TUBERCULOSIS by Abby McCary

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									...in pursuit of good health




            TUBERCULOSIS
                 IN THE
            COMMONWEALTH OF
              PENNSYLVANIA
                  1997



                        Tom Ridge, Governor
              Daniel F. Hoffmann, Secretary of Health


                               May 1998
                                           TABLE OF CONTENTS

                                                                                                                        Page(s)

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1.           Tuberculosis Cases and Case Rates, Counties
             and Major Cities, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2.           Tuberculosis Cases and Case Rates, Health
             Districts, Philadelphia, Allegheny County,
             State Total, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

3.           Tuberculosis Cases and Case Rates by Age,
             Major Areas, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

4.           Tuberculosis Cases and Case Rates by Race/
             Ethnicity, Major Areas, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

5.           Tuberculosis Cases and Case Rates by Sex,
             Major Areas, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

6.           Tuberculosis Cases by Site of Disease,
             Major Areas, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

7.           Tuberculosis Cases With Previous Diagnosis,
             Cases Reported at Death, Major Areas, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

8.           Tuberculosis Cases by Country of Origin,
             Major Areas, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

9.           Tuberculosis Cases, Counties, 1992-1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

1.           Reported Tuberculosis Cases, Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

2.           Reported Tuberculosis Cases by Race/Ethnicity
             Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.           Reported Tuberculosis Cases by Country of Origin
             Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

4.           Reported Tuberculosis Cases by Form of Disease
             Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
5.          Reported Tuberculosis Cases by Age Group
            Pennsylvania, 1991 and 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

6.          Pennsylvania Mycobacteria Isolates, Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . 19

7.         Tuberculosis Cases - HIV Status Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . 20



Attachments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

1.          Tuberculosis Cases by Age, Sex, and
             Race/Ethnicity, PA, 1991 and 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

2.          Reported Tuberculosis Cases by Geographic
             Location, Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

3.          Tuberculosis Cases, Case Rates, and Relative
             Risk, by Race/Ethnicity, Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    24

4.           Drug-Resistant Tuberculosis, Pennsylvania, 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

5.          Combined Completion of Preventive Therapy Report . . . . . . . . . . . . . . . . . . . . . . . . . . 26

6.          Combined Contact Follow-up Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27


Tuberculosis Control Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
                                                         INTRODUCTION


This report is a summary of 1997 tuberculosis morbidity for the Commonwealth. The purpose of
this statistical report is to show the incidence and prevalence of tuberculosis in Pennsylvania. The
report is intended to be used as a resource by any health care provider or individual interested in
tuberculosis control. The morbidity data in this report include information from the two largest
counties - Allegheny and Philadelphia, areas served by the State Health Centers, and the other
County and Municipal Health Departments. The population not included in the Allegheny and
Philadelphia data shall be known as the Health Districts. The information is further reported in
some areas by large city and county, and was compiled by the Tuberculosis Control Program from
the data submitted using the "Report of Verified Case of Tuberculosis" (RVCT) and the SURVS-
TB surveillance software.

During 1997, a total of 528 cases of tuberculosis (TB) were reported in the Commonwealth, for a
rate of 4.4 per 100,000 population. This represents an overall decrease of 9.4 percent from the
previous year, during which there was a total of 583 cases. Philadelphia reported 236 cases in
1997, compared to the 250 cases reported for 1996, a 5.6 percent decrease. Allegheny County
with 54 cases in 1997, had a decrease of 16.9 percent from the 65 cases the previous year. The
Health Districts had 238 cases in 1997 compared to the 268 cases the previous year, a decrease of
11.2 percent.

Tuberculosis in children less than 15 years of age increased from 38 cases in 1996 to 53 cases in
1997. There was a 135 percent increase in Philadelphia, with 20 cases in 1996 and 47 in 1997.
Allegheny County had 2 cases in 1996 and 1 in 1997. The decrease in the Health Districts was
from 16 in 1996 to 5 in 1997. Since tuberculosis disease in children indicates recently acquired
infection and transmission, these data are of sentinel importance.

In 1997, 48 counties (72%) in the Commonwealth reported less than 5 cases of tuberculosis and 3
counties reported 20 or more cases. The counties were: Philadelphia (236), Allegheny (54) and
Luzerne (22). Eighteen counties in the Commonwealth (27%) reported no cases of tuberculosis
during the year.
For the first time that we can document, two cities, each with a population of more than 40,000,
reported no cases of tuberculosis in a calendar year (Scranton and York).
The county/municipal health departments accounted for 345 of the 528 tuberculosis cases
reported in 1997 (65.3%).

There was a 17% decrease in the number of tuberculosis cases among persons 65 years of age and
older. The total number of cases among this population in 1997 was 179 as compared to 215 in
1996. The rate of tuberculosis for persons over age 65 was 9.4 per 100,000 population. The rate
among residents of long term care facilities was 36.7.

PA Dept. of Health -- Tuberculosis in the Commonwealth of Pennsylvania, 1997 --- May 31, 1998 ---- Page 1
Among correctional facility inmates, there were 15 cases of tuberculosis reported in 1997, a
decrease of 32 percent from 1996. This represents a case rate of 34.9 per 100,000 population.

Among homeless persons, there were 15 documented cases of tuberculosis, for a case rate of
157.1 per 100,000 population. This information is based on the total number of homeless
reported by the State Health Data Center and reported as homeless within the past year on the
RVCT.

During 1997, tuberculosis cases among persons born outside the United States accounted for
24.4% of the total cases compared with 21.4% of cases in 1996. Compared with 1996, the
number of cases in 1997 among persons born in the United States decreased by 14.2%, and the
number of cases among foreign-born persons increased by 3.2%.

Of the 129 foreign-born persons counted in 1997, whose records contained information on month
and year of immigration, tuberculosis was diagnosed in 62 (48.1%) within 2 years after entering
the United States. Of this group, two countries (Vietnam and India) accounted for 30% of the
cases.

For the cases reported in 1996 who have completed therapy, 52 percent received some or all of
their treatment as directly observed therapy (DOT). Directly observed regimens are known to be
cost effective and additional resources have been provided to the District Offices and
County/Municipal Health Departments to expand DOT.

Effective July 1, 1997, the Tuberculosis Control Program initiated a policy of mandatory DOT for
100% of patients at high-risk for nonadherence to prescribed TB medications. The policy also
requires 80% of all other patients to receive DOT. This policy has been included in contracts with
all County/Municipal Health Departments.

The initial four drug regimen recommended by American Thoracic Society/Centers for Disease
Control and Prevention (ATS/CDC) was prescribed for 72% of cases in 1997; 15% of patients
were prescribed isoniazid (INH), rifampin (RIF), and pyrazinamide (PZA); 3% were prescribed
INH and RIF.

For the year 1996, the completion of drug therapy was 85% for Allegheny County, 98% for the
State Health Districts, and 95% for Philadelphia. This compares to a national completion rate of
86.1% in 1996. The completion of preventive therapy was 72% for Allegheny County and 81%
for the State Health Districts. Information on the completion of preventive therapy for
Philadelphia is not available. Nationally, 65.4% of patients completed preventive therapy in 1996.




PA Dept. of Health -- Tuberculosis in the Commonwealth of Pennsylvania, 1997 --- May 31, 1998 ---- Page 2
The Department’s Tuberculosis Control Program has directed that all suspected or confirmed
tuberculosis patients be offered counseling and testing for human immunodeficiency virus (HIV)
infection. Since persons infected with both HIV and the tubercle bacillus are at high risk of
developing tuberculosis disease and since the medical management of tuberculosis disease and
infection are altered in the presence of HIV coinfection, it is important to know the HIV status of
patients presenting for treatment of tuberculosis. In 1997, 31 of the 528 tuberculosis cases
reported (5.9%) also had a diagnosis of AIDS. Of the 703 tuberculosis cases reported in 1986,
only 6 (0.9%) also were known to have AIDS.

Of the 528 cases counted in 1997, 417 had positive cultures (79%). Of these, 294
(71%) had drug susceptibility test results available. There were 18 cases (6.1%) resistant to at
least isoniazid and 1 case (0.3%) resistant to at least isoniazid and rifampin, i.e., multidrug-
resistant tuberculosis (MDR-TB).

There was no change in the number of recurrent cases of tuberculosis; recurrence is defined as the
reappearance of disease after being discharged or lost to supervision for 12 or more months. In
1997 and 1996, there were 35 recurrent cases. As recurrent cases generally represent treatment
failures and are due to irregularity or interruption in medication administration, tuberculosis cases
in this category require special efforts to deliver care in ways that assure continuity of treatment
and completion of the prescribed drug regimen.

For cases with occupational information available, 21 were health care workers (5%) and 1 was a
correctional facility employee (0.2%). There were 76 cases with occupational information
unknown or missing (14%). For patients with information available, 4 percent had injected drug
use, 6 percent had non-injected drug use, and 14 percent had excess alcohol use within the past
year. However, information on substance abuse was unknown in over 23 percent of the cases
reported in 1997.

Maintaining the decline in tuberculosis morbidity and reaching the goal of eliminating tuberculosis
in the Commonwealth will require sustained prevention and control efforts - especially rapid
diagnosis, ensured completion of treatment (e.g., DOT), prompt and complete reporting, and
contact investigations.

Tuberculosis continues to be a public health problem in many cities and counties in the
Commonwealth. Elimination of tuberculosis will require coordinated efforts of public health
agencies, voluntary health associations, health-care providers, and community groups.


PA Dept. of Health -- Tuberculosis in the Commonwealth of Pennsylvania, 1997 --- May 31, 1998----Page 3
TABLES
                                 COMMONWEALTH OF PENNSYLVANIA
                                     DEPARTMENT OF HEALTH

                                            TABLE 1

                               TUBERCULOSIS CASES AND CASE RATES
                                COUNTIES AND MAJOR CITIES, 1997

                                                                       NUMBER
                 NUMBER                    RATE         MAJOR          OF CASES                RATE
                   OF       1996           PER          CITIES IN      BY MAJOR    1996        PER
                 CASES      ESTIMATE     100,000        COUNTY         CITIES      ESTIMATE   100,000

PENNSYLVANIA     528      12,056,112       4.4
ADAMS              9          84,921      10.6
ALLEGHENY         54       1,296,037       4.2          Pittsburgh      21          350,363    6.0
ARMSTRONG          1          73,872       1.4
BEAVER             2         187,009       1.1
BEDFORD            2          49,322       4.1
BERKS             10         352,353       2.8          Reading          5           75,723    6.6
BLAIR              3         131,450       2.3          Altoona          2           50,101    4.0
BRADFORD           1          62,352       1.6
BUCKS             17         578,715       2.9
BUTLER             1         167,732       0.6
CAMBRIA            4         158,500       2.5
CAMERON            0           5,745       0.0
CARBON             1          58,783       1.7
CENTRE             6         131,489       4.6
CHESTER            1         410,744       0.2
CLARION            0          42,205       0.0
CLEARFIELD         1          79,640       1.3
CLINTON            0          37,130       0.0
COLUMBIA           2          64,079       3.1
CRAWFORD           5          89,175       5.6
CUMBERLAND         5         207,042       2.4
DAUPHIN           11         246,807       4.5          Harrisburg      10           50,886   19.7
DELAWARE          18         547,592       3.3          Chester          5           40,660   12.3
ELK                1          35,141       2.8
ERIE              13         280,570       4.6          Erie            10          105,270    9.5
FAYETTE            2         145,628       1.4
FOREST             0           4,942       0.0
FRANKLIN           3         127,035       2.4
FULTON             0          14,435       0.0
GREENE             1          42,054       2.4
HUNTINGDON         4          44,977       8.9
INDIANA            0          90,073       0.0
JEFFERSON          1          46,624       2.1
JUNIATA            2          21,793       9.2
LACKAWANNA         3         213,323       1.4          Scranton         0           77,189    0.0
LANCASTER         10         450,834       2.2          Lancaster        5           53,597    9.3
LAWRENCE           0          95,780       0.0
LEBANON            1         117,179       0.9
LEHIGH            11         297,802       3.7          Allentown        9          102,211    8.8
LUZERNE           22         321,309       6.8          Wilkes-Barre     4           44,407    9.0
LYCOMING           0         119,083       0.0
MCKEAN             1          48,156       2.1
MERCER             3         122,155       2.5
MIFFLIN            7          47,006      14.9
MONROE             0         119,581       0.0
MONTGOMERY        14         708,782       2.0
MONTOUR            2          18,044      11.1
NORTHAMPTON        3         257,719       1.2          Bethlehem        1           70,245    1.4
NORTHUMBERLAND     2          95,897       2.1
PERRY              0          43,727       0.0
PHILADELPHIA     236       1,478,002      16.0          Philadelphia   236        1,478,002   16.0
PIKE               1          38,139       2.6
POTTER             0          17,103       0.0
SCHUYLKILL        10         152,630       6.6
SNYDER             1          38,034       2.6
SOMERSET           3          80,517       3.7                                                 S
SULLIVAN           0           6,145       0.0
SUSQUEHANNA        0          42,002       0.0
TIOGA              0          41,510       0.0
UNION              1          40,826       2.4
VENANGO            0          58,820       0.0
WARREN             0          44,624       0.0
WASHINGTON         5         206,708       2.4
WAYNE              0          44,718       0.0
WESTMORELAND       7         376,297       1.9
WYOMING            0          29,362       0.0


                                                 -5-
YORK   4   368,332   1.1         York   0   40,779   0.0




                           -5-
                      COMMONWEALTH OF PENNSYLVANIA
                         DEPARTMENT OF HEALTH

                                TABLE 2

               TUBERCULOSIS CASES AND CASE RATES,
                         HEALTH DISTRICTS,
       PHILADELPHIA, ALLEGHENY COUNTY, AND STATE TOTAL, 1997




         DISTRICT           NUMBER OF CASES     RATE PER 100,000
SOUTHEASTERN                       80                 2.5
 (except Philadelphia)
NORTHEASTERN                       41                 2.9
NORTH CENTRAL                      15                 2.2
SOUTH CENTRAL                      51                 3.4
NORTHWESTERN                       25                 2.6
SOUTHWESTERN                       26                 1.7
 (except Allegheny)

Subtotal Districts                238                 2.6

PHILADELPHIA CO.                  236                 16.0
ALLEGHENY CO.                      54                 4.2


STATE TOTAL                       528                 4.4




                                  - 6-
                            COMMONWEALTH OF PENNSYLVANIA
                              DEPARTMENT OF HEALTH

                                      TABLE 3

                         TUBERCULOSIS CASES AND CASE RATES
                              BY AGE, MAJOR AREAS, 1997


          PENNSYLVANIA      HEALTH DISTRICTS    ALLEGHENY CO.   PHILADELPHIA CO.
 AGE      NUMBER   RATE     NUMBER    RATE      NUMBER   RATE   NUMBER     RATE
Under 5     25     3.2         3       0.5        1       1.2     21       21.6
5-14        28     1.7         2       0.2        0       0.0     26       12.5
15-24       21     1.3         5       0.4        2       1.3     14        6.3
25-44      137     3.9        50       1.8        10      2.6     77       17.7
45-64      138     5.3        58       2.9        18      6.3     62       20.9
65+        179     9.4        120      8.2        23      9.8      36      16.3


TOTAL      528     4.4        238      2.6        54      4.2     236      16.0




                                        -7-
                             COMMONWEALTH OF PENNSYLVANIA
                                 DEPARTMENT OF HEALTH

                                            TABLE 4

                            TUBERCULOSIS CASES AND CASE RATES
                            BY RACE/ETHNICITY, MAJOR AREAS, 1997



     AREA             WHITE             BLACK              ALL RACES          ASIAN OR
                   NON-HISPANIC      NON-HISPANIC           HISPANIC      PACIFIC ISLANDER
                   Number     Rate   Number     Rate      Number   Rate   Number    Rate
Health Districts     161       1.8     27           6.9     22     9.9      28      31.9
 (65 Counties)
Allegheny Co.        32        2.9     15           9.7     0      0.0      7       39.8
Philadelphia Co.     19        2.4    153       24.6        17     47.9     47      86.5
 Total              212        2.0    195       16.7        39     13.5     82      51.3




                                              -8-
                        COMMONWEALTH OF PENNSYLVANIA
                            DEPARTMENT OF HEALTH

                                       TABLE 5

                      TUBERCULOSIS CASES AND CASE RATES
                           BY SEX, MAJOR AREAS, 1997




         AREA           TOTAL CASES                    MALE                 FEMALE
                      Number    Rate           Number         Rate   Number      Rate
Health Districts       238       2.6             158          3.0      80            1.7
 (65 Counties)
Allegheny County        54       4.2             30           4.9      24            3.5
Philadelphia County    236      16.0             135          19.7    101        12.8
 TOTAL                 528       4.4             323          5.6     205            3.3




                                         -9-
                            COMMONWEALTH OF PENNSYLVANIA
                                DEPARTMENT OF HEALTH

                                       TABLE 6

                      TUBERCULOSIS CASES BY SITE OF DISEASE,
                               MAJOR AREAS, 1997




     AREA          TOTAL CASES       PULMONARY                EXTRA              BOTH
                                                            PULMONARY
                     Number        Number            %     Number    %     Number        %
Health Districts       238           178            74.8     45     18.9     15         6.3
(65 Counties)
Allegheny Co.          54            38             70.4     13     24.1     3          5.6
Philadelphia Co.       236          161             68.2     49     20.8     26         11.0
 TOTAL                 528           377            71.4    107     20.3     44         8.3




                                           - 10 -
                                COMMONWEALTH OFPENNSYLVANIA
                                   DEPARTMENT OF HEALTH

                                              TABLE 7

                       TUBERCULOSIS CASES WITH PREVIOUS DIAGNOSIS,
                        CASES REPORTED AT DEATH, MAJOR AREAS, 1997




        AREA              TOTAL CASES               CASES WITH                     CASES REPORTED
                                                 PREVIOUS DIAGNOSIS                   AT DEATH
                                                      Number           Percent     Number    Percent
Health Districts                 238                      18             7.6         14        5.9
 (65 Counties)
Allegheny County                 54                         1            1.9         2         3.7
Philadelphia County              236                      16             6.8         8         3.4
 TOTAL                           528                      35             6.6         24        4.5


                                              TABLE 8

                         TUBERCULOSIS CASES BY COUNTRY OF ORIGIN
                                   MAJOR AREAS, 1997


     AREA             TOTAL CASES             U.S.                 NON-U.S.           ARRIVED U.S.
                                                                                       # 2 YEARS
                                       Number    Percent        Number   Percent    Number   Percent
Health Districts          238           176          73.9         62       26.1       24      10.1
(65 Counties)
Allegheny Co.             54             45          83.3         9        16.7       8       14.8
Philadelphia Co.          236           178          75.4         58       24.6       30      12.7
 TOTAL                    528           399          75.6        129       24.4       62      11.7




                                                 - 11 -
                           COMMONWEALTH OF PENNSYLVANIA
                               DEPARTMENT OF HEALTH
                                        TABLE 9
                               TUBERCULOSIS CASES, 1992 - 1997

