Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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Query Trace: Langer AJ[original query] |
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Second nationwide tuberculosis outbreak caused by bone allografts containing live cells - United States, 2023
Wortham JM , Haddad MB , Stewart RJ , Annambhotla P , Basavaraju SV , Nabity SA , Griffin IS , McDonald E , Beshearse EM , Grossman MK , Schildknecht KR , Calvet HM , Keh CE , Percak JM , Coloma M , Shaw T , Davidson PJ , Smith SR , Dickson RP , Kaul DR , Gonzalez AR , Rai S , Rodriguez G , Morris S , Armitige LY , Stapleton J , Lacassagne M , Young LR , Ariail K , Behm H , Jordan HT , Spencer M , Nilsen DM , Denison BM , Burgos M , Leonard JM , Cortes E , Thacker TC , Lehman KA , Langer AJ , Cowan LS , Starks AM , LoBue PA . MMWR Morb Mortal Wkly Rep 2024 72 (5253) 1385-1389 ![]() ![]() During July 7-11, 2023, CDC received reports of two patients in different states with a tuberculosis (TB) diagnosis following spinal surgical procedures that used bone allografts containing live cells from the same deceased donor. An outbreak associated with a similar product manufactured by the same tissue establishment (i.e., manufacturer) occurred in 2021. Because of concern that these cases represented a second outbreak, CDC and the Food and Drug Administration worked with the tissue establishment to determine that this product was obtained from a donor different from the one implicated in the 2021 outbreak and learned that the bone allograft product was distributed to 13 health care facilities in seven states. Notifications to all seven states occurred on July 12. As of December 20, 2023, five of 36 surgical bone allograft recipients received laboratory-confirmed TB disease diagnoses; two patients died of TB. Whole-genome sequencing demonstrated close genetic relatedness between positive Mycobacterium tuberculosis cultures from surgical recipients and unused product. Although the bone product had tested negative by nucleic acid amplification testing before distribution, M. tuberculosis culture of unused product was not performed until after the outbreak was recognized. The public health response prevented up to 53 additional surgical procedures using allografts from that donor; additional measures to protect patients from tissue-transmitted M. tuberculosis are urgently needed. |
Association Between Birth Region and Time to Tuberculosis Diagnosis After US Entry Among Non–US-Born Persons (preprint)
Talwar A , Li R , Langer AJ . medRxiv 2020 2020.08.02.20160135 Approximately 90% of US tuberculosis (TB) cases among non–US-born persons are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated if birthplace is associated with time of progression to TB disease among non–US-born persons. We derived a Cox regression model comparing differences in time to TB diagnosis after US entry among 19 global birth regions, adjusting for sex, birth year, and age at diagnosis. Compared with persons from Western Europe, the adjusted hazard rate of developing TB was significantly higher (p ≤0.05) for persons from all other regions, except North America and Northern Europe, and highest among persons from Middle Africa (adjusted hazard ratio = 7.0; 95% confidence interval: 6.5–7.4). Time to TB diagnosis among non–US-born persons therefore varied by birth region, which represents an important prognostic indicator for progression to TB disease.Competing Interest StatementThe authors have declared no competing interest.Funding StatementNeither the authors nor their institutions at any time received payment or services from a third party for any aspect of the submitted work.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:All data were collected as part of routine disease surveillance and were not part of human subjects research requiring institutional review board approval.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThe data contain information abstracted from the national tuberculosis case report form called the Report of Verified Case of Tuberculosis (RVCT) (OMB No. 0920-0026). These data have been reported voluntarily to CDC by state and local health departments, and are protected under the Assurance of Confidentiality (Sections 306 and 308(d) of the Public Health Service Act, 42 U.S.C. 242k and 242m(d)), which prevents disclosure of any information that could be used to directly or indirectly identify patients. For more information, see the CDC/ATSDR Policy on Releasing and Sharing Data (http://www.cdc.gov/maso/Policy/ReleasingData.pdf). A limited dataset is available at http://wonder.cdc.gov/TB.html. Researchers seeking additional data may apply to analyze National Tuberculosis Surveillance System data at CDC headquarters by contacting the Division of Tuberculosis Elimination (TBinfo{at}cdc.gov). |
