March 22, 2012 – In recognition of World Tuberculosis Day, the Health Department released new figures showing a decline in local tuberculosis (TB) cases. New York City recorded 689 cases of TB in 2011. This is the lowest number of annual cases ever recorded in New York City, and 82% fewer TB cases than at the peak of the epidemic in 1992. This continuing decline reflects national trends and the combined efforts of the Health Department, healthcare providers and community leaders to expand TB control procedures, including improved infection control practices in hospitals and upgraded laboratory methods that ensure more effective treatment regimens.
“The continued decline in the number of TB cases owes a great deal to New York City’s devoted, knowledgeable healthcare providers who report TB cases and manage TB patients,” said Health Commissioner Dr. Thomas Farley. As the number of TB cases continues to decline, it is essential that healthcare providers continue to collaborate on reporting and monitoring the treatment of TB cases, thereby improving health outcomes for New Yorkers with TB, while ensuring that everyone receives the same standard of care regardless of insurance or immigration status.”
On Friday, the Health Department will host its annual World TB Day conference for healthcare providers and community leaders. The theme is “Stopping TB in My Lifetime.” Health Department staff and invited TB experts will present the latest data on TB in New York City and highlight ways in which healthcare providers and the Health Department can work together to improve services for high-risk populations affected by TB.
Since June 2010, the New York City Health Code has required healthcare providers to submit a discharge plan to the Health Department for review and approval prior to discharging infectious TB patients from the hospital. In addition, providers must now send the Health Department a proposed treatment plan within one month of treatment initiation for all persons newly diagnosed with active TB. These new requirements have improved collaboration and communication between healthcare providers and the Health Department.
“One of the best parts of my practice is working together with the Health Department to provide seamless TB care to our patients,” said Dr. Eric Leibert, assistant director of the Bellevue Chest Service.
“We are moving into 2012 with strong initiatives to improve case management for TB patients and reduce TB in high-risk populations,” said Dr. Diana Nilsen, acting assistant commissioner for TB Control. “This year, we will continue to leverage the latest technologies to safely and efficiently manage patient information, focus efforts to reduce TB in populations at highest risk for TB, and integrate the latest treatment regimen for latent TB infection.”
Reaching New Yorkers at High Risk
While New York City’s TB rate continues to fall, it is still more than twice the national rate (8.5 versus 3.4 cases per 100,000 people). The neighborhoods with the highest TB rates are West Queens (21.4 cases per 100,000 people), Sunset Park (18.8), Flushing-Clearview (15.4), Highbridge-Morrisania (12.5) and Long Island City-Astoria (11.7). Foreign-born persons and ethnic and racial minorities are disproportionately affected by TB. In 2011, 80% of the total reported cases in New York City were among individuals born outside the US. The top five countries of origin among foreign-born persons with TB were China, Mexico, Bangladesh, the Dominican Republic and Ecuador. TB remains a problem in many of these countries and throughout much of the world, causing illness in an estimated 9 million people each year and killing more than 1.5 million annually worldwide.
In order to reduce the rate of TB among foreign-born New Yorkers, the Health Department is working with providers and communities to develop innovative strategies to enhance testing and treatment, empower communities and remove barriers to TB care. The Health Department is conducting health needs assessments among its staff, other healthcare providers, and TB patients and community members from foreign-born communities. Various stakeholders in foreign-born communities contributed to the methods, recruitment and questionnaire content. The results of these health needs assessments will be used to improve TB services provided to foreign-born populations.
New York City has seen a 97% decline in multidrug-resistant TB (MDR-TB) since the early 1990s, thanks to better case management and infection control. The number of MDR-TB cases has remained relatively stable for the past few years. It increased slightly in 2011, with 16 MDR-TB cases reported compared to 11 cases reported in 2010. Two of the cases last year were considered extensively drug-resistant TB (XDR-TB), which is resistant to the most effective anti-TB drugs.
Infection with HIV can increase an individual’s chances of becoming sick from TB, and can complicate treatment. Worldwide, 13% of people with TB are also HIV infected. In New York City, the proportion of TB patients with HIV co-infection has declined over time, from 18% of cases in 2000 to 8% of cases in 2011.
About Tuberculosis (TB)
TB is a bacterial infection that spreads from person to person through the air. The infection can remain latent for many years before causing active disease, usually in the lungs. When people who are sick with TB cough or speak, they expel TB germs into the air. Other people may breathe in the TB germs, and some may become sick.
TB is not spread by shaking hands, sharing food or having sex, and brief contact with someone who is sick (on a train or bus, for example) is unlikely to cause infection. TB typically spreads through close, daily contact.
Most people don’t know they have TB infection until they become sick. People at high risk can stop TB by getting themselves tested and taking treatment to prevent TB disease.
Who Should Get Tested for TB
- People who have symptoms of active TB disease (a bad cough for a least three weeks, weakness or fatigue, weight loss, fever, night sweats)
- People who have spent a long time with someone who has active TB disease (a family member, friend, or co-worker)
- People who have recently come from a country with a high rate of TB
- People who have HIV infection, lowered immunity, or certain medical conditions such as diabetes or chronic kidney failure
- People who have worked or lived in a homeless shelter, prison or other group setting
Free Testing and Treatment
The Health Department offers free, confidential TB testing for those at risk and state-of-the-art TB treatment. Treatment is available in all five boroughs and is open to all, regardless of immigration status or ability to pay. For more information call 311 or search TB at www.nyc.gov.