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Tuberculosis in the United States 2019 Slide Set										Related Pages
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NOTE: The slide set is in the public domain. You may reproduce these slides without permission; however it is requested that you include an attribution that the materials were developed by CDC (e.g., “Source: CDC” or “Slides developed by CDC”). No substantive changes should be made to the content.Slide 1Slide 2Slide 3Slide 4Slide 5Slide 6Slide 7Slide 8Slide 9Slide 10Slide 11Slide 12Slide 13Slide 14Slide 15Slide 16Slide 17Slide 18Slide 19Slide 20Slide 21Slide 22Slide 23Slide 24Slide 25Slide 26Slide 27Slide 28Slide 29Slide 30Slide 31Slide 32Slide 33Slide 34Slide 35During 2019, 82.5% of all reported TB cases were started on IRZE, and an additional 11.5% of cases were started on a different 4-drug regimen.Slide 36Since 1993, the percentage of TB patients receiving at least a portion of their medication through Directly Observed Therapy has risen from 36% in 1993 to over 94% in 2017, the most recent year with full data available.Slide 37During 2017, the most recent year with treatment completion data available, 61.2% of cases were treated exclusively by using DOT, whereas an additional 32.9% of patients received a combination of DOT and self-administered treatment.Slide 38The national goal for treatment completion is that, for patients with newly diagnosed TB disease for whom ≤12 months of treatment is indicated, 95% complete treatment within 12 months. Although the percentage of eligible patients completing therapy in 1 year has risen since 1993, the nation as a whole is still short of the 95% goal, and the percentage has been relatively level since 2009.Slide 39Successful therapy completion for TB patients is a major performance indicator for TB programs. Among patients during 2017 who were alive at diagnosis and started on TB treatment, 87.2% had completed TB treatment successfully. However, 6.7% of all patients died before completing TB treatment; 1.8% moved out of the U.S. within one year; 1.2% were lost to follow-up before completing treatment; 0.7% refused treatment and 2.0% did not complete treatment for other or unknown reasons. Thirty patients (0.3%) had to permanently stop TB treatment because of an adverse treatment event.Slide 40In 2019, 631 isoniazid-resistant TB cases were reported in the United States, a slight decrease from 637 cases during 2018. However, as a percentage of all TB cases, the proportion that were resistant to isoniazid has remained relatively steady at approximately 9%. The trend in the proportion of U.S.-born TB cases with isoniazid resistance remained relatively constant at 6.6% as did the trend for non-U.S.–born cases at 10.5%.Slide 41The percentage of all MDR cases occurring among persons with no previous history of TB disease (i.e., primary MDR TB) has remained steady for the past several years at approximately 1%.Slide 42Coinfection with HIV is a major risk factor for progression of latent TB infection to TB disease. Among 8,690 cases that were alive at diagnosis in 2019, HIV status was known for 90.7%, and 4.7% of persons with known HIV status were coinfected with HIV. Among TB cases diagnosed in persons 25–44 years of age, 95.2% had known HIV status, and 7.6% of these persons were HIV positive. In persons 45-64 years old, 93.7% had known HIV status, and 6.0% were HIV positive.Slide 43Coinfection with HIV is a major risk factor for progression of latent TB infection to TB disease. Among 8,690 cases that were alive at diagnosis in 2019, HIV status was known for 90.7%, and 4.7% of persons with known HIV status were coinfected with HIV. Among TB cases diagnosed in persons 25–44 years of age, 95.2% had known HIV status, and 7.6% of these persons were HIV positive. In persons 45-64 years old, 93.7% had known HIV status, and 6.0% were HIV positive.Slide 44Among persons ≥15 years of age, 1.8% of TB cases occurred among persons who were residents of