Evaluating demographic representation in clinical trials: Use of the adaptive coronavirus disease 2019 treatment trial (ACTT) as a test case
Ortega-Villa AM , Hynes NA , Levine CB , Yang K , Wiley Z , Jilg N , Wang J , Whitaker JA , Colombo CJ , Nayak SU , Kim HJ , Iovine NM , Ince D , Cohen SH , Langer AJ , Wortham JM , Atmar RL , El Sahly HM , Jain MK , Mehta AK , Wolfe CR , Gomez CA , Beresnev T , Mularski RA , Paules CI , Kalil AC , Branche AR , Luetkemeyer A , Zingman BS , Voell J , Whitaker M , Harkins MS , Davey RT Jr , Grossberg R , George SL , Tapson V , Short WR , Ghazaryan V , Benson CA , Dodd LE , Sweeney DA , Tomashek KM . Open Forum Infect Dis 2023 10 (6) ofad290 BACKGROUND: Clinical trials initiated during emerging infectious disease outbreaks must quickly enroll participants to identify treatments to reduce morbidity and mortality. This may be at odds with enrolling a representative study population, especially when the population affected is undefined. METHODS: We evaluated the utility of the Centers for Disease Control and Prevention's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), the COVID-19 Case Surveillance System (CCSS), and 2020 United States (US) Census data to determine demographic representation in the 4 stages of the Adaptive COVID-19 Treatment Trial (ACTT). We compared the cumulative proportion of participants by sex, race, ethnicity, and age enrolled at US ACTT sites, with respective 95% confidence intervals, to the reference data in forest plots. RESULTS: US ACTT sites enrolled 3509 adults hospitalized with COVID-19. When compared with COVID-NET, ACTT enrolled a similar or higher proportion of Hispanic/Latino and White participants depending on the stage, and a similar proportion of African American participants in all stages. In contrast, ACTT enrolled a higher proportion of these groups when compared with US Census and CCSS. The proportion of participants aged ≥65 years was either similar or lower than COVID-NET and higher than CCSS and the US Census. The proportion of females enrolled in ACTT was lower than the proportion of females in the reference datasets. CONCLUSIONS: Although surveillance data of hospitalized cases may not be available early in an outbreak, they are a better comparator than US Census data and surveillance of all cases, which may not reflect the population affected and at higher risk of severe disease. |
Using the food and drug administrations sentinel system for surveillance of TB infection
Walker WL , Schmit KM , Welch EC , Vonnahme LA , Talwar A , Nguyen M , Stojanovic D , Langer AJ , Cocoros NM . Int J Tuberc Lung Dis 2022 26 (12) 1170-1176 BACKGROUND: We examined patterns in care for individuals treated for latent TB infection (LTBI) in the US Food and Drug Administration´s Sentinel System.METHODS: Using administrative claims data, we identified patients who filled standard LTBI treatment prescriptions during 2008-2019. In these cohorts, we assessed LTBI testing, clinical management, and treatment duration.RESULTS: Among 113,338 patients who filled LTBI prescriptions, 80% (90,377) received isoniazid (INH) only, 19% (21,235) rifampin (RIF) only, and 2% (1,726) INH + rifapentine (RPT). By regimen, the proportion of patients with documented prior testing for TBI was 79%, 54%, and 91%, respectively. Median therapy duration was 84 days (IQR 35-84) for the 3-month once-weekly INH + RPT regimen, 60 days (IQR 30-100) for the 6- to 9-month INH regimen, and 30 days (IQR 2-60) for the 4-month RIF regimen.CONCLUSIONS: Among the cohorts, INH-only was the most commonly prescribed LTBI treatment. Most persons who filled a prescription for LTBI treatment did not have evidence of completing recommended treatment duration. These data further support preferential use of shorter-course regimens such as INH + RPT. |
Decrease in Tuberculosis Cases during COVID-19 Pandemic as Reflected by Outpatient Pharmacy Data, United States, 2020.
