tuberculosis in new york state...tuberculosis cases by country of origin, new york state, 2016 table...

TUBERCULOSIS IN

NEW YORK STATE 2016

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,1960‐2016

Figure2.TuberculosisCaseRates,NewYorkStateandtheUnitedStates,1960‐2016

Figure3.NumberandPercentofDeathsamongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),1993‐2016

Figure4.DistributionofTuberculosisCases,NewYorkState,2016

Figure5.NumberandPercentofTuberculosisCasesbyRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Figure6.Race/EthnicityofTuberculosisCases,NewYorkState,2016

Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Figure8.TuberculosisCasesandRatesbyAgeandGender,NewYorkState(ExclusiveofNewYorkCity),2016

Figure9.TuberculosisCasesbyAgeandRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2016

Figure10.TuberculosisCasesbyAgeandRace/Ethnicity,NewYorkCity,2016

Figure11a.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),1985‐2016

Figure11b.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkCity,1985‐2016

Figure12.HIVStatusforTuberculosisCases,NewYorkState,2016

Figure13.NumberandPercentofTuberculosisCasesWhoHaveBeenTestedforHIV,NewYorkState(ExclusiveofNewYorkCity),2007‐2016

Figure14.TuberculosisCasesandRatesamongDOCCSInmates,NewYorkState(ExclusiveofNewYorkCity),1986‐2016

Figure15.NumberandPercentofMultidrug‐ResistantTuberculosisCases,NewYorkState,2012‐2016

Figure16.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState,2016

Figure17.PercentofTuberculosisCasesWhoCompletedTreatmentwithin12Months,byU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2006‐2015

Figure18.NumberandPercentofContactstoInfectiousTuberculosisCasesPlacedonTreatmentforLatentTuberculosisInfectionandCompleted,NewYorkState(ExclusiveofNewYorkCity),2006‐2015

Figure19.NumberandPercentofTuberculosisCasesReceivingAnyDirectlyObservedTherapy,NewYorkState(ExclusiveofNewYorkCity),1991‐2016

LIST OF TABLES

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Table1.TuberculosisCasesandRates,NewYorkState,1960‐2016

Table2.TuberculosisCasesandRatesbyCounty,NewYorkState,2012‐2016

Table3.TuberculosisCasesandRatesbyGender,AgeandRace/Ethnicity,NewYorkState,2016

Table4.TuberculosisCasesbyCountryofOrigin,NewYorkState,2016

Table5.NumberandPercentofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2016

Table6.LengthofTimeForeign‐BornTuberculosisCaseswereintheUnitedStatesPriortoDiagnosis,NewYorkState(ExclusiveofNewYorkCity),2016

Table7a.HIVStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table7b.HIVStatusforTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2016

Table8a.PrimaryReasonforEvaluationofTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table8b.PrimaryReasonforEvaluationofTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2016

Table9a.AdditionalRiskFactorsAmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table9b.AdditionalRiskFactorsAmongTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2016

Table10.High‐RiskCongregateSettingattheTimeofDiagnosisforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table11.HomelessnessAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table12.SubstanceAbuseAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table13a.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table13b.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCasesbyU.S.‐BornandForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2014‐2016

Table14.TuberculosisGenotypingSummaryforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table15.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Table16.Extra‐PulmonarySitesofDiseaseforTuberculosisCases,NewYorkState,2016

Table17a.TreatmentStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2011‐2015

Table17b.TreatmentStatusforTuberculosisCasesReportedin2015,NewYorkState(ExclusiveofNewYorkCity)

Table18.NumberandPercentofInfectiousTuberculosisCaseswithContactsIdentified,NewYorkState(ExclusiveofNewYorkCity),2006‐2015

Table19.NumberandPercentofContactstoInfectiousTuberculosisCasesEvaluatedforLatentTuberculosisInfection,NewYorkState(ExclusiveofNewYorkCity),2006‐2015

EXECUTIVE SUMMARY

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ExecutiveSummary

MORBIDITY & MORTALITY

From2015to2016,tuberculosis(TB)morbidityincreasedinNewYorkState.The2016totalof768cases(565casesinNewYorkCity,203casesintheremainderofNewYorkState)representsa0.4percentincreasefromthe765casesreportedin2015.Thenationasawholeexperienceda2.7percentdecreaseinmorbidity.Sincethemostrecentpeakepidemicin1992with4,574cases,therewasan83.2percentdecreaseinNewYorkStatecomparedtoanationaldeclineof64.2percent.

InNewYorkState(exclusiveofNewYorkCity),thenumberofTBcasesincreased8.0percentfrom188casesin2015to203casesin2016.ThenumberofTBcasesinNewYorkCitydecreasedby2.1percentfrom577casesin2015to565casesin2016.In2016,thenationasawholereported9,287cases,down2.7percentfromthe9,546casesreportedin2015.

NewYorkStaterankedfifthnationallyforTBmorbiditywithanincidencerateof4.0per100,000populationin2016.ThisrateisinfluencedbyNewYorkCity,whichhadaTBcaserateof6.9per100,000.Incontrast,NewYorkState(exclusiveofNewYorkCity)reportedanincidencerateof1.8per100,000.

GEOGRAPHIC DISTRIBUTION

Threecounties–Nassau,SuffolkandWestchester–reported49.3percentoftheTBcasesinNewYorkState(exclusiveofNewYorkCity)in2016.

RACE‐ETHNICITY

In2016,AsianscontinuedtohaveoneofthehighestincidenceratesofTBstatewide(23.3per100,000).White,non‐Hispanicshadthelowestincidencerateof0.6per100,000.

FOREIGN‐BORN

Statewide,theproportionofforeign‐borncasesincreasedfrom81.0(N=620)in2015to82.8in2016(N=636).PeopleborninChinacomprisedthegreatestnumberofforeign‐bornTBcases(N=114)inNewYorkCitywhilethoseborninIndiacomprisedthegreatestnumberofTBcases(N=14)intheremainderofthestate.

DRUG SUSCEPTIBILITY

Amongindividualswithdrugsusceptibilitiesreportedin2016,10casesfromNewYorkCityhadmultidrug‐resistantTB(MDRTB),whichwastwicethenumberidentifiedin2015(N=5).TherewerenoMDRTBcasesreportedinNewYorkState(exclusiveofNewYorkCity)for2016,aslightdeclinefromtheonecasereportedin2015.

TB IN THE PRISONS

Since1991,thenumberofTBcasesamongtheNewYorkStateDepartmentofCorrectionsandCommunitySupervision(DOCCS)inmatepopulationhadbeencontinuallydeclining,andin2011and2012nonewcaseswerereported.However,in2013,threenewDOCCScaseswerereportedandin2014,onenewcasewasreported.In2015and2016,therewerenonewDOCCScasesreported.

TUBERCULOSIS CASES AND RATES

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Table1.TuberculosisCasesandRates,*NewYorkState,1960‐2016

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 3.92016 203 1.8 565 6.9 768 4.0

YearNewYorkState NewYorkCity NewYorkState

(ExclusiveofNewYorkCity) (Total)

*RatecalculationsarebasedonUnitedStatesdecennialCensusdata;per100,000population**Figuresafter1974reflectanationallyrevisedcasedefinitionthatincludesreactivatedcasesSource:NewYorkStateDepartmentofHealthBureauofTuberculosisControl


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From2015to2016,TBcasesandratesincreasedstatewide.In2016,atotalof768caseswerereportedinNewYorkState,representinga0.4percentincreasefromthe765casesreportedin2015andan89.1percentdecreasefromthe7,075casesreportedin1960.Nearlythree‐quartersofthestate’sTBmorbidityisconcentratedinNewYorkCity.

