TUBERCULOSIS IN NEW YORK STATE...Tuberculosis Cases by Country of Origin, New York State, 2016 Table...
Transcript of TUBERCULOSIS IN NEW YORK STATE...Tuberculosis Cases by Country of Origin, New York State, 2016 Table...
TUBERCULOSIS IN
NEW YORK STATE 2016
AnnualStatisticalReport
BureauofTuberculosisControl
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TABLE OF CONTENTS
TableofContents
ListofFigures......................................................................................................................................................3
ListofTables.........................................................................................................................................................4
ExecutiveSummary..........................................................................................................................................5
TuberculosisCasesandRates....................................................................................................................6
GeographicDistribution.............................................................................................................................10
DemographicCharacteristics..................................................................................................................12
TuberculosisintheForeign‐Born.........................................................................................................19
HIVCo‐Infection..............................................................................................................................................23
ReasonsforEvaluation................................................................................................................................26
RiskFactors........................................................................................................................................................27
DrugResistance...............................................................................................................................................31
Genotyping.........................................................................................................................................................33
SiteofDisease...................................................................................................................................................34
CompletionofTherapy................................................................................................................................36
ContactstoInfectiousTuberculosisCases.......................................................................................38
DirectlyObservedTherapy.......................................................................................................................40
ContactInformation......................................................................................................................................41
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LIST OF FIGURES
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Figure1.TuberculosisCasesandRates,NewYorkState,1960‐2016
Figure2.TuberculosisCaseRates,NewYorkStateandtheUnitedStates,1960‐2016
Figure3.NumberandPercentofDeathsamongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),1993‐2016
Figure4.DistributionofTuberculosisCases,NewYorkState,2016
Figure5.NumberandPercentofTuberculosisCasesbyRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Figure6.Race/EthnicityofTuberculosisCases,NewYorkState,2016
Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Figure8.TuberculosisCasesandRatesbyAgeandGender,NewYorkState(ExclusiveofNewYorkCity),2016
Figure9.TuberculosisCasesbyAgeandRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2016
Figure10.TuberculosisCasesbyAgeandRace/Ethnicity,NewYorkCity,2016
Figure11a.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),1985‐2016
Figure11b.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkCity,1985‐2016
Figure12.HIVStatusforTuberculosisCases,NewYorkState,2016
Figure13.NumberandPercentofTuberculosisCasesWhoHaveBeenTestedforHIV,NewYorkState(ExclusiveofNewYorkCity),2007‐2016
Figure14.TuberculosisCasesandRatesamongDOCCSInmates,NewYorkState(ExclusiveofNewYorkCity),1986‐2016
Figure15.NumberandPercentofMultidrug‐ResistantTuberculosisCases,NewYorkState,2012‐2016
Figure16.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState,2016
Figure17.PercentofTuberculosisCasesWhoCompletedTreatmentwithin12Months,byU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
Figure18.NumberandPercentofContactstoInfectiousTuberculosisCasesPlacedonTreatmentforLatentTuberculosisInfectionandCompleted,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
Figure19.NumberandPercentofTuberculosisCasesReceivingAnyDirectlyObservedTherapy,NewYorkState(ExclusiveofNewYorkCity),1991‐2016
LIST OF TABLES
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Table1.TuberculosisCasesandRates,NewYorkState,1960‐2016
Table2.TuberculosisCasesandRatesbyCounty,NewYorkState,2012‐2016
Table3.TuberculosisCasesandRatesbyGender,AgeandRace/Ethnicity,NewYorkState,2016
Table4.TuberculosisCasesbyCountryofOrigin,NewYorkState,2016
Table5.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2016
Table6.LengthofTimeForeign‐BornTuberculosisCaseswereintheUnitedStatesPriortoDiagnosis,NewYorkState(ExclusiveofNewYorkCity),2016
Table7a.HIVStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table7b.HIVStatusforTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2016
Table8a.PrimaryReasonforEvaluationofTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table8b.PrimaryReasonforEvaluationofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2016
Table9a.AdditionalRiskFactorsAmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table9b.AdditionalRiskFactorsAmongTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2016
Table10.High‐RiskCongregateSettingattheTimeofDiagnosisforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table11.HomelessnessAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table12.SubstanceAbuseAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table13a.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table13b.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2014‐2016
Table14.TuberculosisGenotypingSummaryforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table15.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Table16.Extra‐PulmonarySitesofDiseaseforTuberculosisCases,NewYorkState,2016
Table17a.TreatmentStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table17b.TreatmentStatusforTuberculosisCasesReportedin2015,NewYorkState(ExclusiveofNewYorkCity)
Table18.NumberandPercentofInfectiousTuberculosisCaseswithContactsIdentified,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
Table19.NumberandPercentofContactstoInfectiousTuberculosisCasesEvaluatedforLatentTuberculosisInfection,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
EXECUTIVE SUMMARY
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ExecutiveSummary
MORBIDITY & MORTALITY
From2015to2016,tuberculosis(TB)morbidityincreasedinNewYorkState.The2016totalof768cases(565casesinNewYorkCity,203casesintheremainderofNewYorkState)representsa0.4percentincreasefromthe765casesreportedin2015.Thenationasawholeexperienceda2.7percentdecreaseinmorbidity.Sincethemostrecentpeakepidemicin1992with4,574cases,therewasan83.2percentdecreaseinNewYorkStatecomparedtoanationaldeclineof64.2percent.
InNewYorkState(exclusiveofNewYorkCity),thenumberofTBcasesincreased8.0percentfrom188casesin2015to203casesin2016.ThenumberofTBcasesinNewYorkCitydecreasedby2.1percentfrom577casesin2015to565casesin2016.In2016,thenationasawholereported9,287cases,down2.7percentfromthe9,546casesreportedin2015.
NewYorkStaterankedfifthnationallyforTBmorbiditywithanincidencerateof4.0per100,000populationin2016.ThisrateisinfluencedbyNewYorkCity,whichhadaTBcaserateof6.9per100,000.Incontrast,NewYorkState(exclusiveofNewYorkCity)reportedanincidencerateof1.8per100,000.
GEOGRAPHIC DISTRIBUTION
Threecounties–Nassau,SuffolkandWestchester–reported49.3percentoftheTBcasesinNewYorkState(exclusiveofNewYorkCity)in2016.
RACE‐ETHNICITY
In2016,AsianscontinuedtohaveoneofthehighestincidenceratesofTBstatewide(23.3per100,000).White,non‐Hispanicshadthelowestincidencerateof0.6per100,000.
FOREIGN‐BORN
Statewide,theproportionofforeign‐borncasesincreasedfrom81.0(N=620)in2015to82.8in2016(N=636).PeopleborninChinacomprisedthegreatestnumberofforeign‐bornTBcases(N=114)inNewYorkCitywhilethoseborninIndiacomprisedthegreatestnumberofTBcases(N=14)intheremainderofthestate.
DRUG SUSCEPTIBILITY
Amongindividualswithdrugsusceptibilitiesreportedin2016,10casesfromNewYorkCityhadmultidrug‐resistantTB(MDRTB),whichwastwicethenumberidentifiedin2015(N=5).TherewerenoMDRTBcasesreportedinNewYorkState(exclusiveofNewYorkCity)for2016,aslightdeclinefromtheonecasereportedin2015.
TB IN THE PRISONS
Since1991,thenumberofTBcasesamongtheNewYorkStateDepartmentofCorrectionsandCommunitySupervision(DOCCS)inmatepopulationhadbeencontinuallydeclining,andin2011and2012nonewcaseswerereported.However,in2013,threenewDOCCScaseswerereportedandin2014,onenewcasewasreported.In2015and2016,therewerenonewDOCCScasesreported.
TUBERCULOSIS CASES AND RATES
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Table1.TuberculosisCasesandRates,*NewYorkState,1960‐2016
No. Rate No. Rate No. Rate1960 2,376 26.4 4,699 60.4 7,075 42.21961 2,052 22.3 4,360 56.3 6,412 37.81962 2,005 21.4 4,437 56.7 6,442 37.51963 1,865 19.6 4,891 61.7 6,756 38.71964 1,715 17.8 4,207 52.7 5,922 33.61965 1,627 16.6 4,242 53.0 5,869 33.01966 1,633 16.5 3,663 45.7 5,296 29.51967 1,527 15.2 3,542 44.4 5,069 28.11968 1,475 14.5 3,224 40.5 4,699 25.91969 1,384 13.5 2,951 37.4 4,335 23.91970 1,275 12.3 2,590 32.8 3,865 21.21971 1,180 11.3 2,572 32.5 3,752 20.41972 1,176 11.2 2,275 29.0 3,451 18.81973 1,009 9.6 2,101 27.4 3,110 17.11974** 844 8.1 2,022 26.6 2,866 15.91975 1,041 9.9 2,893 38.6 3,934 21.81976 916 8.7 2,156 29.0 3,072 17.11977 829 7.9 1,605 22.0 2,434 13.61978 753 7.1 1,307 18.2 2,060 11.61979 699 6.6 1,530 21.5 2,229 12.61980 780 7.4 1,514 21.4 2,294 13.11981 641 6.1 1,582 22.4 2,223 12.71982 674 6.4 1,594 22.5 2,268 12.91983 658 6.2 1,651 23.1 2,309 13.11984 616 5.8 1,630 22.6 2,246 12.71985 638 6.0 1,843 25.5 2,481 13.91986 615 5.8 2,223 30.6 2,838 15.91987 615 5.8 2,197 30.1 2,812 15.71988 688 6.5 2,317 31.8 3,005 16.81989 657 6.2 2,545 34.8 3,202 17.81990 656 6.1 3,520 48.1 4,176 23.21991 748 7.0 3,673 50.2 4,421 24.61992 763 7.2 3,811 52.0 4,574 25.41993 717 6.7 3,235 44.2 3,952 22.01994 641 6.0 2,995 40.9 3,636 20.21995 621 5.8 2,445 33.4 3,066 17.01996 535 5.0 2,053 28.0 2,588 14.41997 535 5.0 1,730 23.6 2,265 12.61998 442 4.1 1,558 21.3 2,000 11.11999 377 3.5 1,460 19.9 1,837 10.22000 412 3.8 1,332 16.6 1,744 9.22001 415 3.8 1,261 15.7 1,676 8.82002 350 3.2 1,084 13.5 1,434 7.62003 340 3.1 1,140 14.2 1,480 7.82004 324 3.0 1,039 13.0 1,363 7.22005 305 2.8 984 12.3 1,289 6.82006 317 2.9 954 11.9 1,271 6.72007 261 2.4 914 11.4 1,175 6.22008 305 2.8 895 11.2 1,200 6.32009 246 2.2 760 9.5 1,006 5.32010 243 2.2 711 8.7 954 4.92011 221 2.0 689 8.4 910 4.72012 215 1.9 651 8.0 866 4.52013 217 1.9 656 8.0 873 4.52014 202 1.8 585 7.2 787 4.12015 188 1.7 577 7.1 765 3.92016 203 1.8 565 6.9 768 4.0
YearNewYorkState NewYorkCity NewYorkState
(ExclusiveofNewYorkCity) (Total)
*RatecalculationsarebasedonUnitedStatesdecennialCensusdata;per100,000population**Figuresafter1974reflectanationallyrevisedcasedefinitionthatincludesreactivatedcasesSource:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
TUBERCULOSIS CASES AND RATES
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From2015to2016,TBcasesandratesincreasedstatewide.In2016,atotalof768caseswerereportedinNewYorkState,representinga0.4percentincreasefromthe765casesreportedin2015andan89.1percentdecreasefromthe7,075casesreportedin1960.Nearlythree‐quartersofthestate’sTBmorbidityisconcentratedinNewYorkCity.
In2016,NewYorkCityreported73.6percent(N=565/768)ofthetotalcasesdespitehavingonly42percentofthestatepopulation.Therestofthestatereported203cases,whichwasan8.0percentincreasecomparedtothe188reportedin2015.
TherateofTBinNewYorkStateisgreatlyinfluencedbythehighmorbidityinNewYorkCity.OutsideofNewYorkCity,theratein2016was1.8per100,000population,butNewYorkCityreportedarateof6.9per100,000,resultinginanoverallrateof4.0per100,000populationforthewholestate.
Figure1.TuberculosisCasesandRates,*NewYorkState,1960‐2016
Overthelast50years,therehavebeentwopeaksinTBmorbiditywherethenumberandrateofTBsubstantiallyincreased.Thepeakin1975canbeexplainedbyachangeinthecasedefinitiontoincludereactivatedTBcases.Theincreasethatbeganinthemid‐1980sandextendedthroughtheearly1990swasdrivenmainlybytheresurgenceofTBcasesinNewYorkCity.Thisrisewaslargelyduetotwofactors.OnewastheHIV/AIDSepidemicthatstartedintheearly1980s.TheotherwasthereductionofTBcontrolresourcescombinedwiththeriseinhighriskpopulationssuchasforeign‐bornandhomeless.
TUBERCULOSIS CASES AND RATES
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Figure2.TuberculosisCaseRates,*NewYorkStateandtheUnitedStates,1960‐2016
Historically,TBcaseratesinNewYorkState(exclusiveofNewYorkCity)havebeenlowerthanthenationalaverage,whilecaseratesinNewYorkCityhaveexceedednationalrates.In2016,thenationalcaseratewas2.9per100,000populationandrangedfrom0.2to8.3per100,000populationacrossallthestates.NewYorkStaterankedthirdbasedonthenumberofcases(N=768)andfifthbasedonincidencerate(4.0per100,000population),buttheserankingswerelargelyinfluencedbyNewYorkCitywhich,byitself,wouldhaverankedfourthnationallybasedonnumberofcases(N=565)andthirdbasedonincidencerate(6.9per100,000population).
TUBERCULOSIS CASES AND RATES
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Figure3.NumberandPercentofDeathsAmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),1993‐2016
ThenumberandpercentofdeathsamongTBcasesinNewYorkState(exclusiveofNew
YorkCity)decreasedconsiderablyfollowingthelastepidemicthatpeakedintheearly1990s.Thisdropinmortalityslowedby1997andhasvariedeachyearsince2000.ThedeathsportrayedinFigure3werenotallTB‐related.
AmongthereportedTBcasesinNewYorkState(exclusiveofNewYorkCity),therewere11totaldeathsin2016.ThecauseofdeathwasTB‐relatedforthreeofthesecases.Allthreehadothercomorbidities,includingHIV,diabetes,COPD,end‐stagerenaldiseaseandcancer.
