious and latently infected individuals
are not a threat to others, increased
outreach for education, diagnosis and
provision of appropriate preventive
treatment could prevent many future cases of
active TB.”
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