MMWR

Morbidity and Mortality Weekly Report

Trends in Tuberculosis Incidence – United States, 2006

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A CDC analysis of national tuberculosis (TB) surveillance data shows slowing progress in the efforts to eliminate TB in the U.S. In 2006, the national TB rate fell to an all-time low of 4.6 cases per 100,000 people, with a total of 13,767 active cases. However, the decline in the TB rate in 2006 (3.2 percent) was one of the smallest in more than a decade. TB continues to disproportionately affect minorities and foreign-born individuals. Compared with whites, Asians were 21 times more likely to have TB in 2006, and blacks and Hispanics were approximately 8 times more likely. Foreign-born individuals accounted for more than half of all TB cases and had a rate nearly 10 times higher than U.S.-born individuals (21.9 vs. 2.3 cases per 100,000). Among TB cases with a reported HIV test result, 12.4 percent were infected with HIV, a major risk for TB disease. However, almost a third of TB cases did not have a documented HIV test result, underscoring the need for increased HIV testing and improved reporting to ensure that all patients with TB are routinely screened for HIV. The proportion of TB cases that were multidrug-resistant (MDR) remained stable from 2004 to 2005, and accounted for 1.2 percent of cases for which these data are available. Drug-resistant cases are more costly and difficult to treat, and can be fatal. The authors note multiple steps will be needed to accelerate progress and guard against a resurgence of TB in the U.S.

Extensively Drug-Resistant Tuberculosis – United States, 1993-2003

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Office of Communication
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Analysis finds 49 documented cases of extensively drug-resistant (XDR) tuberculosis (TB) in the United States between 1993 to 2006. While the risk of XDR-TB remains relatively low in the U.S., cases have been widely dispersed geographically and pose a continued risk to efforts to treat and control TB. XDR TB is resistant to at least the first-line anti-TB drugs isoniazid and rifampin, as well as any fluoroquinolone and at least one of three second-line injectable TB drugs. CDC researchers compared XDR TB cases during two periods: 1993-99 and 2000-06. As a proportion of MDR TB cases, XDR TB remained stable at roughly 3 percent during the two time periods analyzed. The composition of cases shifted, with the proportion of XDR TB cases that were foreign-born increasing from 39 percent to 76 percent, reflecting the disproportionate impact of TB on this population. Additionally, while HIV status was unknown for many cases, the proportion of XDR TB cases that were HIV-infected declined from 73 percent to 20 percent, likely reflecting improved HIV and TB treatment. Because drug-susceptibility results are incomplete, these data underestimate U.S. XDR TB cases. Recognizing the ease with which XDR TB can spread, the authors stress the need for renewed vigilance in resistance testing, reporting, treatment, contact investigation, and expanded outbreak detection and response capacity.

Racial Difference in Trends of End-State Renal Disease, by Primary Diagnosis – United States 1994-2004

PRESS CONTACT: CDC - National Center for Chronic Disease Prevention and Health Promotion
Nilka Ríos Burrows, MPH
(770) 488-5131

The number of persons at risk of developing kidney failure is expected to increase with the increasing prevalence of major risk factors such as diabetes and high blood pressure. Continued awareness and interventions to reduce the prevalence of these risk factors and improve care among persons with diabetes or high blood pressure are needed to sustain and improve trends in incidence of kidney failure. Early detection and treatment can help prevent, delay, or reduce disease progression. To learn more about kidney failure and kidney disease, please visit http://www.cdc.gov/diabetes/projects/kidney.htm.

Overall, the rate of new cases or incidence rate of kidney failure increased from 261 per million population in 1994 to 349 in 2004. The leading cause of kidney failure in the United States is diabetes, followed by hypertension and glomerulonephritis, a type of kidney disease caused by swelling of the internal kidney structures. We examined trends in the primary cause of kidney failure in the United States and found that the rate of new cases of kidney failure attributed to glomerulonephritis decreased during 1994–2004 among all races analyzed. The rate attributed to diabetes or high blood pressure decreased during 1999–2004 for American Indians/Alaska Natives and Asians/Pacific Islanders but not for whites or blacks.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES