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.
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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
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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.
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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).
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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
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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
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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
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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
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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).
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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