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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

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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


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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.


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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).


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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).


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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


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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



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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).


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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).


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Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2011‐2015

Overthelastfiveyears,maleshaveconsistentlycomprisedahigherproportionofTBcases

comparedtofemalesinNewYorkState(exclusiveofNewYorkCity).In2015,59.6percent(N=112/188)ofreportedcasesweremale.


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Figure8.TuberculosisCasesandRates*byAge**andGender,NewYorkState(ExclusiveofNewYorkCity),2015

In2015,thedifferenceinTBmorbiditybetweenmalesandfemalesinNewYorkState

(exclusiveofNewYorkCity)varieddependingonage.Forcases45yearsofageorolder,thenumberandrateformalesgreatlyexceededthatoffemales.ThelargestgendergapinTBmorbiditywasseenamongcases55‐64yearsoldwherethecaserateformaleswas2.5timesthatoffemales(2.8per100,000formales;1.1per100,000forfemales).


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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.


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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


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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


*Only countriesrepresenting≥5TBcasesarenamed**PuertoRicoandotherU.S.Territoriesareconsideredseperatelyforthepurposeofthistable


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


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


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


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


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


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


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


*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


*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


*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


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


*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


*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


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


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


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

tuberculosis in new york state - new york state … · tuberculosis cases by country of origin, new...

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