2004 Georgia tuberculosis report

2004 Georgia Tuberculosis Report
Georgia Department of Human Resources ............B. J. Walker Commissioner
Division of Public Health.................................Stuart Brown, M.D. Director
Epidemiology Branch.....................................Susan Lance, D.V.M., PhD. Director
Tuberculosis Epidemiology Section....................Rose-Marie F. Sales, M.D., M.P.H. Chief
Tuberculosis Program.....................................Beverly DeVoe, M.S.H. Program Manager
Michael K. Leonard, Jr., M.D. Medical Consultant
Lanetta Culver Surveillance Supervisor
Acknowledgments: We thank the county health department staff and district health office TB coordinators and staff who collected and reported the data that were used in this annual report.
Further information on this report can be obtained by contacting: Rose-Marie F. Sales, M.D., M.P.H. Georgia Department of Human Resources Division of Public Health, TB Epidemiology Section 2 Peachtree St., NW Atlanta, GA 30303 Phone: (404) 657-2634 Fax: (404) 463-3460 E-mail: rfsales@dhr.state.ga.us
Suggested Citation: Georgia Department of Human Resources, Division of Public Health. 2004 Georgia Tuberculosis Report. October 2005
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Tuberculosis (TB) Epidemiology in Georgia

TB Case Numbers and Case Rates

The number of TB cases in Georgia has declined by 41% since 1991, the peak of a TB resurgence that occurred from the mid-1980s to the early 1990s (Figure 1). However, in 2004, 539 new TB cases were reported in Georgia, representing a 1.3% increase from 532 cases reported in 2003. The state TB case rate of 6.1 per 100,000 persons in 2004 remained the same as the state case rate in 2003 and continues to be higher than the U.S. TB case rate (4.9/100,000 in 2004). Georgia had the sixth highest number of TB cases and the seventh highest TB case rate in 2004 compared to other states. The bulk of Georgia's TB cases are in U.S.-born African-Americans (49%) and foreign-born persons (34%).

Figure 1. TB Cases and Case Rates, Georgia, 1982-2004

Number of Cases

Rate/100,000

1000 14.6 800 600 400 200

909 0

16
14 12 539 10
6.1 8 6
4 2

0

0

82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04

Number

Rate

Geographic Distribution of Cases
The metropolitan Atlanta area accounted for 52% of TB cases in Georgia. The counties that reported the highest number of TB cases were: Fulton (116 cases), DeKalb (72), Gwinnett (42), Cobb (29), and Muscogee (20). Of 159 counties, 71 (45%) attained the Healthy People 2010 objective of 1 TB case per 100,000 population. Figure 2 shows the three health districts with case rates higher than the state case rate: Fulton (14.2/100,00), DeKalb (10.6/100,000), and Columbus (9.9/100,000). Tables 1 and 2 show the number of TB cases and TB case rates in 2004 by county and health district, respectively.
TB cases in Fulton and DeKalb counties, the two most populous counties in Georgia, have been steadily decreasing over the past decade. The TB case rate in Fulton County has fallen from 44.4/100,000 in 1991 to 14.2/100,000 in 2004; while in DeKalb County, TB case rates decreased from 19.2/100,000 in 1991 to 10.6/100,000 in 2004.

2

TB cases and case rates have been increasing in the Lawrenceville district for the past three years, from 21 cases in 2001 to 46 cases in 2004, mainly due to an increase in foreign-born cases. Three health districts reported an increase in TB cases for two consecutive years: Dalton (8 cases in 2002 to 21 in 2004), Macon (20 cases in 2002 to 28 in 2004), and Valdosta (2 cases in 2002 to 12 in 2004).
TB Cases by Sex, Race/ethnicity, and Age TB cases in Georgia were predominantly male (61%) and non-Hispanic black
(59%) in 2004 and have consistently been so for many years. Hispanics of all races, nonHispanic whites, and Asians comprised 17%, 14%, and 10% of TB cases in 2004, respectively. The TB case rate was 20.2/100,00 in Asians, 11.9/100,000 in non-Hispanic blacks, and 1.5/100,000 in non-Hispanic whites in 2004. Case rates have been decreasing in these racial/ethnic groups over the past 5 years (Table 3). The case rate among Hispanics increased slightly from 15.1 in 2003 to 15.3 per 100,000 persons in 2004. The largest proportion (36%) of cases among age groups occurred in persons 25-44 years old (Figure 3). The case rate was lowest in children 5-14 years old and highest in persons 4564 years old. The case rates in children 5 to 14 years old and in persons 15 to 24 years old has increased slightly over the past 5 years, while case rates decreased in other age groups (Table 4).
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Figure 3. TB Cases by Age and Sex, Georgia, 2004

