Synopsis for March 18, 2005

The MMWR is embargoed until Thursday, 12 PM EDT.

1. Trends in Tuberculosis ― United States, 2004
2. Congenital Pulmonary Tuberculosis Associated with Maternal Cerebral Tuberculosis ― Florida, 2002
3. Preemptive State Smoke-Free Indoor Air Laws ― United States, 1999-2004

Trends in Tuberculosis ― United States, 2004

National tuberculosis (TB) surveillance data released today by the CDC show significant but slowing progress in the United States’ efforts to eliminate TB.

In 2004, the rate of TB in the U.S. fell to an all-time low of 4.9 cases per 100,000 people, or a total of 14,511 active cases. While this is the lowest U.S. TB rate ever recorded, the decline in 2004 (3.3 percent) was one of the smallest in more than a decade. TB continues to disproportionately affect many U.S. communities. Compared with whites, Asians are 20 times more likely and blacks and Hispanics are eight times more likely to have TB. For the first time in 2004, there were more TB cases among Hispanics (4,160) than any other racial/ethnic group. Slightly more than half of all U.S. TB cases (7,701) were among foreign-born individuals, who were 8.7 times more likely to have TB than U.S.-born individuals (22.5 vs. 2.6 cases per 100,000). The authors note that TB remains a major health threat that must be fought globally and outline multiple steps that can accelerate progress and guard against TB resurgence.

Congenital Pulmonary Tuberculosis Associated with Maternal Cerebral Tuberculosis ― Florida, 2002

In May 2002, physicians at a Florida hospital diagnosed a case of congenital tuberculosis (TB) – TB disease transmitted from mother to baby during pregnancy – in a 44-day-old infant.

The infant was hospitalized with fever and respiratory problems; the cause of the illness was unclear until it was determined that the mother had been recently diagnosed with cerebral TB at a different hospital. Congenital TB is rare, but can be fatal if not treated. The disease is difficult to diagnose unless the mother’s TB history is known. During the investigation, researchers learned that the mother had emigrated from Haiti --a country with high TB rates-- and had tested positive for latent TB infection two years before her pregnancy. Her infection was not treated at that time. This finding underscores the importance of screening women who are at risk for TB -- particularly foreign-born women, since foreign-born individuals are nearly nine times more likely than U.S.-born individuals to have the disease -- and providing preventive treatment to patients with TB infection. Researchers also note that physicians should suspect congenital TB in infants with unexplained fever and respiratory symptoms.

Preemptive State Smoke-Free Indoor Air Laws ― United States, 1999-2004

Almost no progress is being made towards the Healthy People 2010 goal of eliminating all preemptive state tobacco control laws, resulting in the potential for lesser health protection.

Based on the findings of this analysis, preemptive state smoke-free indoor air laws remain common in many states. States without preemption provisions can set minimum requirements and allow the continued passage and enforcement of local ordinances that may establish a greater level of protection of public health. Smoke-free laws and restrictions enable several important public health benefits. These laws have been shown to be the most effective strategy to protect nonsmokers from secondhand smoke exposure. These restrictions also decrease cigarette consumption among those who continue to smoke and may increase cessation rates among workers and the general public.

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