2009 Georgia tuberculosis report

2009 Georgia
Tuberculosis Report

Division of Public Health

2009 Georgia Tuberculosis Report | 1

2009 Georgia Tuberculosis Report

Georgia Department of Community HealthDavid Cook Commissioner

Division of Public Health

Brenda Fitzgerald, M.D

State Health Officer

Public Health Program and Services

Miriam Bell, M.P.H.



Deputy Director



Epidemiology Branch

Anilkumar Mangla, M.S., PhD.,M.P.H.



Acting State Epidemiologist

Tuberculosis Epidemiology Section

Rose-Marie Sales, M.D., M.P.H. Section Chief

Tuberculosis Program

Karen Buford, R.N., M.S., M.S.N.

Program Manager

Susan Ray, M.D.



Medical Consultant

Acknowledgments:
We thank the County Health Department staff, District Health Office TB coordinators, and state TB surveillance staff who collected and reported the data that were used in this annual report. Thanks to Jimmy Clanton for the design and graphics of this report.
Further information on this report can be obtained by contacting: Rose-Marie Sales, M.D., M.P.H. Georgia Department of Community Health Division of Public Health Epidemiology Branch TB Epidemiology Section 2 Peachtree St., NW, Atlanta, GA 30303 Phone: (404) 657-2634 E-mail: rfsales@dhr.state.ga.us
Citation: 2009 Georgia Tuberculosis Report, Georgia Department of Community Health, Division of Public Health, Atlanta, Georgia, April 2010.

2009 Georgia Tuberculosis Report | 1

Table of Contents
Tuberculosis Surveillance in Georgia............................................................................................................................................3 Current Epidemiology of TB in Georgia........................................................................................................................................4 High-Risk Populations........................................................................................................................................................................7 Drug Resistance....................................................................................................................................................................................9 Indicators of Infectiousness..............................................................................................................................................................9 Initial Diagnosis, Health Provider Data and Directly Observed Therapy..........................................................................9 Tuberculosis Mortality.......................................................................................................................................................................9 Tuberculosis Contact Investigations and Latent TB Infection.............................................................................................9 Tuberculosis Program Objectives............................................................................................................................................... 10 Tables: Morbidity Trends and Program Performance Indicators by Health District.................................................. 11 Graphs: Tuberculosis Morbidity Trends by Health District, 1995-2009.......................................................................... 28
2009 Georgia Tuberculosis Report | 2

Tuberculosis (TB) Surveillance in Georgia
Tuberculosis, or TB, is a reportable disease in Georgia. All Georgia physicians, laboratories and other health care providers are required by law to immediately report clinical and laboratory confirmed TB cases under their care to Georgia public health authorities. TB cases may be directly reported to a County Health Department, a District Health office, or to the state TB Program and TB Epidemiology Section of the Georgia Department of Community Health, Division of Public Health (DCH-DPH), which is responsible for the systematic collection of all reported TB cases in the state. Immediate reporting of TB cases enables appropriate public health follow-up of patients, including administration of directly observed therapy, monitoring TB treatment until completion, evaluating and screening contacts exposed to a TB case, and outbreak investigation and control.
TB cases in Georgia can be reported electronically through the State Electronic Notifiable Disease Surveillance System (SendSS), a secure Web-based surveillance software developed by DPH, or by calling, mailing or faxing a report to public health authorities. Hospital infection control practitioners as well as public health nurses, outreach staff, epidemiologists, and communicable disease specialists involved in disease surveillance are encouraged to report TB through SendSS and register to become a SendSS user by logging into the system's website at: https://sendss.state. ga.us then selecting TB from the list of reportable diseases.
Public health authorities collect data on reported TB cases that include demographic, clinical, risk factor, and contact information. The data are analyzed to describe the distribution of the disease among Georgia's population, identify high risk groups and TB clusters, describe trends in morbidity, mortality and drug resistance patterns, treatment outcomes, and infection rates among contacts to TB cases. The data are used at state and local levels to guide policy and decision making, set priorities for program interventions, evaluate program performance for the prevention and control of TB in Georgia, and educate key stakeholders and the general public on TB. Georgia's TB surveillance data are transmitted electronically to the U.S. Centers for Disease Control and Prevention and become part of the national TB surveillance database.
2009 Georgia Tuberculosis Report | 3

Current Epidemiology of Tuberculosis in Georgia

In 2009, Georgia reported 415 new TB cases, representing a 13% decrease from 478 TB cases reported in 2008, the largest single-year decline reported since expanded TB surveillance began in 1993 (Figure 1). The TB case rate in Georgia decreased from 4.9 cases per 100,000 population in 2008 to 4.2 per 100,000 in 2009. Georgia has the ninth highest TB case rate among the 50 states of the United States.
Geographic Distribution
Among 159 counties in Georgia, four metropolitan Atlanta counties reported the highest number of TB cases in 2009: Fulton (81 cases), DeKalb (62), Gwinnett (58), and Cobb (18). Only three other counties reported 10 or more TB cases in 2009: Muscogee (13 cases), Clayton (11), and Chatham (10 cases). Ninety-three counties did not report a single case of TB, 48 counties reported fewer than five cases, and 11 counties reported between 5-9 cases in 2009 (Table 1, Figure 2).
Among Georgia's 18 Health Districts, which have oversight responsibility for public health in the 159 counties of the state, Fulton Health District reported the most TB number of TB cases in 2009 (81 cases), followed by Lawrenceville (63), and DeKalb (62). These three Health Districts accounted for 50% of TB cases reported in Georgia in 2009. The Health Districts with the highest TB case rates in 2009 were: DeKalb (8.3 per 100,000), Fulton (7.8 per 100,000), Columbus (6.4 per 100,000) and Lawrenceville (6.3 per 100,000) (Table 2, Figure 3). The Health Districts that reported the largest decreases in the number of cases from 2008-2009 included Lawrenceville (less 18 cases), DeKalb (less 16 cases) and Cobb (less 10 cases).

Figure 1. TB Cases and Case Rates Georgia,1982-2009

Number of Cases

Rate/100,000

1000

16

900

14

800 700

12

600

10

500

8

400

6

300 200

4

100

2

0

0

1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Year Case Counted

Number Case Rate

Figure 2. High TB Incidence Counties Georgia, 2009

Atlanta

Cobb n= 18
Fulton n= 81

Gwinnett n= 58
DeKalb n= 62

Number of TB Cases: >= 15 cases < 15 cases

Figure 3. TB Case Rates by Health Districts Georgia, 2009

1-2

2-0

Gordon

1-1 Bartow

Polk Paulding

Haralson

3-1

3-2 3-4
3-5
Rockdale
3-3

10-0

4-0 5-2

Case rates/100,000 population:
<= 3.5 (national target) 3.6 to 4.2 > 4.2 (state average)
6-0

7-0
8-2
Seminole Decatur

5-1 9-1
9-2 8-1

2009 Georgia Tuberculosis Report | 4

Sex and Age Distribution
TB occurred predominantly among men (66%) while the highest number and proportion of TB cases by age group for both sexes occurred among persons 25-44 years old (35%) (Figure 4). The highest case rate by age group was among persons 65 years and older (5.7 per 100,000) while the lowest was in children 5-14 years old (0.5 per 100,000) (Figure 5). The TB case rate for children younger than 5 years of age in Georgia decreased from 4.6 per 100,000 in 2008 to 2.3 per 100,000 in 2009.

Figure 4. TB Cases by Age Group and Sex Georgia, 2009

100 90
80 70
60 Number 50
40 30
20 10
0 < 5

5-14 15-24 25-44 45-64 >= 65 Age Group (years)
Male Female

Figure 5. TB Case Rates* by Age Group 2005-2009, Georgia

Age Group 2005
< 5 yrs. 4.3 5-14 yrs. 0.7 15-24 yrs. 5.6 25-44 yrs. 6.6 45-64 yrs. 6.1 65+ yrs. 8.6

2006
4.1 0.8 5.1 6.9 6.6 6.1

2007
3.5 0.8 4.3 6.0 6.0 7.4

2008
4.5 0.6 3.9 6.3 6.6 5.4

2009
2.3 0.5 4.1 5.1 5.4 5.7

*Rates are per 100,000 population

2009 Georgia Tuberculosis Report | 5

Race/Ethnicity Distribution and TB Disparities
TB disproportionately affects racial/ethnic minorities in Georgia. In 2009, non-Hispanic blacks, Hispanics, and Asians accounted for 45%, 22% and 15% of TB cases in Georgia but only represented 30%, 8% and 3% of Georgia's population respectively (Figure 6). Non-Hispanic whites constituted 18% of cases in 2009. The highest TB case rate among race/ethnic groups was in Asians (21.7 per 100,000), followed by Hispanics (11.2 per 100,000), and non-Hispanic blacks (6.2 per 100,000) (Figure 7). The black non-Hispanic TB case rate in 2009 represents an almost 80% drop from the TB case rate in 1993 (30.6 per 100,000) in this population. The black non-Hispanic TB case rate, however, was still five times higher than the white nonHispanic TB case rate (1.2 per 100,000) in 2009 (Figure 8).

Figure 6. TB Cases by Race/Ethnicity Georgia, 1999 and 2009

Asian 7%
White 20%
Hispanic 10%
1999

Black 63%

Asian 15%
White 18%

Black 45%

Hispanic 22%
2009

Figure 7. TB Case Rates* by Race/Ethnicity Georgia, 2005-2009

Race/ Ethnicity
Asian, non-Hispanic Hispanic, All races Black, non-Hispanic White, non-Hispanic

2005 2006 2007 2008 2009 17.8 26.4 21.5 27.2 29.7 13.6 16.5 12.9 11.8 11.2 10.8 9.0 8.3 7.8 6.2 1.5 1.3 1.2 1.2 1.2

*Rates are per 100,000 population

Figure 8. TB Case Rates in non-Hispanic Blacks and Whites, Georgia, 1993-2009

Non-Hispanic Black Non-Hispanic White

Case Rate/100,000

35 30.6 30

25

20

15

10

6.2

5 3.7

1.2

0

1993 1995 1997 1999 2001 2003 2005 2007 2009

Year

2009 Georgia Tuberculosis Report | 6

High-Risk Populations

Foreign-born
The number of TB cases in Georgia among persons born outside of the United States increased fivefold from 1993 to 2008 (from 40 to 197 cases), then decreased 11% from 2008 to 2009. TB cases among foreign-born persons accounted for 42% of TB cases in Georgia in 2009 compared to 41% in 2008. Most foreign-born cases reported in 2009 came from Mexico (28%), Vietnam (8%), and India (7%) countries where TB is an endemic disease (Figures 9-10). Among foreign-born cases, 50% were diagnosed in the first four years of their arrival in the U.S.
In 2009, the majority of foreign-born TB cases were reported from four Health Districts: Lawrenceville (45 cases), DeKalb (37), Fulton (23), and Cobb (15). Among these four Health Districts, foreign-born TB cases accounted for more than half of the TB cases in Lawrenceville (71%), Cobb (71%) and DeKalb (60%). Foreign-born TB cases in the Fulton Health District accounted for 28% of reported TB cases in Fulton.
HIV co-infection
All TB patients need to be tested for HIV infection because TB treatment may change when antiretroviral therapy for HIV is given, and active TB often accelerates the natural progression of HIV infection. Among 376 cases with known HIV status in 2009, 15% were HIV positive compared to 12% in 2008 (Figure 11). HIV status was reported in 91% of cases compared to 86% in 2008. Among the high-risk age group of adults 25-44 years of age, HIV reporting increased from 94% in 2008 to 96% in 2009. Among 56 HIV co-infected TB cases in 2009, 82% were non-Hispanic blacks, 71% were male, and 54% were 25-44 years old.

