TUBERCULOSIS IN
NEW YORK STATE 2015
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,1960‐2015
Figure2.TuberculosisCaseRates,NewYorkStateandtheUnitedStates,1960‐2015
Figure3.NumberandPercentofDeathsamongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),1993‐2015
Figure4.DistributionofTuberculosisCases,NewYorkState,2015
Figure5.NumberandPercentofTuberculosisCasesbyRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Figure6.Race/EthnicityofTuberculosisCases,NewYorkState,2015
Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Figure8.TuberculosisCasesandRatesbyAgeandGender,NewYorkState(ExclusiveofNewYorkCity),2015
Figure9.TuberculosisCasesbyAgeandRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2015
Figure10.TuberculosisCasesbyAgeandRace/Ethnicity,NewYorkCity,2015
Figure11a.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),1985‐2015
Figure11b.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkCity,1985‐2015
Figure12.HIVStatusforTuberculosisCases,NewYorkState,2015
Figure13.NumberandPercentofTuberculosisCasesWhoHaveBeenTestedforHIV,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
Figure14.TuberculosisCasesandRatesamongDOCCSInmates,NewYorkState(ExclusiveofNewYorkCity),1986‐2015
Figure15.NumberandPercentofMultidrug‐ResistantTuberculosisCases,NewYorkState,2011‐2015
Figure16.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState,2015
Figure17.PercentofTuberculosisCasesWhoCompletedTreatmentwithin12Months,byU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2005‐2014
Figure18.NumberandPercentofContactstoInfectiousTuberculosisCasesPlacedonTreatmentforLatentTuberculosisInfectionandCompleted,NewYorkState(ExclusiveofNewYorkCity),2005‐2014
Figure19.NumberandPercentofTuberculosisCasesReceivingAnyDirectlyObservedTherapy,NewYorkState(ExclusiveofNewYorkCity),1991‐2015
LIST OF TABLES
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Table1.TuberculosisCasesandRates,NewYorkState,1960‐2015
Table2.TuberculosisCasesandRatesbyCounty,NewYorkState,2011‐2015
Table3.TuberculosisCasesandRatesbyGender,AgeandRace/Ethnicity,NewYorkState,2015
Table4.TuberculosisCasesbyCountryofOrigin,NewYorkState,2015
Table5.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2015
Table6.LengthofTimeForeign‐BornTuberculosisCaseswereintheUnitedStatesPriortoDiagnosis,NewYorkState(ExclusiveofNewYorkCity),2015
Table7a.HIVStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table7b.HIVStatusforTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2015
Table8a.PrimaryReasonforEvaluationofTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table8b.PrimaryReasonforEvaluationofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2015
Table9a.AdditionalRiskFactorsAmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table9b.AdditionalRiskFactorsAmongTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2015
Table10.High‐RiskCongregateSettingattheTimeofDiagnosisforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table11.HomelessnessAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table12.SubstanceAbuseAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table13a.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table13b.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2013‐2015
Table14.TuberculosisGenotypingSummaryforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table15.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Table16.Extra‐PulmonarySitesofDiseaseforTuberculosisCases,NewYorkState,2015
Table17a.TreatmentStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2010‐2014
Table17b.TreatmentStatusforTuberculosisCasesReportedin2014,NewYorkState(ExclusiveofNewYorkCity)
Table18.NumberandPercentofInfectiousTuberculosisCaseswithContactsIdentified,NewYorkState(ExclusiveofNewYorkCity),2005‐2014
Table19.NumberandPercentofContactstoInfectiousTuberculosisCasesEvaluatedforLatentTuberculosisInfection,NewYorkState(ExclusiveofNewYorkCity),2005‐2014
EXECUTIVE SUMMARY
5
ExecutiveSummary
MORBIDITY & MORTALITY
From2014to2015,tuberculosis(TB)morbiditydecreasedinNewYorkState.The2015totalof765cases(577casesinNewYorkCity,188casesintheremainderofNewYorkState)representsa2.8percentdecreasefromthe787casesreportedin2014.Thenationasawholeexperienceda1.6percentincreaseinmorbidity.Sincethemostrecentpeakepidemicin1992with4,574cases,therewasan83.3percentdecreaseinNewYorkStatecomparedtoanationaldeclineof64.2percent.
InNewYorkState(exclusiveofNewYorkCity),thenumberofTBcasesdecreased6.9percentfrom202casesin2014to188casesin2015.ThenumberofTBcasesinNewYorkCitydecreasedby1.4percentfrom585casesin2014to577casesin2015.In2015,thenationasawholereported9,557cases,up1.6percentfromthe9,406casesreportedin2014.
NewYorkStaterankedsixthnationallyforTBmorbiditywithanincidencerateof3.9per100,000populationin2015.ThisrateisinfluencedbyNewYorkCity,whichhadaTBcaserateof7.1per100,000.Incontrast,NewYorkState(exclusiveofNewYorkCity)reportedanincidencerateof1.7per100,000.
GEOGRAPHIC DISTRIBUTION
Threecounties–Nassau,SuffolkandWestchester–reported52.1percentoftheTBcasesinNewYorkState(exclusiveofNewYorkCity)in2015.
RACE‐ETHNICITY
In2015,AsianscontinuedtohaveoneofthehighestincidenceratesofTBstatewide(23.8per100,000).White,non‐Hispanicshadthelowestincidencerateof0.6per100,000.
FOREIGN‐BORN
Statewide,theproportionofforeign‐borncasesdeclinedfrom82.7(N=651)in2014to81.0in2015(N=620).PeopleborninChinacomprisedthegreatestnumberofforeign‐bornTBcases(N=126)inNewYorkCitywhilethoseborninIndiacomprisedthegreatestnumberofTBcases(N=15)intheremainderofthestate.
DRUG SUSCEPTIBILITY
Amongindividualswithdrugsusceptibilitiesreportedin2015,thenumberofmultidrug‐resistant(MDRTB)casesinNewYorkCitywasfive,a44.4percentdecreasefromtheninecasesseenin2014.InNewYorkState(exclusiveofNewYorkCity),thenumberofMDRTBcasesdeclinedfromtwoin2014toonein2015.
TB IN THE PRISONS
Since1991,thenumberofTBcasesamongtheNewYorkStateDepartmentofCorrectionsandCommunitySupervision(DOCCS)inmatepopulationhadbeencontinuallydeclining,andin2011and2012nonewcaseswerereported.However,in2013,threenewDOCCScaseswerereported.In2014,thisnumberdroppedtoonecaseandin2015nonewcaseswerereported.
TUBERCULOSIS CASES AND RATES
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Table1.TuberculosisCasesandRates,*NewYorkState,1960‐2015
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 3.9
YearNewYorkState NewYorkCity NewYorkState
(ExclusiveofNewYorkCity) (Total)
*RatecalculationsarebasedonUnitedStatesdecennialCensusdata;per100,000population**Figuresafter1974reflectanationallyrevisedcasedefinitionthatincludesreactivatedcasesSource:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
TUBERCULOSIS CASES AND RATES
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From2014to2015,TBcasesandratescontinuedtodeclinestatewide.In2015,atotalof765caseswerereportedinNewYorkState,representinga2.8percentdecreasefromthe787casesreportedin2014andan89.2percentdecreasefromthe7,075casesreportedin1960.Nearlythree‐quartersofthestate’sTBmorbidityisconcentratedinNewYorkCity.