Number of Cases

120 100
80 60 40 20
0 < 5

5-14 15-24 25-44 45-64 >=65 Age in Years

Male Female

TB Cases with HIV
TB cases co-infected with HIV decreased from 74 (17%) cases in 2003 to 72 (16%) in 2004. This represents a substantial decline from 1993, the year when surveillance for HIV co-infection started, and when 42% of TB cases with known HIV status were positive for HIV (Figure 4). HIV testing among TB cases has considerably improved over the past five years. Reporting of HIV status increased from 76% in 2000 to 85% in 2004. Among TB cases in adults aged 25-44 years old, 93% had HIV test results reported. In TB cases with information on HIV status, HIV co-infection was predominantly present among African Americans (85%), males (65%), and in adults aged 25-44 (58%).
Figure 4. HIV status of TB Cases, Georgia, 1993-2004
Number of Cases
900 800 700 600 500 400 300 200 100
0 93 94 95 96 97 98 99 00 01 02 03 04 Year
Positive Negative Unknown

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Drug-resistant Tuberculosis
In 2004, three cases of multidrug-resistant tuberculosis (MDR-TB, i.e., TB resistant to at least isoniazid (INH) and rifampin (RIF), the two most effective anti-TB drugs) were reported in Georgia. From 2000-2004, 17 MDR-TB cases were reported, an average of three MDR-TB cases per year. Of these, 14 (82%) were foreign-born, three had previous TB treatment, and three were initially susceptible to RIF when they started treatment. Most MDR-TB cases in the past five years were reported in DeKalb (5 cases), Gwinnett (4) and Cobb County (3).
Thirty-five cases (8%) of primary resistance to INH and four cases (1%) of primary resistance to RIF were reported in 2004. The proportion of TB cases with primary INH resistance has increased since 1993, while that of MDR-TB cases and primary RIF resistance remained stable (Figure 5). The proportion of primary resistance to ethambutol, another first-line anti-TB drug, decreased over the past 5 years (from 1% in 2000 to 0.2 % in 2004). From 2000 to 2004, a total of 141 primary isoniazid resistant cases were reported in Georgia. The counties of Fulton (31 cases), DeKalb (25) and Gwinnett (17) reported the highest number of INH-resistant cases over this five-year period.
Figure 5. Drug-resistance levels of TB Cases, Georgia, 1993-2004

Percent

7.5

8.4

7.0

6.8

6.0

5.8

6.3

6

5.9

5.3 5.0

5.4

5.3

4.6

4.0

4.2

3.0

2.0

1.8 1.8

1.0

0.7 0.8

1.0 0.6

0.0

0.3

0.2

0.5 0.5 0.7 0.2

93 94 95 96 97 98 99 00 01 02 03 04

Year

MDR

INH*

* Primary INH resistance: resistance to INH (alone or in combination with resistance to other drugs) in TB patients who have not received previous TB treatment

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TB in High-Risk Populations
In 2004, TB cases living in settings where infection is easily transmitted included 35 (6%) homeless persons, 22 (4%) cases from correctional facilities, and 15 (3%) persons living in long-term care facilities (Figure 5). One hundred and four (19%) cases reported some form of substance abuse in 2004; 10 (2%) abused injected drugs, 52 (10%) abused non-injected drugs, and 76 (14%) consumed excess alcohol. TB cases in other high-risk groups included 12 (2%) health care workers and 3 (0.5%) migratory agricultural workers. TB cases in these high-risk groups have decreased from 5 years ago but small increases in numbers was noted from 2003 to 2004 among substance abusers, homeless persons, and residents of correctional and long-term care facilities (Figure 6).

Figure 6. TB in High-Risk Populations, Georgia, 2000-2004

Number

180

160

140

120

100

80

60

40

20

0

00

01

02

03

04

Year

Substance abuse Homeless Correctionals Long-Term Care

TB Mortality
Fifteen persons died of TB in Georgia in 2003, the year for which the most recent mortality data are available. The age-adjusted TB mortality rate decreased from 0.4/100,000 in 2002 to 0.2/100,000 persons in 2003.
TB Racial Disparities
Non-Hispanic blacks make up 29% of the population in Georgia but accounted for 58% of TB cases in 2004. The TB case rate for non-Hispanic blacks in Georgia (11.9/ 100,000) was eight times higher than the case rate for non-Hispanic whites (1.5/100,000) in 2004. From 1993 to 2004, the non-Hispanic black TB case rate decreased 61% (from 30.6 to 11.9/100,000) while the non-Hispanic white case rate decreased 59% (from 3.7 to 1.5/100,000) (Figure 7).

