Tuberculosis Fact Sheet

Tuberculosis (TB) is an airborne infection caused by the bacterium Mycobacterium tuberculosis that primarily affects the lungs.  TB can be spread by coughing, sneezing, laughing or singing.  Repeated exposure to someone with TB disease is generally necessary for infection to take place.  Although TB primarily affects the lungs, other organs and tissues may be affected as well.

• In 2003, total number of new cases of tuberculosis in the United States (14,874), represented the tenth consecutive year the number of reported TB cases has decreased, resulting in the lowest rate for reported TB cases (5.1 per 100,000) since national surveillance began in 1953.
  
  
• In 2003, Asians had the highest TB case rate (29.3 per 100,000) followed by Native Hawaiian or Other Pacific Islander (21.8 per 100,000), African Americans (11.6 per 100,000), Hispanic (10.3 per 100,000), American Indians or Alaskan Natives (8.1 per 100,000) and Whites (1.4 per 100,000).
  
  
• For the second year, over half of new TB cases (53%) were in foreign-born persons.  The case rate among foreign-born persons was eight times higher than among U.S. born persons (23.6 vs. 2.7 per 100,000).
  
  
• In 2002, 784 people died of tuberculosis an increase of 2.6 percent from the 764 deaths in 2001. This was the first time since 1989 TB deaths increased in the United States.
  
  
• The World Health Organization (WHO) estimated that there were 8.8 million new cases of TB and two million deaths resulted from TB in 2002 worldwide. Someone is the world is newly infected with TB bacilli every second and one-third of the world's population is currently infected with TB.
  
  
• The AIDS epidemic is considered a major factor in the increase of TB cases.  HIV's suppression of the immune system both opens the door to new active infection and permits activation of latent disease.  One-third of the increase in global TB cases over the last five years can be attributed to the HIV epidemic.
  
  
• It is important to understand that there is a difference between being infected with TB and having TB disease. Someone who is infected with TB has the TB germs, or bacteria, in his/her body.  The body's defenses, though, are protecting them from the germs, and they are not sick.  Someone with TB disease is sick and, if not properly treated, can spread the disease to other people.  A person with symptoms of TB disease or evidence of infection needs to be seen by a physician.
  
  
• Several symptoms are associated with TB disease, including prolonged coughing (sometimes including coughing up of blood), repeated night sweats, unexplained weight loss, loss of appetite, fever, chills, and general lethargy.  Because these signs may be indicative of other diseases as well, a person must consult a physician to determine the cause of these symptoms.
  
  
• The simplest way to find out if you have a TB infection is to get a TB skin test, widely available at clinics or at a doctors' office. The preferred Mantoux test should be used for screening and diagnosis. A small amount of testing material is injected under the very top layers of skin on the forearm.  In 48 to 72 hours the test is read by a trained person, usually a nurse or doctor. If the test is significant, then you probably have TB infection and the doctor will run more tests, such as a chest x-ray, to determine whether you have active TB disease.  In some groups, such as the elderly or those with impaired immunity, the skin test may not be significant in the presence of TB infection.
  
  
• Tuberculin screening programs should be targeted to each community's high risk groups.  It is extremely important that these screening programs undergo regular evaluation of their usefulness.
  
  
• Tuberculin skin-testing is recommended for diagnostic screening among the following high-risk groups: persons with signs, symptoms, and/ or laboratory abnormalities suggestive of clinically active TB; people who interact with persons with active TB disease; poor and medically under-served people; homeless people; those who come from countries with high TB incidence rates
  nursing home residents; alcoholics and intravenous drug users; people with HIV or AIDS, or who are otherwise immune-suppressed; people in jail or prison;and health care workers and others such as prison guards who work with high-risk populations.
  
  
• Most TB can be cured.  There are drugs that can kill the germs that cause TB, but a person must continually take the prescribed medication, usually for nine months.  Some patients require a year or more for successful treatment.
  
  
• If a person stops taking the medicine before completing treatment, the germs may come back more resilient than before.  Surviving bacteria may become resistant to the drugs used to treat TB, causing multi-drug resistant tuberculosis (MDR TB).
  
  
• Because it is difficult for some people to successfully complete their tuberculosis treatment, several innovations have been developed.  One of these is the use of incentives and enablers, which may be transportation, tokens or food coupons that are given to patients each time they appear at the clinic or doctor's office for treatment.  Incentives and enablers are combined with the use of directly observed therapy (DOT).  DOT is a system of treatment in which the patient is administered his or her medication by a nurse or health worker and is observed taking the medication.
  
  
• In June 1998, the U.S. Food and Drug Administration approved the first new drug for pulmonary tuberculosis in 25 years. The drug, rifapentine (Priftin), is approved for use with other drugs to fight TB. One potential advantage of rifapentine is that it can be taken less often in the final four months of treatment -- once a week compared with twice a week for the standard regimen.
  

For more information on tuberculosis, please review the Tuberculosis Morbidity and Mortality Trend Report and Lung Disease Data in the  Data and Statistics section of www.lungusa.org or call the American Lung Association at 1-800-LUNG-USA (1-800-586-4872).

Centers for Disease Control and Prevention: Reported Tuberculosis in the U.S., 2003.

World Health Organization. Global TB Control Report, 2003.

American Thoracic Society and Centers for Disease Control and Prevention.  Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection.  American Journal of Respiratory and Critical Care Medicine. Vol. 161(4), April 2000.

American Thoracic Society, CDC and Infectious Disease Society of America. Treatment of Tuberculosis.

Morbidity and Mortality Weekly Report 2003; 52: RR-11