2007 Georgia Tuberculosis Report

Georgia Department of Human Resources | Division of Public Health 2007 Georgia Tuberculosis Report | 1

Pub. No. DPH08.327HW

2007 Georgia Tuberculosis Report

Georgia Department of Human Resources ............B. J. Walker



Commissioner

Division of Public Health.................................S. Elizabeth Ford, M.D., M.B.A.



Acting Division Director



Health Information, Policy, Strategy, and

Accountability ............................................. Martha Okafor, Ph.D.



Division Deputy Director

Office of Epidemiology, Evaluation and

Health Information........................................ Dafna Kanny, Ph.D.



Senior Director

Epidemiology Section...........................................John Horan, M.D., M.P.H.



Director

Tuberculosis Epidemiology Team.............................Rose-Marie F. Sales, M.D., M.P.H.



Team Leader

Tuberculosis Program...........................................Beverly DeVoe-Payton, M.S.H. Program Manager



Michael K. Leonard, Jr., M.D. Medical Consultant

Acknowledgments:

We thank the County Health Department staff, District Health Office TB coordinators, and state TB surveillance staff that 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 F. Sales, M.D., M.P.H. Georgia Department of Human Resources Division of Public Health, TB Epidemiology Team 2 Peachtree St., NW, Atlanta, GA 30303 Phone: (404) 657-2634 E-mail: rfsales@dhr.state.ga.us

Suggested Citation: 2007 Georgia Tuberculosis Report, Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia, October 2008. Publication No:DPH08.327HW

2007 Georgia Tuberculosis Report | 1

Table of Contents
TB Surveillance in Georgia........................................................................................................................................................3 Current Epidemiology of TB in Georgia....................................................................................................................................4 High-Risk Populations................................................................................................................................................................6 Drug Resistance..........................................................................................................................................................................7 Indicators of Infectiousness........................................................................................................................................................8 Initial Diagnosis, Health Provider Data, and Directly Observed Therapy.................................................................................................................................................8 TB Mortality...............................................................................................................................................................................8 TB Contact Investigations and Latent TB Infection...................................................................................................................8 TB Program Objectives..............................................................................................................................................................9 Morbidity Trends and Program Performance Tables..................................................................................................................10 Graphs of TB Morbidity Trends by Health District, 1995-2007................................................................................................20
2007 Georgia Tuberculosis Report | 2

Tuberculosis (TB) Surveillance in Georgia
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 Team of the Georgia Department of Human Resources, Division of Public Health (GA DHR-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 GA DHR's Division of Public Health, or by calling, mailing or faxing a report to public health authorities. Hospital infection 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, which 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.
What's new in this edition of the Georgia Tuberculosis Report: Table on Percentage of Latent TB Infection Among Contacts Exposed to a TB Case by Health District, Georgia, 2005-2006 Table on Reasons Why Infected Contacts Stop Latent TB Infection Therapy, Georgia, 2002-2006 Graphs of Tuberculosis Incidence Trends by Health District, Georgia, 1995-2007
2007 Georgia Tuberculosis Report | 3

Current Epidemiology of Tuberculosis (TB) in Georgia
In 2007, 473 tuberculosis (TB) cases were reported in Georgia, representing a 7% decrease from 507 TB cases reported the year before, and a 48% reduction in cases from the height of a resurgence in TB that occurred in Georgia in the early 1990s (Figure 1). Despite the declining incidence of cases, however, Georgia's TB case rate of 5 cases per 100,000 population is still higher than the national average of 4.4 cases per 100,000, and Georgia has the ninth highest TB case rate among the 50 states of the United States. Georgia is also one of 24 states with a case rate higher than the 2000 national interim target TB case rate of 3.5 per 100,000 population.

Figure 1. TB Cases and Case Rates Georgia,1982-2007

Number of Cases
1000 900 800 700 600 500 400 300 200 100 0

Rate/100,000
16 14 12 10 8 6 4 2 0

1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year Number Case Rate

Geographic Distribution Among 159 counties in Georgia, the counties that reported the highest number of TB cases in 2007 were: Fulton (78), DeKalb (72), Gwinnett (53), and Cobb (27). All four counties are in the metropolitan Atlanta area and accounted for 49% of Georgia's TB cases. Only four other counties reported more than 10 TB cases in 2007: Chatham (16 cases), Columbia (16), Clayton (15) and Muscogee (11) counties that are all outside of the metropolitan Atlanta area except for Clayton County. Eighty-one counties did not report a single case of TB, 60 counties reported fewer than 5 cases, and ten counties reported between 5-7 cases in 2007 (Table 1, Figure 2).

Figure 2. High TB Incidence Counties Georgia, 2007

Atlanta

Columbia n= 16

Cobb n=27
Fulton n=78

Gwinnett n=53
DeKalb n=72
Clayton n=15

Chatham n=16

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

Among Georgia's 18 Public Health Districts, DeKalb Health District had the highest TB case rate (9.8/100,000) while Athens Health District had the lowest case rate (1.8/100,000) in 2007 (Table 2). The number of TB cases increased in five Health Districts from the previous year while the number of cases decreased in 10 Health Districts. Seven Health Districts achieved the national target incidence rate for TB elimination of <=3.5/100,000. Seven Health Districts had higher case rates than the state average (Figure 3).

Figure 3. TB Case Rates by Health Districts Georgia, 2007

1-2

G ordon

2-0

1-1 B artow

P olk P aulding

Harals on

3-1

3-2 3-4
3-5
R oc k da le
3-3

10-0

Case rates/100,000 population:
<= 3.5 (national target) 3.6 to 5.0 > 5.0 (state average)

4-0

6-0

5-2

7-0
8-2
S eminole Dec a tu r

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

2007 Georgia Tuberculosis Report | 4

Sex and Age Distribution TB occurred predominantly among men (64%) while the highest number and proportion of TB cases by age group occurred among persons 25-44 years old (170 cases, 36%) (Figure 4).

Figure 4. TB Cases by Age Group and Sex Georgia, 2007

120 100
80 Number 60
40 20
0 < 5

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

The highest case rate by age group was among persons 65 years and older (7.4 per 100,000) while the lowest was in children 5-14 years old (0.8 per 100,000) (Figure 5).

Figure 5. TB Case Rates* by Age Group 2002-2007, Georgia

Age Group 2003
< 5 yrs. 5.0 5-14 yrs. 0.8 15-24 yrs. 4.6 25-44 yrs. 7.3 45-64 yrs. 7.6 65+ yrs. 9.6

2004
3.5 1 4.9 6.9 8.5 8.9

2005
4.3 0.7 5.6 6.6 6.1 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

*Rates are per 100,000 population

Race/Ethnicity Distribution and TB Disparities TB disproportionately affects racial/ethnic minorities in Georgia. In 2007, non-Hispanic blacks, Hispanics, and Asians accounted for 51%, 20% and 14% of TB cases in Georgia while representing 30%, 8% and 3% of Georgia's population respectively (Figure 6). Non-Hispanic whites constituted 15% of cases in 2007. The highest TB case rate among race/ethnic groups was in Asians (21.5 per 100,000), followed by Hispanics (12.9 per 100,000), and non-Hispanic blacks (8.3 per 100,000). Case rates for all race/ethnic groups were lower than the year before (Figure 7). The nonHispanic black case rate has been steadily decreasing but was still seven times higher than the non-Hispanic white rate (1.2 per 100,000) in 2007 (Figure 8).

Figure 6. TB Cases by Race/Ethnicity Georgia, 1997 and 2007

Asian 6%
White 20%
Hispanic 6%
1997

Black 67%

Asian 14%
White 15%

Black 51%

Hispanic 20%

2007

Figure 7. TB Case Rates* by Race/Ethnicity Georgia, 2003-2007

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

2003 2004 2005 2006 2007 22.8 22.4 17.8 26.4 21.5 15.1 15.3 13.6 16.5 12.9 12.2 12 10.8 9.0 8.3 1.5 1.5 1.5 1.3 1.2