a long-term–care facility at the time of their TB diagnostic evaluation, 3.1% occurred among persons who were residents of a correctional facility at the time of their TB diagnostic evaluation, and 4.6% occurred among persons aged ≥15 years who experienced homelessness in the year before their TB diagnostic evaluation.Slide 45The percentage of cases diagnosed with TB while a resident of a correctional facility continued to decline in 2019, from 3.5% in 2018, compared with 3.1% in 2019.Slide 46The states with the highest percentage of their cases diagnosed among residents of correctional facilities in 2019 were Arizona (25.3%, 43 of 170), Mississippi (15.4%, 8 of 52), South Dakota (12.5%, 2 of 16), West Virginia (10.0%, 1 of 10) and Texas (9.7%, 99 of 1,016). Note: categories based on Jenks natural breaks method.Slide 47Among residents of correctional facilities with TB during 2019 over 15 years old, 27.9% were from local jails, 15.5% from state prisons, 14% from federal prisons, and 39.6% from other correctional facilities. In 2019, 119 (44.9%) of cases occurred in person under ICE custody, which can include ICE facilities or persons in any correction facility who are also under ICE custody.Slide 48Substance use disorder is also a TB risk factor. Overall, 1.2% of all 2019 TB patients aged ≥15 years reported injection-drug use (IDU) during the year preceding diagnosis. Reported use of non-injection drugs among patients aged ≥15 years was higher (7.5%) than IDU, as was excessive use of alcohol (8.1%).Slide 49In the past, healthcare personnel, migrant workers and correctional employees were more likely to be represented as occupations among persons with TB. In 2019, the percentages were 4%, 1%, and <1% respectively; the largest category of occupations fell into the other category. Unemployed persons comprised 22% of TB cases and almost 34% were either retired or not seeking employment.Slide 50Among TB cases diagnosed during 2017, a total of 768 (8.6%) patients died, with 265 (33.3%) of those deaths attributed to TB disease or treatment. Of the 833 deaths, 165 (21.5%) were dead at the time of TB diagnosis; 29.7% of those deaths were attributed to TB. The remaining 603 (78.5%) deaths occurred after diagnosis; 34.3% of these deaths were attributed to TB.Slide 51Conversion of a patient’s positive sputum culture to negative is a key indicator of treatment effectiveness. Among 5,115 cases during 2017 with positive sputum cultures, 4,422 (86.5%) had documented sputum culture conversion to negative. Among the 632 (12.4%) cases for which sputum culture conversion was undocumented, the most common reason was that the patient had died (36.1%) before sputum culture conversion; however, a proportion of these cases (19.0%) did not have a known reason reported for not having documented sputum culture conversion.Slide 52This slide shows the increase in genotyping surveillance coverage from 2004 to 2019. In 2004 the proportion of culture confirmed TB cases with at least one genotyped isolate was 52.6%; in 2019 it was 97.0%. The national goal for genotyping surveillance coverage is 100.0%.Slide 53This slide shows the increase in genotyping surveillance coverage from 2004 to 2019. In 2004 the proportion of culture confirmed TB cases with at least one genotyped isolate was 52.6%; in 2019 it was 97.0%. The national goal for genotyping surveillance coverage is 100.0%.Slide 54This slide shows the number of county-based TB genotype clusters by the size of the clusters; a genotype cluster is defined as two or more cases with matching spoligotype and 24-locus MIRU-VNTR (GENType) within a county during the specified 3-year time period. During 2017–2019, there were 900 two-case clusters, 222 three-case clusters, 95 four-case clusters, 37 five-case clusters, 25 six-case clusters, 21 seven-case clusters, 13 eight-case clusters, 10 nine-case clusters, and 28 case clusters that were greater or equal to 10 TB cases in size.Slide 55Clusters are classified into alert levels on the basis