While the overall national incidence of TB has decreased since 1992, disease among the non-U.S. born has been rising. In 1999, non-U.S.-born persons comprised over 40% of national cases. In Boston, a similar decline has occurred, mostly among white, U.S.-born, with 77% of Boston's 77 cases in 1999 occurring in persons born outside the U.S. We analyzed demographic characteristics of non-U.S. born cases reported to the Boston TB Program from 1993-1998, according to CDC reporting documentation. Among the 571 cases, 350 (61%) were from other countries. The average age of non-U.S. born patients was 40, compared to 46 for U.S. born; mean age and time in the U.S. varied greatly by country. 232 (66%) presented with pulmonary disease; 74 were clinical cases. For 286 with positive cultures, 237 (83%) were sensitive to all drugs; 20 demonstrated INH resistance; 27 were resistant to >1 drug. All were treated by nursing case-management, with 122 (35%) placed on DOT at some point. More patients in later years received DOT (25% in 1993; 42% in 1998). 310 (89%) completed treatment in Boston. Of the remaining 40, 24 (7%) moved, 12 (3%) died, and 4 (1%) were lost. No secondary drug resistance developed. Our findings suggest prevention efforts among high-risk populations must be intensified, with selective strategies targeted to ethnic groups based on cultural and personal priorities. Furthermore, case management of persons with TB achieves successful completion of treatment, although greater use of DOT by case managers reflects increasing psychosocial complexity of cases.
Learning Objectives: Recognize special needs of public health programs to provide competent TB infrastructure to diverse populations
Keywords: Tuberculosis, Surveillance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.