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Volume 8, Number 11—November 2002
THEME ISSUE
Tuberculosis Genotyping

Tuberculosis Genotyping Network, United States

Molecular Epidemiology of Tuberculosis in a Sentinel Surveillance Population

Barbara A. Ellis*Comments to Author , Jack T. Crawford*, Christopher R. Braden*, Scott J. N. McNabb*, Marisa Moore*, Steve Kammerer*, and the National Tuberculosis Genotyping and Surveillance Network Work Group
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

Main Article

Table 2

Demographic and risk behavior factors and clinical, laboratory, and treatment outcomes for the sentinel surveillance patients (National Tuberculosis Genotyping Surveillance Network, compared with factors and outcomes of all tuberculosis patients, United States, 1996–2000a,b

Variable Category All U.S. TB cases (n=3,097) (%) All NTGSN cases (n=15,035) (%) Probabilityc
Gender Male 58,356 (62.7) 8,767 (58.3) <0.001
Female 34,734 (37.3) 6,266 (41.7)
Unknown 7 (0.0) 2 (0.0)
Age (yrs) <4 3,289 (3.5) 518 (3.4) NS
5–14 2,397 (2.6) 393 (2.6) NS
15–24 7,988 (8.6) 1,462 (9.7) <0.001
25–44 32,433 (34.8) 5,413 (36.0) 0.005
45–64 25,319 (27.2) 3,850 (25.6) <0.001
>64 21,662 (23.3) 3,397 (22.6) NS
Unknown 9 (0.0) 2 (0.0)
Race/ethnicity White, non-Hispanic 22,655 (24.3) 3,087 (20.5) <0.001
Black, non-Hispanic 30,201 (32.4) 4,775 (31.8) NS
Hispanic 20,475 (22.0) 2,923 (19.4) <0.001
American Indian/Native 1,280 (1.4) 38 (0.3) <0.001
Asian/Pacific Islander 18,346 (19.7) 4,195 (27.9) <0.001
Unknown 140 (0.2) 17 (0.1)
Place of birth U.S.-born 54,341 (58.4) 7,530 (50.1) <0.001
Foreign-born 38,252 (41.1) 7,468 (49.7)
Unknown 504 (0.5) 37 (0.2)
Years in United States (foreign-born only) <1 7,425 (19.4) 1,494 (20.0) NS
1 2,612 (6.8) 567 (7.6) NS
2 2,073 (5.4) 477 (6.4) <0.005
3 1,827 (4.8) 406 (5.4) <0.05
4 1,676 (4.4) 361 (4.8) NS
>5 19,396 (50.7) 3,688 (49.4) <0.001
Unknown 3,243 (8.5) 475 (6.4)
Country of origind Philippines 4,862 (12.7) 1,113 (14.9) <0.0001
Mexico 8,795 (23.0) 1,100 (14.7) <0.0001
Vietnam 3,824 (10.0) 968 (13.0) <0.0001
India 2,527 (6.6) 883 (11.8) <0.0001
China 1,930 (5.0) 370 (5.0) NS
Haiti 1,470 (3.8) 225 (3.0) <0.0005
Peru 636 (1.7) 207 (2.8) <0.0001
Republic of Korea 1,176 (3.1) 202 (2.7) NS
Ethiopia 578 (1.5) 153 (2.0) <0.001
Ecuador 627 (1.6) 115 (1.5) NS
Other 11,827 (30.9) 2,132 (28.5) <0.0001
Status at diagnosis Alive 90,141 (96.8) 14,611 (97.2) 0.02
Dead 2,925 (3.1)( 422 (2.8)
Unknown 31 (0.0) 2 (0.0)
Site of disease Pulmonary 68,611 (73.7) 10,576 (70.3) <0.001
Extrapulmonary 17,406 (18.7) 3,210 (21.4) <0.001
Pulmonary and Extrapulmonary 7,046 (7.6) 1,241 (8.3) 0.003
Unknown 34 (0.0) 8 (0.1)
Primary disease site Pulmonary 73,157 (78.6) 11,365 (75.6) <0.0001
Lymph: cervical 4,312 (4.6) 1,020 (6.8) <0.0001
Pleural 3,842 (4.1) 674 (4.5) <0.05
Miliary 1,407 (1.5) 241 (1.6) NS
All other 10,345 (11.1) 1,727 (11.5) NS
Unknown 34 (0.0) 8 (0.0)
Sputum smear for acid-fast organisms Negative 36,912 (39.6) 5,995 (39.9) <0.0001
Positive 33,235 (35.7) 4,735 (31.5)
Not done/unknown 22,950 (24.6) 4,305 (28.7)
TST at diagnosis Negative 13,215 (14.2) 1,947 (12.9) <0.001
Positive 54,113 (58.1) 8,799 (58.5)
Not done/unknown 25,769 (27.6) 4,289 (28.6)
Case verification criteria Positive culture 74,940 (80.5) 11,967 (79.6) <0.01
Positive smear 765 (0.8) 136 (0.9) NS
Clinical case 11,286 (12.1) 1,858 (12.4) NS
Provider diagnosis 6,106 (6.6) 1,074 (7.1) <0.01
Chest radiographd Cavitary 18,742 (24.8) 2,990 (25.3) NS
Noncavitary 50,652 (66.9) 7,897 (66.8) NS
Normal 2,495 (3.3) 360 (3.0) NS
Not done/unknown 3,802 (5.0) 578 (4.9)
Total 75,691 11,825
HIV statuse Positive 6,062 (18.8) 884 (16.7) NS
Negative 16,525 (51.2) 2,406 (45.5)
Indeterminate 47 (0.1) 6 (0.1)
Refused 1,959 (6.1) 325 (6.1)
Not offered 4,130 (12.8) 899 (17.0)
Test done, unknown 714 (2.2) 115 (2.2)
Unknown 2,812 (8.7) 658 (12.4)
Total 32,249 5,293
Homeless within past year Yes 5,789 (6.2) 646 (4.3) <0.001
No 84,873 (91.2) 14,185 (94.3)
Unknown 2,435 (2.6) 204 (1.4)
Resident of correctional facility at diagnosis Yes 3,352 (3.6) 377 (2.5) <0.001
No 89,479 (96.1) 14,617 (97.2)
Unknown 266 (0.3) 41 (0.3)
Correctional facility type Federal prison 164 (4.9) 6 (1.6) <0.005
State prison 1,036 (30.9) 97 (25.7) <0.05
Local jail 1,905 (56.8) 231 (61.3) NS
Juvenile facility 33 (1.0) 8 (2.1) NS
Other 161 (4.8) 34 (9.0) <0.001
Unknown 53 (1.6) 1 (0.3)
Total 3,352 377
Resident, long-term care facility at diagnosis Yes 3,157 (3.4) 441 (2.9) 0.004
No 89,656 (96.3) 14,552 (96.8)
Unknown 284 (0.3) 42 (0.3)
Long-term care facility type Nursing home 1,794 (56.8) 279 (63.3) <0.01
Hospital-based 441 (14.0) 66 (15.0) NS
Residential 356 (11.3) 34 (7.7) <0.05
All other 504 (16.0) 55 (12.5) NS
Unknown 62 (2.0) 7 (1.6)
Total 3,157 441
Injecting drug usef Yes 2,569 (2.8) 515 (3.4) <0.001
No 83,141 (89.3) 13,771 (91.6)
Unknown 7,387 (7.9) 749 (5.0)
Noninjecting drug usef Yes 6,557 (7.0) 811 (5.4) <0.001
No 78,622 (84.5) 13,367 (88.9)
Unknown 7,918 (8.5) 857 (5.7)
Excessive alcohol useg Yes 13,646 (14.7) 1,661 (11.0) <0.001
No 71,924 (77.3) 12,552 (83.5)
Unknown 7,527 (8.1) 822 (5.5)
Drug resistanceh
First-line drugs Yes 8,456 (11.7) 1,482 (12.6) <0.001
No 57,029 (79.0) 8,886 (75.5)
Not tested/unknown 6,703 (9.3) 1,399 (11.9)
Total 72,188 11,767
Second-line drugs Yes 1,341 (1.9) 208 (1.8) <0.001
No 175 (0.2) 78 (0.7)
Not tested/unknown 70,672 (97.9) 11,481 (97.6)
Total 72,188 11,767
DOT Yes—total DOT 40,511 (43.5) 4,936 (32.8) <0.001
Yes—both DOT and self-administered 20,555 (22.1) 3,648 (24.3) <0.001
No 23,337 (25.1) 5,326 (35.4) <0.001
Unknown 8,694 (9.3) 1,125 (7.5)
Within city limits Yes 80,775 (86.8) 14,603 (97.1) <0.001
No 10,916 (11.7) 374 (2.5)
Unknown 1,406 (1.5) 58 (0.4)
Previous diagnosis of TB Yes 4,794 (5.1) 652 (4.3) <0.001
No 87,567 (94.1) 14,336 (95.4)
Unknown 736 (0.8) 47 (0.3
Duration of therapy (days) Mean 246 245 NS
Median 217 214
Std. dev. 135 130
No. 65,344 10,822