In2016,NewYorkCityreported73.6percent(N=565/768)ofthetotalcasesdespitehavingonly42percentofthestatepopulation.Therestofthestatereported203cases,whichwasan8.0percentincreasecomparedtothe188reportedin2015.

TherateofTBinNewYorkStateisgreatlyinfluencedbythehighmorbidityinNewYorkCity.OutsideofNewYorkCity,theratein2016was1.8per100,000population,butNewYorkCityreportedarateof6.9per100,000,resultinginanoverallrateof4.0per100,000populationforthewholestate.

Figure1.TuberculosisCasesandRates,*NewYorkState,1960‐2016

Overthelast50years,therehavebeentwopeaksinTBmorbiditywherethenumberandrateofTBsubstantiallyincreased.Thepeakin1975canbeexplainedbyachangeinthecasedefinitiontoincludereactivatedTBcases.Theincreasethatbeganinthemid‐1980sandextendedthroughtheearly1990swasdrivenmainlybytheresurgenceofTBcasesinNewYorkCity.Thisrisewaslargelyduetotwofactors.OnewastheHIV/AIDSepidemicthatstartedintheearly1980s.TheotherwasthereductionofTBcontrolresourcescombinedwiththeriseinhighriskpopulationssuchasforeign‐bornandhomeless.


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Figure2.TuberculosisCaseRates,*NewYorkStateandtheUnitedStates,1960‐2016

Historically,TBcaseratesinNewYorkState(exclusiveofNewYorkCity)havebeenlowerthanthenationalaverage,whilecaseratesinNewYorkCityhaveexceedednationalrates.In2016,thenationalcaseratewas2.9per100,000populationandrangedfrom0.2to8.3per100,000populationacrossallthestates.NewYorkStaterankedthirdbasedonthenumberofcases(N=768)andfifthbasedonincidencerate(4.0per100,000population),buttheserankingswerelargelyinfluencedbyNewYorkCitywhich,byitself,wouldhaverankedfourthnationallybasedonnumberofcases(N=565)andthirdbasedonincidencerate(6.9per100,000population).


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Figure3.NumberandPercentofDeathsAmongTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),1993‐2016

ThenumberandpercentofdeathsamongTBcasesinNewYorkState(exclusiveofNew

YorkCity)decreasedconsiderablyfollowingthelastepidemicthatpeakedintheearly1990s.Thisdropinmortalityslowedby1997andhasvariedeachyearsince2000.ThedeathsportrayedinFigure3werenotallTB‐related.

AmongthereportedTBcasesinNewYorkState(exclusiveofNewYorkCity),therewere11totaldeathsin2016.ThecauseofdeathwasTB‐relatedforthreeofthesecases.Allthreehadothercomorbidities,includingHIV,diabetes,COPD,end‐stagerenaldiseaseandcancer.


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Table2.TuberculosisCasesandRates*byCounty,NewYorkState,2012‐2016

No. Rate No. Rate No. Rate No. Rate No. RateAlbany 6 2.0 5 1.6 7 2.3 2 0.7 2 0.7Allegany 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Broome 5 2.5 1 0.5 0 ‐‐‐ 3 1.5 3 1.5Cattaraugus 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Cayuga 0 ‐‐‐ 1 1.2 2 2.5 4 5.0 1 1.2Chautauqua 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Chemung 1 1.1 1 1.1 0 ‐‐‐ 0 ‐‐‐ 2 2.3Chenango 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Clinton 2 2.4 1 1.2 0 ‐‐‐ 2 2.4 0 ‐‐‐Columbia 2 3.2 0 ‐‐‐ 2 3.2 3 4.8 0 ‐‐‐Cortland 1 2.0 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Delaware 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 2.1Dutchess 4 1.3 4 1.3 7 2.4 5 1.7 1 0.3Erie 19 2.1 21 2.3 16 1.7 13 1.4 13 1.4Essex 0 ‐‐‐ 0 ‐‐‐ 1 2.5 0 ‐‐‐ 0 ‐‐‐Franklin 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Fulton 0 ‐‐‐ 1 1.8 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Genesee 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 2 3.3Greene 0 ‐‐‐ 3 6.1 0 ‐‐‐ 0 ‐‐‐ 1 2.0Hamilton 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Herkimer 0 ‐‐‐ 1 1.5 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Jefferson 0 ‐‐‐ 2 1.7 1 0.9 2 1.7 0 ‐‐‐Lewis 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 3.7Livingston 0 ‐‐‐ 2 3.1 0 ‐‐‐ 0 ‐‐‐ 1 1.5Madison 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Monroe 14 1.9 22 3.0 20 2.7 17 2.3 24 3.2Montgomery 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 2.0Nassau 36 2.7 40 3.0 33 2.5 40 3.0 38 2.8Niagara 2 0.9 3 1.4 3 1.4 4 1.8 2 0.9Oneida 5 2.1 8 3.4 3 1.3 5 2.1 8 3.4Onondaga 11 2.4 9 1.9 10 2.1 10 2.1 17 3.6Ontario 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 2 1.9 0 ‐‐‐Orange 6 1.6 9 2.4 8 2.1 2 0.5 7 1.9Orleans 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Oswego 3 2.5 0 ‐‐‐ 1 0.8 0 ‐‐‐ 1 0.8Otsego 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 1.6 0 ‐‐‐Putnam 0 ‐‐‐ 0 ‐‐‐ 2 2.0 0 ‐‐‐ 0 ‐‐‐Rensselaer 3 1.9 1 0.6 2 1.3 0 ‐‐‐ 2 1.3Rockland 11 3.5 15 4.8 11 3.5 8 2.6 4 1.3Saratoga 1 0.5 2 0.9 1 0.5 1 0.5 1 0.5Schenectady 3 1.9 3 1.9 3 1.9 3 1.9 2 1.3Schoharie 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Schuyler 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Seneca 2 5.7 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐St.Lawrence 1 0.9 1 0.9 0 ‐‐‐ 1 ‐‐‐ 0 ‐‐‐Steuben 0 ‐‐‐ 1 1.0 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Suffolk 33 2.2 22 1.5 35 2.3 24 1.6 34 2.3Sullivan 0 ‐‐‐ 1 1.3 1 1.3 0 ‐‐‐ 1 1.3Tioga 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Tompkins 4 3.9 1 1.0 4 3.9 2 2.0 2 2.0Ulster 3 1.6 4 2.2 0 ‐‐‐ 0 ‐‐‐ 1 0.5Warren 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 1 1.5Washington 0 ‐‐‐ 1 1.6 1 1.6 0 ‐‐‐ 0 ‐‐‐Wayne 0 ‐‐‐ 1 1.1 1 1.1 0 ‐‐‐ 1 1.1Westchester 35 3.7 30 3.2 27 2.8 34 3.6 28 3.0Wyoming 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐Yates 2 7.9 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐ 0 ‐‐‐