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Figure 7. TB Case Rates in Non-Hispanic Blacks and Whites, GA, 1993-2004

Rate/100,000

35 30.6 30

25

20

15

11.9

10

3.7

5

1.5

0

93 94 95 96 97 98 99 00 01 02 03 04

Year

Black

White

Black case rate is 8x higher than white case rate
Fulton County had the highest number and one of the highest proportions of nonHispanic black TB cases compared with other counties in the state. Non-Hispanic blacks represented 43% of Fulton County's population yet accounted for 79% (92/116) of county TB cases in 2004. Most (91%) of non-Hispanic blacks in the county are U.S.born. Health Districts that reported high numbers of non-Hispanic black TB cases in 2004 include: DeKalb (53 cases, 74% of District cases), Columbus (23, 66%), Albany (20, 91%), and Macon (20, 71%) (Table 5).
TB case rates for all racial/ethnic groups have been decreasing since 1993 except among Hispanics (10.1/100,000 in 1993 compared to 15.3/100,000 in 2004). The highest case rate among racial/ethnic groups in 2004 occurred among Asians (20.2/100,000) though Asians comprised only 10% of TB cases.
TB in the Foreign-born
In Georgia, the proportion and number of TB cases that are foreign-born increased from 29% (156 cases) in 2003 to 34% (184 cases) in 2004. This represents more than a four-fold increase from 1993, when only 5% (40 cases) of TB cases were foreign-born (Figure 8). Sixty-nine percent of foreign-born TB cases were diagnosed within the first five years of their arrival in the United States.
More than two-thirds (69%) of foreign-born TB cases in 2004 resided in metropolitan Atlanta counties, mostly in DeKalb (41 cases), Lawrenceville (36), Fulton (24), and Cobb (17). Health districts where 50% or more TB cases were foreign-born included: Lawrenceville (78%), Gainesville (62%), DeKalb (57%), Cobb (53%), and Clayton (50%). Health districts where the proportion of foreign-born cases was nearly 50% include: Waycross (46%), Dalton (43%), and Valdosta (42%) (Table 6).

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Figure 8. TB Cases in US-Born and Foreign-born Persons, Georgia, 1993-2004 Number of Cases

800 763

700

600

500

400

355

300

200

184

100 40 0 93 94 95 96 97 98 99 00 01 02 03 04

Year

US-born Foreign-born

The proportion of cases that are foreign-born increased from 5% in 1993 to 34% in 2004
Foreign-born cases were primarily seen in persons from Mexico (50 cases), Vietnam (18), Ethiopia (16), India (11), Guatemala (10) and Somalia (8). Foreign-born TB cases came from 43 different countries of origin in 2004 (Figure 9).
Figure 9. Countries of Origin of Foreign-born TB Cases, Georgia, 2004

39%

27%

4% 5%

10% 9% 6%

Mexico Vietnam Ethiopia India Guatemala Somalia Others

Refugee and Immigrants
In 2004, 155 refugees and immigrants arrived in Georgia with a B-1 or B-2 TB classification (non-infectious TB conditions diagnosed overseas), 63% were re-evaluated for TB and latent TB infection by their county health departments soon after they arrived in Georgia. The DeKalb and Lawrenceville health districts received most of the B1/B2 notifications in 2004; resettling 63 refugees or immigrants with a B-1 classification (noninfectious active TB) and 28 with a B-2 classification (non-infectious inactive TB). Of