Winglee K , Hill AN , Langer AJ , Self JL . Emerg Infect Dis 2022 28 (4) 820-827 We analyzed a pharmacy dataset to assess the 20% decline in tuberculosis (TB) cases reported to the US National Tuberculosis Surveillance System (NTSS) during the coronavirus disease pandemic in 2020 compared with the 2016-2019 average. We examined the correlation between TB medication dispensing data to TB case counts in NTSS and used a seasonal autoregressive integrated moving average model to predict expected 2020 counts. Trends in the TB medication data were correlated with trends in NTSS data during 2006-2019. There were fewer prescriptions and cases in 2020 than would be expected on the basis of previous trends. This decrease was particularly large during April-May 2020. These data are consistent with NTSS data, suggesting that underreporting is not occurring but not ruling out underdiagnosis or actual decline. Understanding the mechanisms behind the 2020 decline in reported TB cases will help TB programs better prepare for postpandemic cases. |
Tuberculosis in indigenous persons - United States, 2009-2019
Springer YP , Kammerer JS , Silk BJ , Langer AJ . J Racial Ethn Health Disparities 2021 9 (5) 1750-1764 BACKGROUND: Populations of indigenous persons are frequently associated with pronounced disparities in rates of tuberculosis (TB) disease compared to co-occurring nonindigenous populations. METHODS: Using data from the National Tuberculosis Surveillance System on TB cases in U.S.-born patients reported in the United States during 2009-2019, we calculated incidence rate ratios and risk ratios for TB risk factors to compare cases in American Indian or Alaska Native (AIAN) and Native Hawaiian or other Pacific Islander (NHPI) TB patients to cases in White TB patients. RESULTS: Annual TB incidence rates among AIAN and NHPI TB patients were on average ≥10 times higher than among White TB patients. Compared to White TB patients, AIAN and NHPI TB patients were 1.91 (95% confidence interval (CI): 1.35-2.71) and 3.39 (CI: 1.44-5.74) times more likely to have renal disease or failure, 1.33 (CI: 1.16-1.53) and 1.63 (CI: 1.20-2.20) times more likely to have diabetes mellitus, and 0.66 (CI: 0.44-0.99) and 0.19 (CI: 0-0.59) times less likely to be HIV positive, respectively. AIAN TB patients were 1.84 (CI: 1.69-2.00) and 1.48 (CI: 1.27-1.71) times more likely to report using excess alcohol and experiencing homelessness, respectively. CONCLUSION: TB among U.S. indigenous persons is associated with persistent and concerning health disparities. |
Association between Birth Region and Time to Tuberculosis Diagnosis among Non-US-Born Persons in the United States
Talwar A , Li R , Langer AJ . Emerg Infect Dis 2021 27 (6) 1645-1653 Approximately 90% of tuberculosis (TB) cases among non-US-born persons in the United States are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated whether birthplace is associated with time to disease progression among non-US-born persons in whom TB disease developed. We derived a Cox regression model comparing differences in time to TB diagnosis after US entry among 19 birth regions, adjusting for sex, birth year, and age at entry. After adjusting for age at entry and birth year, the median time to TB diagnosis was lowest among persons from Middle Africa, 128 months (95% CI 116-146 months) for male persons and 121 months (95% CI 108-136 months) for female persons. We found time to TB diagnosis among non-US-born persons varied by birth region, which represents a prognostic indicator for progression of latent TB infection to TB disease. |
US tuberculosis rates among persons born outside the United States compared with rates in their countries of birth, 2012-2016