Bronx 101 7.3 91 6.6 99 7.1 87 6.3 82 5.9Kings 190 7.6 197 7.9 192 7.7 171 6.9 166 6.6NewYork 93 5.9 102 6.4 72 4.5 88 5.4 67 4.2Queens 244 10.9 242 10.8 212 9.5 218 9.8 240 10.8Richmond 23 4.9 24 5.1 10 2.1 13 3.0 10 2.1

STATETOTAL 866 4.5 873 4.5 787 4.1 765 3.9 768 4.0

1.9 202 1.8

8.0 585 7.2NewYorkCityTotal 577 7.18.0 656

2012 2013 2014

651

NewYorkStateTotal(ExclusiveofNewYorkCity)

2015

188 1.7

County

215 1.9 217

2016

203 1.8

565 6.9

*Ratecalculationsarebasedon2010UnitedStatesCensusdata;per100,000population

Source:NewYorkStateDepartmentofHealthBureauofTuberculosisControl


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TBmorbidityisnotevenlydistributedacrossNYSandvariesgreatlybetweencounties.In2016,allfiveboroughsofNewYorkCityand30(52.6%)ofthe57upstatecountiesreportedatleastoneTBcase.Highernumbersofcaseswereseeninthemetropolitanareas.NearlyhalfofallTBmorbidityreportedforNYS(exclusiveofNewYorkCity)wasconcentratedinNassau,SuffolkandWestchestercounties(49.3%,N=100/203).

Figure4.DistributionofTuberculosisCasesinNewYorkState,2016

DEMOGRAPHIC CHARACTERISTICS

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Table3.TuberculosisCasesandRates*byGender,Age,**andRace/Ethnicity,NewYorkState,2016

Statewide,in2016,thelowestincidenceratesofTBwereseenamongthehighriskpediatricpopulation(<15yearsold),withthoseinthe10‐14yearoldagegrouprepresentingonlythreecasesforarateof0.2per100,000.InNewYorkState(exclusiveofNewYorkCity),thehighestincidenceratewasseenamongthose25‐34yearsold(2.6per100,000),whereasinNewYorkCity,thehighestratewasseenamongthose65yearsandolder(12.6per100,000).

In2016,AsianscontinuedtohavethehighestincidencerateinNewYorkState(23.3per100,000).ForHispanicandblack,non‐Hispaniccases,theincidencerateswerecomparableacrossthestate(4.6and4.6per100,000forNewYorkState(exclusiveofNewYorkCity);5.3and5.9per100,000forNewYorkCity).

No. Rate No. Rate No. RateMale 122 2.2 345 8.9 467 5.0Female 81 1.4 220 5.1 301 3.0Under5years 7 1.1 7 1.4 14 1.25‐9 2 0.3 2 0.4 4 0.310‐14 1 0.1 2 0.4 3 0.215‐19 12 1.4 21 3.9 33 2.420‐24 18 2.3 41 6.4 59 4.225‐34 33 2.6 104 7.5 137 5.235‐44 31 2.1 87 7.5 118 4.545‐54 26 1.5 82 7.4 108 3.855‐64 32 2.3 94 10.6 126 5.565+ 41 2.5 125 12.6 166 6.3White,non‐Hispanic 38 0.4 50 1.8 88 0.8Black,non‐Hispanic 42 4.6 109 5.9 151 5.4Hispanic 50 4.6 124 5.3 174 5.1Asian 68 18.0 259 25.2 327 23.3AmericanIndian 1 2.7 1 5.7 2 3.7MultipleRaces 0 ‐‐‐ 12 8.1 12 3.7Other/Unknown 4 16.8 10 17.3 14 17.2

203 1.8 565 6.9 768 4.0

DemographicCharacteristicsNewYorkState NewYorkCity NewYorkState

(ExclusiveofNewYorkCity) (Total)

Gender

AgeGroup

TOTALCASES

Race/Ethnicity

*Ratecalculationsarebasedon2010UnitedStatesCensusdata;per100,000population**Agecalculationsarebasedondateofbirthandreportdate



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Figure5.NumberandPercentofTuberculosisCasesbyRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Overthelastfiveyears,themajorityofTBcasesreportedinNewYorkState(exclusiveofNew

YorkCity)havebeenofAsianandHispanicdescent.Since2012,Asianshavecontinuedtorepresentalargerpercentageofreportedcasesthananyotherracial/ethnicgroup,especiallyin2014whenthepercentageofAsiancasesdramaticallyincreasedto45.5percent(N=92/202).

In2016,althoughthemajorityofTBcasesinNewYorkState(exclusiveofNewYorkCity)continuedtobeAsianorHispanic,thenumberofwhite,non‐Hispaniccasesincreasedby52.0percentin2016comparedto2015(N=38andN=25,respectively).Inaddition,theproportionofblack,non‐Hispaniccasesreachedthehighestithasbeeninfiveyears(20.7%,N=42/203).


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Figure6.Race/EthnicityofTuberculosisCases,NewYorkState,2016

InNewYorkCity,45.8percent(N=259/565)ofreportedcasesin2016wereAsian,whereasinNewYorkState(exclusiveofNewYorkCity)Asiansrepresented33.5percent(N=68/203)ofcases.Theproportionofwhite,non‐HispaniccasesinNewYorkState(exclusiveofNewYorkCity)wasmorethandoublethatseeninNewYorkCity(18.7%and8.8%,respectively).


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Figure7.PercentofTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Overthelastfiveyears,maleshaveconsistentlycomprisedahigherproportionofTBcases

comparedtofemalesinNewYorkState(exclusiveofNewYorkCity).In2016,60.1percent(N=122/203)ofreportedcasesweremaleand39.9percent(N=81/203)werefemale.


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Figure8.TuberculosisCasesandRates*byAge**andGender,NewYorkState(ExclusiveofNewYorkCity),2016

In2016,thedifferenceinTBmorbiditybetweenmalesandfemalesinNewYorkState

(exclusiveofNewYorkCity)varieddependingonage.ThelargestgendergapinTBmorbiditywasseenamongcases25‐34yearsoldwherethecaserateformaleswas2.3timesthatoffemales(3.6per100,000formales;1.6per100,000forfemales).Amongcases65yearsofageandolder,thenumberoffemalessurpassedthenumberofmales,buttheincidencerateformaleswasstill1.3timesthatoffemales(2.9per100,000and2.2per100,000,respectively).


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Figure9.TuberculosisCasesbyAge*andRace/Ethnicity,NewYorkState(ExclusiveofNewYorkCity),2016

In2016,41(20.2%)casesinNewYorkState(exclusiveofNewYorkCity)were65yearsof

ageandolder.Sixteen(39.0%)ofthesecaseswerewhite,non-Hispanicand15(36.6%)wereAsian.

ThesecondlargestnumberofTBcasesreportedin2016forNewYorkState(exclusiveofNewYorkCity)wasseeninthe25-34yearagegroup(N=33).Thirteen(39.4%)ofthesecaseswereAsianand11(33.3%)wereHispanic.


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Figure10.TuberculosisCasesbyAge*andRace/Ethnicity,NewYorkCity,2016

InNewYorkCity,thelargestnumberofTBcasesreportedin2016wasseeninthe65years

ofageandoldergroup(N=125).Amongthese125cases,73(58.4%)wereAsianand19(15.2%)werewhite,non-Hispanic.

