Tuberculosis -- United States, First 39 Weeks, 1985

During the first 39 weeks of 1985, substantially more tuberculosis cases were reported to MMWR than would be expected based on morbidity trends in previous years. The 15,839 tuberculosis cases provisionally reported for the week ending September 28 represent a 0.4% decrease and 66 fewer cases than for the same period in 1984. However, in the first 39 weeks of 1984, an 8.6% decrease and 1,514 fewer cases were reported, compared to the same period in 1983. For much of 1984, the cumulative number of tuberculosis cases showed a 7%-9% decline over the previous year (Figure 2). Thus, for 1985, the decline from 1984 is less than expected, and, in recent weeks, there has been as much as a 1% increase in case reporting, compared with 1984. Based on final reporting for 1982 through 1984, the number of reported cases of tuberculosis declined an average of 1,706 cases (6.7%) per year.

The areas with the largest increases in cases provisionally reported for 1985 are New York City, California, Texas, upstate New York, Florida, and Massachusetts (Table 4). The area with the largest decrease is New Jersey. Reported by Div of Tuberculosis Control, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Over the past 3 decades, the number of tuberculosis cases per year in the United States increased on only three occasions. An increase in 1963 was due to more complete reporting of primary tuberculosis cases; in 1975, to changes in counting criteria; and in 1980, to an influx of Indochinese refugees (1). As in every year, a number of reporting areas show increased morbidity; the reasons vary by reporting area. Some reasons for 1985 reporting increases might include reporting artifact, expected fluctuations in secular trends, discrete outbreaks (such as tuberculosis among the homeless) (2), an increased influx of foreign-born residents, or development of new risk factors. The decrease in New Jersey case reporting may be a reporting artifact commonly encountered during the first year of a state's participation in the national tuberculosis individual case reporting system; New Jersey began reporting to this system in 1985. CDC's Division of Tuberculosis Control is analyzing data from the newly implemented individual case reporting system to more precisely identify population groups experiencing increased morbidity. The Division is also working with state and local health departments to investigate factors related to increased morbidity. Data from New York City and Florida suggest that acquired immunodeficiency syndrome may be playing a role in the increased morbidity reported from these two areas (3,4). Investigations are continuing in New York City and Florida to evaluate the hypothesis that human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) infection may cause latent tuberculosis infection to become clinically active. If this hypothesis is correct, additional investigations will determine the extent to which the national morbidity may be attributed to HTLV-III/LAV infection.

References

1. Powell KE, Brown ED, Farer LS. Tuberculosis among Indochinese refugees in the United States. JAMA 1983;249:1455-60.

2. CDC. Drug-resistant tuberculosis among the homeless--Boston. MMWR 1985;34:429-31.

3. Pitchenik AE, Cole C, Russell BW, Fischl MA, Spira TJ, Snider DE. Tuberculosis, atypical mycobacteriosis, and the acquired immunodeficiency syndrome among Haitian and non-Haitian patients in South Florida. Ann Intern Med 1984;101:641-5.

4. Stoneburner RL, Kristal A. Increasing tuberculosis incidence and its relationship to acquired immunodeficiency syndrome in New York City. Atlanta, Georgia: International conference on acquired immunodeficiency syndrome (AIDS), April 14-17, 1985.

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