of a log-likelihood ratio (LLR) calculation; clusters with an LLR of 5–<10 are classified as a medium alert level, and clusters with an LLR ≥10 are classified as a high alert level. Clustered cases were often part of medium- (23.2%) or high-level alerts (17.2%). At the cluster level, 388 (28.7%) of 1,351 clusters identified nationally were either medium- or high-level alerts.Slide 56Nationally, CDC attributed 1,703 (12.5%) of 13,577 genotyped cases reported during 2018–2019 to recent transmission.Slide 57CDC has provided national estimates of recent transmission and extensive recent transmission throughout a 2-year period since the publication of Reported Tuberculosis in the United States, 2016. The number of cases attributed to recent transmission has declined. By comparison, estimates were 1,787 cases during 2016–2017 and 1,703 during 2018–2019.Slide 58A greater proportion of genotyped cases were attributed to recent transmission among U.S.-born persons (24.9%) than among non-U.S.–born persons (7.7%).Slide 59Greater proportions of cases attributed to recent transmission and extensive recent transmission were identified among Native Hawaiian/Pacific Islander, non-Hispanic Black, and American Indian/Alaska Native persons, compared with national average estimates.Slide 60Lower proportions of cases attributed to recent transmission and extensive recent transmission were identified among non-Hispanic Asian persons, compared with national average estimates. Lower proportions of cases were attributed to extensive recent transmission among persons of Hispanic ethnicity, compared with national average estimates.Slide 61For more information, please contact Division of Tuberculosis Elimination at http://www.cdc.gov/tb/.Slide 62National Tuberculosis Surveillance System Highlights from 2019This slide series was developed as an accompaniment to the document***Reported Tuberculosis in the United States, 2019***
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						Page last reviewed:  October 1, 2020					Content source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeTuberculosisBasic TB Factsplus iconHow TB SpreadsLatent TB Infection and TB DiseaseSigns & SymptomsTB Risk FactorsExposure to TBTB PreventionVaccinesTB & HIV CoinfectionTB and DiabetesTB TermsPersonal StoriesTesting & Diagnosisplus iconWho Should be TestedTesting for TB InfectionTesting in BCG-Vaccinated PersonsTB Screening and Testing of Health Care PersonnelTesting During PregnancyDiagnosing latent TB infection and TB diseaseTreatmentplus iconDeciding When to Treat Latent TB InfectionTreatment Regimens for Latent TB Infection (LTBI)Treatment for TB DiseaseAdverse EventsTB Treatment of Persons Living with HIVTB Treatment and PregnancyTB Treatment for ChildrenFrequently Asked QuestionsDrug-Resistant TBResearchplus iconTB Epidemiologic Studies Consortiumplus iconResearch ProjectsPublicationsTB Trials Consortiumplus iconStudy DescriptionsBackgroundBehavioral & Social Science ResearchHealth Care Settingsplus iconTB Infection Control in Health Care SettingsResources for TB Screening and Testing of Health Care Personnelplus iconFrequently Asked QuestionsTB in Specific Populationsplus iconHealth DisparitiesAsian PersonsBlack or African American PersonsHispanic or Latino PersonsChildrenPregnancyCorrectional FacilitiesPeople Experiencing HomelessnessInternational TravelersLaboratory Informationplus iconDrug Susceptibility TestingFalse-Positive Investigation ToolkitInterim Laboratory Biosafety Guidance for XDR  tuberculosis strainsModel Performance Evaluation Program (MPEP)Rapid Molecular Testing to Detect Drug-Resistant TB in the USplus iconExecutive SummaryIntroductionBackground on Tests for Molecular Detection of DRGeneral Considerations and Principles for a Molecular DR Testing ServicePossible Scenarios and Scope of Testing for a Molecular DR Testing ServiceResearch NeedsGeneral Recommendations of the Expert PanelCommunication Plan for the ReportRecommendationsReferencesPanel Members and CDC