aNTGSN, National Tuberculosis Genotyping Surveillance Network;TB, tuberculosis; DOT, directly observed therapy; TST, tuberculin skin test; Std. dev., standard deviation; NS, not significant (p>0.05).
.bSubtotals for each category are listed if different from the total case numbers.
cProbability of significant differences between U.S. TB patients and all NTGSN surveillance patients (chi-square test; t-test for duration of therapy); referent group is all other groups combined, excluding not done or unknown categories, unless otherwise noted.
dTop 10 countries for foreign-born patients only.
eExcludes cases with extrapulmonary TB only.
fHIV cases from California are excluded because this site does not report HIV results on Report of a Verified Case of Tuberculosis forms; ages 15–44 years only.
gInjecting or noninjecting drug use within last year; includes use of licensed, prescription, or illegal drugs (not prescribed by a physician).
hExcessive use of alcohol within the past year as indicated by participation in alcohol treatment programs, diagnosis of alcoholism, or observation of intoxication during visits to health-care facilities.
iDrug resistance on initial testing of isolate. First-line drug resistance is resistance to at least one of the following: isoniazid, rifampin, ethambutol, or streptomycin. Second-line drug resistance is resistance to one or more of the following: ethionamide, kanamycin, cycloserine, capreomycin, para-amino salicylic acid, amikacin, rifabutin, ciprofloxacin, ofloxacin, or other drugs. Testing results for one or more of the drugs could have been missing.

Main Article

1 Members of the National Tuberculosis Genotyping and surveillance Network Work Group, in addition to the listed authors, included Joseph Bates, William Benjamin, Pablo Bifani, M. Donald Cave, Rebecca Cox, Wendy Cronin, Ed Desmond, Jeffrey Driscoll, Nancy Dunlap, Jennifer Flood, Kashef Ijaz,, Michael Kucab, Barry Kreiswirth, Zary Liu, D. Mitchell Magee, Jeffrey Massey, Ann Miller, Donna Mulcahy, Robert Pratt, Teresa Quitugua, Barbara Schable, Kenneth Shilkret, Harry Taber, Jeffrey Taylor, Sharon Sharnprapai, Sumi Sun, Zhenhua Yang

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