GEOGRAPHIC DISTRIBUTION
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Table2.TuberculosisCasesandRates*byCounty,NewYorkState,2012‐2016
No. Rate No. Rate No. Rate No. Rate No. RateAlbany 6 2.0 5 1.6 7 2.3 2 0.7 2 0.7Allegany 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Broome 5 2.5 1 0.5 0 ‐‐‐ 3 1.5 3 1.5Cattaraugus 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Cayuga 0 ‐‐‐ 1 1.2 2 2.5 4 5.0 1 1.2Chautauqua 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Chemung 1 1.1 1 1.1 0 ‐‐‐ 0 ‐‐‐ 2 2.3Chenango 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Clinton 2 2.4 1 1.2 0 ‐‐‐ 2 2.4 0 ‐‐‐Columbia 2 3.2 0 ‐‐‐ 2 3.2 3 4.8 0 ‐‐‐Cortland 1 2.0 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Delaware 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 2.1Dutchess 4 1.3 4 1.3 7 2.4 5 1.7 1 0.3Erie 19 2.1 21 2.3 16 1.7 13 1.4 13 1.4Essex 0 ‐‐‐ 0 ‐‐‐ 1 2.5 0 ‐‐‐ 0 ‐‐‐Franklin 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Fulton 0 ‐‐‐ 1 1.8 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Genesee 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 2 3.3Greene 0 ‐‐‐ 3 6.1 0 ‐‐‐ 0 ‐‐‐ 1 2.0Hamilton 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Herkimer 0 ‐‐‐ 1 1.5 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Jefferson 0 ‐‐‐ 2 1.7 1 0.9 2 1.7 0 ‐‐‐Lewis 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 3.7Livingston 0 ‐‐‐ 2 3.1 0 ‐‐‐ 0 ‐‐‐ 1 1.5Madison 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Monroe 14 1.9 22 3.0 20 2.7 17 2.3 24 3.2Montgomery 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 2.0Nassau 36 2.7 40 3.0 33 2.5 40 3.0 38 2.8Niagara 2 0.9 3 1.4 3 1.4 4 1.8 2 0.9Oneida 5 2.1 8 3.4 3 1.3 5 2.1 8 3.4Onondaga 11 2.4 9 1.9 10 2.1 10 2.1 17 3.6Ontario 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 2 1.9 0 ‐‐‐Orange 6 1.6 9 2.4 8 2.1 2 0.5 7 1.9Orleans 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Oswego 3 2.5 0 ‐‐‐ 1 0.8 0 ‐‐‐ 1 0.8Otsego 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 1.6 0 ‐‐‐Putnam 0 ‐‐‐ 0 ‐‐‐ 2 2.0 0 ‐‐‐ 0 ‐‐‐Rensselaer 3 1.9 1 0.6 2 1.3 0 ‐‐‐ 2 1.3Rockland 11 3.5 15 4.8 11 3.5 8 2.6 4 1.3Saratoga 1 0.5 2 0.9 1 0.5 1 0.5 1 0.5Schenectady 3 1.9 3 1.9 3 1.9 3 1.9 2 1.3Schoharie 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Schuyler 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Seneca 2 5.7 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐St.Lawrence 1 0.9 1 0.9 0 ‐‐‐ 1 ‐‐‐ 0 ‐‐‐Steuben 0 ‐‐‐ 1 1.0 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Suffolk 33 2.2 22 1.5 35 2.3 24 1.6 34 2.3Sullivan 0 ‐‐‐ 1 1.3 1 1.3 0 ‐‐‐ 1 1.3Tioga 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Tompkins 4 3.9 1 1.0 4 3.9 2 2.0 2 2.0Ulster 3 1.6 4 2.2 0 ‐‐‐ 0 ‐‐‐ 1 0.5Warren 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 1.5Washington 0 ‐‐‐ 1 1.6 1 1.6 0 ‐‐‐ 0 ‐‐‐Wayne 0 ‐‐‐ 1 1.1 1 1.1 0 ‐‐‐ 1 1.1Westchester 35 3.7 30 3.2 27 2.8 34 3.6 28 3.0Wyoming 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Yates 2 7.9 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐
Bronx 101 7.3 91 6.6 99 7.1 87 6.3 82 5.9Kings 190 7.6 197 7.9 192 7.7 171 6.9 166 6.6NewYork 93 5.9 102 6.4 72 4.5 88 5.4 67 4.2Queens 244 10.9 242 10.8 212 9.5 218 9.8 240 10.8Richmond 23 4.9 24 5.1 10 2.1 13 3.0 10 2.1
STATETOTAL 866 4.5 873 4.5 787 4.1 765 3.9 768 4.0
1.9 202 1.8
8.0 585 7.2NewYorkCityTotal 577 7.18.0 656
2012 2013 2014
651
NewYorkStateTotal(ExclusiveofNewYorkCity)
2015
188 1.7
County
215 1.9 217
2016
203 1.8
565 6.9
*Ratecalculationsarebasedon2010UnitedStatesCensusdata;per100,000population
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
GEOGRAPHIC DISTRIBUTION
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TBmorbidityisnotevenlydistributedacrossNYSandvariesgreatlybetweencounties.In2016,allfiveboroughsofNewYorkCityand30(52.6%)ofthe57upstatecountiesreportedatleastoneTBcase.Highernumbersofcaseswereseeninthemetropolitanareas.NearlyhalfofallTBmorbidityreportedforNYS(exclusiveofNewYorkCity)wasconcentratedinNassau,SuffolkandWestchestercounties(49.3%,N=100/203).
Figure4.DistributionofTuberculosisCasesinNewYorkState,2016
DEMOGRAPHIC CHARACTERISTICS
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Table3.TuberculosisCasesandRates*byGender,Age,**andRace/Ethnicity,NewYorkState,2016
Statewide,in2016,thelowestincidenceratesofTBwereseenamongthehighriskpediatricpopulation(<15yearsold),withthoseinthe10‐14yearoldagegrouprepresentingonlythreecasesforarateof0.2per100,000.InNewYorkState(exclusiveofNewYorkCity),thehighestincidenceratewasseenamongthose25‐34yearsold(2.6per100,000),whereasinNewYorkCity,thehighestratewasseenamongthose65yearsandolder(12.6per100,000).
In2016,AsianscontinuedtohavethehighestincidencerateinNewYorkState(23.3per100,000).ForHispanicandblack,non‐Hispaniccases,theincidencerateswerecomparableacrossthestate(4.6and4.6per100,000forNewYorkState(exclusiveofNewYorkCity);5.3and5.9per100,000forNewYorkCity).
No. Rate No. Rate No. RateMale 122 2.2 345 8.9 467 5.0Female 81 1.4 220 5.1 301 3.0Under5years 7 1.1 7 1.4 14 1.25‐9 2 0.3 2 0.4 4 0.310‐14 1 0.1 2 0.4 3 0.215‐19 12 1.4 21 3.9 33 2.420‐24 18 2.3 41 6.4 59 4.225‐34 33 2.6 104 7.5 137 5.235‐44 31 2.1 87 7.5 118 4.545‐54 26 1.5 82 7.4 108 3.855‐64 32 2.3 94 10.6 126 5.565+ 41 2.5 125 12.6 166 6.3White,non‐Hispanic 38 0.4 50 1.8 88 0.8Black,non‐Hispanic 42 4.6 109 5.9 151 5.4Hispanic 50 4.6 124 5.3 174 5.1Asian 68 18.0 259 25.2 327 23.3AmericanIndian 1 2.7 1 5.7 2 3.7MultipleRaces 0 ‐‐‐ 12 8.1 12 3.7Other/Unknown 4 16.8 10 17.3 14 17.2
203 1.8 565 6.9 768 4.0
DemographicCharacteristicsNewYorkState NewYorkCity NewYorkState
(ExclusiveofNewYorkCity) (Total)
Gender
AgeGroup
TOTALCASES
Race/Ethnicity
*Ratecalculationsarebasedon2010UnitedStatesCensusdata;per100,000population**Agecalculationsarebasedondateofbirthandreportdate
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
DEMOGRAPHIC CHARACTERISTICS
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Figure5.NumberandPercentofTuberculosisCasesbyRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Overthelastfiveyears,themajorityofTBcasesreportedinNewYorkState(exclusiveofNew
YorkCity)havebeenofAsianandHispanicdescent.Since2012,Asianshavecontinuedtorepresentalargerpercentageofreportedcasesthananyotherracial/ethnicgroup,especiallyin2014whenthepercentageofAsiancasesdramaticallyincreasedto45.5percent(N=92/202).
In2016,althoughthemajorityofTBcasesinNewYorkState(exclusiveofNewYorkCity)continuedtobeAsianorHispanic,thenumberofwhite,non‐Hispaniccasesincreasedby52.0percentin2016comparedto2015(N=38andN=25,respectively).Inaddition,theproportionofblack,non‐Hispaniccasesreachedthehighestithasbeeninfiveyears(20.7%,N=42/203).
DEMOGRAPHIC CHARACTERISTICS
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Figure6.Race/EthnicityofTuberculosisCases,NewYorkState,2016
InNewYorkCity,45.8percent(N=259/565)ofreportedcasesin2016wereAsian,whereasinNewYorkState(exclusiveofNewYorkCity)Asiansrepresented33.5percent(N=68/203)ofcases.Theproportionofwhite,non‐HispaniccasesinNewYorkState(exclusiveofNewYorkCity)wasmorethandoublethatseeninNewYorkCity(18.7%and8.8%,respectively).
DEMOGRAPHIC CHARACTERISTICS
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Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Overthelastfiveyears,maleshaveconsistentlycomprisedahigherproportionofTBcases
comparedtofemalesinNewYorkState(exclusiveofNewYorkCity).In2016,60.1percent(N=122/203)ofreportedcasesweremaleand39.9percent(N=81/203)werefemale.
DEMOGRAPHIC CHARACTERISTICS
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Figure8.TuberculosisCasesandRates*byAge**andGender,NewYorkState(ExclusiveofNewYorkCity),2016
In2016,thedifferenceinTBmorbiditybetweenmalesandfemalesinNewYorkState
(exclusiveofNewYorkCity)varieddependingonage.ThelargestgendergapinTBmorbiditywasseenamongcases25‐34yearsoldwherethecaserateformaleswas2.3timesthatoffemales(3.6per100,000formales;1.6per100,000forfemales).Amongcases65yearsofageandolder,thenumberoffemalessurpassedthenumberofmales,buttheincidencerateformaleswasstill1.3timesthatoffemales(2.9per100,000and2.2per100,000,respectively).
