Reports on HIV/AIDS: 1990

MARCH 16, 1990, MMWR, Vol. 39, No. 10, pp. 153-156
Update: Tuberculosis Elimination - United States
In April 1989, CDC's Advisory Committee for the Elimination of Tuberculosis
(ACET) published A Strategic Plan for the Elimination of Tuberculosis in the United
States (1). This plan established the goal of tuberculosis (TB) elimination (i.e., a case
rate of 0.1 per 100,000 persons) by the year 2010, with an interim goal of a case rate
of 3.5 per 100,000 population by the year 2000.
CDC, in collaboration with state and local health departments, uses three sources
to monitor progress toward these goals: 1) an individual-case surveillance system,
2) TB mortality data from CDC's National Center for Health Statistics (NCHS), and
3) program performance data collected on cases, contact follow-up, bacteriologic
conversion of sputum, continuity of drug therapy, completion of therapy, and
preventive therapy. This report updates TB elimination efforts based on the most
recent data from these three sources.
Case Surveillance
In 1988, the last year for which individual-case data are available, 22,436 TB cases
(9.1 per 100,000 U.S. population) were reported, a 0.4% decrease from the 22,517
cases reported in 1987. If the 6.7% average annual decline between 1981 and 1984 had
continued through 1988, an estimated 14,768 fewer cases would have been expected
during 1985-1988 (Figure 1).
When compared with 1985, the number of reported TB cases in the 25-44-year age
group in 1988 increased by 961 cases; however, in other age groups, cases declined
(Table 1). In all age groups, reported cases increased among non-Hispanic blacks and
Hispanics but decreased among non-Hispanic whites, Asians/Pacific Islanders, and
American Indians/Alaskan Natives (Table 1). In the 25-44-year age group, cases
among non-Hispanic blacks increased by 22.6% (from 2898 in 1985 to 3552 in 1988);
Hispanics, by 34.5% (from 1153 to 1551); and non-Hispanic whites, by 2.3% (from
1520 to 1555). Increases in cases occurred among both males and females. In 1988, TB
case rates for racial/ethnic minorities were approximately fourfold to ninefold higher
than for non-Hispanic whites (Table 1).
NCHS Data
Final TB mortality data from NCHS for 1987 indicate that 1755 persons died from
TB in the United States-a 1.5% decrease from the 1782 deaths reported in 1986.
Program Performance Data
Case register and contact follow-up reports contained information on approximately 75% of cases reported during 1988. As of December 31, 1988, 76% of the
patients receiving two or more TB drugs were current with their chemotherapy
regimen. Up-to-date bacteriologic information was available for 57% of patients; for
84% of these patients, contacts were identified, and 93% of these were examined. Of
contacts who were examined, 23% were infected. Preventive therapy was prescribed
for 89% of infected contacts <15 years of age and for 59% of those >15 years of age.
Approximately 1% of the contacts examined had clinically apparent TB.
Data on the bacteriologic conversion of sputum were known for 17,868 (79%) of the
22,517 cases reported during 1987. Sixty-one percent of patients with positive sputum
were known to have become negative (bacteriologic conversion) within 3 months
after starting chemotherapy; 20% remained positive beyond the third month of
chemotherapy; and 7% died within 3 months of being reported. No information was
available on the remaining patients.

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