MMWR

Morbidity and Mortality Weekly Report

(Box) World TB Day – March 24, 2009

PRESS CONTACT: CDC
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
(404) 639-8895

No summary available.

Trends in Tuberculosis – United States, 2008

PRESS CONTACT: CDC
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
(404) 639-8895

A CDC analysis of 2008 tuberculosis (TB) data shows continuing disparities and a slowing decline in U.S. TB rates. In 2008, the national TB rate fell to an all-time low of 4.2 cases per 100,000 people (12,898 new cases). However, progress in eliminating TB has hit a plateau in recent years, with a 3.8 percent average annual rate of decline for 2000-2008, compared to 7.3 percent for 1993-2000. TB continues to disproportionately affect racial/ethnic minorities and foreign-born persons. TB rates among Hispanics, blacks, and Asians were, respectively, 7.5, 8.1, and 23.4 times higher than non-Hispanic whites. Foreign-born persons had a TB rate (20.2 cases per 100,000) 10 times higher than U.S.-born persons (2.0 cases per 100,000). Data also show that among the 7,652 persons with TB with a known human immunodeficiency virus (HIV) test result, 802 (10.5 percent) were infected with HIV. The report shows that multidrug-resistant (MDR) TB -- TB that is resistant to at least isoniazid and rifampin, two important first-line drugs -- accounts for 1.2 percent (125 cases) of all TB cases in the U.S. for which drug-susceptibility data are available. The report summarizes provisional 2008 data from the National TB Surveillance System and describes trends since 1993. The authors note the need for intensified efforts to address the slowing decline in TB rates and the persistent disparities between U.S.-born and foreign-born persons and between whites and minorities in the U.S.

Two Simultaneous Outbreaks of Multidrug-Resistant Tuberculosis – Federated States of Micronesia, 2007-2009

PRESS CONTACT: CDC
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
(404) 639-8895

A tuberculosis (TB) investigation in the Federated States of Micronesia (FSM) highlights the importance of maintaining an adequate TB control infrastructure, including laboratory capacity and access to medications. In July 2008, CDC responded to a request from FSM to help investigate the first documented cases of multidrug-resistant TB (MDR TB) in Chuuk State. MDR TB is resistant to at least isoniazid and rifampin, the two most effective drugs used to treat TB. By May 2008, four patients had died of MDR TB, including a 2-year old and her mother. The CDC investigation found two simultaneous and ongoing outbreaks of MDR TB. Epidemiologists tested 205 contacts for TB, resulting in 17 additional persons found to have confirmed or suspected MDR TB. In Chuuk, resources for TB control, including staffing and medication, were limited. Many U.S. government agencies and other organizations partnered with Chuuk health authorities to provide continued resources to procure second-line drugs, ensure appropriate treatment for TB patients, and identify and evaluate contacts. As a result, all MDR TB patients and infected contacts are being treated appropriately, and the local program is scaling up efforts to provide international standards of TB care. The report points out the challenges of controlling TB in countries with limited resources, especially in the face of multiple, simultaneous outbreaks of MDR TB.

Guidance for Control of Infections with Carbapenem-Resistant or Carbapenamase-Producing Enterobacteriaceae (CRE) in Acute Care Facilities

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These pathogens, carbapenem-resistant Enterobacteriaceae (CRE), are becoming an important cause of infections in healthcare settings, but experience has shown that the strategies recommended in this report can be effective in limiting the transmission of these organisms. Infections with a highly drug resistant group of bacteria known as carbapenem-resistant Enterobacteriaceae (CRE) are emerging as an important challenge in health-care settings. Currently, Klebsiella pneumoniae is the type of CRE most commonly encountered in the United States. These bacteria are resistant to almost all available antibiotics, and infections have been associated with high rates of illness and death. This report provides new recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) for the control of CRE in acute care facilities. CDC and HICPAC recommend an aggressive infection control strategy, including using lab tests that can detect these organisms and managing all patients with CRE using contact precautions, actions that can prevent the spread of infection such as good hand hygiene (handwashing or using waterless hand sanitizer) and using gloves and gowns. The HICPAC guidelines also recommend selective use of surveillance cultures (that is, looking for the organism in patients who might be carriers, but have no signs of infection) to identify and limit transmission of CRE.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES