2011 Georgia tuberculosis report

2011 Georgia Tuberculosis Report
Georgia Department of Public Health.....................Brenda Fitzgerald, M.D. Commissioner
Division of Health Protection.....................................Pat O'Neal, M.D. Director
Epidemiology Branch.......................................Cherie Drenzek, D.V.M., M.S. State Epidemiologist
Tuberculosis Program.......................................Dr. Rose-Marie F. Sales Program Manager David Maggio Epidemiologist Antoine Perrymon Epidemiologist
Acknowledgments: We thank the County Health Department staff, District Health Office TB coordinators, and state TB surveillance staff that collected and reported the data 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: Dr. Rose-Marie F. Sales Georgia Department of Public Health Tuberculosis Program Division of Health Protection 2 Peachtree St., NW, Atlanta, GA 30303 Phone: (404) 657-2634 E-mail: rfsales@dhr.state.ga.us
Suggested citation: Georgia Department of Public Health, 2011 Georgia Tuberculosis Report, Atlanta, Georgia, October 2012.
1

Table of Contents TB Surveillance in Georgia...........................................................3 Current Epidemiology of TB in Georgia..........................................4 High-Risk Populations...............................................................5 Drug Resistance.......................................................................6 Indicators of Infectiousness.........................................................6 Initial Diagnosis, Health Provider Data, And Directly Observed Therapy.....................................................7 TB Mortality...........................................................................7 TB Contact Investigations and Latent TB Infection..............................7 TB Program Objectives...............................................................8 Tables: Morbidity Trends and Program Performance Indicators by Health District..................................................................................10 Figures: Descriptive Epidemiology.................................................19 Graphs: Tuberculosis Morbidity Trends by Health District, 1995-2010......27
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 Section of the Georgia Department of Public Health (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 preventionists 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 Web site 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, 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 (CDC) and become part of the national TB surveillance database.
3

Current Epidemiology of Tuberculosis in Georgia
Georgia reported 347 new tuberculosis (TB) cases in 2011. This represents a 16% decrease from 411 TB cases reported in 2010 (Figure 1), and a 62% decrease since 1991 when the peak of a resurgent period of tuberculosis occurred in Georgia. The TB case rate in Georgia decreased from 4.2 cases per 100,000 population during 2010 to 3.5 cases per 100,000 in 2011. Georgia had the eleventh-highest TB case rate among the 50 states of the United States in 2011.
Geographic Distribution
Among the 159 counties in Georgia, four counties in the metropolitan Atlanta area reported the highest number of TB cases in 2011: DeKalb (76 cases), Gwinnett (48), Fulton (45), and Cobb (16) (Table 1, Figure 2). These four counties accounted for 53% of TB cases reported in Georgia in 2011.
Among Georgia's 18 Health Districts, which have oversight responsibility for public health in the state's 159 counties, DeKalb Health District had the highest TB case rate in 2011 (10.9 per 100,000), followed by Albany (5.0 per 100,000) and Lawrenceville (4.8 per 100,000).
Sex and Age Distribution
In 2011, TB in Georgia occurred predominantly among males (225 cases, 65%), compared to females (122, 35%); while the highest proportion of TB cases by age group occurred among persons 45-64 years old (143 cases, 35%). Among males, the highest proportion of cases occurred in the 45-64 year old age group (37%) while among females, the highest proportion was in the 25-44 year old age group (34%) (Figure 4). The highest TB case rate by age group was among persons 45-64 years old (4.6 per 100,000) while the lowest was among children 5-14 years old (0.7 per 100,000) (Figure 5). The TB case rate for children younger than 5 years of age, an age group at high risk for developing deadly forms of TB, increased from 2.0 per 100,000 in 2010 to 2.3 per 100,000 in Georgia during 2011.
Race/Ethnicity Distribution and TB Disparities
TB disproportionately affects racial/ethnic minorities in Georgia. In 2011, nonHispanic blacks, Asians and Hispanics, accounted for 48%, 17% and 20% of TB cases in Georgia respectively, but only represented 30%, 3.3% and 9.1% of Georgia's population respectively (Figure 6). Non-Hispanic whites constituted 15% of TB cases in 2011. The highest TB case rate among race/ethnic groups was among Asians (16.8 per 100,000), followed by Hispanics (7.6 per 100,000), and non-Hispanic blacks (5.3 per 100,000) (Figure 7). The black non-Hispanic TB case rate in 2011 represents an almost 83% decrease 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 about 6 times higher than the white nonHispanic TB case rate (0.9 per 100,000) in Georgia during 2011 (Figure 8).
4

High-Risk Populations
Foreign-Born
TB cases among persons born outside of the United States accounted for 46% of TB cases in Georgia in 2011 compared to 44% in 2010. Most foreign-born cases reported in 2011 came from Mexico (27%), and India (12%), Guatemala (9%) - countries where TB is an endemic disease (Figures 9-10). Among 159 foreign-born cases, 60 (38%) were diagnosed in the first five years of their arrival in the U.S.
In 2011, four Health Districts reported 68% of the total number of foreign-born TB cases in Georgia: DeKalb (42 cases), Lawrenceville (33), Cobb (15) and Fulton (18). Among these Health Districts, foreign-born TB cases accounted for more than half of the TB cases in Lawrenceville (67%), Cobb (75%) and DeKalb (55%). Foreign-born TB cases in the Fulton Health District accounted for 40% 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 310 TB cases in Georgia with known HIV status in 2011, 10% were HIV-positive compared to 11% in 2010 (Figure 11). Among 31 HIV co-infected TB cases in 2011, 65% were non-Hispanic blacks, 74% were male and 55% were 25-44 years old.
HIV status was reported in 89% of TB cases in 2011 compared to 92% in 2010. In the high-risk age group of adults 25-44 years of age, the percentage of TB cases for which HIV was reported was 94% in 2010 and 2011. Among 37 TB cases whose HIV status was not reported, HIV testing was not offered to 30 cases (81%), the HIV test result was unknown in one case (3%), and six (16%) refused testing. The highest proportion by age group among the TB cases that were not offered the HIV test, occurred among children 0-14 years old (12 cases, 40%).
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 2011, 32 (9%) TB cases in Georgia were homeless, 31 (9%) were residents of correctional facilities, and 4 (1%) were residents of long-term care facilities. Of the 31 TB cases incarcerated in correctional facilities, 19 (61%) were inmates in state prisons, five (16%) in county jails, four (13%) in the Immigration and Custom Enforcement Detention Center in Stewart County, and three (10%) were in federal prisons.
Substance abuse is the most commonly reported behavioral risk factor among patients with TB in the United States. TB patients who abuse substances often
5

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 75 (22%) TB cases in 2011 (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 disseminated TB can develop in very young children. In 2011, children younger than 15 years old comprised 8% of Georgia TB cases; 16 cases (2.3 per 100,000) were reported in children younger than 5 years old, 10 cases (0.7 per 100,000) were reported in children 5-14 years old. One child had TB meningitis.
Latent tuberculosis infection (LTBI) in children younger than five years old is also a reportable disease in Georgia. When LTBI in a child less than five years of age is reported, public health personnel will initiate contact investigations to identify the source of the infection, recommend treatment for latent TB infection, follow up with the child to ensure completion of treatment and monitor for development of active TB disease. Early identification of TB infection and treatment in children can prevent progression to active disease and identify a previously undiagnosed and untreated case of active TB. In 2011, 50 children younger than five years old were reported to have LTBI in Georgia; 31 were identified by TB screening in pediatric clinics, and 19 from contact investigations. Public health staff identified the source case of the child's infection in 31 (62%) of these children.
Drug Resistance
Among 247 culture-positive TB cases in Georgia during 2011, 244 (99%) were tested for initial drug susceptibility to the three first-line anti-TB medications: isoniazid (INH), rifampin (RIF), and ethambutol (EMB). Of 228 tested isolates from Georgia cases with no previous history of TB, 23 (10.1%) had primary resistance to INH, one (0.4%) to RIF, and one (0.4%) to EMB (Table 4). One (0.4%) case in 2011 had multidrug-resistant TB case (MDR-TB, i.e. TB resistant to at least INH and RIF). The percentage of cases with primary INH resistance (INH-R) ranged from 6% to 14% in the past five years while an average of two MDR-TB cases per year was reported in Georgia over that same time period (Figure 13).
Indicators of Infectiousness
Persons with pulmonary or laryngeal TB have the potential to infect 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 2011, 78% of all Georgia TB cases had pulmonary
6

TB, 71% had sputum cultures that were positive for Mycobacterium tuberculosis, 34% were sputum AFB smear-positive, and 20% showed cavitary lesions on chest radiography.
Initial Diagnosis, Health Provider Data, and Directly Observed Therapy
In Georgia, the majority of TB patients are initially diagnosed in a hospital and patients are followed up by county health departments after discharge to continue their TB treatment. In 2011, 230 (66%) of the 347 TB cases in Georgia were reported initially by a hospital. Twelve hospitals in Georgia reported five or more TB cases in 2011: Grady Memorial Hospital (32 cases), Northside Hospital (13 cases), DeKalb Medical Center (12 cases), Gwinnett Medical Center (11 cases), St. Joseph's Hospital in Atlanta (8 cases), Medical Center of Central Georgia in Macon (8 cases), Children's Healthcare of Atlanta at Scottish Rite (6 cases), Phoebe Putney Memorial Hospital in Albany (6 cases), Atlanta Medical Center (5 cases), Memorial Health University Medical Center in Savannah (5 cases), Piedmont Hospital (5 cases), and Wellstar Kennestone Hospital (5 cases). These twelve hospitals accounted for half of all patients hospitalized for TB in Georgia in 2011. County health departments provided case management for 88% of all Georgia TB cases, correctional facilities treated 7%, 3% of cases were cared for solely by a private physician and only 2% were managed solely as in-patients. County health department staff provides directly observed therapy (DOT) to TB patients, which entails watching a patient swallow every dose of their TB medications for at least 6 months. Among 311 Georgia TB cases reported in 2010 with available case completion data, 84% received TB treatment entirely by DOT, 14% were treated by a combination of DOT and self-administered therapy, and only 1% self-administered their medications for the entire duration of their treatment.
TB Mortality
Eighteen persons died of TB in Georgia in 2010. The age-adjusted TB mortality rate in 2010 was 0.2 per 100,000. From 2005 to 2010, an average of 17 people died of TB in Georgia each year (range = 14-31).
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) or interferon gamma release assay (IGRA), repeat the TST or IGRA 8-10 weeks after the last exposure to the index case if the initial TST or IGRA is negative, and have a chest radiology exam performed if the TST or IGRA is positive. Persons with LTBI have a positive TST or IGRA, but are asymptomatic and have a normal chest radiology exam. They are not contagious but
7

have a 10% chance of developing TB disease later in life if they do not receive treatment for LTBI.
Among 5,352 identified contacts of Georgia TB cases reported in 2010 (the most recent year with completed contact investigation data), 4,440 (83%) were completely evaluated for TB disease and LTBI. Of the completely evaluated contacts, 858 (19%) had LTBI and 25 (0.6%) had TB disease. Among the contacts with LTBI, 539 (63%) started LTBI treatment and among 536 infected contacts with treatment outcome information, only 348 (65%) completed LTBI treatment.
TB Program Objectives:
Objective 1: By 2015, 93% of Georgia TB patients will complete a course of TB treatment within 12 months of starting treatment.
Among 340 TB cases reported in Georgia during 2010 who were eligible to complete TB treatment within 12 months and who did not die or move outside of the U.S. during TB treatment, 338 have available data on TB treatment completion. Of the 338 cases with available treatment completion data, 312 (92%) completed treatment within 12 months; 16 (5%) completed treatment after 12 months, 4 (1.2%) were lost to follow-up, three (0.9%) had to stop treatment due to adverse side effects to TB medications, two (0.6%) were uncooperative and refused treatment and one (0.3%) had "Other" cited as the cause for stopping treatment. Among the 16 TB cases that completed TB treatment but extended treatment beyond 12 months, four were non-adherent to treatment plans, four extended TB treatment due to a clinical indication, and no explanation for extended treatment was available for eight other cases.
In 2010, Georgia TB cases who were homeless, drug abuser, correctional facility inmates, were HIV infected, or alcoholics, had lower rates of timely treatment completion (within 12 months) than the over-all average for all TB cases in Georgia. 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: By 2015, 100% of TB cases with sputum smears that are positive for acidfast bacillus (AFB) will have contacts identified.
In 2010, all 139 Georgia TB patients with positive AFB sputum smears had contacts elicited, meeting the program target of 95%.
Objective 3: By 2015, increase the proportion of contacts of acid fast bacilli (AFB) sputum smear positive (SSP) TB cases in Georgia who are evaluated for TB infection or disease to 93%
Among 2,776 contacts to AFB sputum smear positive TB cases in 2010, 2,247 (81%) were completely evaluated for TB infection or disease. Among the 529 contacts
8

who were not completely evaluated, 263 had data on reasons why their evaluations were not completed which included 154 (54%) who refused or were uncooperative, 72 (25%) were lost to follow-up, 18 (6%) had "Other" selected as the reason for incomplete evaluation, 17 (6%) moved, and two (0.7%) died. The incomplete evaluations were due to: 324 (61%) contacts without a second tuberculin skin test (TST) result reported after the first TST was negative, 143 (27%) without an initial TST or interferon gamma release assay (IGRA) test, 44 (8%) with a positive TST or IGRA but no chest radiography report, and 18 (3%) without a second IGRA result after the first IGRA was negative. Objective 4: By 2015, among infected contacts of acid fast bacilli (AFB) sputum smear positive (SSP) TB cases in Georgia, at least 70 percent who started therapy for latent TB infection (LTBI) will complete LTBI therapy.
Among 2,247 contacts of AFB SSP cases who were completely evaluated for TB infection or disease, 402 (18%) had latent TB infection (LTBI). Among those with LTBI, 290 (72%) started LTBI treatment but only 169 (58%) of 289 contacts with information on LTBI treatment outcomes, completed LTBI treatment (Tables 11-12).
9

Table 1. Number of TB Cases and TB Case Rates* per 100,000 population

by County, Georgia, 2010-2011

2010

2011

COUNTY

Number of Case Rate Number of Case Rate

cases

cases

Appling

<5

--

0

0

Atkinson

<5

--

<5

--

Bacon

0

0

0

0

Baker

<5

--

<5

--

Baldwin

<5

--

<5

--

Banks

<5

--

0

0

Barrow

0

0

<5

--

Bartow

<5

--

0

0

Ben Hill

0

0

0

0

Berrien

<5

--

0

0

Bibb

7

4.5

7

4.5

Bleckley

0

0

<5

--

Brantley

0

0

<5

--

Brooks

0

0

<5

--

Bryan

0

0

0

0

Bulloch

0

0

<5

--

Burke

0

0

0

0

Butts

0

0

0

0

Calhoun

0

0

<5

--

Camden

<5

--

0

0

Candler

0

0

0

0

Carroll

0

0

0

0

Catoosa

0

0

<5

--

Charlton

0

0

0

0

Chatham

10

3.8

6

2.2

Chattahoochee

0

0

0

0

Chattooga

<5

--

<5

--

Cherokee

<5

--

<5

--

Clarke

<5

--

<5

--

Clay

0

0

0

0

Clayton

8

3.1

9

3.4

Clinch

<5

--

<5

--

Cobb

26

3.8

16

2.3

Coffee

0

0

0

0

Colquitt

0

0

<5

--

Columbia excludes ASMP

8

6.4

4

3.1

Augusta State Med Prison (ASMP)

18

na

16

na

Cook

0

0

0

0

Coweta

<5

--

<5

--

Crawford

0

0

0

0

Crisp

<5

--

<5

--

Dade

0

0

0

0

Dawson

0

0

0

0

Decatur

<5

--

<5

--

DeKalb

86

12.4

76

10.9

Dodge

0

0

<5

--

Dooly

<5

--

0

0

Dougherty

6

6.3

5

5.3

Douglas

<5

--

<5

--

10

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

2010

Number of Case Rate

cases

0

0

0

0

<5

--

<5

--

0

0

0

0

<5

--

<5

--

0

0

0

0

0

0

51

5.5

<5

--

0

0

<5

--

<5

--

<5

--

0

0

56

7.0

<5

--

6

3.3

0

0

0

0

0

0

0

0

0

0

<5

--

6

4.3

<5

--

0

0

0

0

0

0

<5

--

0

0

<5

--

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

0

0

0

0

<5

--

<5

--

0

0

2011

Number of Case Rate

cases

0

0

0

0

<5

--

0

0

0

0

<5

--

<5

--

<5

--

<5

--

<5

--

<5

--

45

4.7

0

0

0

0

<5

--

0

0

<5

--

<5

--

48

5.8

0

0

8

4.4

<5

--

0

0

0

0

<5

--

0

0

<5

--

<5

--

<5

--

0

0

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

0

0

<5

--

0

0

0

0

<5

--

0

0

<5

--

<5

--

0

0

0

0

0

0

0

0

11

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 excludes Stewart ICE Detention Center (SDC) SDC only Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware

2010

Number of Case Rate

cases

0

0

<5

--

0

0

0

0

0

0

0

0

8

4.2

5

5.0

0

0

0

0

<5

--

<5

--

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

0

0

0

0

6

3.5

<5

--

0

0

<5

--

0

0

<5

--

<5

--

2011

Number of Case Rate

cases

0

0

0

0

0

0

0

0

0

0

<5

--

5

2.6

<5

--

<5

--

0

0

0

0

<5

--

<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

0

0

0

0

0

0

0

0

6

na

4

na

<5

--

<5

--

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

<5

--

<5

--

<5

--

<5

--

<5

--

<5

--

0

0

0

0

0

0

0

0

0

0

5

7.4

<5

--

<5

--

<5

--

0

0

0

0

<5

--

0

0

<5

--

0

0

<5

--

<5

--

0

0

<5

--

<5

--

<5

--

12

COUNTY
Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Georgia Total

2010

Number of Case Rate

cases

0

0

0

0

0

0

0

0

0

0

0

0

<5

--

<5

--

0

0

0

0

<5

--

411

4.2

2011

Number of Case Rate

cases

0

0

0

0

0

0

0

0

0

0

<5

--

<5

--

0

0

<5

--

0

0

0

0

347

3.5

Note: 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.

Table 2. Number of TB Cases and TB Case Rates* per 100,000 population

by Health District, Georgia, 2010- 2011

2010

2011

Health District

Number Case rate Number Case rate

of Cases

of Cases

1.1 Rome

11

1.7

5

0.8

1.2 Dalton

10

2.3

7

1.6

2.0 Gainesville

10

1.6

14

2.2

3.1 Cobb

28

3.4

20

2.4

3.2 Fulton

51

5.5

45

4.7

3.3 Clayton

8

3.1

9

3.4

3.4 Lawrenceville

65

6.6

49

4.8

3.5 DeKalb

86

12.4

76

10.9

4.0 LaGrange

13

1.6

8

1.0

5.1 Dublin

2

1.3

3

1.9

5.2 Macon

17

3.3

16

3.1

6.0 Augusta

19

4.3

8

1.7

Augusta State

18

na

16

na

Medical Prison

(ASMP) only

7.0 Columbus

12

2.9

9

3.5

ICE Detention only

6

na

4

na

8.1 Valdosta

10

4.0

9

3.5

8.2 Albany

15

4.2

18

5.0

9.1 Coastal

18

3.2

13

2.2

9.2 Waycross

7

1.9

11

3.0

10 Athens

5

1.1

7

1.5

Georgia Total

411

4.2

347

3.5

13

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

Georgia, 2011

HEALTH

Foreign-

HIV

Homeless Inmate Nursing

DISTRICT

born % Infected %

%

%

Home %

1.1 Rome

40

0

0

0

0

1.2 Dalton

57

0

0

0

0

2.0 Gainesville

26

10

14

14

0

3.1 Cobb

75

11

10

0

0

3.2 Fulton

40

21

17

2

0

3.3 Clayton

67

25

22

0

0

3.4 Lawrenceville

69

6

0

2

0

3.5 DeKalb

55

13

11

3

0

4.0 LaGrange

13

0

29

0

13

5.1 Dublin

0

0

33

33

0

5.2 Macon

25

0

6

13

6

6.0 Augusta

50

0

0

0

0

ASMP only

0

6

6

100

0

7.0 Columbus

25

0

0

0

0

ICE only

32

0

0

100

0

8.1 Valdosta

22

33

0

0

0

8.2 Albany

39

6

6

0

6

9.1 Coastal

23

8

15

8

0

9.2 Waycross

27

0

0

0

0

10 Athens

57

0

29

20

0

Georgia Total

46

10

9

9

0.8

Substance Abuse %
0 14 21 5 31 11 8 14 15 33 19 0 25 33 25 33 22 8 0 14 17

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

Georgia, 2011

TB Drug

Isoniazid

Rifampin

Ethambutol

HEALTH DISTRICT

No.

%

No.

%

No.

%

1.1 Rome

1

33

0

0

0

0

1.2 Dalton

0

0

0

0

0

0

2.0 Gainesville

3

21

0

0

0

0

3.1 Cobb

0

0

0

0

0

0

3.2 Fulton

2

6

0

0

0

0

3.3 Clayton

2

25

1

13

0

0

3.4 Lawrenceville

2

6

0

0

1

3

3.5 DeKalb

4

10

0

0

0

0

4.0 LaGrange

2

25

0

0

0

0

5.1 Dublin

1

33

0

0

0

0

5.2 Macon

0

0

0

0

0

0

6.0 Augusta & ASMP

1

6

0

0

0

0

7.0 Columbus & ICE

0

0

0

0

0

0

8.1 Valdosta

0

0

0

0

0

0

8.2 Albany

1

8

0

0

0

0

9.1 Coastal

0

0

0

0

0

0

9.2 Waycross

1

11

0

0

0

0

10 Athens

2

50

0

0

0

0

Georgia Total

23

10

1

0.4

1

0.4

14

Table 5. Completion of TB Treatment (Tx) by Health District, Georgia, 2009-2010

2009

2010

HEALTH DISTRICT

No. Cases that

% No. Cases that

%

No. Cases

Completed Tx/ No.

Completed Tx/No.

Missing data

Cases Started Tx*

Cases Started Tx*

1.1 Rome

11/11

100

11/11

100

0

1.2 Dalton

9/9

100

10/10

100

0

2.0 Gainesville

12/13

92

5/5

100

0

3.1 Cobb

19/19

100

24/25

96

0

3.2 Fulton

67/68

98

46/46

100

0

3.3 Clayton

11/11

100

8/8

100

0

3.4 Lawrenceville

46/51

90

56/60

93

0

3.5 DeKalb

47/57

82

77/78

99

0

4.0 LaGrange

11/12

92

7/10

70

1

5.1 Dublin

3/3

100

1/1

100

0

5.2 Macon

10/10

100

15/15

100

0

6.0 Augusta ASMP only

17/18

94

15/15

100

1

8/9

89

17/18

94

0

7.0 Columbus ICE only

16/17

94

10/10

100

0

0/1

0

na

na

na

8.1 Valdosta

5/5

100

8/8

100

0

8.2 Albany

14/14

100

12/13

92

0

9.1 Coastal

18/19

95

14/14

100

0

9.2 Waycross

5/5

100

5/5

100

0

10 Athens

4/4

100

5/5

100

0

Georgia Total

333/356

94

346/357

97

2

*patients who died or moved outside the U.S. during TB treatment are not included in calculation

Table 6. Timely Completion of TB Treatment (Tx) among TB cases eligible for 12-month

TB Tx by Health District, Georgia, 2009-2010

2009

2010

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 1.2 Dalton

9/12

75

11/11

100

9/9

100

10/10

100

2.0 Gainesville 3.1 Cobb 3.2 Fulton

12/13

92

17/18

94

59/63

94

4/5

80

23/25

92

41/44

93

3.3 Clayton 3.4 Lawrenceville 3.5 DeKalb

11/11

100

40/52

77

40/55

73

7/8

88

52/55

94

67/71

94

4.0 LaGrange 5.1 Dublin 5.2 Macon

11/12

92

3/3

100

9/9

100

7/10

70

1/1

100

12/14

86

6.0 Augusta ASMP only

13/18

72

8/9

89

10/11

91

15/18

83

7.0 Columbus 8.1 Valdosta 8.2 Albany

15/16

94

5/5

100

14/14

100

10/10

100

8/8

100

11/13

85

9.1 Coastal 9.2 Waycross 10 Athens

17/18

94

13/14

93

5/5

100

5/5

100

3/4

75

5/5

100

Georgia Total

300/347

86

312/338

92

*patients who died or moved outside the U.S. during TB treatment , or who are not eligible for 12 months TB treatment (rifampin resistant TB, meningeal TB, patients < 15 yrs, old with miliary TB), are not included in calculation

No. cases Missing data
0 0 0 0 0 0 0 0 1 0 0 1 0
0 0 0 0 0 0 2

15

Table 7. Sputum Smear Positive (SSP) Cases with Contacts Identified

by Health District, Georgia, 2009-2010

2009

2010

HEALTH DISTRICT No. SSP Cases with

% No. SSP Cases with

%

Contacts Identified /

Contacts Identified /

No. SSP Cases

No. SSP Cases

1.1 Rome

5/5

100

4/4

100

1.2 Dalton

7/7

100

4/4

100

2.0 Gainesville

5/5

100

7/7

100

3.1 Cobb

6/6

100

9/9

100

3.2 Fulton

37/37

100

27/27

100

3.3 Clayton

3/3

100

4/4

100

3.4 Lawrenceville

18/18

100

17/17

100

3.5 DeKalb

14/14

100

19/19

100

4.0 LaGrange

7/7

100

5/5

100

5.1 Dublin

3/3

100

2/2

100

5.2 Macon

2/2

100

3/3

100

6.0 Augusta

11/11

100

10/10

100

7.0 Columbus

11/11

100

8/8

100

8.1 Valdosta

1/1

100

4/4

100

8.2 Albany

9/9

100

5/5

100

9.1 Coastal

10/10

100

7/7

100

9.2 Waycross

3/3

100

1/1

100

10 Athens

1/1

100

3/3

100

Georgia Total

153/153

100

139/139

100

Table 8. Completely Evaluated Contacts of Sputum Smear Positive Cases

by Health District, Georgia, 2009-2010

2009

2010

HEALTH DISTRICT No. Contacts that were

% No. Contacts that were

%

Completely Evaluated /

Completely Evaluated /

No. Contacts Identified

No. Contacts Identified

1.1 Rome

47/54

87

51/52

98

1.2 Dalton

85/92

92

32/36

89

2.0 Gainesville

14/21

67

41/50

82

3.1 Cobb

43/50

86

42/51

82

3.2 Fulton

532/638

83

253/350

72

3.3 Clayton

590/658

90

51/55

93

3.4 Lawrenceville

97/175

55

111/128

87

3.5 DeKalb

84/110

76

1055/1328

79

4.0 LaGrange

54/73

74

231/270

86

5.1 Dublin

44/49

90

69/71

97

5.2 Macon

1/7

14

29/40

72

6.0 Augusta

205/262

78

72/84

86

7.0 Columbus

149/198

75

47/67

70

8.1 Valdosta

5/5

100

15/16

94

8.2 Albany

251/380

66

92/113

81

9.1 Coastal

42/61

69

30/36

83

9.2 Waycross

20/20

100

--

--

10 Athens

5/8

62

26/29

90

Georgia Total

2268/2861

79

2247/2776

81

16

Table 9. Contacts with Latent TB Infection (LTBI) exposed to Sputum Smear Positive

Cases by Health District, Georgia, 2009-2010

2009

2010

HEALTH DISTRICT No. Contacts with LTBI/ % No. Contacts with LTBI/

%

No. Contacts

No. Contacts

Completely Evaluated

Completely Evaluated

1.1 Rome

13/47

28

21/51

41

1.2 Dalton

41/85

48

7/32

22

2.0 Gainesville

7/14

50

12/41

29

3.1 Cobb

18/43

42

27/42

64

3.2 Fulton

83/532

16

41/253

16

3.3 Clayton

40/590

7

6/51

12

3.4 Lawrenceville

60/97

62

42/111

38

3.5 DeKalb

37/84

44

107/1055

10

4.0 LaGrange

13/54

24

15/231

6

5.1 Dublin

13/44

30

11/69

16

5.2 Macon

1/1

100

6/29

21

6.0 Augusta

31/205

15

35/72

49

7.0 Columbus

35/149

24

10/47

21

8.1 Valdosta

1/5

20

9/15

60

8.2 Albany

68/251

27

20/92

22

9.1 Coastal

18/42

43

12/30

40

9.2 Waycross

6/20

30

--

--

10 Athens

2/5

40

21/26

81

Georgia Total

486/2268

21

402/2247

18

Table 10. Contacts with LTBI exposed to Sputum Smear Positive Cases started on

LTBI Treatment by Health District, Georgia, 2009-2010

2009

2010

HEALTH DISTRICT No. Infected Contacts

% No. Infected Contacts

%

on LTBI Treatment / No.

on LTBI Treatment / No.

Infected Contacts

Infected Contacts

1.1 Rome

5/13

38

14/21

67

1.2 Dalton

32/41

78

7/7

100

2.0 Gainesville

7/7

100

9/12

75

3.1 Cobb

13/18

72

19/27

70

3.2 Fulton

42/83

51

30/41

73

3.3 Clayton

21/40

52

1/6

17

3.4 Lawrenceville

39/60

65

21/42

50

3.5 DeKalb

26/37

70

80/107

75

4.0 LaGrange

13/13

100

13/15

87

5.1 Dublin

8/13

62

10/11

91

5.2 Macon

0/1

0

5/6

83

6.0 Augusta

10/31

32

29/35

83

7.0 Columbus

20/35

57

7/10

70

8.1 Valdosta

1/1

100

6/9

67

8.2 Albany

49/68

72

12/20

60

9.1 Coastal

9/18

50

8/12

67

9.2 Waycross

5/6

83

--

--

10 Athens

0/2

0

19/21

90

Georgia Total

300/486

62

290/402

72

17

Table 11. LTBI Treatment Completion of Infected Contacts exposed to Sputum

Smear Positive Cases by Health District, Georgia, 2009-2010

2009

2010

HEALTH DISTRICT

No. Contacts that % No.

No. Contacts that %

Completed LTBI

Contacts Completed LTBI

Treatment

with

Treatment

/ Contacts Treated

Missing / Contacts Treated

Tx data

1.1 Rome

2/5

40

0

6/14

43

1.2 Dalton

24/32

75

0

3/7

43

2.0 Gainesville

4/7

57

0

6/9

67

3.1 Cobb

10/13

77

0

10/19

53

3.2 Fulton

29/40

72

2

19/30

63

3.3 Clayton

6/7

86

14

1/1

100

3.4 Lawrenceville

21/38

55

1

14/21

67

3.5 DeKalb

14/19

74

7

60/80

75

4.0 LaGrange

4/13

31

0

9/13

69

5.1 Dublin

2/8

25

0

4/9

44

5.2 Macon

--

--

0

4/5

80

6.0 Augusta

7/10

70

0

12/29

41

7.0 Columbus

12/20

60

0

4/7

57

8.1 Valdosta

--

--

1

4/6

67

8.2 Albany

36/49

74

0

7/12

58

9.1 Coastal

5/9

56

0

4/8

50

9.2 Waycross

4/5

80

0

--

--

10 Athens

--

--

0

2/19

10

Georgia Total

180/275

66

25

169/289

58

No. Contacts with Missing Tx data
0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 -0 2

Table 12. Reasons Why Infected Contacts of Sputum Smear Positive cases

Stopped LTBI Treatment, Georgia, 2009-2010

Reasons for Stopping LTBI Therapy

2009

2010

N= 275

N= 289

No.