Figure 9. US-born and Foreign-born TB Cases Georgia,1993-2009
Number 800 700 600 500 400 300 200 100
0 1993 1995 1997 1999 2001 2003 2005 2007 2009
Year
US-born Foreign-born

Figure 10. Percent of Foreign-born TB Cases (n=176) by Country of Origin, Georgia, 2009

Others 41%

Bhutan

4% Ethiopia 4%

Kenya 4%

Mexico 28%
India 8% Vietnam 7%
Guatemala 4%

Figure 11. HIV Status of TB Cases Georgia,1993-2009

Unknown Negative Positive

Number

900 800 700 600 500 400 300 200 100
0
1993 1995 1997 1999 2001 2003 2005 2007 2009
Year

2009 Georgia Tuberculosis Report | 7

Congregate Settings and Substance Abuse
Persons residing in crowded congregate settings such as homeless shelters, prisons, and nursing homes are at risk for acquiring TB. In 2009, 47 (11%) cases were homeless, 25 (6%) were residents of correctional facilities, and 7 (2%) were residents of long-term care facilities. Of the 25 cases incarcerated in correctional facilities, 11 were inmates in county jails, nine in state prisons, and five in the Immigration and Custom Enforcement Detention Center in Stewart County.
Substance abuse is the most commonly reported behavioral risk factor among patients with TB in the United States. TB patients who abuse substances often experience treatment failure and remain infectious longer because treatment failure presumably extends periods of infectiousness. In Georgia, abuse of either illicit drugs or alcohol was reported in 83 (20%) cases in 2009 (Table 3, Figure 12).
Pediatric TB
TB in children is considered a sentinel public health event because it often indicates recent transmission from an infectious adult case. Additionally, potentially lethal forms of TB such as TB meningitis or miliary TB can develop in very young children. In 2009, children younger than 15 years old comprised 6% of Georgia TB cases; 17 cases (2.3 per 100,000) were reported in children younger than 5 years old, seven cases (0.5 per 100,000) were reported in children 5-14 years old. Two children had TB meningitis.
Young children are a priority for the Georgia TB program. All CDC/American Thoracic Society recommendations for treatment of pediatric TB cases and the follow-up of children, who are contacts to TB cases, including directly observed preventive therapy for children < 5 years old, are being followed.

Figure 12. TB in Other High-Risk Populations Georgia, 2005-2009

120

100 20%
80

Number 60

11%

40 20
0 2005

2006

2007 Year

2008

6% 2%
2009

Substance abuse Homeless Correctionals Long-Term Care

2009 Georgia Tuberculosis Report | 8

Drug Resistance

Of 294 culture-confirmed cases in 2009, 286 (97%) were tested for drug susceptibility to the three first line anti-TB medications: isoniazid (INH), rifampin (RIF), and ethambutol (EMB). Of 286 tested isolates from cases with no previous history of TB, 39 (14%) had primary resistance to INH, 5 (1.7%) to RIF, and 3 (1.0%) to EMB (Table 4). Two multidrugresistant TB (MDR-TB, i.e. TB resistant to at least INH and RIF) cases were reported in 2009. The percentage of cases with primary INH resistance (INH-R) ranged from 5% to 9% in the past 5 years while an average of one MDR-TB case per year was reported over that same time period (Figure 13).
Indicators of Infectiousness

Number Percent

Figure 13. Drug Resistance and MDR-TB Georgia, 2005-2009

45

16

40

14 14

35

12

30

10

25

20

7

7

9 8

15

6

6

10

4

5

1

0

2

1

22

0

0

2005 2006 2007 2008 2009

Year

INH RIF MDR-TB % INH-R

Persons with pulmonary or laryngeal TB have the potential of infecting others with TB, and infectiousness is higher if their sputum smears are positive for acid-fast bacilli (AFB), sputum cultures are positive for Mycobacterium tuberculosis, or cavitary lesions are present on chest radiography. In 2009, 80% of cases had pulmonary TB; of these, 65% had sputum cultures that were positive for Mycobacterium tuberculosis, 46% had positive sputum AFB smears, and 31% showed radiographic evidence of cavitary lesions.

TB Mortality
Sixteen persons died of TB in GA in 2007, the most recent year with available mortality data. The age-adjusted TB mortality rate was 0.2 per 100,000. From 2003 to 2007, an average of 19 people died of TB each year (range = 15-31).

Initial Diagnosis, Health Provider Data, and TB Contact Investigations and Latent TB

Directly Observed Therapy

Infection

In Georgia, majority of TB patients are initially diagnosed in a hospital and are followed up by county health departments after discharge to continue their TB treatment. In 2009, 274 (66%) of TB patients were initially reported to public health authorities by 89 different hospitals in Georgia. The hospitals in Georgia that admitted the most number of TB patients in 2009 were Grady Memorial Hospital (51 patients), Gwinnett Medical Center (18), St. Joseph's Hospital of Atlanta (11), DeKalb Medical Center (10), Medical College of Georgia (10), and Northside Hospital (10). County health departments provided case management for 87% of TB patients and 13% of cases were cared for solely by a private physician. County health department staff provide directly observed therapy (DOT) to TB patients, which entails watching a patient swallow every dose of their TB medications for at least 6 months. In 2007, among 401 patients with case completion data, 82% received TB treatment entirely by DOT, 14% were treated by a combination of DOT and self-administered therapy, and only 4% self-administered their medications for the entire duration of their treatment.

Public health authorities routinely conduct a contact investigation among persons exposed to a TB case to identify secondary TB cases and contacts with latent TB infection (LTBI). Index TB cases with positive acid-fast bacillus (AFB) sputum-smear results or pulmonary cavities have the highest priority for investigation. During a contact investigation, public health staff ask recent contacts to a case if they have TB-like symptoms, administer a TB skin test (TST), repeat the TST after 8-10 weeks if the initial TST is negative, and have a chest radiology exam performed if the TST is positive (>= 5 millimeters induration). Persons with LTBI have a positive TST, but are asymptomatic and have a normal chest radiology exam. They are not contagious but have a 10% chance of developing TB disease later in life if they do not receive treatment for LTBI.
Among 4,917 identified contacts of TB cases reported in 2008, the most recent year with completed contact investigation data, 4,005 (82%) were completely evaluated for TB disease and LTBI (Table 8). Of these evaluated contacts, 73

2009 Georgia Tuberculosis Report | 9

(2%) had TB disease and 942 (24%) had LTBI (Table 9).
TB Program Objectives
Objective 1: 90% of Georgia TB patients will complete a course of TB treatment within 12 months of starting treatment.
Among 416 TB patients started on TB treatment in 2008 who were slated to complete treatment in 2009, 93% completed their full course of treatment; however, only 85% of patients eligible for a 12-month treatment course completed treatment in 12 months (Table 5, 6). Timely treatment completion was much lower than the state average among inmates of correctional institutions (64%), HIV-infected individuals (70%), Hispanics (73%), foreign-born persons (79%), and persons abusing illegal drugs (82%). Interventions need to focus on these populations to improve timely treatment completion. Though this objective was not achieved, timely treatment completion has improved since 1994, when directly observed therapy became the recommended standard of care for TB treatment in Georgia (Figure 14).
Objective 2: 95% of TB cases with sputum smears that are positive for acid-fast bacillus will have contacts identified.
In 2009, 147 (97%) of 152 TB patients with positive acidfast bacillus (AFB) sputum smears had contacts elicited, exceeding the program target of 95%. Of five AFB sputumsmear positive TB patients with no contacts elicited during this time period, one case was uncooperative and refused to identify contacts and data on the reason why no contacts were elicited were missing in four cases.
Objective 3: At least 70 percent of persons with latent TB infection (LTBI) who started therapy for latent TB infection (LTBI) will complete LTBI therapy.
In 2008, among 942 contacts with LTBI, 588 (62%) started LTBI therapy. Among 550 contacts who started LTBI treatment and had data on treatment outcomes, 371 (68%) completed LTBI treatment, 72 (13%) chose to stop treatment, 60 (11%) were lost to follow-up, 18 (3%) moved, 13 (2%) stopped treatment because of a provider's decision, 10 (2%) had adverse reactions to the medications, 4 (1%) developed active TB, and 2 (0.4%) died before completing LTBI treatment (Table 11, Figure 15).

Figure 14. Timely TB Treatment Completion and Directly Observed Therapy (DOT) Georgia, 1993-2008

Percent 1993 1995 1997 1999 2001 2003 2005 2007

100

80 68 60

40

20

0

DOT became standard of care

Year Case Counted

85
Completion in 12 months Totally DOT

Figure 15. Completion of Latent TB Infection (LTBI) Therapy, Georgia, 2004-2008

Percent

80

70 63

66

66

68

60

57

50

Completed LTBI Therapy

40

Missing data

30

20

10 0

3

14 1

4

6

2004 2005 2006 2007 2008

Year

2009 Georgia Tuberculosis Report | 10

Tuberculosis Morbidity Trends by Health District Georgia, 1995-2009

TB Case Numbers and Rates

District 1-1 (Rome),1995-2009

60 51 50

40 30 20

33

18

25

22

31

32

32

30

27

30

17

18

12

15

10 0

11.6 7.4 4.0 5.2 3.8 6.1 6.0 5.9 5.4 4.7 5.2 2.8 3.0 1.9 2.4

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates

District 1-2 (Dalton),1995-2009

25

21

21

20

15

14

12 11

10

10

15 11 8 10

17 14 14

10

10

5

4.5

4.0

5.0

3.3

6.6

4.6

3.2

2.2

2.7

5.5

2.5

3.4

3.3

4.0 2.3

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates District 2 (Gainesville),1995-2009

25

20

20

17 15 15 15

19

15

16

15 10

12

13

10 10

8

12

11

5 0

5.9

4.9

3.7

3.7

3.5

2.6

2.1

2.0

2.5

1.5

3.5

2.1

2.6

5.7 1.8

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 3-1 (Cobb),1995-2009

50

44

40

32

30

20 18

32

38 38 36

32 30 30 30 31

24

25

21

10 0

3.1 5.1 6.8 4.9 3.6 6.2 5.2 4.8 3.3 4.2 3.9 3.8 3.7 3.8 2.5

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 3-2 (Fulton),1995-2009

250 200

192 207 187

177

150

133 150

136 119 122 116

100

87 72 78 72 81

50

0

28.1 30.0 26.8 17.8 19.9 22.4 16.5 14.4 15.0 14.2 9.7 7.5 7.9 7.1 7.8

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates District 3-3 (Clayton),1995-2009

30

28

25

23

20 15 10
5

18 14
9
8.8 6.7
4.5

15
13.4
7.0

18

19

15

15 14 15

15 14

11

9.7 6.5 7.1 5.4 5.2 5.6 7.0 5.5 5.1 4.0

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

2009 Georgia Tuberculosis Report | 11

Tuberculosis Morbidity Trends by Health District Georgia, 1995-2009

TB Case Numbers and Rates District 3-4 (Lawrenceville),1995-2009

100 81

80

68

58

60 40 20

12

24

17

26

29

43

21

34

42

46

57

63

0

2.2 4.1 2.8 4.0 4.4 6.8 2.8 4.3 5.1 5.3 6.5 7.3 6.0 8.3 6.3

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 3-5 (DeKalb),1995-2009

120 100
80

92

99 102

104

84

85

78

88

83

72

80

72 78

61

62

60

40

20

16.7 17.0 15.9

14.3 16.9 12.9 11.6 13.0

12.3 10.6 11.6 8.4

9.8 10.5

0

8.3

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 4 (LaGrange),1995-2009

35 30 25 20

24 26

29

25 25

27

19

21 20

20

16 16

16

15

12 12

10

5 0

3.1 4.4 4.9 3.6 3.3 4.9 2.5 2.4 3.6 3.5 2.2 3.6 2.6 1.5 1.5

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates

District 5-1 (Dublin),1995-2009

20 16

15

12

10 5

7 5.6 5 4.0 6 4.7 4 3.1

9.4 8

9

6

8 11.1

5.9

6.6 4 4

5.6

4.4

2.9 2.8

88
5.6 5.5 3
2.1

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates

District 5-2 (Macon),1995-2009

60

51

50 46

40 30 20

31

22

27

28

23

20

23

28

24

31

15

18

11

10 0

10.6 11.6 7.2 4.8 5.6 5.9 4.8 4.3 4.7 5.6 4.8 6.2 3.0 3.5 2.1

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates District 6 (Augusta),1995-2009