*Rates are per 100,000 population

Figure 8. TB Case Rates in non-Hispanic Blacks and Whites, Georgia, 1993-2007

Non-Hispanic Black Non-Hispanic White

Case Rate/100,000

35 30.6

30

25

20

15 10

8.3

5 3.7

1.2

0

1993 1995 1997 1999 2001 2003 2005 2007

Year

2007 Georgia Tuberculosis Report | 5

High-Risk Populations
Foreign-born The number of TB cases among persons born outside of the United States increased fivefold from 1993 to 2007 (from 40 to 194 cases). In 2007, foreign-born TB cases made up 41% of TB cases in Georgia compared to only 5% in 1993. Most foreign-born cases reported in 2007 came from Mexico (28%), India (11%), Guatemala (9%), and Vietnam (9%), countries where TB is an endemic disease (Figures 9 & 10). Of these foreign-born cases, 48% were diagnosed in the first five years of their arrival in the U.S.
Foreign-born persons represented >=50% of TB cases in five Health Districts: Lawrenceville (82%), DeKalb (58%), Cobb (57%), Dalton (53%), and Gainesville (50%). In the Lawrenceville Health District, the number of foreign-born cases has tripled over the past 5 years; most are reported from the cities of Lawrenceville and Norcross. In the DeKalb Health District, the majority of foreign-born cases are reported from the cities of Atlanta and Clarkston.
Refugees and Immigrants Of 156 refugees and immigrants who arrived in Georgia in 2007 with non-infectious TB diagnosed abroad in accordance with U.S. Department of State procedures, 134 (86%) were re-evaluated by county health departments after their arrival in the U.S. Nine (7%) were diagnosed with active TB and received TB treatment from public health clinics in Georgia. Of these nine individuals, six had a Class B1 (non-infectious, active TB) overseas classification and three had a Class B2 (non-infectious, inactive TB) classification.
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 accelerates the natural progression of HIV infection. In 2007, 413 (87%) TB cases had documented test results for HIV. Of these cases, 59 (14%) had HIV infection (Figure 11). Thirty-nine (8%) cases were not offered the HIV test, 11 (2%) refused to be tested, five (1%) had the test done but results were unknown, and five (1%) had an unknown HIV status. HIV co-infected TB cases occurred predominantly among non-Hispanic blacks (80%), males (64%), and in adults aged 25-44 years old (54%). Among TB cases in the 25-44 years old age group, the proportion of those with known HIV test results increased from 90% in 2006 to 95% in 2007.

Figure 9. US-born and Foreign-born TB Cases Georgia,1993-2007

Number 800 700 600 500 400 300 200 100
0 1993

1995

1997

1999 2001 Year

2003

2005

2007

US-born Foreign-born

Figure 10. Percent of Foreign-born TB Cases (n=194) by Country of Origin, Georgia, 2007

Others 43%
Vietnam 9%

Mexico 28%
India 11% Guatem ala 9%

Figure 11. HIV Status of TB Cases Georgia,1993-2007

Unknown Negative Positive

Number

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

2007 Georgia Tuberculosis Report | 6

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 2007, 35 (7%) cases were homeless, 27 (6%) were residents of correctional facilities, and 12 (2%) were residents of long-term care facilities. Of the cases incarcerated in correctional facilities, 13 were inmates in state prisons, 8 in the new Immigration and Custom Enforcement Detention Center at Stewart County, and 6 in county jails. Substance abuse of either drugs or alcohol was reported in 85 (18%) cases in 2007 (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 2007, children younger than 15 years old comprised 8% of Georgia TB cases; 26 cases (3.5 per 100,000) were reported in children younger than 5 years old, 11 cases (0.8 per 100,000) were reported in children 5-14 years old. Three children younger than 15 years old had meningeal TB and one had miliary TB.
Drug Resistance
Of 372 culture-confirmed cases in 2007, 365 (98%) were tested for drug susceptibility to the three first line antiTB medications: isoniazid (INH), rifampin (RIF), and ethambutol (EMB). Of 353 tested isolates from cases with no previous history of TB, 20 (6%) had primary resistance to INH, 3 (0.8%) to RIF, and 3 (0.8%) to EMB (Table 4). Two multidrug-resistant TB (MDR-TB, i.e. TB resistant to at least INH and RIF) cases were reported in 2007. The percentage of cases with primary INH resistance (INH-R) ranged from 5% to 8% in the past 5 years while an average of two MDR-TB cases per year was reported over that same time period (Figure 13).

Figure 12. TB in Other High-Risk Populations Georgia, 2003-2007

120

100

18%

80

Number 60 40 20

7% 6%
2%

0 2003 2004 2005 2006 2007 Year

Substance abuse Homeless Correctionals Long-Term Care

Number Percent

Figure 13. Drug Resistance and MDR-TB Georgia, 2003-2007

35

9

30

8

8

25

7

7

7

66

20

5

5

15

4

10

3 2

5

2

3

1

0

21

0

0

2003 2004 2005 2006 2007

Year

INH RIF MDR-TB % INH-R

2007 Georgia Tuberculosis Report | 7

Indicators of Infectiousness
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 2007, 74% of cases had pulmonary TB, 57% had sputum cultures that were positive for Mycobacterium tuberculosis, 38% had positive sputum AFB smears, and 31% showed radiographic evidence of cavitary lesions.
Initial Diagnosis, Health Provider Data, and Directly Observed Therapy
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 2007, 318 (67%) of TB patients were initially reported to public health authorities by 106 different hospitals in Georgia. The hospitals in Georgia that admitted the most number of TB patients in 2007 were Grady Memorial Hospital (50 patients), a publicly funded hospital in Atlanta, and Gwinnett Medical Center (21 patients), a private hospital in Lawrenceville. County health departments provided case management for 87% of TB patients and only 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 341 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.
TB Mortality
Twenty persons died of TB in GA in 2006, the most recent year with available mortality data. The age-adjusted TB mortality rate was 0.2 per 100,000. From 2002 to 2006, an average of 21 people died of TB each year (range = 15-31).
TB Contact Investigations and Latent TB Infection
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 7,222 identified contacts of TB cases reported in 2006, 5,942 (82%) were completely evaluated for TB disease and LTBI (Table 8). Of these evaluated contacts, 69 (1%) had TB disease and 1,284 (22%) had LTBI (Table 9). Among contacts with LTBI, 929 (72%) were started on LTBI therapy (Table 10).
2007 Georgia Tuberculosis Report | 8

