Clinical markers of severe TB disease in the United States before and after the onset of the COVID-19 pandemic, 2010–2020 Restricted; Files Only

Abstract

The objective of our study was to determine if the number of severe tuberculosis (TB) cases observed in 2020 differed from what would have been expected based on trends from 2010–2019. For this analysis, a severe case was defined as a case with at least one of the following clinical characteristics: cavitation, positive sputum smear, miliary disease, or meningeal site of disease. We analyzed all severe cases reported to the National Tuberculosis Surveillance System during 2010–2020 in the United States. We conducted Poisson regressions to model case counts of severe TB cases during 2010–2019 among three populations: 1) all persons, 2) U.S.-born persons, and non-U.S.–born persons. We used the parameters obtained from these Poisson regression models to predict case counts for 2020. We then repeated this process for each clinical characteristic associated with severe TB disease. Even though the total number of TB cases in 2020 decreased, a greater than predicted number of severe cases were observed in 2020. Among all persons, 3716 severe cases were observed in 2020, 5% greater than the number of predicted cases (3,536; 95% confidence interval (CI): 3,428–3,648). Among U.S.-born persons, 1,085 severe cases were observed in 2020, 1% greater than the number of predicted cases (1,070; 95% CI: 1,028–1,113). Among non-U.S.–born persons, 2620 severe cases were observed in 2020, 7% greater compared to the number of predicted cases (2,451; 95% CI: 2,362–2,543). Possible factors for the drop in total cases and a greater than expected proportion of severe cases in 2020 include 1) delayed diagnosis, 2) decreased access to healthcare, 3) provider focus on COVID-19, and 4) pandemic mitigation efforts.

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	COVID-19 pandemic Delayed diagnosis Tuberculosis Clinical characteristics Severe disease Poisson regression
Committee Chair / Thesis Advisor	Kenneth Castro, Emory University
Committee Members	Kristin Nelson, Emory University Pei-Jean Feng, Centers for Disease Control and Prevention

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