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Tuberculosis -- United States, 1982

In 1982, 25,520 cases of tuberculosis (TB) were reported to CDC, for a case rate of 11.0 per 100,000 population. Compared with 1981, this represents a 6.8% decrease in the number of cases reported and a decline of 7.6% in the case rate (Table 1).

Rates for the 50 states ranged from 25.4/100,000 in Hawaii to 2.0/100,000 in Wyoming. The rate increased in 13 states, remained unchanged in two, and decreased in 35 states and the District of Columbia (Figure 2). The rate among persons living in 56 cities of more than 250,000 population was 22.1/100,000--twice the national rate and 5.6% less than the rate for the same cities in 1981. Urban rates ranged from 61.4/100,000 in Miami, Florida, to 3.8/100,000 in Omaha, Nebraska. The rate increased in 21 of the country's 56 largest cities. Eight cities had rates at least three times the national rate: Miami, Florida; Newark, New Jersey; San Francisco, California; Houston, Texas; Atlanta-Fulton County, Georgia; Washington, D.C.; Chicago, Illinois; and Honolulu, Hawaii.

Of the 25,520 TB cases reported in 1982, Mycobacterium tuberculosis was isolated in 19,050. The proportion of culture-positive cases increased from 70.5% of total cases in 1981 to 74.6% in 1982. Reported by Div of Tuberculosis Control, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: From 1968 through 1978, the average annual decrease in TB cases in the United States was 5.6%. From 1979 through 1981, when there was a large influx of Southeast Asian refugees, the average annual decline was only 1.4%. The 6.8% decrease in the number of cases in 1982 may indicate that the previous downward trend has resumed. This may be explained in part by the smaller number of refugee arrivals in 1982. Another factor that may have influenced the reported morbidity figures for 1982 is the implementation of a new individual case-reporting system that requires more accurate verification of cases before they are counted. In January 1982, 20 additional areas began using the new system, which is being phased in over several years.

Despite the decline in the number of cases reported in 1982, TB persists as a public health problem. Transmission of infection continues, as evidenced by the continued occurrence of disease in young children. It is estimated that more than 10 million persons in this country are infected with tubercle bacilli. They have a lifelong risk of developing disease, unless given preventive treatment. Cases will continue to occur in this group for years to come, and additional cases will occur in new residents of this country who come from areas of the world where TB incidence and infection rates are much higher than in the United States.

State and local health departments are responsible for ensuring the control of TB at the community level. Currently, 40,000-45,000 persons on health department registers require treatment and follow-up for TB. Each year, over 200,000 persons exposed to new cases must be examined, and many of these should receive preventive treatment. TB control has been complicated by the global emergence of organisms resistant to antituberculosis drugs, and community outbreaks of drug-resistant disease continue to occur in the United States.

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