Similartotheremainderofthestatein2016,thesecondlargestnumberofTBcasesinNewYorkCitywasidentifiedinthe25-34yearagegroup(N=104).Forty-nine(47.1%)casesinthisagegroupwereAsianand29(27.9%)wereHispanic.

TUBERCULOSIS IN THE FOREIGN-BORN

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Figure11a.NumberandPercentofTuberculosisCasesbyU.S.-Born*andForeign-BornStatus,NewYorkState(ExclusiveofNewYorkCity),1985-2016

In2016,therewere156foreign-borncasesinNewYorkState(exclusiveofNewYorkCity),anincreasefromthe148reportedin2015.Despitethisincrease,theforeign-bornpercentagedeclinedslightly,from78.7percentin2015to76.8percentin2016.InNewYorkCity,thenumberofforeign-bornTBcasesincreasedfrom472in2015to480in2016.Theproportionofforeign-borncasesalsoincreased,from81.8percentin2015to85.0percentin2016.

Figure11b.NumberandPercentofTuberculosisCasesbyU.S.-Born*andForeign-BornStatus,NewYorkCity,1985-2016

TUBERCULOSIS IN THE FOREIGN‐BORN

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Table4.TuberculosisCasesbyCountryofOrigin,*NewYorkState,2016

In2016,therewere82differentcountriesrepresentedbythe768TBcasesreportedin

NewYorkState,25ofwhichwererepresentedbyatleastfivecases.Similartopreviousyears,themostcommoncountryoforiginforforeign‐bornTBcasesreportedbyNewYorkState(exclusiveofNewYorkCity)wasIndia(N=14)andforNewYorkCity,themostcommoncountrywasChina(N=114).

NewYorkState NewYorkCity NewYorkState(ExclusiveofNewYorkCity) (Total)

UnitedStates 48 78 126China 4 114 118Mexico 7 34 41Philippines 10 30 40India 14 21 35Haiti 8 22 30Ecuador 8 21 29Bangladesh 3 26 29DominicanRepublic 3 22 25Korea,South 7 12 19Burma 6 10 16Pakistan 6 9 15Guyana 0 15 15Nepal 4 10 14Guatemala 8 5 13Honduras 6 6 12Peru 4 6 10ElSalvador 7 2 9PuertoRico** 0 7 7Jamaica 1 6 7HongKong 1 6 7Colombia 1 5 6Vietnam 3 3 6Nigeria 3 3 6Thailand 2 3 5OtherCountries 39 89 128TOTALCASES 203 565 768

Country


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


21

Table5.NumberandPercentofTuberculosisCasesbyU.S.andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2016

In2016,therewere156foreign‐bornTBcasesreportedinNewYorkState(exclusiveofNewYorkCity).Overhalf(54.5%,N=85/156)ofthesecaseswereidentifiedinNassau,SuffolkandWestchesteralone.Amongothercountiesthatreportedatleastfiveforeign‐borncases,OnondagaandOneidareportedthehighestforeign‐bornpercentage(100.0%)whileEriereportedthelowestpercentage(53.8%).Intheremainingcountieswithforeign‐borncases,thenumberandpercentagevaried.

Albany 2 0 2 100.0Allegany 0 0 0 0.0Broome 3 0 3 100.0Cattaraugus 0 0 0 0.0Cayuga 1 1 0 0.0Chautauqua 0 0 0 0.0Chemung 2 1 1 50.0Chenango 0 0 0 0.0Clinton 0 0 0 0.0Columbia 0 0 0 0.0Cortland 0 0 0 0.0Delaware 1 0 1 100.0Dutchess 1 1 0 0.0Erie 13 6 7 53.8Essex 0 0 0 0.0Franklin 0 0 0 0.0Fulton 0 0 0 0.0Genesee 2 1 1 50.0Greene 1 0 1 100.0Hamilton 0 0 0 0.0Herkimer 0 0 0 0.0Jefferson 0 0 0 0.0Lewis 1 1 0 0.0Livingston 1 0 1 100.0Madison 0 0 0 0.0Monroe 24 11 13 54.2Montgomery 1 1 0 0.0Nassau 38 6 32 84.2Niagara 2 1 1 50.0Oneida 8 0 8 100.0Onondaga 17 0 17 100.0Ontario 0 0 0 0.0Orange 7 1 6 85.7Orleans 0 0 0 0.0Oswego 1 1 0 0.0Otsego 0 0 0 0.0Putnam 0 0 0 0.0Rensselaer 2 1 1 50.0Rockland 4 0 4 100.0St.Lawrence 0 0 0 0.0Saratoga 1 1 0 0.0Schenectady 2 0 2 100.0Schoharie 0 0 0 0.0Schuyler 0 0 0 0.0Seneca 0 0 0 0.0Steuben 0 0 0 0.0Suffolk 34 5 29 85.3Sullivan 1 1 0 0.0Tioga 0 0 0 0.0Tompkins 2 0 2 100.0Ulster 1 1 0 0.0Warren 1 1 0 0.0Washington 0 0 0 0.0Wayne 1 1 0 0.0Westchester 28 4 24 85.7Wyoming 0 0 0 0.0Yates 0 0 0 0.0TOTALCASES 203 47 156 76.8

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),2016

In2016,44.2percent(N=69/156)offoreign‐bornTBcasesinNewYorkState(exclusiveof

NewYorkCity)werediagnosedwithinfiveyearsofenteringtheU.S.Forty‐seven(68.1%)ofthese69casesenteredtheU.S.withintwoyearspriortodiagnosis.

LengthofTimeintheUnitedStates(Years) No. %

<1 22 14.11‐5 47 30.16‐10 16 10.311‐20 34 21.821‐30 20 12.831‐40 9 5.841‐50 4 2.651‐60 1 0.661‐70 1 0.6Unknown 2 1.3


HIV CO‐INFECTION

23

KnowledgeofHIVstatusisessentialforthepropermanagementofpatientswithTB.HIVinfectionimpairstheimmunesystemleavingindividualsatgreaterriskforbecominginfectedwithTBanddevelopingactivedisease.

Figure12.HIVStatusforTuberculosisCases,NewYorkState,2016

Eighty‐ninepercent(N=180/203)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)and86.0percent(N=486/565)ofcasesinNewYorkCityhadaknownHIVstatusin2016.Theco‐infectionrateforTBcasesinNewYorkState(exclusiveofNewYorkCity)andNewYorkCitywerenearlyidentical(4.9%and4.8%,respectively).IndividualsmissingHIVtestinginformationandthosewhowerenotofferedorhadrefusedtestingwereconsideredtohaveanunknownstatus.

HIV CO‐INFECTION

24

Figure13.NumberandPercentofTuberculosisCasesWhoHaveBeenTestedforHIV,NewYorkState(ExclusiveofNewYorkCity),2007‐2016

InNewYorkState(exclusiveofNewYorkCity),theproportionofTBcaseswithaknown

HIVstatushasgenerallyincreasedoverthelast10years.In2016,88.7percent(N=180/203)ofTBcaseshadadocumentedHIVresult,whichwas5.2percenthigherthanthe83.5percentseenin2015.