YEAR             1992   1993              1994             1995   1996   1997
STATE            758     748               621              675    583    528
ADAMS              2       8                 1                5      3      9
ALLEGHENY         81      72                54               61     65     54
ARMSTRONG          0       2                 3                3      0      1
BEAVER             9       8                 5                1      4      2
BEDFORD            7       0                 1                2      4      2
BERKS              9      12                11               12     11     10
BLAIR              6       2                 5                4      1      3
BRADFORD           0       1                 1                0      0      1
BUCKS             12      17                13               19     18     17
BUTLER             4       5                 3                2      2      1
CAMBRIA            2       3                 6                6      3      4
CAMERON            0       1                 0                0      0      0
CARBON             2       1                 2                0      0      1
CENTRE             6      10                 8                7      0      6
CHESTER            5       9                 8                4     16      1
CLARION            1       1                 1                0      0      0
CLEARFIELD         5       3                 2                2      2      1
CLINTON            1       1                 0                0      0      0
COLUMBIA           0       0                 3                0      3      2
CRAWFORD           2       4                 1                1      1      5
CUMBERLAND         5      14                10                6      6      5
DAUPHIN           12      11                13               11     12     11
DELAWARE          38      27                14               35     10     18
ELK                0       0                 1                0      0      1
ERIE              29      31                13               27     13     13
FAYETTE            5       9                 5               10      8      2
FOREST             0       0                 0                0      0      0
FRANKLIN           2       5                 4                3      2      3
FULTON             0       1                 1                0      0      0
GREENE             2       2                 0                0      0      1
HUNTINGDON         3       2                 3                2      4      4
INDIANA            3       2                 5                1      0      0
JEFFERSON          1       3                 4                1      0      1
JUNIATA            0       1                 0                1      1      2
LACKAWANNA        19       9                10                7      4      3
LANCASTER         11      13                22                8      7     10
LAWRENCE           2       3                 1                1      2      0
LEBANON            4       1                 1                0      2      1
LEHIGH            10      12                14                8     16     11
LUZERNE           24      12                11               15     10     22
LYCOMING           6       3                 3                1      4      0
MCKEAN             1       0                 0                2      0      1
MERCER             3       6                 1                6      2      3
MIFFLIN            1       1                 6                4      8      7
MONROE             0       2                 2                2      5      0
MONTGOMERY        29      19                27               26     19     14
MONTOUR            0       0                 0                1      0      2
NORTHAMPTON       14       9                 9               10      6      3
NORTHUMBERLAND     0       2                 0                1      3      2
PERRY              0       0                 1                0      0      0
PHILADELPHIA     338     343               281              310    250    236
PIKE               0       1                 0                0      0      1
POTTER             0       0                 0                1      0      0
SCHUYLKILL         7       8                 2                9      9     10
SNYDER             0       2                 0                0      1      1
SOMERSET           4       3                 1                4      4      3
SULLIVAN           0       0                 0                0      0      0
SUSQUEHANNA        4       0                 0                1      0      0
TIOGA              1       0                 0                0      2      0
UNION              0       0                 2                0      1      1
VENANGO            1       1                 1                3      0      0
WARREN             0       5                 1                1      0      0
WASHINGTON        10      10                10                9     11      5
WAYNE              2       2                 1                0      0      0
WESTMORELAND       9       9                 8                9     15      7
WYOMING            0       0                 0                0      1      0
YORK               4       4                 5               10     12      4
FIGURES




   - 13 -
- 14 -
 Figure 2. Reported Tuberculosis Cases by Race/Ethnicity
                            Pennsylvania, 1997

                                      White, Not Hispanic
                                              40%




 Black, Not Hispanic                                        Asian/Pacific Islander
         37%                                                        16%

                                              Hispanic*
                                                 7%


*Persons of Hispanic origin may be of any race




                                          - 15 -
Figure 3. Reported Tuberculosis Cases by Country of Origin
                  Pennsylvania, 1997

                                              Rep. of Korea
                                                 7.0%         Vietnam
                                                               16.0%




                                                                        Mexico
                                                                         9.0%
 U.S. - born            Foreign - born
   75.0%                   25.0%

                                 All Others                             Cambodia
                                   45.0%                                  9.0%



                                                                India
                                                               14.0%




                                - 16 -
Figure 4. Reported Tuberculosis Cases by Form of Disease
                  Pennsylvania, 1997

                                                                   Other
                                                                   22%



Pulmonary                                    Lymphatic                      Genitourinary
  71.4%                                                                          8%
                         Extrapulmonary        34%
                              20.3%



                                                                           Bone and/or Joint
                                                                                 14%
                  Both
                  8.3%
                                                         Pleural
                                                          22%




