ABSTRACT
Subject(s)
Sputum , Tuberculosis, Pulmonary , Humans , Sputum/microbiology , United States , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/microbiology , Adolescent , Male , Middle Aged , Adult , Young Adult , Female , Aged , Child , Child, Preschool , Infant , Logistic Models , Mycobacterium tuberculosis/isolation & purificationABSTRACT
OBJECTIVE: To determine risk factors for multidrug-resistant tuberculosis (MDR-TB) and describe MDR-TB according to three characteristics: previous TB disease, recent transmission of MDR-TB, and reactivation of latent MDR-TB infection.SETTING and DESIGN: We used 2011-2016 surveillance data from the US National Tuberculosis Surveillance System and National Tuberculosis Genotyping Service and used logistic regression models to estimate risk factors associated with MDR-TB.RESULTS: A total of 615/45 209 (1.4%) cases were confirmed as MDR-TB; 111/615 (18%) reported previous TB disease; 41/615 (6.7%) were attributed to recent MDR-TB transmission; and 449/615 (73%) to reactivation. Only 12/41 (29%) patients with TB attributed to recent transmission were known to be contacts of someone with MDR-TB. For non-US-born patients, the adjusted odds ratios of having MDR-TB were 32.6 (95%CI 14.6-72.6) among those who were known to be contacts of someone with MDR-TB and 6.5 (95%CI 5.1-8.3) among those who had had previous TB disease.CONCLUSION: The majority of MDR-TB cases in the United States were associated with previous TB disease or reactivation of latent MDR-TB infection; only a small proportion of MDR-TB cases were associated with recent transmission.
Subject(s)
Mycobacterium tuberculosis , Tuberculosis, Multidrug-Resistant , Tuberculosis , Antitubercular Agents/therapeutic use , Humans , Logistic Models , Odds Ratio , Risk Factors , Tuberculosis/drug therapy , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiology , United States/epidemiologyABSTRACT
SETTING: Even among persons who have completed a course of treatment for their first tuberculosis (TB) episode, patients with a history of TB are at higher risk for having TB. OBJECTIVE: To describe factors from the initial TB episode associated with recurrent TB among patients who completed treatment and remained free of TB for at least 12 months. DESIGN: During 1993-2006, US TB cases stratified by birth origin were examined. Cox proportional hazards regression was used to assess the association of factors during the initial episode with recurrence at least 12 months after treatment completion. RESULTS: Among 632 US-born patients, TB recurrence was associated with age 25-44 years (adjusted hazard ratio [aHR] 1.77, 99% confidence interval [CI] 1.02-3.09, attributable fraction [AF] 1-34%), substance use (aHR 1.57, 99%CI 1.23-2.02, AF 8-22%), and treatment supervised by health departments (aHR 1.42, 99%CI 1.03-1.97, AF 2-28%). Among 211 foreign-born patients, recurrence was associated with human immunodeficiency virus infection (aHR 2.24, 99%CI 1.27-3.98, AF 2-9%) and smear-positive TB (aHR 1.56, 99%CI 1.06-2.30, AF 3-33%). CONCLUSION: Factors associated with recurrence differed by origin of birth, and might be useful for anticipating greater risk for recurrent TB among certain patients with a history of TB.
Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Aged , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Proportional Hazards Models , Recurrence , Retrospective Studies , Risk Factors , Treatment Outcome , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/etiology , United States/epidemiology , Young AdultABSTRACT
OBJECTIVES: 1) To describe homeless persons diagnosed with tuberculosis (TB) during the period 1994-2010, and 2) to estimate a TB incidence rate among homeless persons in the United States. METHODS: TB cases reported to the National Tuberculosis Surveillance System were analyzed by origin of birth. Incidence rates were calculated using the US Department of Housing and Urban Development homeless population estimates. Analysis of genotyping results identified clustering as a marker for transmission among homeless TB patients. RESULTS: Of 270,948 reported TB cases, 16,527 (6%) were homeless. The TB incidence rate among homeless persons ranged from 36 to 47 cases per 100,000 population in 2006-2010. Homeless TB patients had over twice the odds of not completing treatment and of belonging to a genotype cluster. US- and foreign-born homeless TB patients had respectively 8 and 12 times the odds of substance abuse. CONCLUSIONS: Compared to the general population, homeless persons had an approximately 10-fold increase in TB incidence, were less likely to complete treatment and more likely to abuse substances. Public health outreach should target homeless populations to reduce the excess burden of TB in this population.
Subject(s)
Ill-Housed Persons/statistics & numerical data , Tuberculosis/epidemiology , Adolescent , Adult , Aged , Antitubercular Agents/therapeutic use , Cluster Analysis , Female , Health Services Accessibility , Homeless Youth/statistics & numerical data , Humans , Incidence , Male , Medication Adherence , Middle Aged , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/isolation & purification , Prognosis , Risk Factors , Substance-Related Disorders/epidemiology , Time Factors , Treatment Refusal , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/transmission , United States/epidemiology , Young AdultABSTRACT
Recurrent tuberculosis (TB) can result from reactivation of a previous TB episode or reinfection with a new Mycobacterium tuberculosis strain. A retrospective analysis of all recurrent TB cases reported in the United States during 1993-2010 was conducted. The proportion of recurrent cases remained stable during the study period (annual range 4.2-5.7%). Compared with persons without a previous diagnosis of TB, persons with recurrent TB experienced lower treatment completion within 12 months and higher mortality during the recurrent episode. Persons with recurrent TB have poorer outcomes, suggesting the need for targeted interventions to ensure treatment completion.