In2016,57.1percent(N=4/7)ofTBcasesunderfiveyearsoldhadaknownHIVstatusinNewYorkState(exclusiveofNewYorkCity).

HIV CO‐INFECTION

25

Table7a.HIVStatusforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

In2016,11.3percent(N=23/203)ofTBcasesinNewYorkState(excludingNewYorkCity)

hadanunknownHIVstatus(refused,notofferedormissing/unknown),whichwasthelowestpercentageinthelastfiveyears.Ofthe19caseswhorefusedorweren’tofferedtestingin2016,11(57.9%)wereover65yearsold.

Table7b.HIVStatusforTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2016

InNewYorkState(exclusiveofNewYorkCity),theproportionofTBcaseswithaknown

HIVstatuswasgreateramongmalescomparedtofemalesin2016(90.2%and86.5%,respectively).Additionally,80.0percent(N=8/10)ofcaseswithHIVco‐infectionweremale.Thepercentageoffemaleswhorefusedtestingwasnearlyfourtimesgreaterthanthepercentageofmaleswhorefused(6.2%and1.6%,respectively).

No. % No. % No. %Negative 102 83.6 68 84.0 170 83.7Positive 8 6.6 2 2.5 10 4.9Refused 2 1.6 5 6.2 7 3.4NotOffered 8 6.6 4 4.9 12 5.9Missing/Unknown 2 1.6 2 2.5 4 2.0

TOTALCASES

HIVTest Male Female Total

122 81 203Source:NewYorkStateDepartmentofHealth


No. % No. % No. % No. % No. %Negative 157 73.0 167 77.0 166 82.2 152 80.9 170 83.7Positive 6 2.8 14 6.5 6 3.0 5 2.7 10 4.9Refused 25 11.6 19 8.8 19 9.4 12 6.4 7 3.4NotOffered 23 10.7 13 6.0 7 3.5 15 8.0 12 5.9Missing/Unknown 4 1.9 4 1.8 4 2.0 4 2.1 4 2.0

TOTALCASES

HIVTest 2012 2013 2014 2016

203

2015

215 217 202 188Source:NewYorkStateDepartmentofHealth


REASONS FOR EVALUATION

26

Table8a.PrimaryReasonforEvaluationofTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

In2016,45.8percent(N=93/203)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)wereevaluatedbecauseofTBsymptoms.Thesecondmostcommonreasonforevaluationwasanabnormalchestradiograph(22.2%,N=45/203)followedbyanincidentallabresult(20.7%,N=42/203).Overthepastfiveyears,thesehavecontinuedtobethethreemostfrequentlyreportedreasonsforevaluation.

Table8b.PrimaryReasonforEvaluationofTuberculosisCasesbyU.S.‐born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2016

TheproportionofcasesthatunderwentevaluationduetoTBsymptomswassimilarfor

U.S.‐bornandforeign‐borncasesinNewYorkState(exclusiveofNewYorkCity)(46.8%and45.5%,respectively).Sixpercent(N=3/47)ofU.S.‐borncaseswereevaluatedbecausetheyhadbeenincontactwithanotherinfectiousTBcasecomparedto1.9percent(N=3/156)offoreign‐borncases.

No. % No. % No. % No. % No. %TBSymptoms 110 51.2 111 51.2 116 57.4 91 48.4 93 45.8AbnormalChestRadiograph 54 25.1 48 22.1 42 20.8 41 21.8 45 22.2IncidentalLabResult 35 16.3 35 16.1 23 11.4 35 18.6 42 20.7ContactInvestigation 4 1.9 6 2.8 9 4.5 14 7.4 6 3.0TargetedTesting 2 0.9 1 0.5 4 2.0 4 2.1 7 3.4ImmigrationMedicalExam 3 1.4 6 2.8 3 1.5 0 0.0 1 0.5Employment/Administrative 1 0.5 2 0.9 1 0.5 0 0.0 2 1.0HealthCareWorker 1 0.5 0 0.0 1 0.5 0 0.0 1 0.5Unknown 5 2.3 8 3.7 3 1.5 3 1.6 6 3.0TOTALCASES 215 217 202

2016

203

2015

188

PrimaryReasonforEvaluation 2012 2013 2014


No. % No. % No. %TBSymptoms 22 46.8 71 45.5 93 45.8

AbnormalChestRadiograph 10 21.3 35 22.4 45 22.2IncidentalLabResult 7 14.9 35 22.4 42 20.7ContactInvestigation 3 6.4 3 1.9 6 3.0

TargetedTesting 2 4.3 5 3.2 7 3.4ImmigrationMedicalExam 0 0.0 1 0.6 1 0.5Employment/AdministrativeTesting 1 2.1 1 0.6 2 1.0

HealthCareWorker 0 0.0 1 0.6 1 0.5Unknown 2 4.3 4 2.6 6 3.0

TOTALCASES

PrimaryReasonforEvaluationU.S.‐Born Foreign‐Born Total

47 156 203Source: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),2012‐2016

AlthoughmostTBcasesinNewYorkState(exclusiveofNewYorkCity)didn’thaveadditionalriskfactors,between33and47percentofthosediagnosedinthelastfiveyearshadatleastone.Amongthesecases,diabetescontinuestobethemostcommonlyreportedriskfactor.In2016,17.7percent(N=36/203)ofcasesinNewYorkState(exclusiveofNewYorkCity)haddiabetes,whichwassevenpercenthigherthanin2012(10.7%).Additionally,theproportionofcaseswhohadbeeninrecentcontactwithaninfectiousTBpatientwas5.7percentlowerin2016comparedto2015(4.9%and10.6%,respectively).

Table9b.AdditionalRiskFactors*AmongTuberculosisCasesbyGender,NewYorkState(ExclusiveofNewYorkCity),2016

In2016,49.4percentoffemaleTBcasesinNewYorkState(exclusiveofNewYorkCity)hadatleastoneadditionalriskfactorcomparedto38.5percentofmalecases.OversevenpercentoffemalecaseshadbeenincontactwithaninfectiousTBpatientcomparedto3.3percentofmalecases.

No. % No. % No. % No. % No. %DiabetesMellitus 23 10.7 25 11.5 30 14.9 34 18.1 36 17.7Immunosuppression(notHIV/AIDS) 15 7.0 9 4.1 11 5.4 6 3.2 11 5.4IncompleteLTBITherapy 13 6.0 9 4.1 8 4.0 8 4.3 4 2.0End‐StageRenalDisease 3 1.4 4 1.8 6 3.0 3 1.6 4 2.0Post‐OrganTransplantation 1 0.5 0 0.0 4 2.0 3 1.6 1 0.5TNF‐αAntagonistTherapy 2 0.9 2 0.9 1 0.5 1 0.5 4 2.0ContactofInfectiousTBPatient 8 3.7 13 6.0 17 8.4 20 10.6 10 4.9ContactofMDR‐TBPatient 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0MissedContact 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0

OtherRisk OtherFactors 24 11.2 16 7.4 28 13.9 26 13.8 34 16.7None NoAdditionalFactors 131 60.9 146 67.3 117 57.9 100 53.2 116 57.1

2015

188

2012 2013 2014AdditionalRiskFactors

TOTALCASES

MedicalRisk

ExposureRisk**

217 202

2016

203215*Categories are notmutually exclusive**Withinthelast2yearsLTBI=LatentTuberculosisInfection