60

52

50 45

46

40

38 39

30

32

30 20

25

20

24 19 17 16 14 21

10 0

14.8 14.6 14.5 9.1

12.9 10.1 12.2 4.6

7.4

5.5

5.3

3.9

3.6

3.1 4.7

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

2009 Georgia Tuberculosis Report | 12

Tuberculosis Morbidity Trends by Health District Georgia, 1995-2009

TB Case Numbers and Rates District 7 (Columbus),1995-2009

50

46

40 33 30
20

34 28 30

36

34 30

22

21

18

20 21

23

14

10

9.5

13.2 6.3

9.9

8.1

8.5

5.9

10.1 5.0

9.9

8.4

5.9

6.0

3.9 6.4

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 8-1 (Valdosta),1995-2009

30

25 20 15

24

21 18

20

17

14 15

12

13

10 5 0

10.2 8.7

11.5 7.9

9.3

6.2

7

6.2 2

3.0

0.9

9

6

5

5.1 2.5 3.8 2.1

5
5.3 2.0

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates

District 8-2 (Albany),1995-2009

50 40

38 45 40 36 43 38

29

30 20

17 24 21 23 25 21 25 18

10

11.5 13.6 12.3 10.8 12.3 10.8 8.2 4.8 6.4 6.1 6.4 6.8 5.8 6.8 4.9

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates District 9-2 (Waycross),1995-2009

60 50 43

50 48

40

30

30

24

34

25

25

20 10
0

15.0 10.4 8.2

16
16.6 15.8 10.6 7.8 4.9

13
7.6 3.9

9

16 13
2.7 4.7 3.8

8

2.3

5
1.4

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 9-1 (Coastal),1995-2009

70 60 50

58 48

40 30 20

34 33 25 33 19 23 20 17 19 31 26 23 20

10 0

10.4 12.4 7.2 6.9 5.2 6.8 3.9 4.6 4.0 3.3 3.7 5.9 4.8 4.3 3.6

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates

District 10 (Athens),1995-2009

25

22

20

16

16

15 13 13

13 14 13

11 12

10 5 0

9

8

4.6

4.2

5.1

6.6

3.8

3.8

3.4

4.1

2.8

2.9

5
2.2 1.1

6 4
1.8 1.3 0.9

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

2009 Georgia Tuberculosis Report | 13

Table 1. Number of TB Cases and TB Case Rates per 100,000 population by County, Georgia, 2008- 2009

COUNTY
Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia excludes ASMP ASMP only
Cook Coweta Crawford

2008

Number of cases

Case Rate

0

0

<5

--

0

0

0

0

<5

--

0

0

<5

--

<5

--

0

0

<5

--

7

4.5

<5

--

0

0

<5

--

0

0

<5

--

0

0

<5

--

<5

--

0

0

0

0

<5

--

<5

--

0

0

12

4.8

0

0

<5

--

5

<5

--

0

0

14

5.1

<5

--

27

3.9

0

0

6

13.2

5

4.5

11

na

0

0

<5

--

0

0

2009

Number of cases

Case Rate

<5

--

<5

--

0

0

0

0

0

0

0

0

<5

--

<5

--

0

0

0

0

5

3.2

0

0

0

0

0

0

0

0

<5

--

<5

--

<5

--

0

0

<5

--

0

0

<5

--

<5

--

0

0

10

3.9

0

0

0

0

<5

--

<5

--

0

0

11

4.0

0

0

18

2.5

0

0

<5

--

6

5.3

9

na

0

0

0

0

0

0

2009 Georgia Tuberculosis Report | 14

COUNTY
Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis

2008

Number of cases

Case Rate

<5

--

0

0

0

0

0

0

78

10.5

<5

--

<5

--

10

10.4

<5

--

<5

--

<5

--

<5

--

<5

--

<5

--

0

0

0

0

0

0

<5

--

<5

--

0

0

72

7.1

<5

--

0

0

5

6.6

<5

--

<5

--

0

0

68

8.6

0

0

<5

--

<5

--

0

0

<5

--

0

0

0

0

<5

--

6

4.5

0

0

0

0

0

0

0

0

2009 Georgia Tuberculosis Report | 15

2009

Number of cases

Case Rate

<5

--

0

0

0

0

<5

--

62

8.3

0

0

<5

--

6

6.3

<5

--

0

0

0

0

0

0

<5

--

0

0

0

0

<5

--

<5

--

<5

--

<5

--

0

0

81

7.8

<5

--

<5

--

0

0

0

0

5

19.9

<5

--

58

7.2

0

0

9

4.8

0

0

0

0

0

0

0

0

0

0

0

0

5

3.8

0

0

0

0

<5

--

0

0

COUNTY
Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond

2008

Number of cases

Case Rate

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

<5

--

<5

--

0

0

<5

--

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

5

20.8

<5

--

<5

--

0

0

<5

--

8

4.3

8

8.1

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

<5

--

0

0

0

0

0

0

0

0

0

0

5

2.5

2009

Number of cases

Case Rate

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

6

9.6

0

0

<5

--

<5

--

<5

--

<5

--

0

0

0

0

0

0

0

0

0

0

<5

--

<5

--

0

0

0

0

0

0

<5

--

13

6.8

<5

--

0

0

0

0

<5

--

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

0

0

0

0

0

0

8

4.0

2009 Georgia Tuberculosis Report | 16

COUNTY
Rockdale Schley Screven Seminole Spalding Stephens Stewart excludes SDC / SDC only Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth
GEORGIA

2008

Number of cases

Case Rate

5

6.0

0

0

0

0

0

0

<5

--

<5

--

0/10

na

<5

--

0

0

0

0

0

0

<5

--

<5

--

0

0

<5

--

<5

--

<5

--

0

0

0

0

<5

--

<5

--

0

0

<5

--

0

0

0

0

<5

--

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

8

8.5

0

0

0

0

0

0

0

0

478

4.9

2009

Number of cases

Case Rate

<5

--

0

0

5

33.2

0

0

<5

--

0

0

0/5

0/na

<5

--

0

0

0

0

0

0

0

0

<5

--

0

0

<5

--

<5

--

0

0

0

0

0

0

6

9.3

<5

--

0

0

0

0

0

0

5

7.7

0

0

<5

--

0

0

0

0

0

0

0

0

<5

--

<5

--

<5

--

0

0

0

0

0

0

0

0

415

4.2

* In counties where one to four cases were reported, "< 5" is used to represent the number of reported cases, and the case rate is not calculated.

