Data indicate that cases and rates of TB disease continue to fall in the U.S.; however, a higher burden in some populations – such as foreign-born individuals and racial/ethnic minorities – keeps TB elimination out of reach.
Preliminary data from the CDC National TB Surveillance System show a total of 9,588 cases were reported in the U.S. in 2013, marking a 4.2 percent decline in the 2012 rate. Despite overall progress, the TB rate for foreign-born individuals is 13 times higher than among individuals born in the U.S., and the proportion of TB cases in the foreign-born group continues to increase.
Racial disparities persist. Hispanics, blacks and Asians face higher TB rates—7, 7 and 26 times higher, respectively—than whites. Persons infected with HIV and people who are homeless are also especially vulnerable to TB.
Although the proportion of drug-resistant cases remains relatively small, drug resistant TB is a concern because it is difficult and costly to treat and more often fatal. In 2012, multidrug-resistant TB accounted for 1.2 percent of cases (86 cases). Two cases of extensively-drug-resistant TB were reported in 2013. The authors note that eliminating TB in the U.S. requires continuing to address TB in affected populations and improvements in awareness, testing and treatment of TB disease.
Updated CDC recommendations for overseas tuberculosis screening of immigrants and refugees has resulted in better diagnosis of TB before individuals arrive in the United States. CDC reports the completion of implementation of new tuberculosis screening and treatment requirements for US-bound immigrants and refugees. Implementation of these requirements has resulted in twice as many cases of tuberculosis being diagnosed and treated before immigrants and refugees arrive in the U.S. compared with the previous screening program. Since the new requirements were implemented, reports of cases of foreign-born tuberculosis have declined. In addition, the increase in persons diagnosed and treated overseas is projected to result in a savings of more than $15 million in US health care costs.