In2015,NewYorkCityreported75.4percent(N=577)ofthetotalcasesdespitehavingonly42percentofthestatepopulation.Therestofthestatereported188cases,whichwasa6.9percentdecreasecomparedtothe202reportedin2014.
TherateofTBinNewYorkStateisgreatlyinfluencedbythehighmorbidityinNewYorkCity.OutsideofNewYorkCity,theratein2015was1.7per100,000population,butNewYorkCityreportedarateof7.1per100,000,resultinginanoverallrateof3.9per100,000populationforthewholestate.
Figure1.TuberculosisCasesandRates,*NewYorkState,1960‐2015
Overthelast50years,therehavebeentwopeaksinTBmorbiditywherethenumberandrateofTBsubstantiallyincreased.Thepeakin1975canbeexplainedbyachangeinthecasedefinitiontoincludereactivatedTBcases.Theincreasethatbeganinthemid‐1980sandextendedthroughtheearly1990swasdrivenmainlybytheresurgenceofTBcasesinNewYorkCity.Thisrisewaslargelyduetotwofactors.OnewastheHIV/AIDSepidemicthatstartedintheearly1980s.TheotherwasthereductionofTBcontrolresourcescombinedwiththeriseinhighriskpopulationssuchasforeign‐bornandhomeless.
TUBERCULOSIS CASES AND RATES
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Figure2.TuberculosisCaseRates,*NewYorkStateandtheUnitedStates,1960‐2015
Historically,TBcaseratesinNewYorkState(exclusiveofNewYorkCity)havebeenlowerthanthenationalaverage,whilecaseratesinNewYorkCityhaveexceedednationalrates.In2015,thenationalcaseratewas3.0per100,000populationandrangedfrom0.5to9.1per100,000populationacrossallthestates.NewYorkStaterankedthirdbasedonthenumberofcases(N=765)andsixthbasedonincidencerate(3.9per100,000population),buttheserankingswerelargelyinfluencedbyNewYorkCitywhich,byitself,wouldhaverankedfourthnationallybasedonnumberofcases(N=577)andthirdbasedonincidencerate(7.1per100,000population).
TUBERCULOSIS CASES AND RATES
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Figure3.NumberandPercentofDeathsAmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),1993‐2015
ThenumberandpercentofdeathsamongTBcasesinNewYorkState(exclusiveofNewYorkCity)decreasedconsiderablyfollowingthelastepidemicthatpeakedintheearly1990s.Thisdropinmortalityslowedby1997andhasvariedeachyearsince2000.ThedeathsportrayedinFigure3werenotallTB‐related.
AmongthereportedTBcasesinNewYorkState(exclusiveofNewYorkCity),therewere16totaldeathsin2015.ThecauseofdeathwasTB‐relatedforsixofthesecases,fourofwhichwereover89yearsoldwithothercomorbidities,suchasdiabetesandimmunosuppression(otherthanHIV/AIDS).
GEOGRAPHIC DISTRIBUTION
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Table2.TuberculosisCasesandRates*byCounty,NewYorkState,2011‐2015
No. Rate No. Rate No. Rate No. Rate No. RateAlbany 8 2.6 6 2.0 5 1.6 7 2.3 2 0.7Allegany 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Broome 1 0.5 5 2.5 1 0.5 0 ‐‐‐ 3 1.5Cattaraugus 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Cayuga 1 1.2 0 ‐‐‐ 1 1.2 2 2.5 4 5.0Chautauqua 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Chemung 0 ‐‐‐ 1 1.1 1 1.1 0 ‐‐‐ 0 ‐‐‐Chenango 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Clinton 0 ‐‐‐ 2 2.4 1 1.2 0 ‐‐‐ 2 2.4Columbia 0 ‐‐‐ 2 3.2 0 ‐‐‐ 2 3.2 3 4.8Cortland 0 ‐‐‐ 1 2.0 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Delaware 1 2.1 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Dutchess 3 1.0 4 1.3 4 1.3 7 2.4 5 1.7Erie 14 1.5 19 2.1 21 2.3 16 1.7 13 1.4Essex 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 2.5 0 ‐‐‐Franklin 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Fulton 0 ‐‐‐ 0 ‐‐‐ 1 1.8 0 ‐‐‐ 0 ‐‐‐Genesee 2 3.3 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Greene 0 ‐‐‐ 0 ‐‐‐ 3 6.1 0 ‐‐‐ 0 ‐‐‐Hamilton 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Herkimer 0 ‐‐‐ 0 ‐‐‐ 1 1.5 0 ‐‐‐ 0 ‐‐‐Jefferson 1 0.9 0 ‐‐‐ 2 1.7 1 0.9 2 1.7Lewis 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Livingston 0 ‐‐‐ 0 ‐‐‐ 2 3.1 0 ‐‐‐ 0 ‐‐‐Madison 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Monroe 19 2.6 14 1.9 22 3.0 20 2.7 17 2.3Montgomery 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Nassau 33 2.5 36 2.7 40 3.0 33 2.5 40 3.0Niagara 1 0.5 2 0.9 3 1.4 3 1.4 4 1.8Oneida 8 3.4 5 2.1 8 3.4 3 1.3 5 2.1Onondaga 8 1.7 11 2.4 9 1.9 10 2.1 10 2.1Ontario 3 2.8 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 2 1.9Orange 9 2.4 6 1.6 9 2.4 8 2.1 2 0.5Orleans 1 2.3 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Oswego 0 ‐‐‐ 3 2.5 0 ‐‐‐ 1 0.8 0 ‐‐‐Otsego 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 1.6Putnam 4 4.0 0 ‐‐‐ 0 ‐‐‐ 2 2.0 0 ‐‐‐Rensselaer 2 1.3 3 1.9 1 0.6 2 1.3 0 ‐‐‐Rockland 10 3.2 11 3.5 15 4.8 11 3.5 8 2.6Saratoga 0 ‐‐‐ 1 0.5 2 0.9 1 0.5 1 0.5Schenectady 3 1.9 3 1.9 3 1.9 3 1.9 3 1.9Schoharie 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Schuyler 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Seneca 0 ‐‐‐ 2 5.7 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐St.Lawrence 0 ‐‐‐ 1 0.9 1 0.9 0 ‐‐‐ 1 ‐‐‐Steuben 0 ‐‐‐ 0 ‐‐‐ 1 1.0 0 ‐‐‐ 0 ‐‐‐Suffolk 43 2.9 33 2.2 22 1.5 35 2.3 24 1.6Sullivan 1 1.3 0 ‐‐‐ 1 1.3 1 1.3 0 ‐‐‐Tioga 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Tompkins 3 3.0 4 3.9 1 1.0 4 3.9 2 2.0Ulster 1 0.5 3 1.6 4 2.2 0 ‐‐‐ 0 ‐‐‐Warren 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Washington 0 ‐‐‐ 0 ‐‐‐ 1 1.6 1 1.6 0 ‐‐‐Wayne 3 3.2 0 ‐‐‐ 1 1.1 1 1.1 0 ‐‐‐Westchester 38 4.0 35 3.7 30 3.2 27 2.8 34 3.6Wyoming 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Yates 0 ‐‐‐ 2 7.9 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐
Bronx 102 7.4 101 7.3 91 6.6 99 7.1 87 6.3Kings 214 8.5 190 7.6 197 7.9 192 7.7 171 6.9NewYork 109 6.9 93 5.9 102 6.4 72 4.5 88 5.4Queens 250 11.2 244 10.9 242 10.8 212 9.5 218 9.8Richmond 14 3.0 23 4.9 24 5.1 10 2.1 13 3.0
STATETOTAL 910 4.7 866 4.5 873 4.5 787 4.1 765 3.9
NewYorkStateTotal(ExclusiveofNewYorkCity)
2015
188 1.7
County
2.0 215 1.9 217
7.18.0 656
2011 2012 2013
221
2014
651
1.9 202 1.8
8.0 585 7.2NewYorkCityTotal 689 8.4 577
*Ratecalculationsarebasedon2010UnitedStatesCensusdata;per100,000population
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
GEOGRAPHIC DISTRIBUTION
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TBmorbidityisnotevenlydistributedacrossNYSandvariesgreatlybetweencounties.In2015,allfiveboroughsofNewYorkCityand23(40.4%)ofthe57upstatecountiesreportedatleastoneTBcase.Highernumbersofcaseswereseeninthemetropolitanareas.Asinpreviousyears,overhalfofallTBmorbidityreportedforNYS(exclusiveofNewYorkCity)wasconcentratedinNassau,SuffolkandWestchestercounties(52.1%,N=98/188).
Figure4.DistributionofTuberculosisCasesinNewYorkState,2015
DEMOGRAPHIC CHARACTERISTICS
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Table3.TuberculosisCasesandRates*byGender,Age,**andRace/Ethnicity,NewYorkState,2015
TBcasesinthe65yearsandolderagegrouphadthehighestincidencerateinNewYorkCity,
aswellastherestofthestate(12.4per100,000and3.0per100,000,respectively).Statewide,thelowestrateswereseenamongthehighriskpediatricpopulation(<15yearsold),withthoseinthe10‐14yearoldagegrouprepresentingonlysixcasesforarateof0.5per100,000.OverhalfoftheTBcasesunderfiveyearsoldwerelocatedinNewYorkState(exclusiveofNewYorkCity).
In2015,thehighestincidencerateforTBwasseenamongAsiansinNewYorkState(23.7per100,000).ForHispanicandblack,non‐Hispaniccases,theincidencerateswerecomparableacrossthestate(4.9and3.9per100,000forNewYorkState(exclusiveofNewYorkCity);6.0and6.5per100,000forNewYorkCity).
No. Rate No. Rate No. RateMale 112 2.0 341 8.8 453 4.8Female 76 1.3 236 5.5 312 3.1Under5years 10 1.6 8 1.5 18 1.65‐9 3 0.4 6 1.3 9 0.810‐14 3 0.4 3 0.6 6 0.515‐19 8 1.0 19 3.5 27 2.020‐24 15 2.0 41 6.4 56 4.025‐34 32 2.5 102 7.3 134 5.035‐44 22 1.5 92 8.0 114 4.445‐54 20 1.1 94 8.5 114 4.055‐64 27 1.9 89 10.0 116 5.065+ 48 3.0 123 12.4 171 6.5White,non‐Hispanic 25 0.3 39 1.4 64 0.6Black,non‐Hispanic 36 3.9 121 6.5 157 5.6Hispanic 53 4.9 141 6.0 194 5.7Asian 67 17.7 266 25.9 333 23.7AmericanIndian 0 0 1 5.7 1 1.9MultipleRaces 0 0 5 3.4 5 1.5Other/Unknown 7 29.4 4 6.9 11 13.5
188 1.7 577 7.1 765 3.9
Gender
AgeGroup
TOTALCASES
Race/Ethnicity
DemographicCharacteristicsNewYorkState NewYorkCity NewYorkState
(ExclusiveofNewYorkCity) (Total)
*Ratecalculationsarebasedon2010UnitedStatesCensusdata;per100,000population**Agecalculationsarebasedondateofbirthandreportdate
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
DEMOGRAPHIC CHARACTERISTICS
13
Figure5.NumberandPercentofTuberculosisCasesbyRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Overthelastfiveyears,themajorityofTBcasesreportedinNewYorkState(exclusiveofNewYorkCity)havebeenofAsianandHispanicdescent.Since2011,Asianshavecontinuedtorepresentalargerpercentageofreportedcasesthananyotherracial/ethnicgroup,especiallyin2014whenthepercentageofAsiancasesdramaticallyincreasedto45.5percent(N=92/202).In2015,thispercentagedroppedto35.6percent(N=67/188).Thegreatestincreaseinproportionbetween2014and2015wasseenamongblack,non‐Hispanics(10.9%and19.2%,respectively),followedbyHispanics(24.3%and28.2%,respectively).
DEMOGRAPHIC CHARACTERISTICS
14
Figure6.Race/EthnicityofTuberculosisCases,NewYorkState,2015
InNewYorkCity,46.1percent(N=266/577)ofreportedcasesin2015wereAsian,whereasinNewYorkState(exclusiveofNewYorkCity)Asiansrepresented35.6percent(N=67/188)ofcases.Theproportionofwhite,non‐HispaniccasesinNewYorkState(exclusiveofNewYorkCity)wasnearlydoublethatseeninNewYorkCity(13.3%and6.8%,respectively).
DEMOGRAPHIC CHARACTERISTICS
15
Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Overthelastfiveyears,maleshaveconsistentlycomprisedahigherproportionofTBcases
comparedtofemalesinNewYorkState(exclusiveofNewYorkCity).In2015,59.6percent(N=112/188)ofreportedcasesweremale.
DEMOGRAPHIC CHARACTERISTICS
16
Figure8.TuberculosisCasesandRates*byAge**andGender,NewYorkState(ExclusiveofNewYorkCity),2015
In2015,thedifferenceinTBmorbiditybetweenmalesandfemalesinNewYorkState
(exclusiveofNewYorkCity)varieddependingonage.Forcases45yearsofageorolder,thenumberandrateformalesgreatlyexceededthatoffemales.ThelargestgendergapinTBmorbiditywasseenamongcases55‐64yearsoldwherethecaserateformaleswas2.5timesthatoffemales(2.8per100,000formales;1.1per100,000forfemales).
DEMOGRAPHIC CHARACTERISTICS
17
Figure9.TuberculosisCasesbyAge*andRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2015
In2015,slightlyoveraquarterofreportedcasesinNewYorkState(exclusiveofNewYork
City)were65yearsofageandolder(25.5%,N=48/188).Amongthe48casesinthisagegroup,18(37.5%)werewhite,non‐Hispanicand16(33.3%)wereAsian.
ThesecondlargestnumberofTBcasesreportedin2015forNewYorkState(exclusiveofNewYorkCity)wasseeninthe25‐34yearagegroup(N=32).Forty‐onepercent(N=13/32)ofthesecaseswereHispanicand31.3percent(N=10/32)wereAsian.
Incontrasttothebroaderagedistributionofnearlyeveryotherraceandethnicity,allofthewhite,non‐HispanicTBcaseswereatleast35yearsofage,with72.0percent(N=18/25)being65yearsofageorolder.
DEMOGRAPHIC CHARACTERISTICS
18
Figure10.TuberculosisCasesbyAge*andRace/Ethnicity,NewYorkCity,2015
InNewYorkCity,thelargestnumberofTBcasesreportedin2015wasseeninthe65years
ofageandoldergroup(N=123).Amongthese123cases,69(56.1%)wereAsianand24(19.5%)wereblack,non‐Hispanic.
Similartotheremainderofthestatein2015,thesecondlargestnumberofTBcasesinNewYorkCitywasidentifiedinthe25‐34yearagegroup(N=102).Forty‐eight(47.1%)casesinthisagegroupwereAsianand23(22.5%)wereblack,non‐Hispanic.
TUBERCULOSIS IN THE FOREIGN‐BORN
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Figure11a.NumberandPercentofTuberculosisCasesbyU.S.‐Born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),1985‐2015
In2015,therewere148foreign‐borncasesinNewYorkState(exclusiveofNewYorkCity),
adecreasefromthe160reportedin2014.Theforeign‐bornpercentagealsodeclinedslightly,from79.2percentin2014to78.7percentin2015.
InNewYorkCity,thenumberofforeign‐bornTBcasesdecreasedfrom491in2014to472in2015.Theproportionofforeign‐borncasesin2015was81.8percent,twopercentlowerthanthe83.9percentseenin2014.
Figure11b.NumberandPercentofTuberculosisCasesbyU.S.‐Born*andForeign‐BornStatus,NewYorkCity,1985‐2015
TUBERCULOSIS IN THE FOREIGN‐BORN
20
Table4.TuberculosisCasesbyCountryofOrigin,*NewYorkState,2015
In2015,therewere87differentcountriesrepresentedbythe765TBcasesreportedin
NewYorkState,25ofwhichwererepresentedbyatleastfivecases.Similartopreviousyears,themostcommoncountryoforiginforforeign‐bornTBcasesreportedbyNewYorkState(exclusiveofNewYorkCity)wasIndia(N=15)andforNewYorkCity,themostcommoncountrywasChina(N=126).
NewYorkState NewYorkCity NewYorkState(ExclusiveofNewYorkCity) (Total)
UnitedStates 40 97 137China 8 126 134Mexico 9 36 45India 15 22 37Philippines 9 28 37Ecuador 9 22 31Haiti 6 22 28Bangladesh 1 26 27DominicanRepublic 1 24 25Pakistan 5 14 19Guyana 2 17 19Nepal 4 10 14Burma 9 5 14Honduras 8 5 13Colombia 3 9 12Korea,South 4 7 11Peru 3 5 8ElSalvador 7 1 8PuertoRico** 0 7 7Guatemala 4 3 7Jamaica 1 6 7Thailand 3 4 7Vietnam 5 1 6Nigeria 2 4 6HongKong 0 5 5OtherCountries 30 71 101TOTALCASES 188 577 765
Country
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*Only countriesrepresenting≥5TBcasesarenamed**PuertoRicoandotherU.S.Territoriesareconsideredseperatelyforthepurposeofthistable
TUBERCULOSIS IN THE FOREIGN‐BORN
21
Table5.NumberandPercentofTuberculosisCasesbyU.S‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2015
In2015,therewere148foreign‐bornTBcasesreportedinNewYorkState(exclusiveofNewYorkCity).Overhalf(54.1%,N=80/148)ofthesecaseswereidentifiedinNassau,SuffolkandWestchesteralone.Amongothercountiesthatreportedatleastfiveforeign‐borncases,OneidaandRocklandreportedthehighestforeign‐bornpercentage(100.0%)whileMonroereportedthelowestpercentage(64.7%).Intheremainingcountieswithforeign‐borncases,thenumberandpercentagevaried.
Albany 2 0 2 100.0Allegany 0 0 0 0.0Broome 3 0 3 100.0Cattaraugus 0 0 0 0.0Cayuga 4 2 2 50.0Chautauqua 0 0 0 0.0Chemung 0 0 0 0.0Chenango 0 0 0 0.0Clinton 2 0 2 100.0Columbia 3 2 1 33.3Cortland 0 0 0 0.0Delaware 0 0 0 0.0Dutchess 5 3 2 40.0Erie 13 2 11 84.6Essex 0 0 0 0.0Franklin 0 0 0 0.0Fulton 0 0 0 0.0Genesee 0 0 0 0.0Greene 0 0 0 0.0Hamilton 0 0 0 0.0Herkimer 0 0 0 0.0Jefferson 2 1 1 50.0Lewis 0 0 0 0.0Livingston 0 0 0 0.0Madison 0 0 0 0.0Monroe 17 6 11 64.7Montgomery 0 0 0 0.0Nassau 40 6 34 85.0Niagara 4 3 1 25.0Oneida 5 0 5 100.0Onondaga 10 2 8 80.0Ontario 2 0 2 100.0Orange 2 0 2 100.0Orleans 0 0 0 0.0Oswego 0 0 0 0.0Otsego 1 0 1 100.0Putnam 0 0 0 0.0Rensselaer 0 0 0 0.0Rockland 8 0 8 100.0St.Lawrence 1 0 1 100.0Saratoga 1 0 1 100.0Schenectady 3 1 2 66.7Schoharie 0 0 0 0.0Schuyler 0 0 0 0.0Seneca 0 0 0 0.0Steuben 0 0 0 0.0Suffolk 24 7 17 70.8Sullivan 0 0 0 0.0Tioga 0 0 0 0.0Tompkins 2 0 2 100.0Ulster 0 0 0 0.0Warren 0 0 0 0.0Washington 0 0 0 0.0Wayne 0 0 0 0.0Westchester 34 5 29 85.3Wyoming 0 0 0 0.0Yates 0 0 0 0.0TOTALCASES 188 40 148 78.7
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),2015
InNewYorkState(exclusiveofNewYorkCity),43.2percent(N=64/148)offoreign‐born
TBcaseswerediagnosedwithinfiveyearsofenteringtheU.S.Overhalf(64.1%,N=41)ofthese64caseshadenteredtheU.S.withintwoyearspriortodiagnosis.Thenumberofnewlydiagnosedcasesisconsiderablyloweramongforeign‐bornwhohavebeenintheU.S.formorethanfiveyears.
LengthofTimeintheUnitedStates(Years) No. %
<1 17 11.51‐5 47 31.86‐10 19 12.811‐20 28 18.921‐30 22 14.931‐40 8 5.441‐50 2 1.451‐60 3 2.0Unknown 2 1.4
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
HIV CO‐INFECTION
23
KnowledgeofHIVstatusisessentialforthepropermanagementofpatientswithTB.HIVinfectionimpairstheimmunesystemleavingindividualsatgreaterriskforbecominginfectedwithTBanddevelopingactivedisease.
Figure12.HIVStatusforTuberculosisCases,NewYorkState,2015
Eighty‐fourpercent(N=157/188)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)and80.6percent(N=465/577)ofcasesinNewYorkCityhadaknownHIVstatusin2015.Theco‐infectionrateforTBcasesinNewYorkState(exclusiveofNewYorkCity)was2.7percent(N=5/188),whichwaslessthanhalfofthatseeninNewYorkCity(6.1%,N=35/577).IndividualsmissingHIVtestinginformationandthosewhowerenotofferedorhadrefusedtestingwereconsideredtohaveanunknownstatus.
