The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

4199.0: Tuesday, November 18, 2003 - 3:00 PM

Abstract #67849

Trends in primary multidrug-resistant tuberculosis (TB) in the United States, 1993-2000

Todd W. Wilson, MS, CHES, Lilia P. Manangan, RN, MPH, Robert H. Pratt, BS, and Marisa Moore, MD, MPH. National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-10, Atlanta, GA 30333, 404-639-5303,

To describe trends in primary multidrug-resistant TB (MDR TB) in the U.S., we analyzed TB cases reported to the National Tuberculosis Surveillance System during 1993-2000. Culture-positive cases in persons with drug susceptibility test results and no previous TB were included. Primary MDR TB was defined as initial resistance to at least isoniazid and rifampin. Of 116,561 total cases, 1,751 (1.5%) were classified as primary MDR TB. The number and proportion declined sharply from 410 (2.5%) in 1993 to 155 (1.1%) in 1997, and then decreased to 118 (1.0%) in 2000. The number of MDR cases among U.S.-born persons decreased 88% (302 [2.6% of 11,789] in 1993 to 37 [0.6% of 6,139] in 2000) while decreasing 23% among non-U.S.-born persons (105 [2.3% of 4,651] to 81 [1.5% of 5,584]), resulting in the proportion of total MDR cases in non-U.S.-born persons increasing from 26% to 69%. The number of MDR cases decreased 95% (174 to 9) in persons with HIV coinfection and 54% (236 to 109) among those not known to be coinfected. In HIV-infected persons, 88% of the MDR TB cases were among U.S.-born; in persons with MDR TB but not known to be coinfected, 45% were U.S.-born. The substantial decline in primary MDR TB among the U.S.-born, particularly those with HIV infection, likely resulted from successful efforts to interrupt transmission in the U.S. A lesser effect among non-U.S.-born persons is consistent with other evidence suggesting most of these cases result from infection acquired outside the U.S.

Learning Objectives:

Keywords: Surveillance, Tuberculosis

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Centers for Disease Control and Prevention, National Tuberculosis Surveillance System. No commercial products discussed.
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employee of CDC, NCHSTP, Division of TB Elimination

Approaches to Population-based Assessment of Disease Prevalence

The 131st Annual Meeting (November 15-19, 2003) of APHA