DEMOGRAPHIC CHARACTERISTICS
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Figure9.TuberculosisCasesbyAge*andRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2016
In2016,41(20.2%)casesinNewYorkState(exclusiveofNewYorkCity)were65yearsof
ageandolder.Sixteen(39.0%)ofthesecaseswerewhite,non-Hispanicand15(36.6%)wereAsian.
ThesecondlargestnumberofTBcasesreportedin2016forNewYorkState(exclusiveofNewYorkCity)wasseeninthe25-34yearagegroup(N=33).Thirteen(39.4%)ofthesecaseswereAsianand11(33.3%)wereHispanic.
DEMOGRAPHIC CHARACTERISTICS
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Figure10.TuberculosisCasesbyAge*andRace/Ethnicity,NewYorkCity,2016
InNewYorkCity,thelargestnumberofTBcasesreportedin2016wasseeninthe65years
ofageandoldergroup(N=125).Amongthese125cases,73(58.4%)wereAsianand19(15.2%)werewhite,non-Hispanic.
Similartotheremainderofthestatein2016,thesecondlargestnumberofTBcasesinNewYorkCitywasidentifiedinthe25-34yearagegroup(N=104).Forty-nine(47.1%)casesinthisagegroupwereAsianand29(27.9%)wereHispanic.
TUBERCULOSIS IN THE FOREIGN-BORN
19
Figure11a.NumberandPercentofTuberculosisCasesbyU.S.-Born*andForeign-BornStatus,NewYorkState(ExclusiveofNewYorkCity),1985-2016
In2016,therewere156foreign-borncasesinNewYorkState(exclusiveofNewYorkCity),anincreasefromthe148reportedin2015.Despitethisincrease,theforeign-bornpercentagedeclinedslightly,from78.7percentin2015to76.8percentin2016.InNewYorkCity,thenumberofforeign-bornTBcasesincreasedfrom472in2015to480in2016.Theproportionofforeign-borncasesalsoincreased,from81.8percentin2015to85.0percentin2016.
Figure11b.NumberandPercentofTuberculosisCasesbyU.S.-Born*andForeign-BornStatus,NewYorkCity,1985-2016
TUBERCULOSIS IN THE FOREIGN‐BORN
20
Table4.TuberculosisCasesbyCountryofOrigin,*NewYorkState,2016
In2016,therewere82differentcountriesrepresentedbythe768TBcasesreportedin
NewYorkState,25ofwhichwererepresentedbyatleastfivecases.Similartopreviousyears,themostcommoncountryoforiginforforeign‐bornTBcasesreportedbyNewYorkState(exclusiveofNewYorkCity)wasIndia(N=14)andforNewYorkCity,themostcommoncountrywasChina(N=114).
NewYorkState NewYorkCity NewYorkState(ExclusiveofNewYorkCity) (Total)
UnitedStates 48 78 126China 4 114 118Mexico 7 34 41Philippines 10 30 40India 14 21 35Haiti 8 22 30Ecuador 8 21 29Bangladesh 3 26 29DominicanRepublic 3 22 25Korea,South 7 12 19Burma 6 10 16Pakistan 6 9 15Guyana 0 15 15Nepal 4 10 14Guatemala 8 5 13Honduras 6 6 12Peru 4 6 10ElSalvador 7 2 9PuertoRico** 0 7 7Jamaica 1 6 7HongKong 1 6 7Colombia 1 5 6Vietnam 3 3 6Nigeria 3 3 6Thailand 2 3 5OtherCountries 39 89 128TOTALCASES 203 565 768
Country
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*Only countriesrepresenting≥5TBcasesarenamed**PuertoRicoandotherU.S.Territoriesareconsideredseperatelyforthepurposeofthistable
TUBERCULOSIS IN THE FOREIGN‐BORN
21
Table5.NumberandPercentofTuberculosisCasesbyU.S.andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2016
In2016,therewere156foreign‐bornTBcasesreportedinNewYorkState(exclusiveofNewYorkCity).Overhalf(54.5%,N=85/156)ofthesecaseswereidentifiedinNassau,SuffolkandWestchesteralone.Amongothercountiesthatreportedatleastfiveforeign‐borncases,OnondagaandOneidareportedthehighestforeign‐bornpercentage(100.0%)whileEriereportedthelowestpercentage(53.8%).Intheremainingcountieswithforeign‐borncases,thenumberandpercentagevaried.
Albany 2 0 2 100.0Allegany 0 0 0 0.0Broome 3 0 3 100.0Cattaraugus 0 0 0 0.0Cayuga 1 1 0 0.0Chautauqua 0 0 0 0.0Chemung 2 1 1 50.0Chenango 0 0 0 0.0Clinton 0 0 0 0.0Columbia 0 0 0 0.0Cortland 0 0 0 0.0Delaware 1 0 1 100.0Dutchess 1 1 0 0.0Erie 13 6 7 53.8Essex 0 0 0 0.0Franklin 0 0 0 0.0Fulton 0 0 0 0.0Genesee 2 1 1 50.0Greene 1 0 1 100.0Hamilton 0 0 0 0.0Herkimer 0 0 0 0.0Jefferson 0 0 0 0.0Lewis 1 1 0 0.0Livingston 1 0 1 100.0Madison 0 0 0 0.0Monroe 24 11 13 54.2Montgomery 1 1 0 0.0Nassau 38 6 32 84.2Niagara 2 1 1 50.0Oneida 8 0 8 100.0Onondaga 17 0 17 100.0Ontario 0 0 0 0.0Orange 7 1 6 85.7Orleans 0 0 0 0.0Oswego 1 1 0 0.0Otsego 0 0 0 0.0Putnam 0 0 0 0.0Rensselaer 2 1 1 50.0Rockland 4 0 4 100.0St.Lawrence 0 0 0 0.0Saratoga 1 1 0 0.0Schenectady 2 0 2 100.0Schoharie 0 0 0 0.0Schuyler 0 0 0 0.0Seneca 0 0 0 0.0Steuben 0 0 0 0.0Suffolk 34 5 29 85.3Sullivan 1 1 0 0.0Tioga 0 0 0 0.0Tompkins 2 0 2 100.0Ulster 1 1 0 0.0Warren 1 1 0 0.0Washington 0 0 0 0.0Wayne 1 1 0 0.0Westchester 28 4 24 85.7Wyoming 0 0 0 0.0Yates 0 0 0 0.0TOTALCASES 203 47 156 76.8
County Total U.S.‐BornNumber Number
Foreign‐BornPercent
Foreign‐BornNumber
*U.S.‐bornisdefinedassomeoneborninoneofthe50states,DistrictofColumbia,orbornoutsidetheUnitedStatestoatleastoneparentwhowasaU.S.citizen.Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
TUBERCULOSIS IN THE FOREIGN‐BORN
22
Table6.LengthofTimeForeign‐BornTuberculosisCaseswereintheUnitedStatesPriortoDiagnosis,NewYorkState(ExclusiveofNewYorkCity),2016
In2016,44.2percent(N=69/156)offoreign‐bornTBcasesinNewYorkState(exclusiveof
NewYorkCity)werediagnosedwithinfiveyearsofenteringtheU.S.Forty‐seven(68.1%)ofthese69casesenteredtheU.S.withintwoyearspriortodiagnosis.
LengthofTimeintheUnitedStates(Years) No. %
<1 22 14.11‐5 47 30.16‐10 16 10.311‐20 34 21.821‐30 20 12.831‐40 9 5.841‐50 4 2.651‐60 1 0.661‐70 1 0.6Unknown 2 1.3
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
HIV CO‐INFECTION
23
KnowledgeofHIVstatusisessentialforthepropermanagementofpatientswithTB.HIVinfectionimpairstheimmunesystemleavingindividualsatgreaterriskforbecominginfectedwithTBanddevelopingactivedisease.
Figure12.HIVStatusforTuberculosisCases,NewYorkState,2016
Eighty‐ninepercent(N=180/203)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)and86.0percent(N=486/565)ofcasesinNewYorkCityhadaknownHIVstatusin2016.Theco‐infectionrateforTBcasesinNewYorkState(exclusiveofNewYorkCity)andNewYorkCitywerenearlyidentical(4.9%and4.8%,respectively).IndividualsmissingHIVtestinginformationandthosewhowerenotofferedorhadrefusedtestingwereconsideredtohaveanunknownstatus.
HIV CO‐INFECTION
24
Figure13.NumberandPercentofTuberculosisCasesWhoHaveBeenTestedforHIV,NewYorkState(ExclusiveofNewYorkCity),2007‐2016
InNewYorkState(exclusiveofNewYorkCity),theproportionofTBcaseswithaknown
HIVstatushasgenerallyincreasedoverthelast10years.In2016,88.7percent(N=180/203)ofTBcaseshadadocumentedHIVresult,whichwas5.2percenthigherthanthe83.5percentseenin2015.
In2016,57.1percent(N=4/7)ofTBcasesunderfiveyearsoldhadaknownHIVstatusinNewYorkState(exclusiveofNewYorkCity).
HIV CO‐INFECTION
25
Table7a.HIVStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
In2016,11.3percent(N=23/203)ofTBcasesinNewYorkState(excludingNewYorkCity)
hadanunknownHIVstatus(refused,notofferedormissing/unknown),whichwasthelowestpercentageinthelastfiveyears.Ofthe19caseswhorefusedorweren’tofferedtestingin2016,11(57.9%)wereover65yearsold.
Table7b.HIVStatusforTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2016
InNewYorkState(exclusiveofNewYorkCity),theproportionofTBcaseswithaknown
HIVstatuswasgreateramongmalescomparedtofemalesin2016(90.2%and86.5%,respectively).Additionally,80.0percent(N=8/10)ofcaseswithHIVco‐infectionweremale.Thepercentageoffemaleswhorefusedtestingwasnearlyfourtimesgreaterthanthepercentageofmaleswhorefused(6.2%and1.6%,respectively).
No. % No. % No. %Negative 102 83.6 68 84.0 170 83.7Positive 8 6.6 2 2.5 10 4.9Refused 2 1.6 5 6.2 7 3.4NotOffered 8 6.6 4 4.9 12 5.9Missing/Unknown 2 1.6 2 2.5 4 2.0
TOTALCASES
HIVTest Male Female Total
122 81 203Source:NewYorkStateDepartmentofHealth
BureauofTuberculosisControl
No. % No. % No. % No. % No. %Negative 157 73.0 167 77.0 166 82.2 152 80.9 170 83.7Positive 6 2.8 14 6.5 6 3.0 5 2.7 10 4.9Refused 25 11.6 19 8.8 19 9.4 12 6.4 7 3.4NotOffered 23 10.7 13 6.0 7 3.5 15 8.0 12 5.9Missing/Unknown 4 1.9 4 1.8 4 2.0 4 2.1 4 2.0
TOTALCASES
HIVTest 2012 2013 2014 2016
203
2015
215 217 202 188Source:NewYorkStateDepartmentofHealth
BureauofTuberculosisControl
REASONS FOR EVALUATION
26
Table8a.PrimaryReasonforEvaluationofTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
In2016,45.8percent(N=93/203)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)wereevaluatedbecauseofTBsymptoms.Thesecondmostcommonreasonforevaluationwasanabnormalchestradiograph(22.2%,N=45/203)followedbyanincidentallabresult(20.7%,N=42/203).Overthepastfiveyears,thesehavecontinuedtobethethreemostfrequentlyreportedreasonsforevaluation.
Table8b.PrimaryReasonforEvaluationofTuberculosisCasesbyU.S.‐born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2016
TheproportionofcasesthatunderwentevaluationduetoTBsymptomswassimilarfor
U.S.‐bornandforeign‐borncasesinNewYorkState(exclusiveofNewYorkCity)(46.8%and45.5%,respectively).Sixpercent(N=3/47)ofU.S.‐borncaseswereevaluatedbecausetheyhadbeenincontactwithanotherinfectiousTBcasecomparedto1.9percent(N=3/156)offoreign‐borncases.
No. % No. % No. % No. % No. %TBSymptoms 110 51.2 111 51.2 116 57.4 91 48.4 93 45.8AbnormalChestRadiograph 54 25.1 48 22.1 42 20.8 41 21.8 45 22.2IncidentalLabResult 35 16.3 35 16.1 23 11.4 35 18.6 42 20.7ContactInvestigation 4 1.9 6 2.8 9 4.5 14 7.4 6 3.0TargetedTesting 2 0.9 1 0.5 4 2.0 4 2.1 7 3.4ImmigrationMedicalExam 3 1.4 6 2.8 3 1.5 0 0.0 1 0.5Employment/Administrative 1 0.5 2 0.9 1 0.5 0 0.0 2 1.0HealthCareWorker 1 0.5 0 0.0 1 0.5 0 0.0 1 0.5Unknown 5 2.3 8 3.7 3 1.5 3 1.6 6 3.0TOTALCASES 215 217 202
2016
203
2015
188
PrimaryReasonforEvaluation 2012 2013 2014
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
No. % No. % No. %TBSymptoms 22 46.8 71 45.5 93 45.8
AbnormalChestRadiograph 10 21.3 35 22.4 45 22.2IncidentalLabResult 7 14.9 35 22.4 42 20.7ContactInvestigation 3 6.4 3 1.9 6 3.0
TargetedTesting 2 4.3 5 3.2 7 3.4ImmigrationMedicalExam 0 0.0 1 0.6 1 0.5Employment/AdministrativeTesting 1 2.1 1 0.6 2 1.0
HealthCareWorker 0 0.0 1 0.6 1 0.5Unknown 2 4.3 4 2.6 6 3.0
TOTALCASES
PrimaryReasonforEvaluationU.S.‐Born Foreign‐Born Total
47 156 203Source:NewYorkStateDepartmentofHealth
BureauofTuberculosisControl*U.S.‐bornisdefinedassomeoneborninoneofthe50states,DistrictofColumbia,orbornoutsidetheUnitedStatestoatleastoneparentwhowasaU.S.citizen
RISK FACTORS
27
Asidefromthecommonlycollectedriskfactors,suchasHIVstatus,drug/alcoholusage,occupationandcountryofbirth,thereareadditionalmedicalandexposureriskfactorsthatareassociatedwithTB.Medicalriskfactorsareconditionsthatweakenanindividual’simmunedefensesagainstTBandmaycomplicatethemanagementofthedisease.ExposureriskfactorsarethosethatplaceanindividualatincreasedriskofTBtransmission.
Table9a.AdditionalRiskFactors*AmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
AlthoughmostTBcasesinNewYorkState(exclusiveofNewYorkCity)didn’thaveadditionalriskfactors,between33and47percentofthosediagnosedinthelastfiveyearshadatleastone.Amongthesecases,diabetescontinuestobethemostcommonlyreportedriskfactor.In2016,17.7percent(N=36/203)ofcasesinNewYorkState(exclusiveofNewYorkCity)haddiabetes,whichwassevenpercenthigherthanin2012(10.7%).Additionally,theproportionofcaseswhohadbeeninrecentcontactwithaninfectiousTBpatientwas5.7percentlowerin2016comparedto2015(4.9%and10.6%,respectively).
Table9b.AdditionalRiskFactors*AmongTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2016
In2016,49.4percentoffemaleTBcasesinNewYorkState(exclusiveofNewYorkCity)hadatleastoneadditionalriskfactorcomparedto38.5percentofmalecases.OversevenpercentoffemalecaseshadbeenincontactwithaninfectiousTBpatientcomparedto3.3percentofmalecases.
No. % No. % No. % No. % No. %DiabetesMellitus 23 10.7 25 11.5 30 14.9 34 18.1 36 17.7Immunosuppression(notHIV/AIDS) 15 7.0 9 4.1 11 5.4 6 3.2 11 5.4IncompleteLTBITherapy 13 6.0 9 4.1 8 4.0 8 4.3 4 2.0End‐StageRenalDisease 3 1.4 4 1.8 6 3.0 3 1.6 4 2.0Post‐OrganTransplantation 1 0.5 0 0.0 4 2.0 3 1.6 1 0.5TNF‐αAntagonistTherapy 2 0.9 2 0.9 1 0.5 1 0.5 4 2.0ContactofInfectiousTBPatient 8 3.7 13 6.0 17 8.4 20 10.6 10 4.9ContactofMDR‐TBPatient 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0MissedContact 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0
OtherRisk OtherFactors 24 11.2 16 7.4 28 13.9 26 13.8 34 16.7None NoAdditionalFactors 131 60.9 146 67.3 117 57.9 100 53.2 116 57.1
2015
188
2012 2013 2014AdditionalRiskFactors
TOTALCASES
MedicalRisk
ExposureRisk**
217 202
2016
203215*Categories are notmutually exclusive**Withinthelast2yearsLTBI=LatentTuberculosisInfection
Source:NewYorkStateDepartment ofHealthBureau ofTuberculosisControl
No. % No. % No. %DiabetesMellitus 21 17.2 15 18.5 36 17.7Immunosuppression(notHIV/AIDS) 5 4.1 6 7.4 11 5.4IncompleteLTBITherapy 2 1.6 2 2.5 4 2.0End‐StageRenalDisease 4 3.3 0 0.0 4 2.0Post‐OrganTransplantation 1 0.8 0 0.0 1 0.5TNF‐αAntagonistTherapy 1 0.8 3 3.7 4 2.0ContactofInfectiousTBPatient 4 3.3 6 7.4 10 4.9ContactofMDR‐TBPatient 0 0.0 0 0.0 0 0.0MissedContact 0 0.0 0 0.0 0 0.0
OtherRisk OtherFactors 15 12.3 19 23.5 34 16.7None NoAdditonalFactors 75 61.5 41 50.6 116 57.1
203
AdditionalRiskFactors
MedicalRisk
ExposureRisk**
TOTALCASES 122 81
Male Female Total
*Categoriesarenotmutuallyexclusive**Withinthelast2yearsLTBI=LatentTuberculosisInfection
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
RISK FACTORS
28
Figure14.TuberculosisCasesandRates*AmongDOCCS**Inmates,NewYorkState(ExclusiveofNewYorkCity),1986‐2016
Duringthelate1980sandearly1990s,asubstantialproportionofTBcasesreportedby
NewYorkState(exclusiveofNewYorkCity)wereintheNewYorkStateDepartmentofCorrectionsandCommunitySupervision(DOCCS)inmatepopulation.AmongtheDOCCSinmatepopulation,therehasbeenanotabledeclineincasessince1991when102newcases(176per100,000inmates)werereported.In2011and2012therewerenonewcasesreported,butin2013therewerethreenewcases(5.5per100,000inmates)andin2014therewasonenewcase(1.8per100,000inmates).In2015and2016therewerenonewTBcasesreportedamongtheDOCCSinmatepopulation.
RISK FACTORS
29
ThereisanincreasedriskofTBtransmissionforresidentsandstaffofcongregatesettings(e.g.,correctionalfacilitiesandlong‐termcarefacilities)duetothecloseproximityandprolongedcontactwithothers.Residentsofcongregatesettingsmayalsohavesignificantcomorbiditiesthatamplifythisriskevenfurther.
Table10.High‐RiskCongregateSettingattheTimeofDiagnosisforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
ThenumberandpercentageofcasesdiagnosedwhileresidinginacongregatesettingvariedoverthelastfiveyearsinNewYorkState(exclusiveofNewYorkCity),butwashighestin2016(3.9%,N=8/203)andlowestin2015(2.1%,N=4/188).In2016,75percent(N=6/8)ofcasesdiagnosedinacongregatesettingwereidentifiedinalong‐termcarefacility,mostofwhichwereinanursinghome(N=4).
Table11.HomelessnessAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
ThehomelesspopulationisatincreasedriskofacquiringortransmittingTBtoothersashomelessnessisoftenaccompaniedbyotherriskfactorsassociatedwithTB,suchassubstanceabuse,HIVinfection,andinadequatemedicalcare.Apersonisconsideredtobehomelessiftheydon’thaveafixed,regularnighttimeresidence.Theseindividualsmayliveonthestreets,alternatebetweenmanytemporaryresidences,orresideinprivatelyorpubliclysupervisedshelters.
From2012to2016,anaverageof1.8percent(N=18/1,025)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)werehomelesswithinthe12monthspriortodiagnosis.In2016,2.5percent(N=5/203)ofTBcaseswerehomeless,whichwassimilartothepreviousyear(2.7%,N=5/188).
No. % No. % No. % No. % No. %JuvenileFacility 0 0.0 0 0.0 1 0.5 0 0.0 1 0.5
LocalJail 0 0.0 0 0.0 1 0.5 1 0.5 0 0.0StatePrison 0 0.0 3 1.4 1 0.5 0 0.0 0 0.0FederalPrison 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5OtherFacility 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0Alcohol/DrugTreatment 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0Hospital‐Based 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0MentalHealthResidence 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0NursingHome 3 1.4 2 0.9 1 0.5 2 1.1 4 2.0Residential 1 0.5 0 0.0 0 0.0 0 0.0 2 1.0OtherLong‐TermCare 1 0.5 2 0.9 0 0.0 0 0.0 0 0.0Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
2013
CorrectionalFacility
Long‐TermCareFacility
CongregateSettingatTimeofTBDiagnosis
2012
TOTALCASES 215 217 202
2016
203
2014 2015
188Source:NewYorkStateDepartmentofHealth
BureauofTuberculosisControl
No. %2012 1 0.52013 5 2.32014 2 1.02015 5 2.72016 5 2.5
Year HomelessCases
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
RISK FACTORS
30
SubstanceabuseweakenstheimmunesystemwhichcanleavepeoplemoreinfectiousoratgreaterriskofbecominginfectedanddevelopingactiveTB.Also,thedrugsusedtotreatTBcanbetoxictotheliversosubstanceabuse,suchasexcessalcoholuse,canincreasethedamagingeffectsoftreatment.
Table12.SubstanceAbuse*AmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
InNewYorkState(exclusiveofNewYorkCity),excessalcoholusehasbeenthemost
commonlyreportedformofsubstanceabuseamongTBcasesoverthelastfiveyears.Therewere14cases(6.9%)in2016whoreportedalcoholabuse,four(28.6%)ofwhichalsoreportednon‐injectiondruguse.
No. % No. % No. % No. % No. %InjectionDrugUse 0 0.0 2 0.9 1 0.5 0 0.0 0 0.0Non‐InjectionDrugUse 5 2.3 6 2.8 3 1.5 2 1.1 8 3.9ExcessAlcoholUse 10 4.7 22 10.1 13 6.4 15 8.0 14 6.9TOTALCASES
SubstanceAbuse 2015
188
2013 2014 2016
203215 217 202
2012
*Categoriesarenot mutuallyexclusive Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
DRUG RESISTANCE
31
Thefirst‐linedrugsusedfortreatingTBdiseaseareisoniazid(INH),rifampin(RIF),pyrazinamide(PZA),ethambutol(EMB),andlesscommonlystreptomycin(SM),butthereareothersecond‐linedrugsthatcanbeusedwhennecessary.MostTBstrainsaresusceptibletoallfirst‐linedrugs,butresistancetooneormorecanoccur,whichcouldcomplicatethemanagementofthedisease.MDRTBiscausedbyaTBstrainthatisresistanttoatleastINHandRIF.ExtensivelydrugresistantTB(XDRTB)isMDRTBwithadditionalresistancetosecond‐linedrugs,suchasanyfluoroquinolone(levofloxacin,moxifloxacin,andofloxacin)andatleastoneoftheinjectabledrugs(amikacin,kanamycin,andcapreomycin).Drugsusceptibilitytestingisperformedwheneverpossibletoidentifyanydrugresistance.
Table13a.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Overthelastfiveyears,therehavebeen782culture‐confirmedTBcasesinNewYorkState(exclusiveofNewYorkCity).Drugsusceptibilityresultshavebeenreportedfor99.2percent(N=776/782)ofthesecases,most(84.3%,N=654)ofwhichhavebeensusceptibletoallfirst‐lineTBdrugs.Despitethishighlevelofsusceptibility,therewere122caseswithfirst‐linedrugresistancebetween2012and2016,eightofwhichhadMDRTB.
In2016,drugsusceptibilityresultswerereportedfor98.7percent(N=148/150)ofculture‐confirmedcasesinNewYorkState(exclusiveofNewYorkCity).Sevenpercent(N=3/41)ofU.S.‐borncaseshadfirst‐lineresistancecomparedto19.6percent(N=21/107)offoreign‐borncases.
Table13b.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCasesbyU.S.‐Born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2014‐2016
No. % No. % No. % No. % No. %161 ‐‐‐ 157 ‐‐‐ 164 ‐‐‐ 150 ‐‐‐ 150 ‐‐‐158 98.1 157 100.0 163 99.4 150 100.0 148 98.7
Susceptibletoallfirst‐linedrugs 133 84.2 134 85.4 139 85.3 123 82.0 125 84.5INHandRIFresistant(MDRTB) 3 1.9 2 1.3 2* 1.2 1 0.7 0 0.0INHresistanceonly 11 7.0 6 3.8 11 6.7 11 7.3 8 5.4RIFresistanceonly 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0ResistanceotherthanINHandRIF 11 7.0 14 8.9 11 6.7 15 10.0 15 10.1
2016First‐LineDrugSusceptibilityResults 2012 2013 2014 2015
PositiveCultureSusceptibilityTestReported
SusceptibilityTestResults
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*1casehadextensivelydrugresistantTB(XDRTB)INH=Isoniazid;RIF=Rifampin;MDRTB=Multidrug‐resistantTB
No. % No. % No. % No. % No. % No. %34 ‐‐‐ 130 ‐‐‐ 26 ‐‐‐ 124 ‐‐‐ 42 ‐‐‐ 108 ‐‐‐33 97.1 130 100.0 26 100.0 124 100.0 41 97.6 107 99.1
Susceptibletoallfirst‐linedrugs 29 87.9 110 84.6 21 80.8 102 82.3 38 92.7 87 81.3INHandRIFresistance(MDRTB) 0 0.0 2** 1.5 0 0.0 1 0.8 0 0.0 0 0.0INHresistanceonly 2 6.1 9 6.9 2 7.7 9 7.3 1 2.4 7 6.5RIFresistanceonly 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0ResistanceotherthanINHandRIF 2 6.1 9 6.9 3 11.5 12 9.7 2 4.9 13 12.1
PositiveCultureSusceptibilityTestReported
SusceptibilityTestResults
Foreign‐BornFirst‐LineDrugSusceptibilityResults2014 2015 2016
U.S.‐Born Foreign‐Born U.S.‐Born Foreign‐Born U.S.‐Born
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*U.S.‐bornisdefinedassomeonebornin oneofthe50states,DistrictofColumbia,orbornoutsidetheUnitedStatestoatleastoneparentwhowasaU.S.citizen**1casehadextensivelydrugresistantTB(XDRTB)INH=Isoniazid;RIF=Rifampin;MDRTB=Multidrug‐resistantTB
DRUG RESISTANCE
32
Figure15.NumberandPercentofMultidrug‐ResistantTuberculosisCases,*NewYorkState,2012‐2016
Overthelastfiveyears,thereweresixtimesasmanyMDRTBcasesinNewYorkCity
comparedtotheremainderofthestate(N=48andN=8,respectively).In2016,noMDRTBcaseswerereportedforNewYorkState(exclusiveofNewYorkCity),whereasinNewYorkCitytherewere10(2.3%)MDRTBcasesreported.
.
GENOTYPING
33
Table14.TuberculosisGenotypingSummaryforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
NewYorkStaterequiresthatallinitialpositiveculturesbesubmittedforgenotyping.Beginningin2004,realtimespoligotypingandsubsequentrestrictionfragmentlengthpolymorphism(RFLP)testingwereperformedattheDepartment’sWadsworthCenterforLaboratoriesandResearch,butasof2009RFLPwasdiscontinued.Inaddition,theCDC‐sponsoredNationalTuberculosisGenotypingregionallabinMichiganhasperformedmycobacterialinterspersedrepetitiveunit(MIRU)andspoligotyping,bothofwhichareneededforagenotypetobeconsideredcomplete.
In2016,99.3percent(N=149/150)ofisolatesinNewYorkState(exclusiveofNewYorkCity)wereavailableforgenotyping.Ofthese149isolates,98.7percent(N=147)hadacompletegenotype(spoligotypeandMIRUresult).AnadditionaltwoisolatesonlyhadaspoligotypeoraMIRUresultavailable,so100.0percentofcaseshadatleastsomegenotypeinformationavailable.
No. % No. % No. % No. % No. %
163 ‐‐‐ 161 ‐‐‐ 170 ‐‐‐ 157 ‐‐‐ 154 ‐‐‐TotalFalsePositives 2 ‐‐‐ 3 ‐‐‐ 3 ‐‐‐ 7 ‐‐‐ 4 ‐‐‐Controlstrain 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Contamination 1 0.6 0 0.0 0 0.0 6 3.1 0 0.0M.bovisBCG 1 0.6 3 1.9 3 1.8 1 0.6 4 2.5
TotalTruePositives 161 ‐‐‐ 158 ‐‐‐ 167 ‐‐‐ 150 ‐‐‐ 150 ‐‐‐IsolatesAvailable 155 ‐‐‐ 158 ‐‐‐ 162 ‐‐‐ 150 ‐‐‐ 149 ‐‐‐
CompleteGenotype* 142 91.6 128 81.0 154 95.1 146 97.3 147 98.7PartialGenotype 154 99.4 151 95.6 160 98.8 149 99.3 147 98.7
NoResult 1 0.6 6 3.8 2 1.2 0 0.0 2 1.3
TruePositives
20142012 2013Genotyping 2015 2016
InitialPositiveCultures
FalsePositives
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*CompletegenotypemeanshavingbothaspoligotypeandMIRUresultMIRU=mycobacterialinterspersedrepetitiveunit
SITE OF DISEASE
34
TheprimarysiteofdiseaseformostTBcasesispulmonary,butextrapulmonaryinvolvementalsooccurs.TBisspreadfrompersontopersonthroughairbornetransmission,socaseswithpulmonaryinvolvementhavethegreatestpotentialtoinfectothers.
Table15.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016
Inthelastfiveyears,theproportionofTBcaseswithpulmonarydiseaserangedfrom69to
80percentinNewYorkState(exclusiveofNewYorkCity).ThehighestproportionofcaseswithpulmonaryTBwasobservedin2015(80.4%)andthelowestwasseenin2016(69.0%).
Figure16.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState,2016
In2016,77.9percent(N=440/565)ofTBcasesinNewYorkCityhadpulmonarydiseasecomparedto69.0percent(N=140/203)ofcasesintherestofthestate.Amongthese580pulmonarycasesthroughoutthestate,104alsohaddiseaseinoneormoreextra‐pulmonarysites.
No. % No. % No. % No. % No. %Pulmonary 126 58.6 119 54.8 129 63.9 124 66.0 115 56.7Extrapulmonary 65 30.2 67 30.9 45 22.3 37 19.7 63 31.0Both 24 11.2 31 14.3 28 13.9 27 14.4 25 12.3
TOTALCASES 203
PrimarySiteofDisease 2015 20162013 20142012
202217215 188Source:NewYorkStateDepartmentofHealth
BureauofTuberculosisControl
SITE OF DISEASE
35
Table16.Extra‐PulmonarySitesofDisease*forTuberculosisCases,NewYorkState,2016
Therewere292casesinNewYorkStatewithatleastoneextra‐pulmonarysiteofdiseasein2016.Amongthesecases,themostcommonsitesofdiseasewerelymphatic(N=100),pleural(N=69)andbone/joint(N=44).
NewYorkState NewYorkCity NewYorkState(ExclusiveofNewYorkCity) (Total)
Lymphatic 33 67 100
Pleural 18 51 69
Bone/Joint 9 35 44
Peritoneal 7 18 25
Meningeal 4 10 17
Genitourinary 7 10 17
Laryngeal 0 2 2
Other 16 47 63
Extra‐PulmonarySiteofDisease
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*Categoriesarenotmutuallyexclusive
COMPLETION OF THERAPY
36
Table17a.TreatmentStatusforTuberculosisCases,*NewYorkState(ExclusiveofNewYorkCity),2011‐2015
InNewYorkState(exclusiveofNewYorkCity),theaveragetreatmentcompletionratefor
TBcaseswhowerealiveatdiagnosisandstartedtreatmentbetween2011and2015(themostrecentyearforwhichcompletioninformationisavailable)was89.6percent(N=916/1,022).Thehighestcompletionpercentageof91.1percent(N=195/214)wasseenforcasesreportedin2013,followedby90.9percent(N=189/208)forthosereportedin2012.
Table17b.TreatmentStatusforTuberculosisCases*Reportedin2015,NewYorkState(ExclusiveofNewYorkCity)
Forthe184TBcasesinNewYorkState(exclusiveofNewYorkCity)whowerealiveat
diagnosisandwhostartedtreatmentin2015,87.5percent(N=161/184)completedtherapy.ThisincludestheoneMDRTBcasereportedin2015.
No. % No. % No. % No. % No. %
Complete 197 90.4 189 90.9 195 91.1 174 87.9 161 87.5Died 15 6.9 8 3.8 10 4.7 13 6.6 14 7.6Uncooperative/Refused 2 0.9 0 0.0 3 1.4 3 1.5 2 1.1Lost 0 0.0 1 0.5 1 0.5 2 1.0 0 0.0AdverseTreatmentEvent 1 0.5 2 1.0 2 0.9 0 0.0 1 0.5Other 3 1.4 8 3.8 3 1.4 6 3.0 6 3.3TOTALCASES 214
TreatmentStatus 2011 2012
218
2013 2015
184
2014
198208Source:NewYorkStateDepartmentofHealth
BureauofTuberculosisControl*ExcludespatientsfoundnottohaveTB, thosewhowerereportedatdeathandthosewhoneverstartedtreatment
No. % No. % No. %Complete 160 87.4 1 100.0 161 87.5Died 14 7.7 0 0.0 14 7.6Uncooperative/Refused 2 1.1 0 0.0 2 1.1AdverseTreatmentEvent 1 0.5 0 0.0 1 0.5Other 6 3.3 0 0.0 6 3.3
TOTALCASES 1841183
TreatmentStatus Non‐MDR MDR Total
*ExcludespatientsfoundnottohaveTB,thosewhowerereportedatdeathandthosewhoneverstartedtreatmentMDRTB=Multidrug‐resistantTB
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
COMPLETION OF THERAPY
37
Figure17.PercentofTuberculosisCasesWhoCompletedTreatmentWithin12Months,*byU.S.‐Born**andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
For2015(themostrecentyearforwhichcompleteinformationisavailable),94.3percent(N=148/157)ofpatientsinNewYorkState(exclusiveofNewYorkCity)eligible^tocompletetreatmentwithin12months,didso.Alargerpercentageofforeign‐borncasescompletedtherapywithin12monthscomparedtoU.S.‐borncasesin2014(95.3%and90.0%,respectively).Anadditional3.2percent(N=5/157)ofpatientscompletedtreatmentinmorethan12monthsforanoverallcompletionrateof97.5percent.^Patientswithrifampinresistance,thosewithmeningealTB,andchildrenunder15whohavedisseminatedTB(miliaryTBorevidenceofmiliaryTBonchestradiograph,orapositivebloodculture)areineligibletocompletewithin12monthssotheyareexcluded.Thosewhowereneverstartedontreatment,weredeadatdiagnosis,orwhodiedwhileontreatmentarealsoexcluded.EffectiveJanuary2009,theCDCrevisedthedefinitionofwhoiseligibletocompletetreatmenttoalsoexcludepatientswhomovedoutofthecountrywhileontreatment.
CONTACTS TO INFECTIOUS TUBERCULOSIS CASES
38
PeoplewhocomeinclosecontactwithaninfectiousTBcaseforaprolongedperiodoftimeareathighriskofbecominginfected.SinceTBisspreadpersontopersonbybreathinginairborneparticlesfromanotherinfectedindividual,pulmonaryTBcaseswhoareexhibitingsymptoms,suchascoughing,aremostlikelytotransmitTBtoothers.Fornewlydiagnosedcases,investigationsareconductedtoidentifyclosecontactswhomayhavebeeninfected.Oncecontactsareidentified,theyarenotifiedoftheirexposureandeffortsaremadetogeteachindividualevaluated.Uponevaluation,ifacontacthasapositivetuberculinskintest(TST)orapositiveInterferon‐GammaReleaseAssay,furtherevaluationisdonetodetermineiftheinfectionisactiveTBdiseaseorLTBI.Treatmentoptionsforeitherconditionarethendiscussed.IndividualswhohavebeenrecentlyinfectedhaveagreaterriskoftheirinfectiondevelopingintoactiveTBdiseasesoitisimportantforLTBIpatientstocompletetreatment.
Table18.NumberandPercentofInfectiousTuberculosisCaseswithContactsIdentified,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
In2015(themostrecentyearforwhichcompleteinformationisavailable),100.0percent(N=72/72)ofinfectiousTBcasesinNewYorkState(exclusiveofNewYorkCity)hadcontactsidentified.Thisexceedsthestateobjectiveof97.0percentandmeetsthenationalobjectiveof100.0percentfor2015.
Table19.NumberandPercentofContactstoInfectiousTuberculosisCasesEvaluatedforLatentTuberculosisInfection,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
Seventy‐fivepercent(N=1,431/1,922)ofcontactstoinfectiouscasesinNewYorkState(exclusiveofNewYorkCity)wereevaluatedforLTBIin2015(themostrecentyearforwhichcompleteinformationisavailable).Thiswasthelowestevaluationpercentageoverthelast10years.Manycontactsidentifiedduringtwolargeinvestigationsinajailandahealthcarefacilitywerenolongeratthosefacilitiesandcouldnotbelocated.Inaddition,themajorityofcontactsidentifiedduringanotherlargeinvestigationinaclose‐knitcommunitycenterrefusedevaluation.
YearTotal
InfectiousCases
No. %2006 97 92 94.82007 78 76 97.42008 92 90 97.82009 66 65 98.52010 73 72 98.62011 80 78 97.52012 75 75 100.02013 63 62 98.42014 72 72 100.02015 72 72 100.0
InfectiousCaseswithContactsIdentified
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
YearTotal
ContactsIdentified
No. %2006 2,970 2,506 84.42007 4,050 3,322 82.02008 3,549 2,647 74.62009 1,768 1,447 81.82010 2,253 2,027 89.92011 3,662 3,049 83.32012 1,851 1,587 85.72013 1,462 1,215 83.12014 1,843 1,571 85.22015 1,922 1,431 74.5
ContactsEvaluated
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
CONTACTS TO INFECTIOUS TUBERCULOSIS CASES
39
Figure18.NumberandPercentofContactstoInfectiousTuberculosisCasesPlacedonTreatmentforLatentTuberculosisInfectionandCompleted,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
AmongthecontactstoinfectiouscasesinNewYorkState(exclusiveofNewYorkCity)whowereevaluatedin2015(themostrecentyearforwhichcompleteinformationisavailable),12.5percent(N=179/1,431)werediagnosedwithLTBI.Sixty‐eightpercent(N=122/179)ofthesecontactswerestartedonatreatmentregimenand74.6percent(N=91/122)ofthosewhostartedtreatmentcompletedtheprescribedregimen.
DIRECTLY OBSERVED THERAPY
40
Figure21.NumberandPercentofTuberculosisCases*ReceivingAnyDirectlyObservedTherapy,NewYorkState(ExclusiveofNewYorkCity),1991‐2016
InNewYorkState(exclusiveofNewYorkCity)theproportionofcasesreceivingdirectly
observedtherapy(DOT)hasbeenincreasingsincetheearly1990swhenitwasfirstactivelypromotedbytheNewYorkStateDepartmentofHealth,localhealthunits,andothers.In1991,45.2percent(N=297/657)ofTBcasesontreatmentreceivedatleastpartoftheirtherapyasDOT.Sincethen,theproportionofcasesreceivingaportionoftheirtreatmentasDOThasmorethandoubledto98.9percent(N=187/189)in2016.
CONTACT INFORMATION
41
NewYorkStateDepartmentofHealthBureauofTuberculosisControl
NewYorkStateDepartmentofHealthBureauofTuberculosisControlEmpireStatePlazaCorningTower,Room565Albany,NY12237
Tel(518)474‐7000MainFax(518)473‐6164ConfidentialFax(518)408‐[email protected]
Formoreinformation:www.health.ny.gov/diseases/communicable/tuberculosis
NewYorkCityDepartmentofHealthandMentalHygieneBureauofTuberculosisControl
NewYorkCityDepartmentofHealth&MentalHygieneBureauofTuberculosisControl42‐0928thStreet,CN72BLongIslandCity,NY11101Tel(844)713‐0559(TBHotline)Fax(844)713‐0557/0558Formoreinformation:www1.nyc.gov/site/doh/health/health‐topics/tuberculosis.page