HIV CO‐INFECTION
24
Figure13.NumberandPercentofTuberculosisCasesWhoHaveBeenTestedforHIV,NewYorkState(ExclusiveofNewYorkCity),2006‐2015
InNewYorkState(exclusiveofNewYorkCity),theproportionofTBcaseswithaknownHIVstatushasgenerallyincreasedoverthelast10years.In2015,83.5percent(N=157/188)ofTBcaseshadadocumentedHIVresult,whichwas1.6percentlowerthanthe85.1percent(N=172/202)seenin2014,but16.9percenthigherthanthatseenin2006(66.6%,N=211/317).
In2015,40.0percent(N=4/10)ofTBcasesunderfiveyearsoldhadaknownHIVstatusinNewYorkState(exclusiveofNewYorkCity).TheproportionofcaseswithaknownHIVstatuswasalsorelativelylowinthe65yearsandolderagegroup(60.4%,N=29/48).
HIV CO‐INFECTION
25
Table7a.HIVStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
In2015,16.5percent(N=31/188)ofTBcasesinNewYorkState(excludingNewYorkCity)
hadanunknownHIVstatus(refused,notofferedormissing/unknown).ThepercentageofcasesthatrefusedanHIVtestin2015(6.4%)wasthelowestseeninthelastfiveyears,butthepercentagenotofferedanHIVtestwasmorethandoublethatseenin2014(8.0%and3.5%,respectively).Ofthe15casesnotofferedtesting,seven(46.7%)wereunder10yearsoldandtheothereight(53.3%)wereover65yearsold.
Table7b.HIVStatusforTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2015
InNewYorkState(exclusiveofNewYorkCity),theproportionofTBcaseswithaknown
HIVstatuswassimilaramongmalesandfemalesin2015(82.0%and85.7%,respectively),althoughthefiveTBcaseswithHIVco‐infectionwereallmale.AmongcaseswhodidnothaveaknownHIVstatus,10werefemale(13.2%)and21weremale(18.8%).Thepercentageofmaleswhorefusedtestingwasmorethandoublethatoffemales(8.1%and3.9%,respectively).
No. % No. % No. % No. % No. %Negative 166 75.1 157 73.0 167 77.0 166 82.2 152 80.9Positive 10 4.5 6 2.8 14 6.5 6 3.0 5 2.7Refused 23 10.4 25 11.6 19 8.8 19 9.4 12 6.4NotOffered 20 9.0 23 10.7 13 6.0 7 3.5 15 8.0Missing/Unknown 2 0.9 4 1.9 4 1.8 4 2.0 4 2.1
TOTALCASES
2015
221 215 217 202 188
HIVTest 2011 2012 2013 2014
Source:NewYorkStateDepartmentofHealthBureau ofTuberculosisControl
No. % No. % No. %Negative 86 77.5 66 85.7 152 80.9Positive 5 4.5 0 0.0 5 2.7Refused 9 8.1 3 3.9 12 6.4NotOffered 11 9.9 4 5.2 15 8.0Missing/Unknown 1 0.9 3 3.9 4 2.1
TOTALCASES
HIVTest Male Female Total
112 76 188Source:NewYorkStateDepartmentof Health
BureauofTuberculosisControl
REASONS FOR EVALUATION
26
Table8a.PrimaryReasonforEvaluationofTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
In2015,48.4percent(N=91/188)ofTBcasesinNewYorkState(exclusiveofNewYork
City)wereevaluatedbecauseofTBsymptoms.Thesecondmostcommonreasonforevaluationwasanabnormalchestradiograph(21.8%,N=41/188)followedbyanincidentallabresult(18.6%,N=35/188).Overthepastfiveyears,thesehavecontinuedtobethethreemostfrequentlyreportedreasonsforevaluation.
Table8b.PrimaryReasonforEvaluationofTuberculosisCasesbyU.S.‐born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2015
Fifty‐fourpercent(N=80/148)offoreign‐borncasesinNewYorkState(exclusiveofNewYorkCity)underwentTBevaluationduetoTBsymptomscomparedto27.5percent(N=11/40)ofU.S.‐borncasesin2015.Almostonethird(30%,N=12/40)ofU.S.‐borncaseswereevaluatedbecausetheyhadbeenincontactwithanotherinfectiousTBcase.Thiswastheleastcommonreasonforevaluationamongforeign‐borncases(1.4%,N=2/148).
No. % No. % No. % No. % No. %
TBSymptoms 116 52.5 110 51.2 111 51.2 116 57.4 91 48.4AbnormalChestRadiograph 54 24.4 54 25.1 48 22.1 42 20.8 41 21.8IncidentalLabResult 28 12.7 35 16.3 35 16.1 23 11.4 35 18.6ContactInvestigation 10 4.5 4 1.9 6 2.8 9 4.5 14 7.4TargetedTesting 5 2.3 2 0.9 1 0.5 4 2.0 4 2.1ImmigrationMedicalExam 4 1.8 3 1.4 6 2.8 3 1.5 0 0.0Employment/Administrative 0 0.0 1 0.5 2 0.9 1 0.5 0 0.0HealthCareWorker 0 0.0 1 0.5 0 0.0 1 0.5 0 0.0Unknown 4 1.8 5 2.3 8 3.7 3 1.5 3 1.6TOTALCASES
2012 2013 2014
221 215 217 202
2015
188
PrimaryReasonforEvaluation2011
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
No. % No. % No. %TBSymptoms 11 27.5 80 54.1 91 48.4
AbnormalChestRadiograph 7 17.5 34 23.0 41 21.8IncidentalLabResult 9 22.5 25 16.9 34 18.1ContactInvestigation 12 30.0 2 1.4 14 7.4
TargetedTesting 0 0.0 4 2.7 4 2.1ImmigrationMedicalExam 0 0.0 0 0.0 0 0.0
Employment/AdministrativeTesting 0 0.0 0 0.0 0 0.0HealthCareWorker 0 0.0 0 0.0 0 0.0Unknown 1 2.5 3 2.0 4 2.1
TOTALCASES
PrimaryReasonforEvaluationU.S.‐Born Foreign‐Born Total
40 148 188Source: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),2011‐2015
AlthoughmostTBcasesinNewYorkState(exclusiveofNewYorkCity)didn’thaveadditionalriskfactors,between33and47percentofthosediagnosedinthelastfiveyearshadatleastone.Amongthesecases,mostfactorsweremedicalriskfactors,withdiabetes,immunosuppression(notHIV/AIDS)andincompletelatenttuberculosisinfection(LTBI)therapybeingmostcommon.
TheproportionofTBcasesinNewYorkState(exclusiveofNewYorkCity)withdiabeteshascontinuedtoriseoverthelastfiveyears.In2015,18.1percent(N=34/188)ofcaseshaddiabetes,whichwasalmostaneightpercentincreasefromthe10.4percentseenin2011.Additionally,theproportionofcasesin2015thatwereevaluatedduetorecentcontactwithaninfectiousTBpatientwasnearlydoublethatseenin2011(10.6%and5.4%,respectively).
Table9b.AdditionalRiskFactors*AmongTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2015
In2015,50.9percentofmaleTBcasesinNewYorkState(exclusiveofNewYorkCity)hadatleastoneadditionalriskfactorcomparedto41.8percentoffemalecases.Diabeteswasmorecommonamongmalesthanfemales(23.2%,N=26,formales;10.5%,N=8forfemales).
