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1. World Tuberculosis Day — March 24, 2011 (Box)

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2. Trends in Tuberculosis — United States, 2010

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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Preliminary data from CDC's National TB Surveillance System show that although TB reached an all-time low in the U.S. in 2010, TB continues to significantly affect many communities, including racial/ethnic minorities, foreign-born individuals, and persons living with HIV. In 2010, a total of 11,181 TB cases were reported in the U.S. The rate declined 3.9 percent from 2009 to 2010, to 3.6 cases per 100,000 people. Despite declines, TB rates for all racial/ethnic minorities were higher than those of whites, with TB rates seven times higher for Hispanics, eight times higher for blacks, and 25 times higher for Asians. More TB cases were reported among Hispanics than any other racial/ethnic group. The TB rate for foreign-born individuals was 11 times higher than that of those born in the U.S. TB poses a particular risk to people living with HIV, and according to available data, nearly nine percent of people with TB were also infected with HIV. Drug resistance, which makes cases of TB more difficult and costly to treat, continues to pose a threat to TB control in the U.S. In 2009, approximately 1.3 percent of TB cases were multi-drug resistant (113 total cases). One case of extensively-drug resistant TB has been reported to-date in 2010. The authors note that additional steps are needed to accelerate progress against TB and guard against resurgence of the disease.

3. Assessment of Declines in Reported Tuberculosis Cases — Georgia and Pennsylvania, 2009

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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An analysis of state TB surveillance data for Georgia and Pennsylvania suggests the larger-than-expected decline in TB cases in 2009 in these states was not because of problems with reporting and surveillance, and might have represented a real decline in TB cases. To further understand the reasons for the dramatic decline in TB cases nationwide in 2009, which was first reported last year, public health officials from CDC, along with the Georgia Division of Public Health and the Pennsylvania Department of Health, analyzed TB data from two states that experienced large declines. In particular, investigators wanted to assess potential failure in reporting of diagnosed TB cases to the states' surveillance systems. After analyzing data for each state, no evidence of changes or delays in surveillance efforts that could lead to artificially low case counts or underreporting were found. The number of reports of suspected TB and specimens submitted to labs for TB testing remained stable or increased, suggesting the declines were not due to failure of healthcare providers to consider TB and report suspected cases to public health. Both states experienced a decrease in the proportion of suspected TB reports and specimens tested by labs that were ultimately counted as cases. Researchers believe these findings suggest the 2009 decline might have reflected an actual epidemiologic decline in TB cases in these states.

4. Vitamin B12 Deficiency in Resettled Bhutanese Refugees — United States, 2008–2011

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Approximately 30,000 Bhutanese refugees have resettled to the United States since 2008, with approximately 60,000 expected before resettlement is complete. A substantial proportion (approximately 30 percent–60 percent) of Bhutanese refugees are deficient in vitamin B12, most likely because of a lack of vitamin B12 in their diet in refugee camps in Nepal. All Bhutanese refugees should be given nutrition advice and should receive supplemental vitamin B12 upon arrival in the United States. Refugees with clinical manifestations suggestive of B12 deficiency should be tested for adequate serum vitamin B12 concentrations and, if found to have a B12 deficiency, screened for underlying causes, treated with parenteral vitamin B12 or high-dose oral supplements and evaluated for response to therapy.



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