Source:NewYorkStateDepartment ofHealthBureau ofTuberculosisControl

No. % No. % No. %DiabetesMellitus 21 17.2 15 18.5 36 17.7Immunosuppression(notHIV/AIDS) 5 4.1 6 7.4 11 5.4IncompleteLTBITherapy 2 1.6 2 2.5 4 2.0End‐StageRenalDisease 4 3.3 0 0.0 4 2.0Post‐OrganTransplantation 1 0.8 0 0.0 1 0.5TNF‐αAntagonistTherapy 1 0.8 3 3.7 4 2.0ContactofInfectiousTBPatient 4 3.3 6 7.4 10 4.9ContactofMDR‐TBPatient 0 0.0 0 0.0 0 0.0MissedContact 0 0.0 0 0.0 0 0.0

OtherRisk OtherFactors 15 12.3 19 23.5 34 16.7None NoAdditonalFactors 75 61.5 41 50.6 116 57.1

203

AdditionalRiskFactors

MedicalRisk

ExposureRisk**

TOTALCASES 122 81

Male Female Total

*Categoriesarenotmutuallyexclusive**Withinthelast2yearsLTBI=LatentTuberculosisInfection


RISK FACTORS

28

Figure14.TuberculosisCasesandRates*AmongDOCCS**Inmates,NewYorkState(ExclusiveofNewYorkCity),1986‐2016

Duringthelate1980sandearly1990s,asubstantialproportionofTBcasesreportedby

NewYorkState(exclusiveofNewYorkCity)wereintheNewYorkStateDepartmentofCorrectionsandCommunitySupervision(DOCCS)inmatepopulation.AmongtheDOCCSinmatepopulation,therehasbeenanotabledeclineincasessince1991when102newcases(176per100,000inmates)werereported.In2011and2012therewerenonewcasesreported,butin2013therewerethreenewcases(5.5per100,000inmates)andin2014therewasonenewcase(1.8per100,000inmates).In2015and2016therewerenonewTBcasesreportedamongtheDOCCSinmatepopulation.

RISK FACTORS

29

ThereisanincreasedriskofTBtransmissionforresidentsandstaffofcongregatesettings(e.g.,correctionalfacilitiesandlong‐termcarefacilities)duetothecloseproximityandprolongedcontactwithothers.Residentsofcongregatesettingsmayalsohavesignificantcomorbiditiesthatamplifythisriskevenfurther.

Table10.High‐RiskCongregateSettingattheTimeofDiagnosisforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

ThenumberandpercentageofcasesdiagnosedwhileresidinginacongregatesettingvariedoverthelastfiveyearsinNewYorkState(exclusiveofNewYorkCity),butwashighestin2016(3.9%,N=8/203)andlowestin2015(2.1%,N=4/188).In2016,75percent(N=6/8)ofcasesdiagnosedinacongregatesettingwereidentifiedinalong‐termcarefacility,mostofwhichwereinanursinghome(N=4).

Table11.HomelessnessAmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

ThehomelesspopulationisatincreasedriskofacquiringortransmittingTBtoothersashomelessnessisoftenaccompaniedbyotherriskfactorsassociatedwithTB,suchassubstanceabuse,HIVinfection,andinadequatemedicalcare.Apersonisconsideredtobehomelessiftheydon’thaveafixed,regularnighttimeresidence.Theseindividualsmayliveonthestreets,alternatebetweenmanytemporaryresidences,orresideinprivatelyorpubliclysupervisedshelters.

From2012to2016,anaverageof1.8percent(N=18/1,025)ofTBcasesinNewYorkState(exclusiveofNewYorkCity)werehomelesswithinthe12monthspriortodiagnosis.In2016,2.5percent(N=5/203)ofTBcaseswerehomeless,whichwassimilartothepreviousyear(2.7%,N=5/188).

No. % No. % No. % No. % No. %JuvenileFacility 0 0.0 0 0.0 1 0.5 0 0.0 1 0.5

LocalJail 0 0.0 0 0.0 1 0.5 1 0.5 0 0.0StatePrison 0 0.0 3 1.4 1 0.5 0 0.0 0 0.0FederalPrison 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5OtherFacility 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0Alcohol/DrugTreatment 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0Hospital‐Based 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0MentalHealthResidence 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0NursingHome 3 1.4 2 0.9 1 0.5 2 1.1 4 2.0Residential 1 0.5 0 0.0 0 0.0 0 0.0 2 1.0OtherLong‐TermCare 1 0.5 2 0.9 0 0.0 0 0.0 0 0.0Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

2013

CorrectionalFacility

Long‐TermCareFacility

CongregateSettingatTimeofTBDiagnosis

2012

TOTALCASES 215 217 202

2016

203

2014 2015

188Source:NewYorkStateDepartmentofHealth


No. %2012 1 0.52013 5 2.32014 2 1.02015 5 2.72016 5 2.5

Year HomelessCases


RISK FACTORS

30

SubstanceabuseweakenstheimmunesystemwhichcanleavepeoplemoreinfectiousoratgreaterriskofbecominginfectedanddevelopingactiveTB.Also,thedrugsusedtotreatTBcanbetoxictotheliversosubstanceabuse,suchasexcessalcoholuse,canincreasethedamagingeffectsoftreatment.

Table12.SubstanceAbuse*AmongTuberculosisCasesWithinthePastYear,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

InNewYorkState(exclusiveofNewYorkCity),excessalcoholusehasbeenthemost

commonlyreportedformofsubstanceabuseamongTBcasesoverthelastfiveyears.Therewere14cases(6.9%)in2016whoreportedalcoholabuse,four(28.6%)ofwhichalsoreportednon‐injectiondruguse.

No. % No. % No. % No. % No. %InjectionDrugUse 0 0.0 2 0.9 1 0.5 0 0.0 0 0.0Non‐InjectionDrugUse 5 2.3 6 2.8 3 1.5 2 1.1 8 3.9ExcessAlcoholUse 10 4.7 22 10.1 13 6.4 15 8.0 14 6.9TOTALCASES

SubstanceAbuse 2015

188

2013 2014 2016

203215 217 202

2012

*Categoriesarenot mutuallyexclusive 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),2012‐2016

Overthelastfiveyears,therehavebeen782culture‐confirmedTBcasesinNewYorkState(exclusiveofNewYorkCity).Drugsusceptibilityresultshavebeenreportedfor99.2percent(N=776/782)ofthesecases,most(84.3%,N=654)ofwhichhavebeensusceptibletoallfirst‐lineTBdrugs.Despitethishighlevelofsusceptibility,therewere122caseswithfirst‐linedrugresistancebetween2012and2016,eightofwhichhadMDRTB.

In2016,drugsusceptibilityresultswerereportedfor98.7percent(N=148/150)ofculture‐confirmedcasesinNewYorkState(exclusiveofNewYorkCity).Sevenpercent(N=3/41)ofU.S.‐borncaseshadfirst‐lineresistancecomparedto19.6percent(N=21/107)offoreign‐borncases.