Tsang CA , Langer AJ , Kammerer JS , Navin TR . Emerg Infect Dis 2020 26 (3) 533-540 The US Centers for Disease Control and Prevention recommends screening populations at increased risk for tuberculosis (TB), including persons born in countries with high TB rates. This approach assumes that TB risk for expatriates living in the United States is representative of TB risk in their countries of birth. We compared US TB rates by country of birth with corresponding country rates by calculating incidence rate ratios (IRRs) (World Health Organization rate/US rate). The median IRR was 5.4. The median IRR was 0.5 for persons who received a TB diagnosis <1 year after US entry, 4.9 at 1 to <10 years, and 10.0 at >10 years. Our analysis suggests that World Health Organization TB rates are not representative of TB risk among expatriates in the United States and that TB testing prioritization in the United States might better be based on US rates by country of birth and years in the United States. |
Tuberculosis - United States, 2019
Schwartz NG , Price SF , Pratt RH , Langer AJ . MMWR Morb Mortal Wkly Rep 2020 69 (11) 286-289 Since 1989, the United States has pursued a goal of eliminating tuberculosis (TB) through a strategy of rapidly identifying and treating cases and evaluating exposed contacts to limit secondary cases resulting from recent TB transmission (1). This strategy has been highly effective in reducing U.S. TB incidence (2), but the pace of decline has significantly slowed in recent years (2.2% average annual decline during 2012-2017 compared with 6.7% during 2007-2012) (3). For this report, provisional 2019 data reported to CDC's National Tuberculosis Surveillance System were analyzed to determine TB incidence overall and for selected subpopulations and these results were compared with those from previous years. During 2019, a total of 8,920 new cases were provisionally reported in the United States, representing a 1.1% decrease from 2018.* TB incidence decreased to 2.7 cases per 100,000 persons, a 1.6% decrease from 2018. Non-U.S.-born persons had a TB rate 15.5 times greater than the rate among U.S.-born persons. The U.S. TB case count and rate are the lowest ever reported, but the pace of decline remains slow. In recent years, approximately 80% of U.S. TB cases have been attributed to reactivation of latent TB infection (LTBI) acquired years in the past, often outside the United States (2). An expanded TB elimination strategy for this new decade should leverage existing health care resources, including primary care providers, to identify and treat persons with LTBI, without diverting public health resources from the continued need to limit TB transmission within the United States. Partnerships with health care providers, including private providers, are essential for this strategy's success. |
Epidemiology of tuberculosis in the United States
Langer AJ , Navin TR , Winston CA , LoBue P . Clin Chest Med 2019 40 (4) 693-702 Although considerable progress has been made in reducing US tuberculosis incidence, the goal of eliminating the disease from the United States remains elusive. A continued focus on preventing new tuberculosis infections while also identifying and treating persons with existing tuberculosis infection is needed. Continued vigilance to ensure ongoing control of tuberculosis transmission remains key. |
Noncountable tuberculosis case reporting, National Tuberculosis Surveillance System, United States, 2010-2014
Pratt RH , Manangan LP , Cummings CN , Langer AJ . Public Health Rep 2019 135 (1) 33354919884302 OBJECTIVES: Supplemental federal funding is allocated to state and local tuberculosis (TB) programs using a formula that considers only countable cases reported to the National Tuberculosis Surveillance System (NTSS). Health departments submit reports of cases, which are countable unless another (US or international) jurisdiction has already counted the case or the case represents a recurrence of TB diagnosed </=12 months after completion of treatment for a previous TB episode. Noncountable cases are a resource burden, so in 2009, NTSS began accepting noncountable case reports as an indicator of program burden. We sought to describe the volume and completeness of noncountable case reports. METHODS: We analyzed 2010-2014 NTSS data to determine the number and distribution of noncountable cases reported. We also surveyed jurisdictions to determine the completeness of noncountable case reporting and obtain information on jurisdictions' experience in reporting noncountable cases. In addition, we prepared a hypothetical recalculation of the funding formula to evaluate the effect of including noncountable cases on funding allocations. RESULTS: Of 54 067 TB case reports analyzed, 1720 (3.2%) were noncountable; 47 of 60 (78.3%) jurisdictions reported >/=1 noncountable case. Of 60 programs surveyed, 34 (56.7%) responded. Of the 34 programs that responded, 24 (70.6%) had not reported all their noncountable cases to NTSS, and 11 (32.4%) stated that reporting noncountable cases was overly burdensome, considering the cases were not funded. CONCLUSIONS: Complete data on noncountable TB cases help support estimates of programmatic burden. Ongoing training and a streamlined reporting system to NTSS can facilitate noncountable case reporting. |
Factors associated with latent tuberculosis infection treatment failure among patients with commercial health insurance - United States, 2005-2016
Iqbal SA , Isenhour CJ , Mazurek G , Langer AJ , Chang MH , Truman BI . J Public Health Manag Pract 2019 27 (4) E151-E161 CONTEXT: Approximately 80% of US tuberculosis (TB) cases verified during 2015-2016 were attributed to untreated latent TB infection (LTBI). Identifying factors associated with LTBI treatment failure might improve treatment effectiveness. OBJECTIVE: To identify patients with indicators of isoniazid (INH) LTBI treatment initiation, completion, and failure. METHODS: We searched inpatient and outpatient claims for International Classification of Diseases (Ninth and Tenth Revisions), National Drug, and Current Procedural Terminology codes. We defined treatment completion as 180 days or more of INH therapy during a 9-month period. We defined LTBI treatment failure as an active TB disease diagnosis more than 1 year after starting LTBI treatment among completers and used exact logistic regression to model possible differences between groups. Among treatment completers, we matched 1 patient who failed treatment with 2 control subjects and fit regression models with covariates documented on medical claims paid 6 months or less before INH treatment initiation. PARTICIPANTS: Commercially insured US patients in a large commercial database with insurance claims paid during 2005-2016. MAIN OUTCOME MEASURES: (1) Trends in treatment completion; (2) odds ratios (ORs) for factors associated with treatment completion and treatment failure. RESULTS: Of 21 510 persons who began LTBI therapy during 2005-2016, 10 725 (49.9%) completed therapy. Treatment noncompletion is associated with those younger than 45 years, living in the Northeast or South Census regions, and women. Among persons who completed treatment, 30 (0.3%) progressed to TB disease. Diagnoses of rheumatoid arthritis during the 6 months before treatment initiation and being aged 65 years or older (reference: ages 0-24 years) were significantly associated with INH LTBI treatment failure (adjusted exact OR = 5.1; 95% CI, 1.2-28.2; and adjusted exact OR = 5.1; 95% CI, 1.2-25.3, respectively). CONCLUSION: Approximately 50% of persons completed INH LTBI therapy, and of those, treatment failure was associated with rheumatoid arthritis and persons 65 years or older among a cohort of US LTBI patients with commercial health insurance. |
Changes in tuberculosis epidemiology, United States, 1993-2017
Armstrong LR , Winston CA , Stewart B , Tsang CA , Langer AJ , Navin TR . Int J Tuberc Lung Dis 2019 23 (7) 797-804 BACKGROUND: After 20 years of steady decline, the pace of decline of tuberculosis (TB) incidence in the United States has slowed.METHODS: Trends in TB incidence rates and case counts since 1993 were assessed using national US surveillance data. Patient characteristics reported during 2014-2017 were compared with those for 2010-2013.RESULTS: TB rates and case counts slowed to an annual decline of respectively 2.2% (95%CI -3.4 to -1.0) and 1.5% (95%CI -2.7 to -0.3) since 2012, with decreases among US-born persons and no change among non-US-born persons. Overall, persons with TB diagnosed during 2014-2017 were older, more likely to have combined pulmonary and extra-pulmonary disease than extra-pulmonary disease alone, more likely to be of non-White race, and less likely to have human immunodeficiency virus infection, or cavitary pulmonary disease. During 2014-2017, non-US-born persons with TB were more likely to have diabetes mellitus, while the US-born were more likely to have smear-positive TB and use non-injecting drugs.CONCLUSION: Changes in epidemiologic trends are likely to affect TB incidence in the coming decades. The Centers for Disease Control and Prevention has called for increased attention to TB prevention through the detection and treatment of latent tuberculous infection. |
Bacillus Calmette-Guerin cases reported to the National Tuberculosis Surveillance System, United States, 2004-2015
Wansaula Z , Wortham JM , Mindra G , Haddad MB , Salinas JL , Ashkin D , Morris SB , Grant GB , Ghosh S , Langer AJ . Emerg Infect Dis 2019 25 (3) 451-456 Mycobacterium bovis bacillus Calmette-Guerin (BCG) is used as a vaccine to protect against disseminated tuberculosis (TB) and as a treatment for bladder cancer. We describe characteristics of US TB patients reported to the National Tuberculosis Surveillance System (NTSS) whose disease was attributed to BCG. We identified 118 BCG cases and 91,065 TB cases reported to NTSS during 2004-2015. Most patients with BCG were US-born (86%), older (median age 75 years), and non-Hispanic white (81%). Only 17% of BCG cases had pulmonary involvement, in contrast with 84% of TB cases. Epidemiologic features of BCG cases differed from TB cases. Clinicians can use clinical history to discern probable BCG cases from TB cases, enabling optimal clinical management. Public health agencies can use this information to quickly identify probable BCG cases to avoid inappropriately reporting BCG cases to NTSS or expending resources on unnecessary public health interventions. |
Tuberculosis - United States, 2018
Talwar A , Tsang CA , Price SF , Pratt RH , Walker WL , Schmit KM , Langer AJ . Am J Transplant 2019 19 (5) 1582-1588 In 2018, a total of 9,029 new tuberculosis (TB) cases were reported in the United States, representing a 0.7% decrease from 2017.* The U.S. TB incidence in 2018 (2.8 per 100,000 persons) represented a 1.3% decrease from 2017; the rate among non–U.S.-born persons was >14 times that in U.S.-born persons. This report summarizes provisional TB surveillance data reported to CDC’s National Tuberculosis Surveillance System (NTSS) through 2018. Although the total number of cases and incidence are the lowest ever reported in the United States, a recent model predicted that the U.S. TB elimination goal (annual incidence of <1 case per 1 million persons) will not be attained in the 21st century without greatly increased investment in detection and treatment of latent TB infection (LTBI).1 Programs to identify, test, and treat populations at high risk for TB remain important to eliminating TB in the United States. |
Tuberculosis - United States, 2017
Stewart RJ , Tsang CA , Pratt RH , Price SF , Langer AJ . MMWR Morb Mortal Wkly Rep 2018 67 (11) 317-323 In 2017, a total of 9,093 new cases of tuberculosis (TB) were provisionally* reported in the United States, representing an incidence rate of 2.8 cases per 100,000 population. The case count decreased by 1.8% from 2016 to 2017, and the rate declined by 2.5% over the same period. These decreases are consistent with the slight decline in TB seen over the past several years (1). This report summarizes provisional TB surveillance data reported to CDC's National Tuberculosis Surveillance System for 2017 and in the last decade. The rate of TB among non-U.S.-born persons in 2017 was 15 times the rate among U.S.-born persons. Among non-U.S.-born persons, the highest TB rate among all racial/ethnic groups was among Asians (27.0 per 100,000 persons), followed by non-Hispanic blacks (blacks; 22.0). Among U.S.-born persons, most TB cases were reported among blacks (37.1%), followed by non-Hispanic whites (whites; 29.5%). Previous studies have shown that the majority of TB cases in the United States are attributed to reactivation of latent TB infection (LTBI) (2). Ongoing efforts to prevent TB transmission and disease in the United States remain important to continued progress toward TB elimination. Testing and treatment of populations most at risk for TB disease and LTBI, including persons born in countries with high TB prevalence and persons in high-risk congregate settings (3), are major components of this effort. |
