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Current rate of progress not enough to eliminate TB
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Although the incidence of tuberculosis is decreasing in the United States, the CDC recently warned that progress toward the elimination of the disease in the country remains slow, and it is unlikely that TB will be eradicated in this century.
According to a recent MMWR, 9,093 new cases of TB were reported in the U.S. last year, representing a 1.8% reduction from 2016 and a 2.5% reduction in overall incidence. Still, the current rate of 2.8 cases per 100,000 persons remains 28 times higher than the elimination threshold of less than one case per million persons, according to Rebekah J. Stewart, MSN, MPH, of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), and colleagues.
“I had hoped we would eliminate TB in my children’s lifetime, but the goal is elusive,” Jonathan Mermin, MD, director of NCHHSTP, said in a press release. “Nine thousand TB cases in this country is far too many. Each case represents a human and financial burden shouldered by those with TB, their families and the nation’s health care system.”
The CDC estimates that TB treatment costs $18,000 per case but can exceed $500,000 in people with extensively drug-resistant TB. According to the report, more than 80% of TB cases in the U.S. are associated with reactivation of latent infection, and half of all new infections are reported in four states: California, New York, Texas and Florida. People born outside of the country remain disproportionately affected. Their rate of infection was approximately 15 times higher than that of people born in the U.S., declining only 0.9% vs. 7% since 2016.
To achieve TB elimination by 2100, the annual decline in incidence needs to increase from 2% to 3.9%, Stewart and colleagues reported.
Despite slow progress, the CDC noted that TB control efforts in the U.S. prevented about 300,000 cases and saved up to $14 billion over the past 20 years. Moving forward, the agency said a dual approach that involves diagnosing and treating active cases, as well as identifying and treating latent infections, is needed to eliminate TB.
“While tremendous progress has been made toward eradicating TB, there’s still more we can do to ensure those at risk are accurately tested and treated as their latent TB infection could progress to active, becoming highly contagious and deadly,” Lee Reichman, MD, MPH, senior advisor and founding executive director of the Global Tuberculosis Institute at the Rutgers New Jersey Medical School, told Infectious Disease News. “This year, the CDC is revising their Tuberculosis Technical Instructions requiring U.S. Civil Surgeons to transition from 100-year-old skin tests to far more accurate and objective IGRA blood tests. And WHO recently updated their latent TB guidelines, supporting the use of IGRA blood tests for latent TB detection. These changes are a very important step in the right direction towards eliminating this disease. In today’s globalized society, we know now more than ever that until TB is eradicated everywhere, it’s not eradicated anywhere.” – by Stephanie Viguers
- Reference:
- Stewart RJ, et al. MMWR Morb Mortal Wkly Rep. 2018;doi:10.15585/mmwr.mm6711a2.
Disclosures: Mermin, Reichman and Stewart report no relevant financial disclosures.