MMWR

Morbidity and Mortality Weekly Report

(Box) World TB Day — March 24, 2008

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National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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No summary available

Trends in Tuberculosis — United States, 2007

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National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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A CDC analysis of 2007 national tuberculosis (TB) surveillance data shows continuing disparities and a slowing decline in U.S. TB rates. In 2007, the national TB rate fell to an all-time low of 4.4 cases per 100,000 people (13,293* new cases). However, progress in eliminating TB has slowed recently, with 3.8 percent average annual declines in rates for 2000-2007, compared to 7.3 percent average annual declines for 1993-2000. TB continues to disproportionately affect foreign-born persons and racial/ethnic minorities. Foreign-born persons had a TB rate nearly 10 times higher than U.S.-born persons (20.6 vs. 2.1 cases per 100,000) and accounted for 58.5 percent of all cases with known origin. Hispanics had a rate seven times higher than whites, and for the fourth consecutive year, accounted for more TB cases than any other racial/ethnic group. The TB rate was 23 times higher in Asians than in whites. Blacks had a rate eight times higher than whites, and accounted for the greatest disparity in TB rates among U.S.-born persons. Among persons with TB and a known HIV test result, 11.3 percent were co-infected with HIV, a major risk factor for TB disease. The proportion of multidrug-resistant TB cases remained stable in 2006, accounting for 1.1 percent of cases for which these data are available. The authors note that continued disparities among persons with TB and the diminishing decline of TB incidence threaten progress toward TB elimination in the U.S.

Provider-Initiated HIV Testing and Counseling of TB Patients — Livingstone, Zambia, September 2004–December 2006

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CDC-supported pilot study demonstrated that provider-initiated HIV testing and counseling approach results in high uptake of HIV testing among TB patients and is feasible and acceptable to TB clinic staff. Furthermore, training TB staff members to use HIV rapid test kits enabled same-day results; and shifting the task of HIV testing from laboratorians to other health-care personnel alleviated the problem of shortages of trained laboratory workers. In sub-Saharan Africa where HIV prevalence is high among tuberculosis (TB) patients, TB clinics are an excellent place to identify HIV-infected persons for referral to HIV care and treatment and for delivering HIV prevention messages. A recent CDC-supported pilot study, to test the feasibility of offering WHO-recommended, routine “opt-out” provider-initiated HIV testing and counseling as part of routine TB care, demonstrated high uptake of HIV testing among TB patients. The pilot showed that the program was practical, acceptable, and sustainable to TB clinic staff, and, additionally, training TB staff members to use HIV rapid test kits enabled same-day results and eliminated the need for repeated patient visits. Furthermore, shifting the task of HIV testing from laboratorians to other health-care personnel alleviated the problem of shortages of trained laboratory workers. A national scale-up of the program is underway and CDC, through the President’s Emergency Plan for AIDS Relief, is supporting the effort.

Immunization Information Systems Progress — United States, 2006

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Division of Media Relations
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Immunization Information Systems have made progress enrolling children and health-care providers in their systems. In 2006, approximately 65 percent (or 15 million) of U.S. children aged <6 years participated in grantee IIS, an increase from 56 percent in 2005, or approximately 2 million more children. In addition, IIS private provider site participation increased from 44 percent in 2005 to 47 percent in 2006. This report highlights selected data from CDC′s 2006 Immunization Information System Annual Report (IISAR). The data indicated that 65 percent of all U.S. children aged <6 years, approximately 15 million children, participated in an Immunization Information System (IIS), an increase from 56 percent in 2005. IISs can provide accurate data on which to make informed immunization decisions and better protect against vaccine-preventable diseases. Most grantees (70 percent) reported that their IISs have the capacity to track vaccinations for persons of all ages. Data on vaccinations were entered within 30 days of vaccine administration for 69 percent of children aged <6 years. However, results for several data completeness measures are low. These findings underscore the need to continue efforts to address challenges to full participation and ensure high quality information.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES