Trends in recent transmission of tuberculosis in the United States, 2011-2018 Public
Anderson, Erin (Spring 2020)
Published
Abstract
Preventing cases of tuberculosis (TB) resulting from recent transmission (RT) is key to eliminating TB in the United States. Monitoring trends in RT over time can aid state and local TB programs in prioritizing TB control activities and developing specific prevention strategies to interrupt TB transmission in their jurisdictions. Using routinely collected data from the National Tuberculosis Surveillance System (NTSS) and molecular surveillance data from CDC’s TB Genotyping Information Management System (TBGIMS), we describe geographic trends in RT in the U.S. between 2011 and 2018. We analyzed all TB cases reported to NTSS by the 50 U.S. states and the District of Columbia between January 1, 2011 and December 31, 2018 that were eligible to be assessed for RT. Cases estimated to be attributed to RT were identified using a plausible source-case method. We used loglinear regression to evaluate changes in the proportion of genotyped cases estimated to be attributed to RT over time and within geographic area. Of the 55,868 cases eligible to be assessed for RT, 7,703 (13.8%) were estimated to be attributed to RT. Significant decreasing trends in RT-attributed cases were observed at the national level (p<0.0001) as well as in the Midwest (p<0.005), Texas (p<0.01), and the South (p<0.05) from 2011-2018. When comparing the proportions of cases attributed to RT in each sequential two-year time period to the previous two-year time period, we observed a statistically significant reduction in the national proportion of RT-attributed cases in 2017-2018. When stratified by geographic area, statistically significant reductions were observed in Florida (IRR: 0.75; 95% CI: 0.59, 0.95) in 2015-2016 as well as in New York (IRR: 0.79; 95% CI: 0.64, 0.98) and Texas (IRR: 0.85; 95% CI: 0.73, 0.99) in 2017-2018. Our findings suggest that the national decrease in the proportion of cases attributed to RT from 2011-2018 in the U.S. was not uniformly distributed across geographic areas or two-year time periods. Further research is needed to determine whether decreases in RT among certain subpopulations resulted in an overall decrease in RT.
Table of Contents
Introduction...........................................................................................................................................................1
Methods.................................................................................................................................................................2
Results...................................................................................................................................................................5
Discussion..............................................................................................................................................................7
References............................................................................................................................................................11
Tables...................................................................................................................................................................12
Figures..................................................................................................................................................................15
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