Table13b.DrugSusceptibilityResultsforCulture‐ConfirmedTuberculosisCasesbyU.S.‐Born*andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2014‐2016

No. % No. % No. % No. % No. %161 ‐‐‐ 157 ‐‐‐ 164 ‐‐‐ 150 ‐‐‐ 150 ‐‐‐158 98.1 157 100.0 163 99.4 150 100.0 148 98.7

Susceptibletoallfirst‐linedrugs 133 84.2 134 85.4 139 85.3 123 82.0 125 84.5INHandRIFresistant(MDRTB) 3 1.9 2 1.3 2* 1.2 1 0.7 0 0.0INHresistanceonly 11 7.0 6 3.8 11 6.7 11 7.3 8 5.4RIFresistanceonly 0 0.0 1 0.6 0 0.0 0 0.0 0 0.0ResistanceotherthanINHandRIF 11 7.0 14 8.9 11 6.7 15 10.0 15 10.1

2016First‐LineDrugSusceptibilityResults 2012 2013 2014 2015

PositiveCultureSusceptibilityTestReported

SusceptibilityTestResults


*1casehadextensivelydrugresistantTB(XDRTB)INH=Isoniazid;RIF=Rifampin;MDRTB=Multidrug‐resistantTB

No. % No. % No. % No. % No. % No. %34 ‐‐‐ 130 ‐‐‐ 26 ‐‐‐ 124 ‐‐‐ 42 ‐‐‐ 108 ‐‐‐33 97.1 130 100.0 26 100.0 124 100.0 41 97.6 107 99.1

Susceptibletoallfirst‐linedrugs 29 87.9 110 84.6 21 80.8 102 82.3 38 92.7 87 81.3INHandRIFresistance(MDRTB) 0 0.0 2** 1.5 0 0.0 1 0.8 0 0.0 0 0.0INHresistanceonly 2 6.1 9 6.9 2 7.7 9 7.3 1 2.4 7 6.5RIFresistanceonly 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0ResistanceotherthanINHandRIF 2 6.1 9 6.9 3 11.5 12 9.7 2 4.9 13 12.1

PositiveCultureSusceptibilityTestReported

SusceptibilityTestResults

Foreign‐BornFirst‐LineDrugSusceptibilityResults2014 2015 2016

U.S.‐Born Foreign‐Born U.S.‐Born Foreign‐Born U.S.‐Born


*U.S.‐bornisdefinedassomeonebornin oneofthe50states,DistrictofColumbia,orbornoutsidetheUnitedStatestoatleastoneparentwhowasaU.S.citizen**1casehadextensivelydrugresistantTB(XDRTB)INH=Isoniazid;RIF=Rifampin;MDRTB=Multidrug‐resistantTB

DRUG RESISTANCE

32

Figure15.NumberandPercentofMultidrug‐ResistantTuberculosisCases,*NewYorkState,2012‐2016

Overthelastfiveyears,thereweresixtimesasmanyMDRTBcasesinNewYorkCity

comparedtotheremainderofthestate(N=48andN=8,respectively).In2016,noMDRTBcaseswerereportedforNewYorkState(exclusiveofNewYorkCity),whereasinNewYorkCitytherewere10(2.3%)MDRTBcasesreported.

.

GENOTYPING

33

Table14.TuberculosisGenotypingSummaryforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

NewYorkStaterequiresthatallinitialpositiveculturesbesubmittedforgenotyping.Beginningin2004,realtimespoligotypingandsubsequentrestrictionfragmentlengthpolymorphism(RFLP)testingwereperformedattheDepartment’sWadsworthCenterforLaboratoriesandResearch,butasof2009RFLPwasdiscontinued.Inaddition,theCDC‐sponsoredNationalTuberculosisGenotypingregionallabinMichiganhasperformedmycobacterialinterspersedrepetitiveunit(MIRU)andspoligotyping,bothofwhichareneededforagenotypetobeconsideredcomplete.

In2016,99.3percent(N=149/150)ofisolatesinNewYorkState(exclusiveofNewYorkCity)wereavailableforgenotyping.Ofthese149isolates,98.7percent(N=147)hadacompletegenotype(spoligotypeandMIRUresult).AnadditionaltwoisolatesonlyhadaspoligotypeoraMIRUresultavailable,so100.0percentofcaseshadatleastsomegenotypeinformationavailable.

No. % No. % No. % No. % No. %

163 ‐‐‐ 161 ‐‐‐ 170 ‐‐‐ 157 ‐‐‐ 154 ‐‐‐TotalFalsePositives 2 ‐‐‐ 3 ‐‐‐ 3 ‐‐‐ 7 ‐‐‐ 4 ‐‐‐Controlstrain 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Contamination 1 0.6 0 0.0 0 0.0 6 3.1 0 0.0M.bovisBCG 1 0.6 3 1.9 3 1.8 1 0.6 4 2.5

TotalTruePositives 161 ‐‐‐ 158 ‐‐‐ 167 ‐‐‐ 150 ‐‐‐ 150 ‐‐‐IsolatesAvailable 155 ‐‐‐ 158 ‐‐‐ 162 ‐‐‐ 150 ‐‐‐ 149 ‐‐‐

CompleteGenotype* 142 91.6 128 81.0 154 95.1 146 97.3 147 98.7PartialGenotype 154 99.4 151 95.6 160 98.8 149 99.3 147 98.7

NoResult 1 0.6 6 3.8 2 1.2 0 0.0 2 1.3

TruePositives

20142012 2013Genotyping 2015 2016

InitialPositiveCultures

FalsePositives


*CompletegenotypemeanshavingbothaspoligotypeandMIRUresultMIRU=mycobacterialinterspersedrepetitiveunit

SITE OF DISEASE

34

TheprimarysiteofdiseaseformostTBcasesispulmonary,butextrapulmonaryinvolvementalsooccurs.TBisspreadfrompersontopersonthroughairbornetransmission,socaseswithpulmonaryinvolvementhavethegreatestpotentialtoinfectothers.

Table15.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState(ExclusiveofNewYorkCity),2012‐2016

Inthelastfiveyears,theproportionofTBcaseswithpulmonarydiseaserangedfrom69to

80percentinNewYorkState(exclusiveofNewYorkCity).ThehighestproportionofcaseswithpulmonaryTBwasobservedin2015(80.4%)andthelowestwasseenin2016(69.0%).

Figure16.PrimarySiteofDiseaseforTuberculosisCases,NewYorkState,2016

In2016,77.9percent(N=440/565)ofTBcasesinNewYorkCityhadpulmonarydiseasecomparedto69.0percent(N=140/203)ofcasesintherestofthestate.Amongthese580pulmonarycasesthroughoutthestate,104alsohaddiseaseinoneormoreextra‐pulmonarysites.

No. % No. % No. % No. % No. %Pulmonary 126 58.6 119 54.8 129 63.9 124 66.0 115 56.7Extrapulmonary 65 30.2 67 30.9 45 22.3 37 19.7 63 31.0Both 24 11.2 31 14.3 28 13.9 27 14.4 25 12.3

TOTALCASES 203

PrimarySiteofDisease 2015 20162013 20142012

202217215 188Source:NewYorkStateDepartmentofHealth


SITE OF DISEASE

35

Table16.Extra‐PulmonarySitesofDisease*forTuberculosisCases,NewYorkState,2016

Therewere292casesinNewYorkStatewithatleastoneextra‐pulmonarysiteofdiseasein2016.Amongthesecases,themostcommonsitesofdiseasewerelymphatic(N=100),pleural(N=69)andbone/joint(N=44).