No. % No. % No. % No. % No. %DiabetesMellitus 23 10.4 23 10.7 25 11.5 30 14.9 34 18.1Immunosuppression(notHIV/AIDS) 18 8.1 15 7.0 9 4.1 11 5.4 6 3.2IncompleteLTBITherapy 13 5.9 13 6.0 9 4.1 8 4.0 8 4.3End‐StageRenalDisease 4 1.8 3 1.4 4 1.8 6 3.0 3 1.6Post‐OrganTransplantation 2 0.9 1 0.5 0 0.0 4 2.0 3 1.6TNF‐αAntagonistTherapy 0 0.0 2 0.9 2 0.9 1 0.5 1 0.5ContactofInfectiousTBPatient 12 5.4 8 3.7 13 6.0 17 8.4 20 10.6ContactofMDR‐TBPatient 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0MissedContact 1 0.5 0 0.0 0 0.0 0 0.0 1 0.5
OtherRisk OtherFactors 12 5.4 24 11.2 16 7.4 28 13.9 26 13.8None NoAdditionalFactors 144 65.2 131 60.9 146 67.3 117 57.9 100 53.2
2015
188
2012 2013 2014AdditionalRiskFactors 2011
TOTALCASES
MedicalRisk
ExposureRisk**
217 202221 215*Categoriesarenotmutuallyexclusive**Withinthelast2yearsLTBI=LatentTuberculosisInfection
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
No. % No. % No. %DiabetesMellitus 26 23.2 8 10.5 34 18.1Immunosuppression(notHIV/AIDS) 4 3.6 2 2.6 6 3.2IncompleteLTBITherapy 5 4.5 3 3.9 8 4.3End‐StageRenalDisease 3 2.7 0 0.0 3 1.6Post‐OrganTransplantation 2 1.8 1 1.3 3 1.6TNF‐αAntagonistTherapy 1 0.9 0 0.0 1 0.5ContactofInfectiousTBPatient 10 8.9 9 11.8 19 10.1ContactofMDR‐TBPatient 0 0.0 0 0.0 0 0.0MissedContact 1 0.9 0 0.0 1 0.5
OtherRisk OtherFactors 19 17.0 10 13.2 26 13.8None NoAdditonalFactors 55 49.1 45 59.2 100 53.2
188
AdditionalRiskFactors
MedicalRisk
ExposureRisk**
TOTALCASES 112 76
Male Female Total
*Categoriesarenotmutuallyexclusive**Withinthelast2yearsLTBI=LatentTuberculosisInfection
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
RISK FACTORS
28
Figure14.TuberculosisCasesandRates*AmongDOCCS**Inmates,NewYorkState(ExclusiveofNewYorkCity),1986‐2015
Duringthelate1980sandearly1990s,asubstantialproportionofTBcasesreportedby
NewYorkState(exclusiveofNewYorkCity)wereintheNewYorkStateDepartmentofCorrectionsandCommunitySupervision(DOCCS)inmatepopulation.AmongtheDOCCSinmatepopulation,therehasbeenanotabledeclineincasessince1991when102newcases(176per100,000inmates)werereported.In2011and2012therewerenonewcasesreported,butin2013therewerethreenewcases(5.5per100,000inmates)andin2014therewasonenewcase(1.8per100,000inmates).In2015therewerenonewTBcasesreportedamongtheDOCCSinmatepopulation.
RISK FACTORS
29
ThereisanincreasedriskofTBtransmissionforresidentsandstaffofcongregatesettings(e.g.,correctionalfacilitiesandlong‐termcarefacilities)duetothecloseproximityandprolongedcontactwithothers.Residentsofcongregatesettingsmayalsohavesignificantcomorbiditiesthatamplifythisriskevenfurther.
Table10.High‐RiskCongregateSettingattheTimeofDiagnosisforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
ThenumberandpercentageofcasesdiagnosedwhileresidinginacongregatesettingvariedoverthelastfiveyearsinNewYorkState(exclusiveofNewYorkCity),butwashighestin2011(6.2%,N=10)andlowestin2012(2.3%,N=5).In2015,four(2.1%)caseswereidentifiedinacongregatesetting.Twocaseswereinacorrectionalfacilityandtwowereinalong‐termcarefacility.
Table11.HomelessnessAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
ThehomelesspopulationisatincreasedriskofacquiringortransmittingTBtoothersashomelessnessisoftenaccompaniedbyotherriskfactorsassociatedwithTB,suchassubstanceabuse,HIVinfection,andinadequatemedicalcare.Apersonisconsideredtobehomelessiftheydon’thaveafixed,regularnighttimeresidence.Theseindividualsmayliveonthestreets,alternatebetweenmanytemporaryresidences,orresideinprivatelyorpubliclysupervisedshelters.
From2011to2015,anaverageof1.6percent(N=16/1,043)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)werehomelesswithinthe12monthspriortodiagnosis.In2015,2.7percent(N=5/188)ofTBcaseswerehomeless,whichwasthehighestproportionidentifiedinthelastfiveyears.
No. %2011 3 1.42012 1 0.52013 5 2.32014 2 1.02015 5 2.7
YearHomelessCases
Source:New YorkStateDepartmentofHealthBureau ofTuberculosis Control
No. % No. % No. % No. % No. %JuvenileFacility 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0LocalJail 3 1.4 0 0.0 0 0.0 1 0.5 1 0.5StatePrison 0 0.0 0 0.0 3 1.4 1 0.5 0 0.0FederalPrison 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0OtherFacility 2 0.9 0 0.0 0 0.0 0 0.0 1 0.5Alcohol/DrugTreatment 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0Hospital‐Based 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0MentalHealthResidence 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0NursingHome 2 0.9 3 1.4 2 0.9 1 0.5 2 1.1Residential 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0OtherLong‐TermCare 1 0.5 1 0.5 2 0.9 0 0.0 0 0.0Unknown 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0
2014 2015
TOTALCASES 221 215 217 202 188
CorrectionalFacility
Long‐TermCareFacility
CongregateSettingatTimeofTBDiagnosis
2011 2012 2013
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
RISK FACTORS
30
SubstanceabuseweakenstheimmunesystemwhichcanleavepeoplemoreinfectiousoratgreaterriskofbecominginfectedanddevelopingactiveTB.Also,thedrugsusedtotreatTBcanbetoxictotheliversosubstanceabuse,suchasexcessalcoholuse,canincreasethedamagingeffectsoftreatment.
Table12.SubstanceAbuse*AmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
InNewYorkState(exclusiveofNewYorkCity),excessalcoholusehasbeenthemostcommonlyreportedformofsubstanceabuseamongTBcasesoverthelastfiveyears.Therewere15cases(8.0%)in2015whoreportedalcoholabuse,twoofwhichalsoreportednon‐injectiondruguse.
