U.S. epidemic contained, leaders look to elimination

A 6.7% decline nationwide but still some hot spots

As expected, new cases of tuberculosis declined nearly 7% across the country, marking a four-year trend that suggests the nation has recovered from an epidemic that began nearly 10 years ago. A growing TB problem in other countries, however, threatens the goal of a TB-free nation, especially with increased travel and immigration.

"TB is getting stronger, and the world is getting smaller," Helene Gayle, MD, MPH, said during a World TB Day press conference. Gayle is the director of the Centers for Disease Control and Prevention’s National Center for HIV, STD, and TB Prevention. "In an era marked by increased tourism and a global marketplace, no region of the world exists in isolation. International collaboration — as it was in the fight against smallpox — will be essential to eliminate TB."

For 1996, states reported a total of 21,327 new cases of TB (see chart, p. 52), a 6.7% decrease from the 22,860 cases reported in 1995. Rates were down 13% in New York, 11% in Texas, and 8% in California.

Opportunity for elimination

CDC officials attributed the steady decrease in cases to increased funding (from $45 million in 1992 to $145 million in 1997), directly observed therapy, international collaboration, better diagnostic tools, and improved detection and reporting of new cases.

"We have the rare opportunity to eliminate a public health threat," says Ken Castro, MD, director of the division of TB elimination. "TB elimination is an achievable goal."

The 1996 rates point to some trouble spots, however. Rates increased 36% in Washington, DC, and 22% in Oregon. Also, cases of "Strain W" TB have spread from New York City, New Jersey, and Florida to other states, including South Carolina, Colorado, Ohio, Pennsylvania, Georgia, Nevada, California, and Puerto Rico.

"The drug-resistant outbreaks are still occurring in low-morbidity areas where people aren’t thinking about TB, and expertise continues to dwindle," says Bess Miller, MD, assistant director of the division. "Education initiatives have to be continued in those areas."

At the same time, an increasing number of new cases are being reported in the foreign-born population. Cases among individuals born outside the United States increased from 22% in 1986 to 37% in 1996. The CDC has recently initiated programs in Mexico and Asia to assist in TB control, Miller adds.