Revisiting rates of reactivation tuberculosis: a population-based approach.

RATIONALE Reactivation tuberculosis (TB) occurs as a result of reactivation of latent TB infection (LTBI), and was reported to occur in the United States at a rate of 0.10 to 0.16 cases per 100 person-years in the 1950s; it has not been measured since. OBJECTIVES To calculate the rate of reactivation TB in a U.S. community. METHODS A population-based tuberculin skin test survey for LTBI was performed in western Palm Beach County, Florida, from 1998 to 2000 along with a cluster analysis of TB case isolates in the same area from 1997 to 2001. Reactivation (unclustered) TB was presumed to have arisen from the population with LTBI. MEASUREMENTS AND MAIN RESULTS The rate of reactivation TB among persons with LTBI without HIV infection was 0.040 cases per 100 person-years (95% confidence interval [CI], 0.024-0.067) using the n method and 0.058 cases per 100 person-years (95% CI, 0.038-0.089) using the n-1 method. HIV infection was the strongest risk factor for reactivation (rate ratio [RR], 57; 95% CI, 27-120; P < 0.001). Among persons without HIV infection, reactivation was increased among those older than 50 years (RR, 3.8; 95% CI, 1.3-11) and among those born in the United States (RR, 3.2; 95% CI, 1.1-9.3). CONCLUSIONS Rates of reactivation TB in this area have declined substantially since the 1950s. The greatest part of this decline may be attributed to the disappearance of old, healed TB in the population. If similar declines are seen in other areas of the United States, the cost-effectiveness of screening and treatment of LTBI may be substantially less than previously estimated.

[1]  Alling Dw,et al.  The after-history of pulmonary tuberculosis. IV. Far advanced tuberculosis. , 1954 .

[2]  C. Palmer,et al.  Height, weight, tuberculous infection, and tuberculous disease. , 1971, Archives of environmental health.

[3]  D. Vlahov,et al.  Update on the seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1994. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[4]  P. Small,et al.  Tuberculosis in the homeless. A prospective study. , 2000, American journal of respiratory and critical care medicine.

[5]  T. To,et al.  The significance of the tuberculin skin test in elderly persons. , 1987, Annals of internal medicine.

[6]  L. Geiter,et al.  Ending Neglect: The Elimination of Tuberculosis in the United States , 2000 .

[7]  Z. Taylor.  The cost-effectiveness of screening for latent tuberculosis infection. , 2000, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[8]  Elvin Geng,et al.  Changes in the transmission of tuberculosis in New York City from 1990 to 1999. , 2002, The New England journal of medicine.

[9]  C. Horsburgh,et al.  Integration of a participatory research strategy into a rural health survey , 2003, Journal of General Internal Medicine.

[10]  D. Rose.  Benefits of screening for latent Mycobacterium tuberculosis infection. , 2000, Archives of internal medicine.

[11]  Julia Gunn,et al.  Risk of progression to active tuberculosis among foreign-born persons with latent tuberculosis. , 2007, Chest.

[12]  J. Battershill.  Cutaneous testing in the elderly patient with tuberculosis. , 1980, Chest.

[13]  Ferebee Sh.  Controlled chemoprophylaxis trials in tuberculosis. A general review. , 1970 .

[14]  E. Nardell,et al.  Genotyping Analyses of Tuberculosis Cases in U.S.- and Foreign-Born Massachusetts Residents , 2002, Emerging infectious diseases.

[15]  W. Stead,et al.  Does the risk of tuberculosis increase in old age? , 1983, The Journal of infectious diseases.

[16]  C. Palmer,et al.  Tuberculosis morbidity of young men in relation to tuberculin sensitivity and body build. , 1957, American review of tuberculosis.

[17]  D. van Soolingen,et al.  Molecular epidemiology of tuberculosis and other mycobacterial infections: main methodologies and achievements , 2001, Journal of internal medicine.

[18]  C. F. von Reyn,et al.  Human immunodeficiency virus infection in a rural community in the United States. , 2004, American journal of epidemiology.

[19]  T. Ezzati-Rice,et al.  Risk behavior and correlates of risk for HIV infection in the Dallas County Household HIV survey. , 1994, American journal of public health.

[20]  Dowdle Wr,et al.  A strategic plan for the elimination of tuberculosis in the United States. , 1989, MMWR. Morbidity and mortality weekly report.

[21]  S. Vermund,et al.  A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. , 1989, The New England journal of medicine.

[22]  K. Castro,et al.  Epidemiology of tuberculosis in the United States. , 2005, Clinics in chest medicine.

[23]  G. Schoolnik,et al.  The epidemiology of tuberculosis in San Francisco. A population-based study using conventional and molecular methods. , 1994, The New England journal of medicine.

[24]  R. Mitchell.  Mortality and relapse of uncomplicated advanced pulmonary tuberculosis before chemotherapy: 1,504 consecutive admissions followed for fifteen to twenty-five years. , 1955, American review of tuberculosis.

[25]  W W Stead,et al.  Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. , 1985, The New England journal of medicine.

[26]  R. Horsburgh,et al.  Priorities for the treatment of latent tuberculosis infection in the United States. , 2004, The New England journal of medicine.

[27]  M. Fahs,et al.  Tuberculosis prevention: cost-effectiveness analysis of isoniazid chemoprophylaxis. , 1988, American journal of preventive medicine.

[28]  S. Grzybowski,et al.  THE CHALLENGE OF TUBERCULOSIS IN DECLINE. A STUDY BASED ON THE EPIDEMIOLOGY OF TUBERCULOSIS IN ONTARIO, CANADA. , 1964, The American review of respiratory disease.

[29]  K. Citron.  Trends in tuberculosis. , 1984, Postgraduate medical journal.

[30]  T. Sterling,et al.  Latent TB infection treatment acceptance and completion in the United States and Canada. , 2010, Chest.

[31]  E. Salpeter,et al.  Monitored Isoniazid Prophylaxis for Low-Risk Tuberculin Reactors Older Than 35 Years of Age: A Risk-Benefit and Cost-Effectiveness Analysis , 1997, Annals of Internal Medicine.

[32]  M. Murray.  Sampling Bias in the Molecular Epidemiology of Tuberculosis , 2002, Emerging infectious diseases.

[33]  C. F. von Reyn,et al.  Environmental risk factors for infection with Mycobacterium avium complex. , 2006, American journal of epidemiology.

[34]  D. Alling,et al.  The after-history of pulmonary tuberculosis. VI. The first fifteen years following diagnosis. , 1960, The American review of respiratory disease.

[35]  E. L. Crossley.  A GENERAL REVIEW , 1954 .

[36]  G W Comstock,et al.  The prognosis of a positive tuberculin reaction in childhood and adolescence. , 1974, American journal of epidemiology.

[37]  G. Comstock,et al.  Tuberculosis studies in Muscogee County, Georgia. Twenty-year evaluation of a community trial of BCG vaccination. , 1976, Public health reports.

[38]  T. Sterling,et al.  The scope and impact of treatment of latent tuberculosis infection in the United States and Canada. , 2006, American journal of respiratory and critical care medicine.

[39]  E. Vynnycky,et al.  Interpreting DNA fingerprint clusters of Mycobacterium tuberculosis. , 1999 .