2009 Georgia Tuberculosis Report | 17

Table 2. Number of TB Cases and TB Case Rates per 100,000 population by Health District, Georgia, 2008- 2009

Health District
1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb 4.0 LaGrange 5.1 Dublin 5.2 Macon 6.0 Augusta
Augusta State Medical Prison 7.0 Columbus
ICE Detention Center 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens Total

2008

Number of cases Case rate

12

1.9

17

4.0

11

1.8

31

3.8

72

7.1

14

5.1

81

8.3

78

10.5

12

1.5

8

5.5

18

3.5

14

3.1

11

na

14

3.9

10

46.1

13

5.3

25

6.8

23

4.3

8

2.3

6

1.3

478

4.9

2009

Number of Cases

Case rate

15

2.4

10

2.3

16

5.7

21

2.5

81

7.8

11

4.0

63

6.3

62

8.3

12

1.5

3

2.1

11

2.1

21

4.7

9

na

23

6.4

5

na

5

2.0

18

4.9

20

3.6

5

1.4

4

0.9

415

4.2

2009 Georgia Tuberculosis Report | 18

Table 3. Percentage of TB Cases with Risk Factors for TB by Health District, Georgia, 2009

Health District
1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb 4.0 LaGrange 5.1 Dublin 5.2 Macon 6.0 Augusta
ASMP inmates 7.0 Columbus
ICE detainees 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens GEORGIA

Foreign-born %
13 70 44 71 28 64 71 60 8 100 18 33 22 13 100 60 28 5 0 25 42

HIV Infected %
0 0 0 10 28 18 8 14 8 0 9 25 22 9 0 0 11 10 0 0 15

Homeless %
0 0 0 0 39 9 2 6 8 0 0 10 11 4 0 0 22 5 0 0 11

Inmate Nursing Substance

%

Home % Abuse %

0

7

29

0

0

20

0

0

13

5

0

0

4

1

36

0

0

0

0

0

6

5

3

11

0

8

33

33

0

33

0

0

36

5

5

5

100

0

44

0

4

44

100

0

0

0

0

0

11

0

28

0

0

25

0

0

20

0

0

0

6

2

20

2009 Georgia Tuberculosis Report | 19

Table 4. Primary Resistance to First-line Anti-TB Medications by Health District, Georgia, 2009

TB Drug HEALTH DISTRICT 1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb 4.0 LaGrange 5.1 Dublin 5.2 Macon 6.0 Augusta & ASMP 7.0 Columbus & ICE 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens GEORGIA

Isoniazid

No.

%

1

8

0

0

0

0

1

7

19

33

0

0

7

19

1

3

0

0

0

0

0

0

4

13

3

11

0

0

1

6

0

0

1

20

0

0

39

14

Rifampin

No.

%

0

0

0

0

1

0

1

0

0

0

1

1

0

0

0

0

0

0

5

Ethambutol

No.

%

0

0

0

0

0

0

0

0

0

0

1

7

2

0

0

0

0

0

3

1

3

0

0

0

0

0

0

0

0

0

14

0

0

3

1

3

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

3

1

2009 Georgia Tuberculosis Report | 20

Table 5. Completion of Cases' TB Treatment by Health District, Georgia, 2007-2008

2007

2008

HEALTH DISTRICT No. Cases that Completed

% No. Cases that Completed Tx/No. %

Treatment (Tx) / No. Cases Started

Cases Started on Tx

on Treatment

1.1 Rome

15/15

100

9/9

100

1.2 Dalton

10/11

91

15/16

94

2.0 Gainesville

14/14

100

9/10

90

3.1 Cobb

28/28

100

22/22

100

3.2 Fulton

68/69

99

64/66

97

3.3 Clayton

12/12

100

10/11

91

3.4 Lawrenceville

47/48

98

61/69

88

3.5 DeKalb

59/63

94

66/68

97

4.0 LaGrange

17/18

94

7/8

88

5.1 Dublin

7/7

100

7/7

100

5.2 Macon

9/10

90

16/16

100

6.0 Augusta

10/12

83

11/12

92

ASMP

11/12

92

11/11

100

7.0 Columbus

9/11

82

12/12

100

ICE

1/5

20

0/5

0

8.1 Valdosta

3/3

100

13/13

100

8.2 Albany

17/17

100

19/22

86

9.1 Coastal

23/24

96

19/21

90

9.2 Waycross

8/10

80

4/6

67

10 Athens

8/8

100

6/6

100

GEORGIA

376/397

95

981/410

93

2009 Georgia Tuberculosis Report | 21

Table 6. Timely Completion of Cases' TB Tx by Health District, GA, 2007-2008

2007

2008

HEALTH DISTRICT No. Cases Completed Tx in 12

% No. Cases Completed Tx in 12

%

months / No. Started Tx

months / No. Started Tx

1.1 Rome

14/15

93

7/9

78

1.2 Dalton

10/11

91

14/16

88

2.0 Gainesville

13/14

93

7/10

70

3.1 Cobb

24/28

86

10/22

45

3.2 Fulton

66/69

96

60/64

94

3.3 Clayton

11/12

92

10/11

91

3.4 Lawrenceville

43/48

90

54/69

78

3.5 DeKalb

51/63

81

60/68

88

4.0 LaGrange

16/18

89

7/8

88

5.1 Dublin

7/7

100

7/7

100

5.2 Macon

6/10

60

14/16

88

6.0 Augusta

10/12

83

11/12

92

ASMP

10/12

83

8/11

73

7.0 Columbus

8/11

73

10/12

92

ICE

1/5

20

0/5

0

8.1 Valdosta

3/3

100

13/13

100

8.2 Albany

15/17

88

19/22

86

9.1 Coastal

21/24

88

18/21

86

9.2 Waycross

8/10

80

4/6

67

10 Athens

8/8

100

6/6

100

GEORGIA

345/397

87

349/410

85

2009 Georgia Tuberculosis Report | 22

Table 7. Sputum Smear Positive (SSP) Cases with Contacts Identified by Health District, Georgia, 2007-2008

