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TB Notes Newsletter

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No. 4, 2012


DTBE’s Annual Surveillance Report – What’s New?

The Division of Tuberculosis Elimination’s annual surveillance summary, Reported Tuberculosis in the United States, 2011, features several notable enhancements. This year’s report includes reporting of HIV/TB data by states that did not previously report HIV test results. As a result, data completion for HIV test results increased in 2011 by 20% for all ages and by 22% for persons aged 25–44.  Another new table depicts trend data by Hispanic ethnicity and non-Hispanic race, by origin of birth, for years 1993 – 2011. The report also includes a new table of TB cases by homeless status among those 15 years of age or older, stratified by metropolitan statistical area (MSA).  Tables presenting trends for multidrug-resistant (MDR) and isoniazid (INH)-resistant TB are now stratified by location of birth and by previous TB status.

The slide set contains a new slide depicting trend data of TB cases reporting homelessness among those 15 years of age or older, for years 1993-2011. An additional slide in the slide set depicts trend data of TB cases by residence in correctional facilities among those 15 years of age or older for years 1993-2011.

The report features a special section dedicated to data from the US-affiliated Pacific Islands. This special section is accompanied by a slide set.

The report is available to download in full at In addition to making the full report available as a PDF, users may browse through individual tables and download slides for use in their own presentations. The online TB surveillance report is simple to use and very convenient.

These key changes to the annual surveillance summary and improved online access provide an overall better document for CDC, state and local partners, researchers, and the general public.

—Reported by Carla Jeffries
Div of TB Elimination

Predicting U.S. Tuberculosis Case Counts by Foreign-Born Country of Origin

The following information was presented as a poster by DTBE’s Rachel Yelk Woodruff, MPH, Carla Winston, PhD, and Roque Miramontes, PA-C, MPH, at the 2012 National TB Workshop in Atlanta, Georgia. It won the first place award in the NTCA poster competition.

This report describes an analysis to predict the number of TB cases diagnosed in the United States from the top 5 countries of birth through 2020. TB case counts reported to the National Tuberculosis Surveillance System from 2000-2010 were log-transformed. Linear regression was performed on the log-transformed case counts to calculate predicted annual case counts and 95% prediction intervals for the years 2011-2020 for U.S.-born TB cases, foreign-born cases, foreign-born cases from the top 5 countries of birth, and foreign-born cases excluding the top 5 countries of birth.

Highlights from the prediction analyses results presented in the poster include:

  • A continued increase in the proportion of TB cases diagnosed in the U.S. among foreign-born persons
  • Decreases in U.S.-born and foreign-born TB cases from 2010 observed to 2020 predicted estimates
  • Steeper decline among U.S.-born than foreign-born
  • Potential increase in foreign-born from India and China
  • Top 5 countries of birth impact the decline among foreign-born
  • Of the top 5 countries of birth for foreign-born TB cases--
  • Reliable declines could be predicted only for Vietnam
  • The remaining countries (Mexico, Philippines, India, and China) have potential for increase or decrease, based on model results and 95% prediction interval

A main limitation of the model presented is that it did not take into account programmatic, social, or cultural factors; TB rate in country of birth; migration patterns; socioeconomics; implementation of TB Technical Instructions; guidelines for TB screening of foreign-born persons entering the U.S.; or TB control in country of birth.

In conclusion, predicting foreign-born cases will assist TB control programs in concentrating limited resources where they can provide the greatest impact on reducing the burden of TB disease and will guide development of culturally competent outreach and materials.

—Reported by Rachel Yelk Woodruff, MPH
Div of TB Elimination


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