TB Program Objectives
Objective 1: 90% of Georgia TB patients will complete a course of TB treatment within 12 months of starting treatment.

Among 453 TB patients started on TB treatment in 2006 who were slated to complete treatment in 2007, 92% completed their full course of treatment; however, only 81% of patients eligible for a 12-month treatment course completed treatment in 12 months (Table 5, 6). 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). Timely treatment completion was much lower than the state average among HIV-infected persons (67%), homeless persons (73%), and persons abusing illegal drugs (76%).
Objective 2: 95% of TB cases with sputum smears that are positive for acid-fast bacillus will have contacts identified.

Figure 14. Timely TB Treatment Completion and Directly Observed Therapy (DOT) Georgia, 1993-2006

Percent

90

80

70

60

50

40

30

20

10

DOT became standard of care

0

1993 1995 1997 1999 2001 2003 Year

Completion in 12 months Totally DOT
2005

Georgia attained this objective in 2006, the most recent year with completed data on contacts to TB cases. Of 185 TB cases with sputum smears that were positive for acid-fast bacillus (an indicator of infectiousness), 176 (95%) had contacts identified by county health departments (Table 7). Of the nine sputum AFB-smear positive cases with no identified contacts, the reasons for why no contacts were identified were: case was uncooperative/refused to be interviewed and had no proxy interviewee (3 cases), case was too ill to be interviewed and had no proxy interviewee (1), contact investigation was not done (1), and data were missing for 4 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.

Of 921 infected contacts started on LTBI therapy in 2006 who should have completed preventive treatment by 2007, 522 (57%) completed LTBI treatment, 175 (19%) chose to stop therapy on their own, 100 (11%) were lost to follow-up, 61 (7%) stopped taking medications due to a recommendation from their provider, 40 (4%) moved before completing therapy, 13 (1%) had an adverse reaction to the medications, 7 (0.8%) developed active TB, and 3 (0.3%) died before LTBI therapy was completed. The decline in LTBI treatment completion for infected contacts who started therapy in 2006 may in part be explained by incomplete reporting of LTBI treatment outcomes in previous years (which may inflate completion rates if contacts with missing treatment completion data did not complete treatment), as well as by increases in the percentages of infected contacts who were lost to follow-up or who stopped LTBI therapy
due to a provider's decision (Tables 10-12, Figure 15)

Figure 15. Completion of Latent TB Infection (LTBI) Therapy, Georgia, 2002-2006

Percent

70 60 55

60

63

66

57

50

40

Completed LTBI Therapy

30

Missing data

20

18

14

10

9

0

3

1

2002 2003 2004 2005 2006

Year

2007 Georgia Tuberculosis Report | 9

Table 1. Number of TB Cases and TB Case Rates per 100,000 population by County, Georgia, 2006-2007*

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 Augusta State Medical Prison) Cook Coweta Crawford Crisp Dade Dawson Decatur

2006

Number of Case Rate

cases

<5

--

<5

--

<5

--

0

0

0

0

0

0

<5

--

<5

--

0

0

0

0

6

3.9

0

0

<5

--

<5

--

<5

--

<5

--

<5

--

<5

--

<5

--

<5

--

0

0

0

0

<5

--

0

0

21

8.7

0

0

0

0

<5

--

<5

--

0

0

18

7.0

<5

--

30

4.4

<5

--

6

13.4

2007

Number of Case Rate

cases

<5

--

<5

--

0

0

0

0

0

0

<5

--

<5

--

0

0

0

0

<5

--

<5

--

0

0

0

0

0

0

<5

--

<5

--

<5

--

<5

--

0

0

0

0

0

0

<5

--

<5

--

0

0

16

6.4

0

0

0

0

<5

--

5

4.4

0

0

15

5.1

0

0

27

3.9

<5

--

<5

--

<5

--

<5

--

0

0

<5

--

<5

--

<5

--

0

0

0

0

<5

--

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

2007 Georgia Tuberculosis Report | 10

COUNTY
DeKalb 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 Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty

2006

Number of Case Rate

cases

62

8.6

0

0

8

7.4

0

0

0

0

<5

--

<5

--

0

0

<5

--

<5

--

0

0

<5

--

6

6.3

<5

--

0

0

73

7.5

<5

--

0

0

<5

--

0

0

<5

--

0

0

59

7.8

<5

--

6

3.5

<5

--

0

0

0

0

0

0

0

0

5

--

19

14.9

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

<5

--

0

0

<5

--

0

0

<5

--

2007

Number of Case Rate

cases

72

10

<5

--

<5

--

<5

--

0

0

0

0

0

0

<5

--

<5

--

0

0

0

0

<5

--

7

7.3

<5

--

<5

--

78

7.9

<5

--

0

0

<5

--

<5

--

<5

--

0

0

53

6.8

<5

--

5

2.8

<5

--

0

0

0

0

0

0

0

0

<5

--

5

3.8

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

5

8.3

2007 Georgia Tuberculosis Report | 11

COUNTY
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 Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell

2006

Number of Case Rate

cases

0

0

0

0

<5

--

0

0

<5

--

0

0

<5

--

0

0

0

0

<5

--

0

0

6

25.2

<5

--

0

0

0

0

<5

--

12

6.4

5

5.5

0

0

0

0

<5

--

<5

--

0

0

<5

--

0

0

<5

--

<5

--

<5

--

<5

--

0

0

0

0

12

5.7

<5

--

0

0

0

0

0

0

<5

--

<5

--

<5

--

<5

--

0

0

0

0

<5

--

0

0

<5

--

<5

--

2007 Georgia Tuberculosis Report | 12

2007

Number of Case Rate

cases

0

0

0

0

<5

--

0

0

<5

--

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

<5

--

0

0

<5

--

<5

--

11

5.9

<5

--

0

0

0

0

<5

--

<5

--

0

0

<5

--

0

0

<5

--

<5

--

<5

--

<5

--

0

0

0

0

7

3.6

<5

--

0

0

<5

--

0

0

<5

--

<5

--

0

0

<5

--

0

0

0

0

<5

--

0

0

0

0

<5

--

COUNTY
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

2006

Number of Case Rate

cases

<5

--

<5

--

0

0

0

0

0

0

9

14.2

<5

--

0

0

<5

--

0

0

0

0

<5

--

<5

--

0

0

0

0

0

0

<5

--

<5

--

0

0

<5

--

<5

--

0

0

0

0

0

0

507

5.4

2007

Number of Case Rate

cases

7

15.5

<5

--

<5

--

0

0

0

0

7

11.0

0

0

0

0

0

0

0

0

<5

--

0

0

<5

--

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

0

0

0

0

473

5.0

* 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.

2007 Georgia Tuberculosis Report | 13

Table 2. Number of TB Cases and TB Case Rates per 100,000 population by Health District, Georgia, 2006-2007

HEALTH DISTRICT

2006

2007

Number of cases

Case rate

Number of cases

Case rate

1.1 Rome

17

2.8

18

3.0

1.2 Dalton

14

3.4

14

3.3

2.0 Gainesville

12

2.1

15

2.6

3.1 Cobb

30

3.8

30

3.7

3.2 Fulton

73

7.5

78

7.9

3.3 Clayton

19

7

15

5.5

3.4 Lawrenceville

68

7.3

57

6.0

3.5 DeKalb

62

8.6

72

9.8

4.0 LaGrange

27

3.6

20

2.6

5.1 Dublin

16

11.1

9

5.6

5.2 Macon

31

6.2

15

3.0

6.0 Augusta

17

3.9

16

3.6

Augusta State Medical

14

13

Prison (ASMP)

7.0 Columbus

21

5.9

21

6

ICE Detention Center

0

8

8.1 Valdosta

9

3.8

5

2.1

8.2 Albany

25

6.8

20

5.8

9.1 Coastal

31

5.9

26

4.8

9.2 Waycross

16

4.7

13

3.8

10 Athens

5

1.1

8

1.8

GEORGIA

507

5.4

473

5.0

Table 3. Percentage of TB Cases with Risk Factors for TB by Health District Georgia, 2007

HEALTH DISTRICT

Foreign-

HIV

Homeless Inmate Nursing

born % Infected %

%

%

Home %

Substance Abuse %

1.1 Rome

39

0

11

6

0

17

1.2 Dalton

57

0

0

0

0

14

2.0 Gainesville

53

8

0

0

0

27

3.1 Cobb

57

7

7

3

3

13

3.2 Fulton

30

27

17

0

3

22

3.3 Clayton

33

23

0

7

0

13

3.4 Lawrenceville

81

11

0

2

0

4

3.5 DeKalb

60

12

11

3

3

12

4.0 LaGrange

20

12

5

0

5

45

5.1 Dublin

0

14

0

0

11

22

5.2 Macon

20

21

0

0

0

13

6.0 Augusta &

19

8

0

0

0

12

ASMP

8

17

0

100

0

58

7.0 Columbus &

24

19

10

0

10

19

ICE Detention

100

0

0

100

0

29

8.1 Valdosta

20

0

0

0

0

40

8.2 Albany

5

10

10

0

0

30

9.1 Coastal

19

24

0

8

8

12

9.2 Waycross

23

0

0

0

8

0

10 Athens

38

0

12

0

0

38

GEORGIA

41

14

7

6

2

18

2007 Georgia Tuberculosis Report | 14

Table 4. Primary Resistance to First-line Anti-TB Medications by Health District Georgia, 2007

TB Drug

Isoniazid

Rifampin

Ethambutol

HEALTH DISTRICT

No.

%

No.

%

No.

%

1.1 Rome

0

0

0

0

0

0

1.2 Dalton

0

0

0

0

0

0

2.0 Gainesville

2

20

0

0

0

0

3.1 Cobb

4

17

0

0

0

0

3.2 Fulton

4

6

2

3

1

2

3.3 Clayton

0

0

0

0

0

0

3.4 Lawrenceville

3

7

0

0

1

2

3.5 DeKalb

2

4

0

0

0

0

4.0 LaGrange

0

0

0

0

0

0

5.1 Dublin

0

0

1

14

0

0

5.2 Macon

0

0

0

0

0

0

6.0 Augusta &

1

8

0

0

0

0

ASMP

2

22

7.0 Columbus &

1

6

0

0

0

0

ICE Detention

0

0

0

0

1

14

8.1 Valdosta

1

20

0

0

0

0

8.2 Albany

0

0

0

0

0

0

9.1 Coastal

0

0

0

0

0

0

9.2 Waycross

0

0

0

0

0

0

10 Athens

0

0

0

0

0

0

GEORGIA

20

6

3

0.8

3

0.8

Table 5. Completion of Cases' TB Treatment by Health District, Georgia, 2005-2006

HEALTH DISTRICT

2005

2006

No. Cases that Completed % No. Cases that Completed %

Treatment / No. Cases that

Treatment / No. Cases that

Started Treatment

Started Treatment

1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton

23/25

92

16/16

100

8/10

80

13/13

100

15/15

100

10/10

100

22/24

92

26/29

90

77/81

95

68/71

96

11/12

92

11/16

69

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 GEORGIA

43/52

83

52/60

87

65/69

94

50/53

94

10/10

100

21/24

88

7/7

100

12/13

92

20/21

95

22/27

82

14/14

100

11/13

85

8/8

100

15/15

100

26/27

96

17/18

94

5/5

100

8/8

100

19/21

90

22/23

96

15/17

88

15/16

94

8/8

100

15/15

100

7/7

100

4/4

100

403/433

93

417/453

92

2007 Georgia Tuberculosis Report | 15

Table 6. Timely Completion (within 12 months) of Cases' TB Treatment by Health District, Georgia, 2005-2006

HEALTH DISTRICT

2005

2006

No. Cases that Completed % No. Cases that Completed

%

Treatment in 12 months /

Treatment in 12 months /

No. that Started Treatment

No. that Started Treatment

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 GEORGIA

22/25

88

13/15

87

7/10

70

13/13

100

15/15

100

7/9

78

17/24

71

20/25

80

65/81

80

57/71

80

10/12

83

10/16

62

40/52

77

51/60

85

54/69

78

49/53

92

7/10

70

20/24

83

7/7

100

12/13

92

18/21

86

14/26

54

13/14

93

23/28

82

8/8

100

13/15

87

23/27

85

14/18

78

5/5

100

5/8

62

15/21

71

19/23

83

14/17

82

13/16

81

6/8

75

14/15

93

6/7

86

2/4

50

377/460

82

364/448

81

Table 7. Sputum Smear Positive (SSP) Cases with Contacts Identified by Health District, Georgia, 2005-2006