No. % No. % No. % No. % No. %InjectionDrugUse 1 0.5 0 0.0 2 0.9 1 0.5 0 0.0Non‐InjectionDrugUse 7 3.2 5 2.3 6 2.8 3 1.5 2 1.1ExcessAlcoholUse 20 9.0 10 4.7 22 10.1 13 6.4 15 8.0TOTALCASES 221 215 217 202
2011 2012 2015
188
2013 2014SubstanceAbuse
*Categoriesarenotmutuallyexclusive 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),2011‐2015
Overthelastfiveyears,therehavebeen804culture‐confirmedTBcasesinNewYorkState(exclusiveofNewYorkCity).Drugsusceptibilityresultshavebeenreportedfor99.1percent(N=797/804)ofthesecases,most(83.4%,N=665)ofwhichhavebeensusceptibletoallfirst‐lineTBdrugs.Despitethishighlevelofsusceptibility,therewere132caseswithfirst‐linedrugresistancebetween2011and2015,14ofwhichhadMDRTB.
In2015,drugsusceptibilityresultswerereportedforallculture‐confirmedcasesinNewYorkState(exclusiveofNewYorkCity).Inprioryears,theproportionofcaseswithdrugresistancehasbeengreateramongforeign‐borncomparedtoU.S.‐born,butin2015,17.7percent(N=22/124)offoreign‐borncaseshadfirst‐lineresistancecomparedto19.2percent(N=5/26)ofU.S.‐borncases.
Table13b.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCasesbyU.S.‐Born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2013‐2015
No. % No. % No. % No. % No. %172 161 157 164 150
169 98.3 158 98.1 157 100.0 163 99.4 150 100.0
Susceptibletoallfirst‐linedrugs 136 80.5 133 84.2 134 85.4 139 85.3 123 82.0
INHandRIFresistant(MDRTB) 6 3.6 3 1.9 2 1.3 2* 1.2 1 0.7
INHresistanceonly 12 7.1 11 7.0 6 3.8 11 6.7 11 7.3
RIFresistanceonly 1 0.6 0 0.0 1 0.6 0 0.0 0 0.0
ResistanceotherthanINHandRIF 14 8.3 11 7.0 14 8.9 11 6.7 15 10.0
First‐LineDrugSusceptibilityResults 2011 2012 2013 2014 2015
PositiveCulture
SusceptibilityTestReported
SusceptibilityTestResults
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*1casehadextensivelydrugresistantTB(XDRTB)INH=Isoniazid;RIF=Rifampin;MDRTB=Multidrug‐resistantTB
No. % No. % No. % No. % No. % No. %30 127 34 130 26 124
30 100.0 127 100.0 33 97.1 130 100.0 26 100.0 124 100.0
Susceptibletoallfirst‐linedrugs 28 93.3 106 83.5 29 87.9 110 84.6 21 80.8 102 82.3
INHandRIFresistance(MDRTB) 0 0.0 2 1.6 0 0.0 2** 1.5 0 0.0 1 0.8
INHresistanceonly 0 0.0 6 4.7 2 6.1 9 6.9 2 7.7 9 7.3
RIFresistanceonly 0 0.0 1 0.8 0 0.0 0 0.0 0 0.0 0 0.0
ResistanceotherthanINHandRIF 2 6.7 12 9.4 2 6.1 9 6.9 3 11.5 12 9.7
PositiveCulture
SusceptibilityTestReported
SusceptibilityTestResults
U.S.‐Born Foreign‐Born U.S.‐Born Foreign‐Born U.S.‐Born Foreign‐BornFirst‐LineDrugSusceptibilityResults2013 2014 2015
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,2011‐2015
Overthelastfiveyears,therewerenearlyfourtimesasmanyMDRTBcasesinNewYork
Citycomparedtotheremainderofthestate(N=54andN=14,respectively).Despitethislargedifferenceinnumber,theproportionofMDRTBcaseswascomparable.
GENOTYPING
33
Table14.TuberculosisGenotypingSummaryforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
NewYorkStaterequiresthatallinitialpositiveculturesbesubmittedforgenotyping.Beginningin2004,realtimespoligotypingandsubsequentrestrictionfragmentlengthpolymorphism(RFLP)testingwereperformedattheDepartment’sWadsworthCenterforLaboratoriesandResearch,butasof2009RFLPwasdiscontinued.Inaddition,theCDC‐sponsoredNationalTuberculosisGenotypingregionallabinMichiganhasperformedmycobacterialinterspersedrepetitiveunit(MIRU)andspoligotyping,bothofwhichareneededforagenotypetobeconsideredcomplete.
In2015,100.0percent(N=150/150)ofisolatesinNewYorkState(exclusiveofNewYorkCity)wereavailableforgenotyping.Ofthese150isolates,97.3percent(N=146)hadacompletegenotype(spoligotypeandMIRUresult).AnadditionalthreeisolatesonlyhadaspoligotypeoraMIRUresultavailable,so99.3percentofcaseshadatleastsomegenotypeinformationavailable.
No. % No. % No. % No. % No. %
177 ‐‐‐ 163 ‐‐‐ 161 ‐‐‐ 170 ‐‐‐ 157 ‐‐‐TotalFalsePositives 5 ‐‐‐ 2 ‐‐‐ 3 ‐‐‐ 3 ‐‐‐ 7 ‐‐‐Controlstrain 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Contamination 2 1.1 1 0.6 0 0.0 0 0.0 6 3.1M.bovisBCG 3 1.7 1 0.6 3 1.9 3 1.8 1 0.6
TotalTruePositives 172 ‐‐‐ 161 ‐‐‐ 158 ‐‐‐ 167 ‐‐‐ 150 ‐‐‐
IsolatesAvailable 172 ‐‐‐ 155 ‐‐‐ 158 ‐‐‐ 162 ‐‐‐ 150 ‐‐‐CompleteGenotype* 155 90.1 142 91.6 128 81.0 154 95.1 146 97.3
PartialGenotype 167 97.1 154 99.4 151 95.6 160 98.8 149 99.3NoResult 5 2.9 1 0.6 6 3.8 2 1.2 0 0.0
2015
InitialPositiveCultures
FalsePositives
TruePositives
Genotyping20142011 2012 2013
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*CompletegenotypemeanshavingbothaspoligotypeandMIRUresultMIRU=mycobacterialinterspersedrepetitiveunit
SITE OF DISEASE
34
TheprimarysiteofdiseaseformostTBcasesispulmonary,butextrapulmonaryinvolvementalsooccurs.TBisspreadfrompersontopersonthroughairbornetransmission,socaseswithpulmonaryinvolvementhavethegreatestpotentialtoinfectothers.
Table15.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015
Inthelastfiveyears,theproportionofTBcaseswithpulmonarydiseaserangedfrom69to80percentinNewYorkState(exclusiveofNewYorkCity).ThelowestproportionofcaseswithpulmonaryTBwasobservedin2013(69.1%)andthehighestwasseenin2015(80.4%).
Figure16.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState,2015
ForNewYorkStateasawhole,613(80.1%)TBcaseswerereportedwithpulmonarydiseasein2015.Amongthese613pulmonarycases,115alsohaddiseaseinoneormoreextra‐pulmonarysites.