%

No.

%

Completed Therapy

180

66

169

58

Chose to Stop

39

14

48

17

Lost to Follow-Up

29

10

40

14

Provider Decision

6

2

7

2

Moved

16

6

12

4

Adverse Reactions

4

2

12

4

Active TB Developed

0

0

0

0

Death

1

0.4

1

0.4

18

Figure 1. TB Cases and Case Rates Georgia,1982-2011

Number of Cases

Rate/100,000

1000

16

900

14

800

12

700

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 2010

Year Case Counted

Number Case Rate

Figure 2. Number of TB Cases by Health Districts Georgia, 2011

1-2

2-0

G
1-1 B

P

P

3-2 3-4

10-0

H

3-1

3-5

Rockdale
3-3

4-0 5-2

Number of TB Cases:
Low incidence: 2-10 Medium incidence: 11-20 High incidence: >20 (29-86)
6-0

7-0
8-2
S D

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

19

Figure 3. TB Case Rates by Health Districts Georgia, 2011

G
1-1
B
P P
H

1-2 2-0

3-2

3-4

3-1

3-5

3-3

Rockdale

10-0

4-0 5-2

Case rates/100,000 population:
<= 3.5 (2000 national target) 3.6 to 4.2 > 4.2 (2010 state average)
6-0

7-0
8-2
S

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

Fig. 4, TB Cases by Age Group and Sex Georgia, 2011

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

5-14

15-24

25-44

45-64

65

Age group (years)

Male Female

20

Figure 5. TB Case Rates* by Age Group 2007-2011, Georgia

Age Group 2007

2008

2009

2010

2011

< 5 yrs. 5-14 yrs.

3.5

4.5

2.3

2

2.3

0.8

0.6

0.5

0.9

0.7

15-24 yrs.

4.3

3.9

4.1

3.3

2.8

25-44 yrs.

6

6.3

5.1

5

4.4

45-64 yrs.

6

6.6

5.4

5.8

4.6

65+ yrs.

7.4

5.4

5.7

5.5

4.3

*Rates are per 100,000 population

Figure 6. TB Cases by Race/Ethnicity Georgia, 2000 and 2011

Asian 10%
White 18%

Black 61%

Asian 17%
White 15%

Hispanic 11%

2000

Hispanic 20%

2011

Black 48%

21

Figure 7. TB Case Rates* by Race/Ethnicity Georgia, 2007-2011

Race/ Ethnicity

2007 2008 2009 2010 2011

Asian, non-Hispanic

21.5

27.2

29.7

24.1 16.8

Hispanic, All races

12.9

11.8

11.2

8.2

7.6

Black, non-Hispanic

8.3

7.8

6.2

7.1

5.3

White, non-Hispanic

1.2

1.2

1.2

1

0.9

*Rates are per 100,000 population

Figure 8. TB Case Rates in non-Hispanic Blacks and Whites, Georgia, 1993-2011

Non-Hispanic Black Non-Hispanic White

Case Rate/100,000

35
30.6
30

25

20

15

10 5 3.7

5.3

0

0.9

1993 1995 1997 1999 2001 2003 2005 2007 2009 2011

Year

22

Figure 9. US-born and Foreign-born TB Cases Georgia,1993-2011
800 700 600 500 400 300 200 100
0 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011
Year
US-born Foreign-born

Figure 10. Percent of Foreign-born TB Cases (n=159) by Country of Origin, Georgia, 2011

Others 42%

Mexico 27%
Vietnam 5%

Guatemala 9%

India 12%
Ethiopia 5%

23

Figure 11. HIV Status of TB Cases Georgia,1993-2011

Unknown Negative Positive

Number

900 800 700 600 500 400 300 200 100
0
1993 1995 1997 1999 2001 2003 2005 2007 2009 2011
Year

Figure 12. TB in Other High-Risk Populations Georgia, 2007-2011

120 100
80 Number 60
40 20
0 2007 2008 2009 2010 2011 Year

Substance abuse Homeless Correctionals Long-Term Care

24

Number Percent

Figure 13. Primary Drug Resistance and MDR-TB Georgia, 2007-2011

45

16

40

14

14

35

30

25

9

20

15

6

10

12 10 10
8
7
6 4

5

2

0

0

2007 2008 2009 2010 2011

Year

INH RIF MDR-TB % INH-R

Figure 14. TB Treatment Completion within 12 months and Directly Observed Therapy (DOT) Georgia, 1993-2010*

Percent

100

92

80 68

84

60
40 35
20

Completion in 12 months Totally DOT

0 DOT became standard of care

1993 1995 1997 1999 2001 2003 2005 2007 2009

Year Case Counted

*In 2009, CDC changed the calculation for TB treatment completion within 12 months to exclude TB cases who moved out of the U.S. while on TB treatment.