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those who were re-evaluated upon arrival in Georgia, five (11%) of 45 persons with a B-1 classification and one of 49 (2%) persons with a B-2 classification had culture-confirmed TB. Of 651 refugee children younger than 15 years old who were screened for TB with a tuberculin skin test in 2004, 133 (20%) had a positive skin test.
Contacts to TB Cases
In 2003, the year with the most complete data for contact investigations, 5,623 contacts to active TB cases were identified. Of these, 39% were household contacts, 26% were leisure activity-related contacts, 23% were work-related contacts, and the rest were contacts exposed to TB in other environments. At least 95% of 203 TB cases with positive sputum smears (an indicator of infectiousness) had contacts identified.
Of 5,623 identified contacts, 3,478 (62%) were completely evaluated for active TB disease and latent TB infection (LTBI) by tuberculin skin tests and chest radiography. LTBI was detected in 1,115 (20%) contacts and 708 (64%) were started on LTBI treatment to prevent progression to active TB disease. Only 59% of infected contacts with available treatment completion data completed LTBI treatment.
Latent TB Infection in Children < 5 years old
Mandatory reporting to public health authorities of LTBI in children less than 5 years of age began in January 2004. Forty-three such children were reported in 2004; 36 (84%) received LTBI treatment by directly observed preventive therapy from public health workers.
TB Program Objectives:
Objective 1: 90% of TB patients will complete a course of curative TB treatment within 12 months of starting treatment.
Among 446 patients who were scheduled to complete TB treatment in 2004, 93% completed their full course of treatment. Timely completion of therapy, however, was only 80%. Timely treatment completion was lower than the state average among patients exclusively treated by private providers (50%), HIV infected cases (73%), residents of correctional facilities (77%), and abusers of non-injectable drugs (78%). Directly observed therapy was given to 95% of cases in 2003 (Figure 10, Tables 7-9).
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Figure 10. Timely Treatment Completion and Directly Observed Therapy (DOT), Georgia, 1993-2003

Percent

100

80

80

68

76

60

40

35

20

19

11

0

93 94 95 96 97 98 99 00 01 02 03

Year

Completion in 12 mos. Totally DOT Both DOT & self-admin

Timely treatment completion increased from 68% in 1993 to 80% in 2003; DOT was provided to 95% of TB cases.

Objective 2: At least 95 percent of cases with sputum smears that are positive for acidfast bacillus will have contacts identified.
Georgia achieved this objective in 2004; 193 (95%) of 203 TB cases with positive sputum smears in 2003 had contacts identified.
Objective 3: At least 85 percent of persons with latent TB infection (LTBI) and started on treatment for latent TB infection will complete preventive LTBI therapy.
Of 605 infected contacts with available treatment information that should have completed LTBI treatment in 2004, only 59% completed LTBI treatment.

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Progress toward TB Elimination in Georgia TB cases in Georgia have been decreasing over the past decade, however the rate
of decline began to slow in recent years, and for the first time in 5 years, a slight increase in the number of TB cases was reported in 2004. This increase may be due to a combination of factors: the shift to an electronic disease surveillance system which may have increased the efficiency in reporting TB suspects and TB cases, an increase in foreign-born cases, and increases in several high-risk groups. Georgia has been successful in decreasing TB transmission among its U.S.-born population and will need to develop focused strategies to address the increasing proportion of TB cases among its foreign-born population. Although TB case rates are decreasing in African-Americans and the proportion of TB cases among US-born African-Americans is decreasing, racial disparities persist.
Recent cut-backs in state and federal funding have led to staff shortages and decreased resources to implement core TB prevention and control strategies such as directly-observed therapy to ensure treatment completion of active TB cases and contact follow-up to detect secondary cases and treat latent TB infection. A single case of multidrug resistant TB, the control of a TB outbreak, and mass TB screenings after a school or workplace TB exposure, strain the resources of state and local TB programs. TB does not only affect the poor and disenfranchised. Clusters of TB cases are reported among suburban school children, college students, and in a variety of work places. Current TB program activities must be sustained and intensified to achieve TB elimination in Georgia.
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Table 1. Number of TB Cases and Case Rates (per 100,000) by County, Georgia, 2003-2004

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 Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty Douglas

Number of cases <5 <5 0 0 <5 0 <5 5 <5 0 7 <5 0 0 0 0 <5 0 0 0 <5 <5 <5 0 17 0 5 <5 5 0 15 0 23 <5 5 5 <5 <5 0 0 <5 0 <5 84 <5 0 7 <5

2003

Case Rate
5.6 12.7
0 0 2.2 0 7.5 5.9 17.4 0 4.5 8.4 0 0 0 0 8.7 0 0 0 30.0 4.1 3.4 0 7.2 0 18.9 0.6 4.8 0 5.7 0 3.5 7.7 11.6 5.1 6.3 3.9 0 0 6.3 0 3.5 12.4 5.2 0 7.3 2.0