                                          - 17 -
 Figure 5. Reported Tuberculosis Cases by Age Group
            Pennsylvania, 1991 and 1997

         1991      45-64                   1997   45-64
                   20%                            26%
25-44                          25-44
34%                            26%
                       15-24                              15-24
                        5%                                 4%



  0-14                              0-14
  3%         65+                    10%           65+
             38%                                  34%




                           - 18 -
   Figure 6. Mycobacteria Isolates (Program and Reference)
                   Pennsylvania, 1997
                              M. tuberculosis
                                   24%

             M. xenopi                                Other
                2%                                    12%


                                                        M. kansasii
                                                            3%




    M. avium complex                                  M. gordonae
          35%                                             19%

                                       M. fortuitum
                                           5%
Information Obtained from Bureau of Laboratories
                                        - 19 -
  Figure 7. Tuberculosis - HIV Status
            Pennsylvania, 1997
                Indeterminate
                     0.6%
  Unknown                        Negative
   26.6%                          24.0%




                                     Positive
                                      7.3%
Refused
 11.5%                            Test Done, Results Unk
                                          6.0%
                 Not Offered
                   24.0%




                        - 20 -
ATTACHMENTS




     - 21 -
      Attachment 1. Tuberculosis Cases by Age, Sex
     And Race/Ethnicity, Pennsylvania, 1991 and 1997
                                                           PERCENT
                                            CASES          CHANGE
                                 1991               1997
  TOTALS                         782                528       -32.5
  SEX
         MALE                    514                323       -37.2
        FEMALE                   268                205       -23.5
  AGE
         0-14                    25                 53         112
         15-24                   40                 21        -47.5
         25-44                   264                137       -48.1
         45-64                   153                138        -9.8
          65+                    300                179       -40.3
  RACE/ETHNICITY
        WHITE                    389                212       -45.5
        BLACK                    319                195       -38.9
    ASIAN/PAC.ISL.               71                 82        -15.5
      HISPANIC                   42 *               39         -7.1

*HISPANIC PERSONS APPEAR TWICE

                                        - 22 -
   Attachment 2. Reported Tuberculosis Cases By
       Geographic Location Pennsylvania, 1997
                                 REPORTED   PERCENT

   LOCATION        POPULATION     CASES     CASES     RATE

CITIES -
>100,000            2,035,846        276      52      13.6
     (N=4)

CITIES -
40,000 - 100,000     503,587          32      6       6.4
     (N=9)

ALL OTHER
                    9,516,679        220      42      2.3
AREAS



TOTAL               12,056,112       528      100     4.4




                                 - 23 -
   Attachment 3. Tuberculosis Cases, Case Rates, and
   Relative Risk by Race/Ethnicity, Pennsylvania, 1997
RACE/ETHNICITY       CASES   PERCENT    CASE RATE   RELATIVE RISK

White,
                      212      40.2         2            1
Non-Hispanic

Black,
                      195      36.9        16.7         8.4
Non-Hispanic


Hispanic*             39        7.4        13.5         6.8


Asian/Pacific Isl.    82       15.5        51.3         25.7




      TOTAL           528       100        4.4




*PERSONS OF HISPANIC ORIGIN MAY BE OF ANY RACE
                              - 24 -
       Attachment 4. Drug - Resistant Tuberculosis
                  Pennsylvania 1997


Culture-positive cases                                417

 Cases with drug susceptibility testing      PA 294 (71%)
      accomplished                           US (1997) (84%)

 Cases resistant to at least isoniazid       PA 18 (6.1%)
                                             US (1997)(7.6%)

 Cases resistant to at least isoniazid and   PA    1 (0.3%)
       rifampin (MDR-TB)                     US (1997)(1.3%)

                             - 25 -
To obtain additional information on
Tuberculosis call 717-787-6267 or write to:



Pennsylvania Department of Health
Tuberculosis Control Program
P.O. Box 90
Harrisburg, PA 17108-0090




The Pennsylvania Department of Health is
an equal opportunity agency.




HD0019P




                    - 28 -

								
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