The number of tuberculosis cases has dropped, as has the infection rate of cases per 100,000 people, compared with 2002, yet public health officials still found cause for concern in a report released Thursday by the Centers for Disease Control and Prevention.
Nationally, the number of TB cases reported in 2003 declined by 1.4% to 14,871 from 15,075 cases in 2002, according to the Atlanta-based CDC, and the infection rate itself fell by one-tenth of a percentage point from 5.2 to 5.1.
But to let no silver lining pass without sewing on a dark cloud, the CDC also reported the rate of decline in the infection rate, 1.9%, was the smallest since 1992, when a seven-year upsurge in TB occurrences peaked.
In addition, the number of TB cases went up in 19 states compared with a year ago.
Self-satisfaction, particularly on the part of members of the public who do not see the battle fought day to day, is what prompts the public words of caution, according to Susan Lippold, M.D., a public health warrior. Lippold said she was drawn to her current work after seeing the ravages of TB firsthand growing up in six Asian countries as the daughter of an entomologist working for the United Nations and U.S. aid agencies.
"I think that's the concern whenever things are relaxed and we?re pleased things are going in the right direction, there are not enough resources provided," said Lippold, medical director for the TB Control Program with the Chicago Department of Health and a CDC-paid medical officer.
"If you're talking to TB workers, this is phenomenal and it's good work, but this is still a serious disease that keeps us busy," she said. "We've seen this go back up."
During the upsurge between 1985 and 1992, the CDC report cites contributing factors as the deterioration of infrastructure for TB services; immigration of persons from TB-endemic countries; and a combination of the HIV epidemic, TB transmission in congregate settings such as prisons and multiple outbreaks of multidrug-resistant TB.
Lippold has been heading the Chicago program for 27 months. In addition to unwarranted relaxation, she says she's concerned about tight government budgets.
"There's declining funds this year, modestly, but still declining at a local, state and national level," she said. "With the crunch that the city budget is in and the state budget is in, we're certainly fighting for money."
California topped all states with 3,230 cases and with a rate of 9.1 cases per 100,000 people. Washington, D.C., posted the highest rate at 14.
Other top states based on the number of cases were Texas, 1,594 (7.2); New York, 1,477 (7.7); Florida, 1,046 (6.1); and Illinois, 633 (5). Illinois was the only state of the top five with a case rate that fell below the national average of 5.1 last year. The Illinois rate in 2002 was 5.4.
The number of TB cases went up in 2003 from 2002 in California (by 61), Texas (44) and New York (43), but dropped in Florida (by 40) and Illinois (47).
Wyoming had the fewest cases (4) and the lowest rate (0.8).
In addition, comparing data from 1998 to 2003, the number of cases of TB among foreign-born persons is up to 7,845 from 7,598 in 1998, even though the TB rate for foreign-born persons has dropped to 23.4 from 30.2 in 1998. The top five birth countries with the most foreign-born TB cases in 2003 were Mexico, with 25.6%; Philippines, 11.6%; Vietnam, 8.4%; India, 7.7%; and China, 4.8%.
While 53.5% of U.S. cases of TB involve foreign-born patients, this is not the experience in Chicago, Lippold said. "Our cases are still more than 50% in the U.S.-born African-American population," she said.
Her department is working on the second year of a CDC grant to staff a community outreach and education program as well as perform an evaluation of existing systems of care, she said.
The national report on TB statistics was the lead article in this week's Morbidity and Mortality Weekly Report and comes in advance of World TB Day on March 24.
The report also featured a case study of the probable nosocomial TB infection of four patients and a hospital employee in a Washington, D.C., hospital in 2002.
The infections occurred after a sixth patient had spent three weeks in two general medical wards at the hospital before being diagnosed with TB.