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MMWR – Morbidity and Mortality Weekly Report


1. Trends in Tuberculosis — United States, 2011

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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Data indicate that TB reached an all-time low in the U.S. in 2011, while continuing to significantly affect racial/ethnic minorities and the foreign-born.  Preliminary data from the CDC National TB Surveillance System indicate a total of 10,521 TB cases were reported in the U.S in 2011.  The rate of 3.4 cases per 100,000 population is a decline of 6.4 percent from 2010.  Despite the decline, 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.  Asians now surpass Hispanics as the racial/ethnic group with the largest number of TB cases.  The TB rate for foreign-born persons was 12 times higher than that for those born in the U.S.  TB poses a particular risk to people with HIV, and according to available data, 8 percent of people with TB were also infected with HIV.  Drug resistance, which makes TB more difficult and costly to treat, continues to pose a threat to TB control.  In 2010, multidrug-resistant TB remained stable at 1.3 percent of cases (109 total), and four cases of extensively-drug resistant TB were reported in 2011.  The authors note that despite declines, maintaining strong public health systems and vigilance against TB, as well as treating latent infection to prevent the development of TB disease, are critical to further reducing the burden of disease and avoiding resurgence.

2. Tuberculosis Outbreak Associated with a Homeless Shelter — Kane County, Illinois, 2007–2011

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Media Relations
(404) 639-8895           

Despite overall declines in U.S. TB cases, outbreaks continue to pose serious challenges to our ability to control TB, and populations such as persons affected by homelessness are particularly vulnerable.  TB outbreaks among homeless persons are particularly problematic, because it can be difficult to locate contacts of these individuals in order to evaluate and provide the lengthy treatment (6-9 months) to those who need it. Additionally, certain factors common in this population (such as alcohol use and congregation in crowded shelters) can increase TB risk.  After public health officials in Kane County, Illinois recognized a TB outbreak among guests staying at a homeless shelter, officials at the Centers for Disease Control and Prevention assisted with an investigation to determine the extent of transmission.  As of September 2011, a total of 28 cases were determined to be related to the outbreak; all were homeless and had been overnight guests at the shelter.  Excess alcohol use and occasional or frequent attendance at two bars were also associated with being a case – suggesting that transmission may not have been limited to the shelter.  The authors note that this outbreak underscores the importance of maintaining the ability of our public health systems to quickly and effectively respond to protect the public when a TB outbreak is identified.

3. Progress Toward Global Polio Eradication — Africa, 2011

Division of News & Electronic Media           
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Interruption of wild poliovirus (WPV) transmission in Nigeria is critical to the successful eradication of polio in Africa. In 2011, 350 WPV cases were reported by 12 African countries, a 47 percent decrease from the 657 cases reported in 2010. Importation of WPV into 29 previously polio-free African countries during 2003–2011 led to reestablished WPV transmission in Angola, Chad, Democratic Republic of the Congo (DRC), and Sudan, though the last confirmed case in Sudan was in 2009. Since 2003, multiple polio outbreaks in Africa have been traced to importations from Nigeria, the only country in Africa in which transmission has never ceased. To successfully eradicate polio, it is critical to interrupt the transmission of WPV from Nigeria. Urgent action is needed to strengthen supplemental immunization responses throughout the region and particularly in the polio-affected countries of Nigeria, Chad, and DRC, and to maintain sensitive surveillance throughout Africa.

4. Notes from the Field: Multistate Outbreak of Salmonella Altona and Johannesburg Infections Linked to Chicks and Ducklings from a Mail-Order Hatchery — United States, February–October 2011

Division of News & Electronic Media           
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The report describes an outbreak of two clusters of human Salmonella infections in the United States between February and October 2011 linked to chicks and ducklings from a single mail-order hatchery.  From February 25 to October 10, 2011, a cluster of 68 cases caused by Salmonella serotype Altona and a cluster of 28 cases caused by Salmonella Johannesburg were identified in 24 states. Many of the infections occurred in young children. Children can be exposed to Salmonella by holding, cuddling, or kissing the birds and by touching things where the bird lives, such as cages or feed and water bowls. Young children are especially at risk for illness because their immune systems are still developing and because they are more likely than others to put their fingers or other items into their mouths. Salmonella infections in children may be severe and can result in hospitalization and, occasionally, death. Preventing these infections will require an integrated approach at the hatchery, agricultural feed store, and consumer levels.


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