25

Figure 15. Completion of Latent TB Infection (LTBI) Therapy among all contacts of TB cases,
Georgia, 2005-2010

Percent

80

70 66

66

68

60

57

60

65

50

Completed LTBI Therapy

40

Missing data

30

20

10 0

14 1

4

6

8

1

2005 2006 2007 2008 2009 2010

Year

26

Tuberculosis Morbidity Trends by Health District Georgia, 1995-2011

TB Case Numbers and Rates

District 1-1 (Rome),1995-2011

60 51 50

40 30 20

33 18 25 22 31 32 32 30 27 30 17 18 12 15 11

10 0

11.6

5

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 1.7 0.8

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

27

TB Case Numbers and Rates

District 1-2 (Dalton),1995-2011

25

21

21

20

15

14

12 11

10

10

15 11 10 8

17 14 14

10

10 10

7

5 0

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 2.3 1.6

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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

TB Case Numbers and Rates District 2 (Gainesville),1995-2011

25

20

20

17

15 15 15

15

12

13

10 10

19

15

16

14

12

11

10

10

8

5 0

5.9 4.9 3.7 3.7

3.5 2.6 2.1

2.0 2.5 1.5 3.5

5.7

2.1 2.6 1.8

1.7

2.2

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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

28

TB Case Numbers and Rates District 3-1 (Cobb),1995-2011

50

44

40

32

30 20 18

38 38 36

32

32 30 30 30 31

29

24

25

21 20

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 3.5 2.4

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

TB Case Numbers and Rates District 3-2 (Fulton),1995-2011

250 200

192 207 187

177

150

133 150 136 119 122 116

100

87 72 78 72 81

51 45

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 5.5 4.7

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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

29

TB Case Numbers and Rates District 3-3 (Clayton),1995-2011

30

28

25

23

20

18

18

19

14

15

15

15 14 15

15 14

15 10
5

9
4.5

8.8

6.7

13.4 7.0

9.7

6.5

7.1

5.4

5.2

5.6

7.0

5.5

11 8

9

5.1 4.0 3.1 3.4

0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

TB Case Numbers and Rates District 3-4 (Lawrenceville),1995-2011

100 81

80

68

58 57

60

43

42 46

40

24 26 29

20 12

17

34 21

63 65 49

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 6.6 4.8

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

30

TB Case Numbers and Rates District 3-5 (DeKalb),1995-2011

120 100
80

92

99 102 104 84 85

78

88

83

72

80

72 78

86 76

61

62

60

40

20

16.7 17.0 15.9

14.316.9 12.9 11.6 13.0

12.310.6 11.6 8.4

9.8 10.5

8.3 121.40.9

0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

TB Case Numbers and Rates District 4 (LaGrange),1995-2011

35

30

24 26

29

25 25

27

25 19

21 20

20

20

16 16

16

15

12 12 13

10

8

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 1.6 1

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

31

TB Case Numbers and Rates

District 5-1 (Dublin),1995-2011

20 16

15

12

10 5

7 5.6 5 4.0 6 4.7 4 3.1

9.4 8 6 9

8

88

11.1

5.9

6.6 4 4

5.6

4.4

2.9 2.8

5.6 5.5 3 2 3
2.1 1.3 1.9

0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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

TB Case Numbers and Rates

District 5-2 (Macon),1995-2011

60

51

50 46

40 30 20

31 22 27 28 23 20 23 28 24 31 15 18 11 16 16

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 3.1 3.1

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

32

TB Case Numbers and Rates District 6 (Augusta)*,1995-2011

60

52

50

45 38 39

46

40

30

32

30 20

25

20

24 19 17 16 14 21 20

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

8
4.3 1.7

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Number Rate

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

*Augusta State Medical Prison cases not included

TB Case Numbers and Rates District 7 (Columbus)*,1995-2011

50

46

40 33

34

36

34

28 30

30

30 20 10
0

22

21

18

20 21

23

13.2

14

12 9

9.5

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

2.9 3.5

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate
*ICE Detention Center cases not included

33

TB Case Numbers and Rates District 8-1 (Valdosta),1995-2011

30

24

25 20 15 10
5 0

21 18
10.2 8.7

20

17
11.5 7.9

14 15
9.3

12

7

6

9

13 10 9

5

5

6.2

6.22
0.9

3.0

5.1

2.5

3.8

2.1

5.3

2.0

4.0 3.5

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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

TB Case Numbers and Rates

District 8-2 (Albany),1995-2011

50 40

38 45 40 36 43 38

29

30 20

17 24 21 23 25 21 25 18 15 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 4.2 5

0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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

34

TB Case Numbers and Rates District 9-1 (Coastal),1995-2011

70

58

60 48

50

40

34 33 33

31

30 20

25

19 23 20 17 19

26 23 20 18 13

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 3.2 2.2

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

TB Case Numbers and Rates District 9-2 (Waycross),1995-2011

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 9 16 13 8

5

12 7

7.6 3.9 2.7 4.7 3.8 2.3 1.4 1.9

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

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

Rate

35

TB Case Numbers and Rates

District 10 (Athens),1995-2011

25

22

20

16

16

15 13 13

13 14 13

11 12

10 5 0

6.6

9586447

4.6 4.2 5.1

3.8 3.8 3.4 4.1 2.8 2.9 2.2 1.1 1.8 1.3 0.9 0.9 1.5

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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

36

37