HEALTH DISTRICT
1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb 4.0 LaGrange 5.1 Dublin 5.2 Macon 6.0 Augusta 7.0 Columbus 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens GEORGIA

2007

2008

No. SSP Cases with Contacts Identi- % No. SSP Cases with Contacts Identi- %

fied / No. SSP Cases

fied / No. SSP Cases

6/6

100

4/5

80

5/5

100

5/5

100

5/5

100

2/2

100

10/10

100

8/8

100

34/34

100

32/34

94

5/5

100

3 / 4

75

14/21

67

16/21

76

23/26

88

22/25

88

7/7

100

3/3

100

2/2

100

0/0

--

4/4

100

10/10

100

11/11

100

8/8

100

13/13

100

8/8

100

3/3

100

5/5

100

7/7

100

10/10

100

11/11

100

10/10

100

4/4

100

4/4

100

4/4

100

4/4

100

165/179

92

153/167

92

2009 Georgia Tuberculosis Report | 23

Table 8. Completely Evaluated Contacts by Health District, Georgia, 2007-2008

HEALTH DISTRICT
1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb 4.0 LaGrange 5.1 Dublin 5.2 Macon 6.0 Augusta 7.0 Columbus 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens GEORGIA

2007

2008

No. Contacts that were Completely % No. Contacts that were Completely %

Evaluated / No. Contacts Identified

Evaluated / No. Contacts Identified

190/209

91

73/83

88

107/122

88

195/216

90

76/89

85

51/66

77

466/541

86

102/130

78

1446/1606

90

1101/1298

85

80/89

90

312/342

91

182/226

80

233/355

66

193/241

80

386/593

65

101/124

82

86/98

88

54/54

100

92/95

97

76/88

86

116/131

88

412/457

90

568/695

82

291/322

90

136/152

90

29/32

91

49/56

88

300/332

90

352/432

82

147/161

91

89/104

86

66/75

88

34/36

94

43/49

88

29/34

85

4265/4824

88

4005/4917

82

2009 Georgia Tuberculosis Report | 24

Table 9. Contacts with Latent TB Infection by Health District, Georgia, 2007-2008

HEALTH DISTRICT
1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb 4.0 LaGrange 5.1 Dublin 5.2 Macon 6.0 Augusta 7.0 Columbus 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens GEORGIA

2007

No. Contacts with LTBI/ No. Contacts % Completely Evaluated

85/190

45

28/107

26

11/76

14

68/466

15

207/1446

14

23/80

29

93/182

51

79/193

41

16/101

16

9/54

17

16/76

21

78/412

19

86/291

30

7/29

24

45/300

15

46/147

31

23/66

35

15/43

35

935/4265

22

2008

No. Contacts with LTBI/ No. Contacts % Completely Evaluated

19/73

26

66/195

34

17/51

33

37/102

36

238/1101

22

84/312

27

90/233

39

87/386

22

22/86

26

15/92

16

18/116

16

83/695

12

26/136

19

15/49

31

90/352

26

23/89

26

6/34

18

6/29

21

942/4005

24

2009 Georgia Tuberculosis Report | 25

Table 10. Infected Contacts Started on LTBI Treatment by Health District Georgia, 2007-2008

HEALTH DISTRICT
1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb 4.0 LaGrange 5.1 Dublin 5.2 Macon 6.0 Augusta 7.0 Columbus 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens GEORGIA

2007 No. Infected Contacts on LTBI Treatment / No. Infected Contacts
79/85 27/28 9/11 43/68 124/207 15/23 70/93 43/79 15/16 8/9 14/16 34/78 50/86 7/7 30/45 34/46 19/23 14/15 635/935

2008

% No. Infected Contacts on LTBI Treat- % ment / No. Infected Contacts

93

13/19

68

96

51/66

77

82

16/17

94

63

31/37

84

60

149/238

63

65

49/84

58

75

47/90

52

54

52/87

60

94

18/22

82

89

6/15

40

88

11/18

61

44

36/83

43

58

17/26

65

100

14/15

93

67

54/90

60

74

17/23

74

83

2/6

33

93

5/6

83

68

588/942

62

2009 Georgia Tuberculosis Report | 26

Table 11. LTBI Treatment Completion of Infected Contacts by Health District Georgia, 2007-2008

HEALTH DISTRICT
1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb 4.0 LaGrange 5.1 Dublin 5.2 Macon 6.0 Augusta 7.0 Columbus 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens GEORGIA

2007
No. Contacts that Completed LTBI Treatment/ Contacts Treated
64/79 18/27 5/9 23/43 83/123 9/15 51/69 27/31 11/15 7/8 6/14 14/34 25/42 7/7 17/30 18/34 14/19 4/14 403/613

% No. Contacts with Missing data

81

0

67

0

56

0

54

0

68

1

60

0

74

1

87

12

73

0

88

0

43

0

41

0

60

8

100

0

57

0

53

0

74

0

29

0

66

22

2008
No. Contacts that Completed LTBI Treatment/ Contacts Treated
8/13 38/51 16/16 24/31 110/145 28/48 24/36 30/45 10/15 5/6 5/11 10/34 6/14 7/14 33/47 16/17 0/2 1/5 371/550

% No. Contacts with Missing data

62

0

74

0

100

0

77

0

76

4

58

1

67

11

67

7

67

3

83

0

46

0

29

2

43

3

50

0

70

7

94

0

0

0

20

0

68

38

Table 12. Reasons Why Infected Contacts Treated for LTBI Stopped LTBI Therapy Georgia, 2004-2008

Reasons for Stopping LTBI Therapy
Completed Therapy Chose to Stop Lost to Follow-Up Provider Decision Moved Adverse Reactions Active TB Developed Death

