Tuberculosis -- United States, First 39 Weeks, 1985
During the first 39 weeks of 1985, substantially more
tuberculosis
cases were reported to MMWR than would be expected based on
morbidity
trends in previous years. The 15,839 tuberculosis cases
provisionally
reported for the week ending September 28 represent a 0.4% decrease
and 66 fewer cases than for the same period in 1984. However, in
the
first 39 weeks of 1984, an 8.6% decrease and 1,514 fewer cases were
reported, compared to the same period in 1983. For much of 1984,
the
cumulative number of tuberculosis cases showed a 7%-9% decline over
the previous year (Figure 2). Thus, for 1985, the decline from
1984
is less than expected, and, in recent weeks, there has been as much
as
a 1% increase in case reporting, compared with 1984. Based on
final
reporting for 1982 through 1984, the number of reported cases of
tuberculosis declined an average of 1,706 cases (6.7%) per year.
The areas with the largest increases in cases provisionally
reported for 1985 are New York City, California, Texas, upstate New
York, Florida, and Massachusetts (Table 4). The area with the
largest
decrease is New Jersey.
Reported by Div of Tuberculosis Control, Center for Prevention
Svcs,
CDC.
Editorial Note
Editorial Note: Over the past 3 decades, the number of
tuberculosis
cases per year in the United States increased on only three
occasions. An increase in 1963 was due to more complete reporting
of
primary tuberculosis cases; in 1975, to changes in counting
criteria;
and in 1980, to an influx of Indochinese refugees (1). As in every
year, a number of reporting areas show increased morbidity; the
reasons vary by reporting area. Some reasons for 1985 reporting
increases might include reporting artifact, expected fluctuations
in
secular trends, discrete outbreaks (such as tuberculosis among the
homeless) (2), an increased influx of foreign-born residents, or
development of new risk factors. The decrease in New Jersey case
reporting may be a reporting artifact commonly encountered during
the
first year of a state's participation in the national tuberculosis
individual case reporting system; New Jersey began reporting to
this
system in 1985. CDC's Division of Tuberculosis Control is
analyzing
data from the newly implemented individual case reporting system to
more precisely identify population groups experiencing increased
morbidity. The Division is also working with state and local
health
departments to investigate factors related to increased morbidity.
Data from New York City and Florida suggest that acquired
immunodeficiency syndrome may be playing a role in the increased
morbidity reported from these two areas (3,4). Investigations are
continuing in New York City and Florida to evaluate the hypothesis
that human T-lymphotropic virus type III/lymphadenopathy-associated
virus (HTLV-III/LAV) infection may cause latent tuberculosis
infection
to become clinically active. If this hypothesis is correct,
additional investigations will determine the extent to which the
national morbidity may be attributed to HTLV-III/LAV infection.
References
Powell KE, Brown ED, Farer LS. Tuberculosis among Indochinese
refugees in the United States. JAMA 1983;249:1455-60.
CDC. Drug-resistant tuberculosis among the homeless--Boston.
MMWR 1985;34:429-31.
Pitchenik AE, Cole C, Russell BW, Fischl MA, Spira TJ, Snider
DE.
Tuberculosis, atypical mycobacteriosis, and the acquired
immunodeficiency syndrome among Haitian and non-Haitian
patients
in South Florida. Ann Intern Med 1984;101:641-5.
Stoneburner RL, Kristal A. Increasing tuberculosis incidence
and
its relationship to acquired immunodeficiency syndrome in New
York
City. Atlanta, Georgia: International conference on acquired
immunodeficiency syndrome (AIDS), April 14-17, 1985.
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