Tuberculosis test usage and medical expenditures from outpatient insurance claims data, 2013
Owusu-Edusei K Jr , Winston CA , Marks SM , Langer AJ , Miramontes R . Tuberc Res Treat 2017 2017 3816432 Objective: To evaluate TB test usage and associated direct medical expenditures from 2013 private insurance claims data in the United States (US). Methods: We extracted outpatient claims for TB-specific and nonspecific tests from the 2013 MarketScan(R) commercial database. We estimated average expenditures (adjusted for claim and patient characteristics) using semilog regression analyses and compared them to the Centers for Medicare and Medicaid Services (CMS) national reimbursement limits. Results: Among the TB-specific tests, 1.4% of the enrollees had at least one claim, of which the tuberculin skin test was most common (86%) and least expensive ($9). The T-SPOT(R) was the most expensive among the TB-specific tests ($106). Among nonspecific TB tests, the chest radiograph was the most used test (78%), while chest computerized tomography was the most expensive ($251). Adjusted average expenditures for the majority of tests ( approximately 74%) were above CMS limits. We estimated that total United States medical expenditures for the employer-based privately insured population for TB-specific tests were $53.0 million in 2013, of which enrollees paid 17% ($9 million). Conclusions: We found substantial differences in TB test usage and expenditures. Additionally, employer-based private insurers and enrollees paid more than CMS limits for most TB tests. |
Tuberculosis - United States, 2016
Schmit KM , Wansaula Z , Pratt R , Price SF , Langer AJ . MMWR Morb Mortal Wkly Rep 2017 66 (11) 289-294 In 2016, a total of 9,287 new tuberculosis (TB) cases were reported in the United States; this provisional count represents the lowest number of U.S. TB cases on record and a 2.7% decrease from 2015. The 2016 TB incidence of 2.9 cases per 100,000 persons represents a slight decrease compared with 2015 (-3.4%). However, epidemiologic modeling demonstrates that if similar slow rates of decline continue, the goal of U.S. TB elimination will not be reached during this century. Although current programs to identify and treat active TB disease must be maintained and strengthened, increased measures to identify and treat latent TB infection (LTBI) among populations at high risk are also needed to accelerate progress toward TB elimination. |
Tuberculosis among foreign-born persons diagnosed ≥10 years after arrival in the United States, 2010-2015
Tsang CA , Langer AJ , Navin TR , Armstrong LR . MMWR Morb Mortal Wkly Rep 2017 66 (11) 295-298 The majority of tuberculosis (TB) cases in the United States are attributable to reactivation of latent TB infection (LTBI). LTBI refers to the condition when a person is infected with Mycobacterium tuberculosis without signs and symptoms, or radiographic or bacteriologic evidence of TB disease. CDC and the U.S. Preventive Services Task Force (USPSTF) recommend screening populations at increased risk for LTBI, including persons who have lived in congregate settings at high risk and persons who were born in, or are former residents of countries with TB incidence ≥20 cases per 100,000 population. In 2015, foreign-born persons constituted 66.2% of U.S. TB cases. During the past 30 years, screening of persons from countries with high TB rates has focused on overseas screening for immigrants and refugees, and domestic screening for persons who have newly arrived in the United States. However, since 2007, an increasing number and proportion of foreign-born patients receiving a diagnosis of TB first arrived in the United States ≥10 years before the development and diagnosis of TB disease. To better understand how this group of patients differs from persons who developed TB disease and received a diagnosis <10 years after U.S. arrival, CDC analyzed data for all reported TB cases in the United States since 1993 in the National TB Surveillance System (NTSS). After adjusting for age and other characteristics, foreign-born persons who arrived in the United States ≥10 years before diagnosis were more likely to be residents of a long-term care facility or to have immunocompromising conditions other than human immunodeficiency virus (HIV) infection. These findings support using the existing CDC and USPSTF recommendations for TB screening of persons born in countries with high TB rates regardless of time since arrival in the United States. |