HEALTH DISTRICT

2005

2006

No. SSP Cases with

% No. SSP Cases with

%

Contacts Identified /

Contacts Identified /

No. SSP Cases

No. SSP Cases

1.1 Rome

18/18

100

5/5

100

1.2 Dalton

5/5

100

8/8

100

2.0 Gainesville

4/4

100

3/3

100

3.1 Cobb

13/13

100

7/8

88

3.2 Fulton

36/36

100

36/36

100

3.3 Clayton

7/8

88

6/6

100

3.4 Lawrenceville

25/25

100

18/21

86

3.5 DeKalb

27/28

96

16/21

76

4.0 LaGrange

10/10

100

9/9

100

5.1 Dublin

4/4

100

4/4

100

5.2 Macon

11/11

100

10/10

100

6.0 Augusta

9/9

100

13/13

100

7.0 Columbus

20/20

100

4/4

100

8.1 Valdosta

3/3

100

6/6

100

8.2 Albany

16/16

100

8/8

100

9.1 Coastal

6/6

100

16/16

100

9.2 Waycross

3/3

100

2/2

100

10 Athens

1/1

100

1/1

100

GEORGIA

218/220

99

176/185

95

2007 Georgia Tuberculosis Report | 16

Table 8. Completely Evaluated Contacts by Health District, Georgia, 2005-2006

HEALTH DISTRICT

2005

2006

No. Contacts that were

% No. Contacts that were

%

Completely Evaluated /

Completely Evaluated /

No. Contacts Identified

No. Contacts Identified

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

187/227

82

163/182

90

171/191

90

148/163

91

182/197

92

71/82

87

780/824

95

430/492

87

1298/1643

79

1174/1521

77

109/118

92

78/103

76

236/298

79

184/225

82

303/375

81

183/284

64

142/161

88

125/145

86

138/139

99

135/142

95

226/250

90

144/157

92

478/536

89

882/1103

80

374/426

88

158/192

82

20/21

95

372/405

92

1395/3544

39

1375/1640

84

101/108

94

243/289

84

21/24

88

57/70

81

73/86

85

20/27

74

6234/9163

68

5942/7222

82

Table 9. Contacts with Latent TB Infection by Health District, Georgia, 2005-2006

HEALTH DISTRICT

2005

2006

No. Contacts with LTBI/ % No. Contacts with LTBI/

%

No. Contacts

No. Contacts Completely

Completely Evaluated

Evaluated

1.1 Rome

47/187

25

63/163

39

1.2 Dalton

37/171

22

70/148

47

2.0 Gainesville

67/182

37

25/71

35

3.1 Cobb

65/780

8

64/430

15

3.2 Fulton

360/1298

28

211/1174

18

3.3 Clayton

41/109

28

29/78

37

3.4 Lawrenceville

82/236

35

76/184

41

3.5 DeKalb

86/303

28

50/183

27

4.0 LaGrange

35/142

25

43/125

34

5.1 Dublin

23/138

17

36/135

27

5.2 Macon

50/226

22

56/144

39

6.0 Augusta

119/478

25

117/882

13

7.0 Columbus

106/374

28

64/158

40

8.1 Valdosta

8/20

40

13/372

4

8.2 Albany

124/1395

9

239/1375

17

9.1 Coastal

41/101

41

102/243

42

9.2 Waycross

5/21

24

13/57

23

10 Athens

34/73

47

13/20

65

GEORGIA

1330/6234

21

1284/5942

22

2007 Georgia Tuberculosis Report | 17

Table 10. Infected Contacts Started on LTBI Treatment by Health District Georgia, 2005-2006

HEALTH DISTRICT

2005

2006

No. Infected Contacts

% No. Infected Contacts

%

on LTBI Treatment / No.

on LTBI Treatment / No.

Infected Contacts

Infected Contacts

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

32/47

68

57/63

90

26/37

70

61/70

87

54/67

81

15/25

60

49/65

75

34/64

53

249/360

69

138/211

65

30/41

73

24/29

83

48/82

58

57/76

75

49/86

57

41/50

82

26/35

74

36/43

84

19/23

83

33/36

92

36/50

72

47/56

84

47/119

40

57/117

49

55/106

52

50/64

78

8/8

100

8/13

62

74/124

60

170/239

71

36/41

88

95/102

93

0/5

0

4/13

31

23/34

68

2/13

15

861/1330

65

929/1284

72

Table 11. LTBI Treatment Completion of Infected Contacts by Health District Georgia, 2005-2006

HEALTH DISTRICT

2005
No. Contacts that % Completed LTBI Treatment / Contacts Treated

Missing data

2006
No. Contacts that % Completed LTBI Treatment / Contacts Treated

1.1 Rome 1.2 Dalton 2.0 Gainesville 3.1 Cobb 3.2 Fulton 3.3 Clayton

18/23 15/26 34/54 25/43 167/229 9/21

78

9

58

0

63

1

58

6

73

15

43

8

21/54

39

32/59

54

10/15

67

13/34

38

59/138

43

10/24

42

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

17/29 19/26 11/17 11/15 25/34 19/43 25/40
2/4 13/15 26/34
0/0 13/21 449/674

59

19

73

22

65

9

73

4

74

2

44

4

62

9

50

4

87

11

76

2

--

--

62

1

67 126

42/57

74

36/40

90

29/36

81

17/33

52

22/47

47

31/56

55

27/50

54

6/8

75

103/169

61

59/95

62

3/4

75

2/2

100

522/921

57

Missing data
3 2 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 8

2007 Georgia Tuberculosis Report | 18

Table 12. Reasons Why Infected Contacts Treated for LTBI Stopped LTBI Therapy Georgia, 2002-2006

