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Current Trends Tuberculosis -- United States, 1983

In 1983, 23,846 cases of tuberculosis were reported to CDC, for a rate of 10.2 cases per 100,000 population. Compared with 1982, this represents a 6.6% decrease in the number of cases reported and a decline of 7.3% in the rate.

Rates for the 50 states ranged from 23.1/100,000 in Hawaii to 1.3/100,000 in North Dakota (Table 3). The rate increased in 13 states, remained unchanged in one, and decreased in 36.

The rate among persons living in 56 cities with populations of 250,000 or more was 21.2/100,000--more than twice the national rate (Table 4). Urban rates ranged from 58.4/100,000 in Miami, Florida, to 2.5/100,000 in Toledo, Ohio. Eight cities had rates at least three times the national rate: Miami, Florida; Newark, New Jersey; Atlanta, Georgia; San Francisco, California; Tampa, Florida; Honolulu, Hawaii; Washington, D.C.; and Oakland, California.

In 1983, 1,360 tuberculosis cases were reported among children under 15 years of age, including 818 cases among children less than 5 years of age; in 1982, there were 1,349 and 789 such cases, respectively.

Final tuberculosis mortality data for 1981 show 1,937 deaths. Compared with the final totals of 2,007 and 1,978 deaths in 1979 and 1980 and the 1982 provisional estimate of 1,980 deaths by the National Center for Health Statistics, there was essentially no change in tuberculosis mortality over the 4-year period 1979-1982. Reported by Div of Tuberculosis Control, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: From 1968 through 1978, the average annual decrease in tuberculosis cases in the United States was 5.6%. From 1978 through 1981, when there was a large influx of Southeast Asian refugees, the average annual decline was only 1.4%. A 6.8% decrease in the number of cases in 1982 and the 6.6% decrease in 1983 indicate the previous downward trend has resumed.

Three factors may have contributed to the decreased number of tuberculosis cases reported in 1983: (1) There was an increase in the number of states using the new individual case reporting system, which requires more accurate verification of cases before they are counted; (2) the number of refugees arriving in the United States with tuberculosis declined; and (3) the number of indigenous tuberculosis cases may have actually declined.

Despite the decline in reported cases in 1983, tuberculosis persists as a public health problem. Transmission of infection continues, as evidenced by the continued occurrence and lack of decline of disease in young children. Tuberculosis mortality has not declined; moreover, in 1980, tuberculosis was the leading cause of death among 38 notifiable diseases for which mortality data were reported (1). The number of tuberculosis deaths that year exceeded the combined total of deaths for the other 37 notifiable diseases. 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, which can be minimized by giving preventive treatment. Additional cases will occur in new residents of this country who come from areas of the world where tuberculosis infection rates are much higher than in the United States. Unless otherwise contraindicated, these persons should receive a course of preventive therapy (2).

State and local health departments are responsible for ensuring the control of tuberculosis in the community. It is estimated that 40,000 persons on health department registers are currently under treatment or medical supervision for tuberculosis and that each year, approximately 200,000 persons exposed to new cases must be examined. Many of these persons are placed on preventive treatment. Tuberculosis control has been complicated by the global emergence of organisms resistant to antituberculous drugs (3). Community outbreaks continue to occur in the United States (4,5).

References

  1. CDC. Annual summary 1982: reported morbidity and mortality in the United States. MMWR 1983;31:148.

  2. American Thoracic Society/Centers for Disease Control (ATS/CDC). Treatment of tuberculosis and other mycobacterial diseases. Am Rev Respir Dis 1983;127:790-6.

  3. Kleeberg HH, Boshoff MS. A world atlas of initial drug resistance. Tuberculosis Research Institute of the South African Medical Research Council, Pretoria, South Africa, 1980.

  4. CDC. Interstate outbreak of drug-resistant tuberculosis involving children--California, Montana, Nevada, Utah. MMWR 1983;32:516-8.

  5. Silverman PR. An outbreak of tuberculosis in southern Delaware: the meaning of surveillance and containment. Del Med J 1984;56:156-8.

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