2004 Number of
cases <5 <5 0 0 <5 <5 0 6 0 0 10 <5 <5 <5 0 <5 <5 0 0 <5 0 8 <5 0 10 0 <5 <5 <5 0 14 0 29 <5 <5 11 0 <5 0 <5 <5 0 0 72 <5 <5 8 <5

Case Rate
5.6 12.5
0 0 4.4 6.4 0 6.9 0 0 6.4 8.3 12.9 6.1 0 4.9 12.9 0 0 2.2 0 7.9 1.7 0 4.2 0 7.5 2.3 2.9 0 5.3 0 4.4 5.1 6.8 10.9 0 0.9 0 18.2 6.2 0 0 10.6 5.1 25.8 8.4 2.8

12

COUNTY
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 Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether

Number of cases 0 0 0 <5 5 0 <5 <5 7 0 0 122 <5 <5 0 0 <5 0 36 0 7 0 <5 0 <5 <5 <5 9 0 0 0 <5 0 0 0 <5 0 0 <5 <5 <5 0 <5 <5 0 <5 <5 <5 0 0 <5

2003

Case Rate
0 0 0 4.8 22.8 0 4.7 1.0 7.5 0 0 15.0 3.8 37.9 0 0 4.1 0 5.1 0 4.5 0 7.3 0 4.3 26.9 1.3 7.5 0 0 0 7.8 0 0 0 3.9 0 0 4.3 3.5 3.4 0 9.3 2.1 0 7.1 3.7 14.0 0 0 8.8

13

Number of cases <5 0 <5 <5 <5 <5 0 <5 6 <5 0 116 7 0 0 <5 0 <5 42 0 6 0 0 <5 0 0 5 10 <5 <5 0 0 <5 0 0 <5 0 0 <5 0 <5 <5 0 5 0 <5 0 <5 0 <5 <5

2004

Case Rate
8.3 0 8.9 9.6 9.0 17.8 0 2.9 6.4 0.75 0 14.2 26.2 0 0 8.2 0 6.4 6.0 0 3.7 0 0 3.7 0 0 3.1 8.1 20.1 4.0 0 0 5.9 0 0 3.8 0 0 2.1 0 1.6 11.9 0 5.2 0 7.2 0 14.1 0 8.9 4.4

COUNTY
Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington

Number of cases 0 <5 0 0 0 <5 12 <5 0 0 <5 <5 0 0 <5 <5 0 0 <5 0 0 21 <5 0 <5 <5 <5 <5 0 <5 0 0 5 0 0 <5 <5 0 5 0 0 <5 <5 <5 0 <5 6 0 <5 0 <5

2003

Case Rate
0 12.6
0 0 0 5.1 6.5 3.9 0 0 1.0 8.2 0 0 6.7 2.5 0 0 121.0 0 0 10.6 2.7 0 6.5 21.6 6.6 11.9 0 3.0 0 0 22 0 0 9.2 2.3 0 18.9 0 0 5.0 10.4 19.1 0 3.6 9.6 0 5.6 0 4.8

14

Number of cases 0 6 <5 0 0 <5 20 0 0 0 <5 <5 0 0 <5 <5 0 <5 <5 0 0 14 <5 0 <5 <5 <5 0 0 <5 0 0 0 <5 0 <5 <5 <5 0 0 <5 <5 <5 <5 0 <5 <5 <5 <5 0 <5

2004

Case Rate
0 25.1 4.3
0 0 2.5 10.9 0 0 0 2.8 4.0 0 0 6.3 2.5 0 5.1 81 0 0 7.1 5.3 0 19.6 10.8 3.3 0 0 6.1 0 0 0 11.1 0 18.3 2.3 7.5 0 0 14.2 4.9 10.6 9.6 0 3.6 4.7 5.6 5.6 0 4.7

COUNTY
Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

Number of cases <5 0 0 <5 5 0 0 0 <5

2003

Case Rate
14.5 0 0 8.8 5.7 0 0 0 4.6

Number of cases 0 0 0 0 9 0 0 0 0

2004

Case Rate
0 0 0 0 10.0 0 0 0 0

Table 2. TB Cases and Case Rates by Health District, Georgia, 2003-2004

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 8.1 Valdosta 8.2 Albany 9.1 Coastal 9.2 Waycross 10 Athens Total