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

2002 n=575
% 55 17 8 8 10 2 0 0.5

2003 n=655
% 60 19 13 4 3 1 0.6 0.2

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 Georgia Tuberculosis Report | 19

Tuberculosis Morbidity Trends by Health District, Georgia, 1995-2007

TB Case Numbers and Rates

District 1-1 (Rome),1995-2007

60 51 50

40 30 20

33

18

25

22

31

32

32

30

27

30

17

18

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

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates

District 1-2 (Dalton),1995-2007

25

21

21

20 15 12 11 14 10 10

15 11 8 10

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

0

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 2 (Gainesville),1995-2007

25

20

20

17

19

15 15 15

15

15

12

13

12

10 10

10

8

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

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates

District 3-1 (Cobb),1995-2007

50

44

40

32

32

38 38 36

32 30 30 30

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

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 3-2 (Fulton),1995-2007

250 200

192 207 187

177

150

133 150

136 119 122 116

100

87 72 78

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

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates

District 3-3 (Clayton),1995-2007

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

9.7 6.5 7.1 5.4 5.2 5.6 7 5.5

0

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

Year

Number Rate

Rates are per 100,000 population

2007 Georgia Tuberculosis Report | 20

Tuberculosis Morbidity Trends by Health District, Georgia, 1995-2007

TB Case Numbers and Rates District 3-4 (Lawrenceville),1995-2007

80

68

70 60

58

57

50

43

42 46

40 30 20

12

24

17

26

29

34 21

10 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

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 3-5 (DeKalb),1995-2007

120 100 80

92

99 102

104

84

85

78

88

83

72

80

61

72

60

40

20

15.9 16.7 17 14.3 16.9 12.9 11.6 13 12.3 10.6 11.6 8.4 9.8

0

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 4 (LaGrange),1995-2007

35

30

24 26

29

25 25

27

25 19

21 20

20

20

16 16

16

15

10

5

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

0

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 5-1 (Dublin),1995-2007

18

16

16

14

12

12 10 8 6 4 2

7 5.6 5
4

6 4.7 4
3.1

9.4 8

9

8 11.1

6
5.9

6.6 4 4

5.6

4.4

2.9 2.8

8
5.6

0

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 5-2 (Macon),1995-2007

60

51

50 46

40 30

31 22 27 28 23 20 23 28 24 31

20

15

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

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates

District 6 (Augusta),1995-2007

60

52

50 45

46

40

38 39

30

32

30 20

25

20

24 19 17 16

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

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

Year

Number Rate

Rates are per 100,000 population

2007 Georgia Tuberculosis Report | 21

Tuberculosis Morbidity Trends by Health District, Georgia, 1995-2007

TB Case Numbers and Rates

District 7 (Columbus),1995-2007

50

46

40 33 30 20

34

36

34

28 30

30

22

21

18

20 21

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

0

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 8-1 (Valdosta),1995-2007

30

24

25 21

20

18

15

20

17

14 15

12

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 2.1

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 8-2 (Albany),1995-2007

50 40

38

45

40

36

43

38

30

29

24 21 23 25 21

20

17

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

0

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 9-1 (Coastal),1995-2007

70

58

60 48

50

40 30 20

34 33 25 33 19 23 20 17 19 31 26

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

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

Year

Number Rates are per 100,000 population

Rate

TB Case Numbers and Rates District 9-2 (Waycross),1995-2007

60 50 43

50 48

40

30

30

24

34

25

25

20 15

16.6 15.8

16

13 9 16 13

10

10.4 8.2

0

10.6 7.8 4.9 7.6 3.9 2.7 4.7 3.8

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

Year

Number Rate

Rates are per 100,000 population

TB Case Numbers and Rates District 10 (Athens),1995-2007

25

22

20

16

16

15 13 13

13 14 13

11 12

10

9

8

5 0

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 1.8

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

Year

Number Rate

Rates are per 100,000 population

2007 Georgia Tuberculosis Report | 22

2007 Georgia Tuberculosis Report
Georgia Department of Human Resources | Division of Public Health
2007 Georgia Tuberculosis Report | 23