Leveling of tuberculosis incidence - United States, 2013-2015
Salinas JL , Mindra G , Haddad MB , Pratt R , Price SF , Langer AJ . MMWR Morb Mortal Wkly Rep 2016 65 (11) 273-278 After 2 decades of progress toward tuberculosis (TB) elimination with annual decreases of ≥0.2 cases per 100,000 persons (1), TB incidence in the United States remained approximately 3.0 cases per 100,000 persons during 2013-2015. Preliminary data reported to the National Tuberculosis Surveillance System indicate that TB incidence among foreign-born persons in the United States (15.1 cases per 100,000) has remained approximately 13 times the incidence among U.S.-born persons (1.2 cases per 100,000). Resuming progress toward TB elimination in the United States will require intensification of efforts both in the United States and globally, including increasing U.S. efforts to detect and treat latent TB infection, strengthening systems to interrupt TB transmission in the United States and globally, accelerating reductions in TB globally, particularly in the countries of origin for most U.S. CASES: |
Nonpasteurized dairy products, disease outbreaks, and state laws-United States, 1993-2006
Langer AJ , Ayers T , Grass J , Lynch M , Angulo FJ , Mahon BE . Emerg Infect Dis 2012 18 (3) 385-91 Although pasteurization eliminates pathogens and consumption of nonpasteurized dairy products is uncommon, dairy-associated disease outbreaks continue to occur. To determine the association of outbreaks caused by nonpasteurized dairy products with state laws regarding sale of these products, we reviewed dairy-associated outbreaks during 1993-2006. We found 121 outbreaks for which the product's pasteurization status was known; among these, 73 (60%) involved nonpasteurized products and resulted in 1,571 cases, 202 hospitalizations, and 2 deaths. A total of 55 (75%) outbreaks occurred in 21 states that permitted sale of nonpasteurized products; incidence of nonpasteurized product-associated outbreaks was higher in these states. Nonpasteurized products caused a disproportionate number ( approximately 150x greater/unit of product consumed) of outbreaks and outbreak-associated illnesses and also disproportionately affected persons <20 years of age. States that restricted sale of nonpasteurized products had fewer outbreaks and illnesses; stronger restrictions and enforcement should be considered. |
Multistate outbreak of MDR TB identified by genotype cluster investigation.
Barry PM , Gardner TJ , Funk E , Oren E , Field K , Shaw T , Langer AJ . Emerg Infect Dis 2012 18 (1) 113-6 ![]() In 2008, diagnosis and investigation of 2 multidrug-resistant tuberculosis cases with matching genotypes led to identification of an outbreak among foreign-born persons who performed short-term seafood production work in Alaska during 2006. Tuberculosis control programs should consider the possibility of domestic transmission even among foreign-born patients. |
Investigation of an apparent outbreak of Rhodococcus equi bacteremia
Langer AJ , Feja K , Lasker BA , Hinrikson HP , Morey RE , Pellegrini GJ , Smith TL , Robertson C . Diagn Microbiol Infect Dis 2010 67 (1) 95-100 During January to April 2007, hospital staff reported 3 patients with Rhodococcus equi bloodstream infections. Isolates were analyzed at the Centers for Disease Control and Prevention, Atlanta, GA, to confirm identification and to assess strain relatedness; 2 were R. equi but genetically distinct, and 1 was identified as Gordonia polyisoprenivorans. Rapid reference laboratory support prevented an unnecessary outbreak investigation. |
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