2003

Number of

Case rate

cases

30

5.4

10

2.7

13

2.5

25

3.3

122

15.0

15

5.7

41

5.0

84

12.4

25

3.6

4

2.9

23

4.7

32

7.4

3

18

5.0

7

3.0

24

6.7

20

4.0

25

7.6

11

2.8

532

6.1

2004

Number of

Case rate

cases

27

4.7

21

5.5

8

1.5

32

4.2

116

14.2

14

5.2

46

5.3

72

10.6

25

3.5

4

2.8

28

5.6

24

5.5

11

35

9.9

12

5.1

22

6.1

17

3.3

13

3.9

12

2.9

539

6.1

15

Table 3. TB Case Rates by Race/Ethnicity, Georgia, 2000-2004

Race/ethnicity Asian, non-Hispanic Black, non-Hispanic Hispanic, all races White, non-Hispanic

2000 31.5 17.9 17.7 2.4

2001 27 13.9 13.3 2.1

2002 19.4 12.8 14.3 1.7

2003 20.5 12.1 15.1 1.5

2004 20.2 11.9 15.3 1.5

Table 4. TB Case Rates by Age Group, Georgia, 2000-2004

Age Group < 5 yrs. 5-14 yrs 15-24 yrs. 25-44 yrs. 45-64 yrs. >= 65 yrs.

2000 4.2 0.2 3.8 8.8 10.5 11

2001 3.4 0.7 4.5 8.9 8.3 9.7

2002 3.4 0.7 4.4 8.7 8.0 9.7

2003 5 0.8 4.7 7.4 7.7 9.6

2004 3.5 1 4.9 7 8.6 9

Table 5. TB Cases by Race/ethnicity, 18 Health Districts, Georgia 2004

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

Asian, non-

Hispanic

N

%

3

11

2

10

3

38

3

9

3

3

2

14

17

37

6

8

2

8

0

0

1

4

1

3

3

9

0

0

0

0

2

12

3

23

0

0

Black, non-

Hispanic

N

%

2

7

0

0

3

38

17

53

92

79

8

57

9

20

53

74

12

48

2

50

20

71

26

74

23

66

5

42

20

91

13

76

4

31

4

33

Hispanic, all

races

N

%

7

26

10

48

1

12

9

28

17

15

1

7

15

33

9

12

5

20

0

0

2

7

1

3

4

11

4

33

0

0

1

6

3

23

4

33

White, non-

Hispanic

N

%

15

56

9

43

1

12

3

9

4

3

3

21

5

11

3

4

6

24

2

50

5

18

7

20

4

11

3

25

2

9

1

6

3

23

4

33

16

Table 6. TB Cases by Country of Birth (U.S. or Foreign-born), 18 Health Districts Georgia, 2004

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

U.S.-born

N

%

18

67

11

52

3

38

15

47

89

77

7

50

10

22

28

39

18

72

4

100

25

89

33

94

29

83

7

58

22

100

14

82

7

54

10

83

Foreign-born

N

%

9

33

9

43

5

62

17

53

24

21

7

50

36

78

41

57

7

28

0

0

3

11

1

3

6

17

5

42

0

0

3

18

6

46

2

17

Table 7. TB Treatment Completion Trends, 1999-2003, Georgia

Treatment Completion Over-all completion Completion in 12 months

1999 536/598 (90%)
458/590 (78%)

2000 552/601 (92%)
477/589 (81%)

2001 473/512 (92%)
409/506 (81%)

2002 410/447 (92%)
345/444 (78%)

2003 394/424 (93%)
356/446 (80%)

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Table 8. Completion of Treatment in 12 months by Health District, Georgia, 1999-2003

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 8-1 Valdosta 8-2 Albany 9-1 Savannah 9-2 Waycross 9-3 Brunswick 10 Athens
GEORGIA

1999

2000

2001

2002

2003

18/18 (100%) 23/28 (82%) 26/27 (96%) 22/26 (85%) 18/24 (75%)

11/20 (55%) 10/11 (91%) 7/9 (78%) 4/7 (57%) 9/10 (90%)

10/13 (77%) 8/12 (67%) 6/10 (60%) 5/6 (83%) 6/11 (54%)

20/24 (83%) 23/32 (72%) 30/37 (81%) 23/35 (66%) 21/24 (88%)

95/130 (73%) 133/153(87%) 97/116 (84%) 86/103 (83%) 83/108 (77%)

7/14 (50%) 13/20 (65%) 11/12 (92%) 13/15 (87%) 10/12 (83%)