2004 n=720 %
63 19 10 3 3 1 0.4 0.1

2005 n=738 %
66 15 9 4 3 2 0.4 0

2006 n=921 %
57 19 11 7 4 1 0.8 0.3

2007 n=613 %
66 16 9 3 3 2 0.7 0.2

2008 N=550 %
68 13 11 2 3 2 1 0.4

2009 Georgia Tuberculosis Report | 27

Tuberculosis Morbidity Trends by Health District, Georgia, 1995-2008

TB Case Numbers and Rates

District 1-1 (Rome),1995-2008

60 51 50

40 30 20

33 18 25 22 31 32 32 30 27 30 17 18 12

10 0

11.6 7.4 4

5.2 3.8 6.1 6

5.9 5.4 4.7 5.2 2.8 3 1.9

95 96 97 98 99 00 01 02 03 04 05 06 07 07

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates

District 1-2 (Dalton),1995-2008

25

21

21

20

15

12 11

14 10

10

15 11 8 10

17 14 14
10

5

4.5 4

5

3.3 6.6 4.6 3.2 2.2 2.7 5.5 2.5 3.4 3.3 4

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates District 2 (Gainesville),1995-2008

25

20

20

17 15 15 15

19 15

15 10

12

13

10 10

8

12

11

5 0

5.9 4.9 3.7 3.7 3.5 2.6 2.1 2

2.5 1.5 3.5 2.1 2.6 1.8

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 3-1 (Cobb),1995-2008

50

44

40

32

32

38 38 36

32 30 30 30 31

30

24

25

20 18

10 0

3.1 5.1 6.8 4.9 3.6 6.2 5.2 4.8 3.3 4.2 3.9 3.8 3.7 3.8

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 3-2 (Fulton),1995-2008

250 200

192 207 187

177

150

133 150

136 119 122 116

100

87 72 78 72

50

0

28.1 30 26.8 17.8 19.9 22.4 16.5 14.4 15 14.2 9.7 7.5 7.9 7.1

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 3-3 (Clayton),1995-2008

30

28

25

23

20 15 10
5

18 14
9 8.8 6.7
4.5

15 13.4
7

18

19

15

15 14 15

15 14

9.7 6.5 7.1 5.4 5.2 5.6 7

5.5 5.1

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

2009 Georgia Tuberculosis Report | 28

Tuberculosis Morbidity Trends by Health District, Georgia, 1995-2008

TB Case Numbers and Rates District 3-4 (Lawrenceville),1995-2008

100 81

80

68

60

58

57

43

42 46

40 20

12 24 17 26 29

34 21

0

2.2 4.1 2.8 4 4.4 6.8 2.8 4.3 5.1 5.3 6.5 7.3 6 8.3

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 3-5 (DeKalb),1995-2008

120 100
80

92

99 102

104

84

85

78

88

83

72

80

72 78

61

60

40

20

16.7 17 15.9

14.3 16.9 12.9 11.6 13

12.3 10.6 11.6 8.4 9.8 10.5

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 4 (LaGrange),1995-2008

35 30 25 20

24 26

29

25 25

27

19

21 20

20

16 16

16

15

12

10

5 0

3.1 4.4 4.9 3.6 3.3 4.9 2.5 2.4 3.6 3.5 2.2 3.6 2.6 1.5

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates

District 5-1 (Dublin),1995-2008

20 16

15

12

10 5

7 5
5.6 4

6 4
4.7 3.1

9.4 8

9

6

8

11.1

5.9

6.6 4 4

5.6

4.4

2.9 2.8

88
5.6 5.5

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates

District 5-2 (Macon),1995-2008

60

51

50 46

40 30 20

31 22 27 28 23 20 23 28 24 31 15 18

10 0

10.6 11.6 7.2 4.8 5.6 5.9 4.8 4.3 4.7 5.6 4.8 6.2 3 3.5

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates District 6 (Augusta),1995-2008

60

52

50 45

46

40

38 39

30

32

30 20

25

20

24 19 17 16 14

10 0

14.8 14.6 14.5 9.1

12.9 10.1 12.2 4.6

7.4

5.5

5.3

3.9

3.6 3.1

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

2009 Georgia Tuberculosis Report | 29

Tuberculosis Morbidity Trends by Health District, Georgia, 1995-2008

TB Case Numbers and Rates District 7 (Columbus),1995-2008

50

46

40 33 30
20

34 28 30

36

34 30

22

21

18

20 21 14

10

9.5

13.2 6.3

9.9

8.1

8.5

5.9

10.1 5

9.9 8.4 5.9 6 3.9

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 8-1 (Valdosta),1995-2008

30

25 20 15

24

21 18

20

17

14 15

12

13

10 5 0

10.2 8.7

11.5 7.9

9.3

6.2

6.2 2

7
3

0.9

9

6

5

5.1

2.5

3.8

5.3 2.1

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates

District 8-2 (Albany),1995-2008

50 40

38 45 40 36 43 38

29

30 20

17 24 21 23 25 21 25

10

11.5 13.6 12.3 10.8 12.3 10.8 8.2 4.8 6.4 6.1 6.4 6.8 5.8 6.8

0

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

TB Case Numbers and Rates District 9-2 (Waycross),1995-2008

60 50 43

50 48

40

30

30

24

34

25

25

20 10
0

15

10.4 8.2

16 16.6 15.8
10.6 7.8 4.9

13 9 16 13 8 7.6 3.9 2.7 4.7 3.8 2.3

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates District 9-1 (Coastal),1995-2008

70 60 50

58 48

40 30 20

34 33 25 33 19 23 20 17 19 31 26 23

10 0

10.4 12.4 7.2 6.9 5.2 6.8 3.9 4.6 4

3.3 3.7 5.9 4.8 4.3

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number
Rates are per 100,000 population Source: GA TB surveillance database

Rate

TB Case Numbers and Rates

District 10 (Athens),1995-2008

25

22

20

16

16

15 13 13

13 14 13

11 12

10 5 0

4.6

4.2

5.1

6.6

3.8

3.8

3.4

4.1

2.8

9

8

5

6

2.9 2.2 1.1 1.8 1.3

95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Number Rate

Rates are per 100,000 population Source: GA TB surveillance database

2009 Georgia Tuberculosis Report | 30

2009 Georgia Tuberculosis Report Georgia Department of Human Resources | Division of Public Health
2009 Georgia Tuberculosis Report | 31