NewYorkState NewYorkCity NewYorkState(ExclusiveofNewYorkCity) (Total)

Lymphatic 33 67 100

Pleural 18 51 69

Bone/Joint 9 35 44

Peritoneal 7 18 25

Meningeal 4 10 17

Genitourinary 7 10 17

Laryngeal 0 2 2

Other 16 47 63

Extra‐PulmonarySiteofDisease


*Categoriesarenotmutuallyexclusive

COMPLETION OF THERAPY

36

Table17a.TreatmentStatusforTuberculosisCases,*NewYorkState(ExclusiveofNewYorkCity),2011‐2015

InNewYorkState(exclusiveofNewYorkCity),theaveragetreatmentcompletionratefor

TBcaseswhowerealiveatdiagnosisandstartedtreatmentbetween2011and2015(themostrecentyearforwhichcompletioninformationisavailable)was89.6percent(N=916/1,022).Thehighestcompletionpercentageof91.1percent(N=195/214)wasseenforcasesreportedin2013,followedby90.9percent(N=189/208)forthosereportedin2012.

Table17b.TreatmentStatusforTuberculosisCases*Reportedin2015,NewYorkState(ExclusiveofNewYorkCity)

Forthe184TBcasesinNewYorkState(exclusiveofNewYorkCity)whowerealiveat

diagnosisandwhostartedtreatmentin2015,87.5percent(N=161/184)completedtherapy.ThisincludestheoneMDRTBcasereportedin2015.

No. % No. % No. % No. % No. %

Complete 197 90.4 189 90.9 195 91.1 174 87.9 161 87.5Died 15 6.9 8 3.8 10 4.7 13 6.6 14 7.6Uncooperative/Refused 2 0.9 0 0.0 3 1.4 3 1.5 2 1.1Lost 0 0.0 1 0.5 1 0.5 2 1.0 0 0.0AdverseTreatmentEvent 1 0.5 2 1.0 2 0.9 0 0.0 1 0.5Other 3 1.4 8 3.8 3 1.4 6 3.0 6 3.3TOTALCASES 214

TreatmentStatus 2011 2012

218

2013 2015

184

2014

198208Source:NewYorkStateDepartmentofHealth

BureauofTuberculosisControl*ExcludespatientsfoundnottohaveTB, thosewhowerereportedatdeathandthosewhoneverstartedtreatment

No. % No. % No. %Complete 160 87.4 1 100.0 161 87.5Died 14 7.7 0 0.0 14 7.6Uncooperative/Refused 2 1.1 0 0.0 2 1.1AdverseTreatmentEvent 1 0.5 0 0.0 1 0.5Other 6 3.3 0 0.0 6 3.3

TOTALCASES 1841183

TreatmentStatus Non‐MDR MDR Total

*ExcludespatientsfoundnottohaveTB,thosewhowerereportedatdeathandthosewhoneverstartedtreatmentMDRTB=Multidrug‐resistantTB


COMPLETION OF THERAPY

37

Figure17.PercentofTuberculosisCasesWhoCompletedTreatmentWithin12Months,*byU.S.‐Born**andForeign‐BornStatus,NewYorkState(ExclusiveofNewYorkCity),2006‐2015

For2015(themostrecentyearforwhichcompleteinformationisavailable),94.3percent(N=148/157)ofpatientsinNewYorkState(exclusiveofNewYorkCity)eligible^tocompletetreatmentwithin12months,didso.Alargerpercentageofforeign‐borncasescompletedtherapywithin12monthscomparedtoU.S.‐borncasesin2014(95.3%and90.0%,respectively).Anadditional3.2percent(N=5/157)ofpatientscompletedtreatmentinmorethan12monthsforanoverallcompletionrateof97.5percent.^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),2006‐2015

In2015(themostrecentyearforwhichcompleteinformationisavailable),100.0percent(N=72/72)ofinfectiousTBcasesinNewYorkState(exclusiveofNewYorkCity)hadcontactsidentified.Thisexceedsthestateobjectiveof97.0percentandmeetsthenationalobjectiveof100.0percentfor2015.

Table19.NumberandPercentofContactstoInfectiousTuberculosisCasesEvaluatedforLatentTuberculosisInfection,NewYorkState(ExclusiveofNewYorkCity),2006‐2015

Seventy‐fivepercent(N=1,431/1,922)ofcontactstoinfectiouscasesinNewYorkState(exclusiveofNewYorkCity)wereevaluatedforLTBIin2015(themostrecentyearforwhichcompleteinformationisavailable).Thiswasthelowestevaluationpercentageoverthelast10years.Manycontactsidentifiedduringtwolargeinvestigationsinajailandahealthcarefacilitywerenolongeratthosefacilitiesandcouldnotbelocated.Inaddition,themajorityofcontactsidentifiedduringanotherlargeinvestigationinaclose‐knitcommunitycenterrefusedevaluation.

YearTotal

InfectiousCases

No. %2006 97 92 94.82007 78 76 97.42008 92 90 97.82009 66 65 98.52010 73 72 98.62011 80 78 97.52012 75 75 100.02013 63 62 98.42014 72 72 100.02015 72 72 100.0

InfectiousCaseswithContactsIdentified


YearTotal

ContactsIdentified

No. %2006 2,970 2,506 84.42007 4,050 3,322 82.02008 3,549 2,647 74.62009 1,768 1,447 81.82010 2,253 2,027 89.92011 3,662 3,049 83.32012 1,851 1,587 85.72013 1,462 1,215 83.12014 1,843 1,571 85.22015 1,922 1,431 74.5

ContactsEvaluated


CONTACTS TO INFECTIOUS TUBERCULOSIS CASES

39

Figure18.NumberandPercentofContactstoInfectiousTuberculosisCasesPlacedonTreatmentforLatentTuberculosisInfectionandCompleted,NewYorkState(ExclusiveofNewYorkCity),2006‐2015

AmongthecontactstoinfectiouscasesinNewYorkState(exclusiveofNewYorkCity)whowereevaluatedin2015(themostrecentyearforwhichcompleteinformationisavailable),12.5percent(N=179/1,431)werediagnosedwithLTBI.Sixty‐eightpercent(N=122/179)ofthesecontactswerestartedonatreatmentregimenand74.6percent(N=91/122)ofthosewhostartedtreatmentcompletedtheprescribedregimen.

DIRECTLY OBSERVED THERAPY

40

Figure21.NumberandPercentofTuberculosisCases*ReceivingAnyDirectlyObservedTherapy,NewYorkState(ExclusiveofNewYorkCity),1991‐2016

InNewYorkState(exclusiveofNewYorkCity)theproportionofcasesreceivingdirectly

observedtherapy(DOT)hasbeenincreasingsincetheearly1990swhenitwasfirstactivelypromotedbytheNewYorkStateDepartmentofHealth,localhealthunits,andothers.In1991,45.2percent(N=297/657)ofTBcasesontreatmentreceivedatleastpartoftheirtherapyasDOT.Sincethen,theproportionofcasesreceivingaportionoftheirtreatmentasDOThasmorethandoubledto98.9percent(N=187/189)in2016.

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...tuberculosis cases by country of origin, new york state, 2016 table...

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