26/27 (96%) 30/38 (79%) 14/17 (82%) 23/26 (88%) 19/27 (70%)

69/98 (70%) 56/68 (82%) 59/72 (82%) 60/77 (78%) 55/61 (90%)

18/19 (95%) 19/26 (73%) 11/14 (79%) 12/14 (86%) 20/23 (87%)

7/9 (78%) 6/7 (86%) 5/6 (83%) 7/7 (100%) 4/4 (100%)

14/25 (56%) 19/23 (83%) 16/22 (73%) 11/17 (65%) 15/19 (79%)

34/41 (83%) 21/25 (84%) 38/46 (83%) 15/16 (94%) 23/31 (74%)

6/6 (100%) 8/11 (73%) 13/16 (81%) 5/5 (100%) 1/1 (100%)

15/20 (75%) 16/23 (70%) 11/17 (65%) 19/29 (66%) 15/17 (88%)

16/17 (94%) 9/10 (90%) 11/14 (79%) 1/2 (50%) 6/6 (100%)

29/36 (81%) 26/32 (81%) 17/25 (68%) 4/12 (33%) 17/22 (77%)

7/11 (64%) 16/18 (89%) 10/11 (91%) 9/12 (82%) 12/15 (80%)

41/44 (93%) 25/32 (78%) 19/22 (86%) 9/15 (60%) 16/22 (73%)

5/7 (71%) 6/8 (75%) 1/3 (33%) 5/6 (83%) (see Dist 9.1)

10/11 (91%) 10/12 (83%) 7/10 (70%) 13/15 (87%) 5/8 (62%)

458/590 (78%)

477/589 (81%)

409/506 (81%)

345/444 (78%)

356/446 (80%)

Table 9. Provision of Directly Observed Therapy, Georgia, 1999-2003

Directly-Observed Therapy (DOT) Totally Self-administered (SA) Totally DOT Both DOT and SA

1999 % 11 57 30

2000 % 9 65 22

2001 % 5 69 22

2002 % 5 72 22

2003 % 4 76 19

Table 10. Clinical Characteristics of TB Patients, Georgia, 2000-2004

Clinical Characteristic % Pulmonary TB % Sputum smear positive % Sputum culture positive % Started on 4 anti-TB drugs in cases > 5 yrs. old % Sputum conversion after two months of TB treatment

2000 80% 41% 60% 78%

2001 78% 38% 58% 82%

2002 78% 44% 60% 83%

2003 78% 38% 56% 85%

2004 78% 41% 61% 83%

72% 78% 80% 76% 81%

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Table 11. Summary of TB Trends, Georgia, 2000-2004

Characteristic

2000

2001

2002

2003

2004

Number of TB cases

695

577

535

532

539

TB case rate/100,000

8.4

6.9

6.3

6.1

6.1

No. and % tested for HIV in adults 490 (78%) 464 (85%) 437 (87%) 430 (88%) 446 (89%)

No. and % drug susceptibility testing 532 (99%) 428 (98%) 418 (99%) 390 (98%) 425 (98%)

INH resistance rate

7.1%

6.1%

7.7%

5.1%

8.2%

MDR-TB rate

1.1%

0.5%

0.5%

0.5%

0.7%

No. and % Black, non-Hispanic

424 (62%) 340 (59%) 322 (60%) 309 (59%) 313 (58%)

No. and % Hispanic, all races

78 (11%) 63 (11%) 75 (14%) 82 (16%) 92 (17%)

No. and % Asian, non-Hispanic

62 (9%) 58 (10%) 44 (8%) 49 (9%) 51 (10%)

No. and % Foreign-born

154 (22%) 159 (28%) 172 (32%) 156 (29%) 184 (34%)

No. and % Homeless

50 (7%) 61 (11%) 44 (8%) 34 (6%) 35 (6%)

No. and % Substance abusers

161 (23%) 119 (21%) 116 (22%) 90 (17%) 104 (19%)

No. and % in Correctional facilities

38 (6%) 33 (6%) 28 (5%) 20 (4%) 22 (4%)

No. and % in Long-term care facilities 21 (3%) 21 (4%) 8 (2%) 9 (2%) 15 (3%)

No. and % Health care worker

13 (2%) 10 (2%) 13 (2%) 18 (3%) 12 (2%)

No. and % Migrant agricultural worker 8 (1%) 4 (0.7%) 11 (2%) 6 (1%) 3 (0.6%)

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