ParticipantsAppendix 1Appendix 2Appendix 3The Uses of Nucleic Acid Amplification Tests for the Diagnosis of TBplus iconGeneral ConsiderationsGeneral Recommendations of the Expert PanelRecommendations to ACET, CDC, DTBEData & Statisticsplus iconTB Incidence in the United StatesReported TB in the US, 2022 Surveillance Reportplus iconNational DataReporting Area DataRisk FactorsDemographicsTB Treatment and Case OutcomesDrug-Resistant TBMolecular SurveillanceTuberculosis in the United States, 2022 (Slide Set)Archived Surveillance Reports and Slide Sets2021 State and City ReportArchived State and City ReportsProfessional Resources & Toolsplus iconTools for Healthcare ProvidersResources for TB Programsplus iconStrengthening Civil Surgeons’ Capacity to Improve LTBI Surveillance and Outcomes Among Status AdjustersNotice of Funding Opportunity (NOFO)Program EvaluationTB Centers of ExcellenceTB Elimination AllianceTB Genotypingplus iconConventional TB GenotypingWhole Genome SequencingTB GIMSAnalytic ToolsLatent Tuberculosis Infection ResourcesPublications & Productsplus iconPatient and Public MaterialsFact SheetsGuidelinesplus iconControl & EliminationDrug-Resistant TBInfection Control & PreventionLaboratory & GenotypingTB & HIVTB in Specific PopulationsTesting & DiagnosisTreatmentVaccines & ImmunizationsArchived TB GuidelinesGuides & Toolkitsplus iconAggregate ReportsCDC TB Surveillance TrainingCore CurriculumEffective TB Interviewing for Contact InvestigationEthnographic GuidesFalse-Positive Investigation ToolkitForging Partnerships to Eliminate TuberculosisGuide to Application of GenotypingLTBI: A Guide for Primary Health Care ProvidersMantoux Tuberculin Skin Testing ProductsReport of Verified Case of Tuberculosis (RVCT)Self-Study ModulesTB Contact Investigation Interviewing Skills CourseTB eDOT ToolkitUnderstanding the TB Cohort Review ProcessNewslettersplus iconTB Notes, No. 4, 2023TB Notes, No. 3, 2023TB Notes. No. 2, 2023TB Notes. No. 1, 2023TB Notes, No. 4, 2022TB Notes, No. 3, 2022TB Notes, No. 2, 2022TB Notes, No. 1, 2022TB Notes, No. 4, 2021TB Notes, No. 3, 2021TB Notes, No. 2, 2021TB Notes, No. 1, 2021Pamphlets, Brochures, Bookletsplus iconQuestions and AnswersPatient Education SeriesTuberculosis - Get the FactsTuberculosis - The Connection between TB and HIV12-Dose Regimen for Latent TB Infection-Patient Education BrochurePostersplus iconMantoux Tuberculin Skin Test Wall ChartWorld TB DayThink TBStop TBTake on TBReports & Articlesplus iconDTBE Authored Journal ArticlesTuberculosis Laboratory Aggregate ReportsSlide Setsplus iconIntroduction to TuberculosisEpidemiology of Tuberculosis Among Non-U.S.​–Born Persons in the United States, 1993–2016Self-Study Modules on Tuberculosis, 1-5 Slide SetsThe Tuberculosis (TB) in Correctional Settingsplus iconFacilitator GuideIntroduction to TB GenotypingEpidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2017Prevention and Control of Tuberculosis in Correctional and Detention FacilitiesGuidelines for Preventing the Transmission of M. TB in Health care SettingsInvestigation of Contacts of Persons with Infectious TBEpidemiology of Pediatric Tuberculosis in the United StatesTargeted Tuberculosis Testing and Treatment of Latent Tuberculosis InfectionElectronic Tools & ResourcesWeb-Based Courses & Webinarsplus iconTB 101 for Health Care WorkersContent SyndicationInfographicsplus iconSocial Media GraphicsCustomizable Take on TB Infographic with InstructionsEventsWorld TB Dayplus iconU.S. TB ChampionsHistoryFeaturesplus iconTB Risk FactorsTreating Latent TB Infection with Short-Course RegimensWorld Tuberculosis (TB) Day 2021World Tuberculosis (TB) Day 2020Linksplus iconState TB Control OfficesAbout Usplus iconMission Statement and Activitiesplus iconDTBE Strategic PlanNational TB Program ObjectivesOrganization ChartAdvisory Groupsplus iconFederal TB Task Force To receive email updates about this page, enter your email address: Email Address			What's this?				Submit


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