No. % No. % No. % No. % No. %Pulmonary 141 63.8 126 58.6 119 54.8 129 63.9 124 66.0Extrapulmonary 54 24.4 65 30.2 67 30.9 45 22.3 37 19.7Both 26 11.8 24 11.2 31 14.3 28 13.9 27 14.4
TOTALCASES
2013 20142011 2012
202217215221 188
PrimarySiteofDisease 2015
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
SITE OF DISEASE
35
Table16.Extra‐PulmonarySitesofDisease*forTuberculosisCases,NewYorkState,2015
Therewere267casesinNewYorkStatewithatleastoneextra‐pulmonarysiteofdiseasein
2015.Amongthesecases,themostcommonsitesofdiseasewerelymphatic(N=109),pleural(N=80)andbone/joint(N=30).
NewYorkState NewYorkCity NewYorkState(ExclusiveofNewYorkCity) (Total)
Lymphatic 24 85 109Pleural 14 66 80Bone/Joint 6 24 30Meningeal 3 11 17Peritoneal 3 12 15Genitourinary 5 8 13Laryngeal 0 2 2Other 14 48 62
Extra‐PulmonarySiteofDisease
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*Categoriesarenotmutuallyexclusive
COMPLETION OF THERAPY
36
Table17a.TreatmentStatusforTuberculosisCases,*NewYorkState(ExclusiveofNewYorkCity),2010‐2014
InNewYorkState(exclusiveofNewYorkCity),theaveragetreatmentcompletionratefor
TBcaseswhowerealiveatdiagnosisandstartedtreatmentbetween2010and2014(themostrecentyearforwhichcompletioninformationisavailable)was90.6percent(N=976/1,077).Thehighestcompletionpercentageof92.5percent(N=221/239)wasseenin2010,followedby91.1percent(N=195/214)in2013.
Table17b.TreatmentStatusforTuberculosisCases*Reportedin2014,NewYorkState(ExclusiveofNewYorkCity)
AmongthetwoMDRTBcasesreportedinNewYorkState(exclusiveofNewYorkCity)in
2014,onecompletedtreatmentandtheothermovedoutofthecountrybeforefinishingtreatment.
No. % No. % No. % No. % No. %Complete 221 92.5 197 90.4 189 90.9 195 91.1 174 87.9Died 13 5.4 15 6.9 8 3.8 10 4.7 13 6.6Uncooperative/Refused 0 0.0 2 0.9 0 0.0 3 1.4 3 1.5Lost 1 0.4 0 0.0 1 0.5 1 0.5 2 1.0AdverseTreatmentEvent 1 0.4 1 0.5 2 1.0 2 0.9 0 0.0Other 3 1.3 3 1.4 8 3.8 3 1.4 6 3.0
TOTALCASES 214
2014
198208
TreatmentStatus 2010 2011 2012
239 218
2013
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
*ExcludespatientsfoundnottohaveTB,thosewhowerereportedatdeathandthosewhoneverstartedtreatment
No. % No. % No. %Complete 173 88.3 1 50.0 174 87.9Died 13 6.6 0 0.0 13 6.6Uncooperative/Refused 3 1.5 0 0.0 3 1.5Lost 2 1.0 0 0.0 2 1.0AdverseTreatmentEvent 0 0.0 0 0.0 0 0.0Other 5 2.6 1 50.0 6 3.0
TOTALCASES 1982196
TreatmentStatus Non‐MDR MDR Total
*ExcludespatientsfoundnottohaveTB,thosewhowerereportedatdeathandthosewhoneverstartedtreatmentMDRTB=Multidrug‐resistantTB
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
COMPLETION OF THERAPY
37
Figure17.PercentofTuberculosisCasesWhoCompletedTreatmentWithin12Months,*byU.S.‐Born**andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2005‐2014
For2014(themostrecentyearforwhichcompleteinformationisavailable),92.3percent(N=156/169)ofpatientsinNewYorkState(exclusiveofNewYorkCity)eligible^tocompletetreatmentwithin12months,didso.Alargerpercentageofforeign‐borncasescompletedtherapywithin12monthscomparedtoU.S.‐borncasesin2014(93.4%and87.5%,respectively).Anadditional5.3percent(N=9/169)ofpatientscompletedtreatmentinmorethan12monthsforanoverallcompletionrateof97.6percent.
^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),2005‐2014
In2014(themostrecentyearforwhichcompleteinformationisavailable),100.0percent(N=72/72)ofinfectiousTBcasesinNewYorkState(exclusiveofNewYorkCity)hadcontactsidentified.Thisexceedsthestateobjectiveof97.0percentandmeetsthenationalobjectiveof100.0percentfor2014.
Table19.NumberandPercentofContactstoInfectiousTuberculosisCasesEvaluatedforLatentTuberculosisInfection,NewYorkState(ExclusiveofNewYorkCity),2005‐2014
Eighty‐fivepercent(N=1,571/1,843)ofcontactstoinfectiouscasesinNewYorkState(exclusiveofNewYorkCity)wereevaluatedforLTBIin2014(themostrecentyearforwhichcompleteinformationisavailable).Thisisanincreaseof2.1percentcomparedtothe83.1percentwhowereevaluatedin2013.Commonreasonsfornotevaluatingcontactsincludetheinabilitytolocatetheindividualandthecontactrefusingevaluation.
YearTotal
InfectiousCases
No. %2005 104 103 99.0
2006 97 92 94.8
2007 78 76 97.4
2008 92 90 97.8
2009 66 65 98.5
2010 73 72 98.6
2011 80 78 97.5
2012 75 75 100.0
2013 63 62 98.4
2014 72 72 100.0
InfectiousCaseswithContactsIdentified
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
YearTotal
ContactsIdentified
No. %2005 1,865 1,665 89.3
2006 2,970 2,506 84.4
2007 4,050 3,322 82.0
2008 3,549 2,647 74.6
2009 1,768 1,447 81.8
2010 2,253 2,027 89.9
2011 3,662 3,049 83.3
2012 1,851 1,587 85.7
2013 1,462 1,215 83.1
2014 1,843 1,571 85.2
ContactsEvaluated
Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl
CONTACTS TO INFECTIOUS TUBERCULOSIS CASES
39
Figure18.NumberandPercentofContactstoInfectiousTuberculosisCasesPlacedonTreatmentforLatentTuberculosisInfectionandCompleted,NewYorkState(ExclusiveofNewYorkCity),2005‐2014
AmongthecontactstoinfectiouscasesinNewYorkState(exclusiveofNewYorkCity)whowereevaluatedin2014(themostrecentyearforwhichcompleteinformationisavailable),16.0percent(N=251/1,571)werediagnosedwithLTBI.Seventy‐ninepercent(N=198/251)ofthesecontactswerestartedonatreatmentregimenand76.8percent(N=152/198)ofthosewhostartedtreatmentcompletedtheprescribedregimen.
DIRECTLY OBSERVED THERAPY
40
Figure21.NumberandPercentofTuberculosisCases*ReceivingAnyDirectlyObservedTherapy,NewYorkState(ExclusiveofNewYorkCity),1991‐2015
InNewYorkState(exclusiveofNewYorkCity)theproportionofcasesreceivingdirectly
observedtherapy(DOT)hasbeenincreasingsincetheearly1990swhenitwasfirstactivelypromotedbytheNewYorkStateDepartmentofHealth,localhealthunits,andothers.In1991,45.2percent(N=297/657)ofTBcasesontreatmentreceivedatleastpartoftheirtherapyasDOT.Sincethen,theproportionofcasesreceivingaportionoftheirtreatmentasDOThasmorethandoubledto96.2percent(N=176/183)in2015.
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