Fourteen Percent of Dangerous MDR TB Cases in U.S. in 2017 Were Diagnosed in New York City

Martin Mejia/Associated Press

Fourteen percent of all cases of multi-drug resistant (MDR) TB reported in the United States in 2017 were diagnosed in New York City, which has less than three percent of the country’s population.

In a report released earlier this month, the Centers for Disease Control (CDC) said that 97 cases of MDR TB were reported in the country in 2017. Fourteen of those cases, or 14.6 of all cases in the country, were reported in New York City, according to to the New York City Department of Health and Mental Hygiene.

MDR TB is an extremely dangerous form of TB that is very expensive to treat.

“Active TB can usually be treated successfully in six to nine months at a cost of $17,000 per patient, according to the Centers for Disease Control (CDC), but MDR TB treatment costs more than $150,000 per patient and can take between 20 and 26 months,” Breitbart News reported  previously:

The six to nine month treatment regimen for active TB, which has been standard practice in the United States for some 50 years, involves a combination of four drugs: rifampin, isoniazid, pyrazinamide, and ethambutol.

Over the past several decades, new strains of TB have developed around the world which are resistant to at least two of these four drugs, hence the term MDR TB. Treatment for MDR TB begins only after the patient is observed to be resistant to the standard four drug protocol. Subsequent to diagnosis, a number of expensive “second level” drugs are added to the patient’s treatment regimen.

Almost all patients treated for active TB survive. “In contrast, the morbidity rate among those diagnosed with MDR TB worldwide is 39 percent,” Breitbart News reported:

Worldwide, the number of MDR TB cases has increased from 273,000 new cases in 2000 to 480,000 new cases in 2014. During that same time, the number of new active TB cases worldwide each year has fluctuated around 9 million.

In 2014, an estimated 1.5 million people (17 percent of the new TB cases that year) died of TB. Of those, 190,000 died of MDR TB (39 percent of the new MDR TB cases that year). In the United States, 550 people died of the 9,421 new cases that year (one half of 1 percent). (Note: the overall number of active TB cases increased by 1.7 percent in 2015 to 9,563). . .

The higher worldwide morbidity rate of TB, compared to the United States, is largely due to the fact that almost every new patient in our country goes through the six to nine month regimen with the standard treatment of those four usually reliable drugs: rifampin, isoniazid, pyrazinamide, and ethambutol.

The New York City Department of Mental Health and Mental Hygiene also reported the number of new cases of active tuberculosis (TB) in New York City increased ten percent in one year, from 556 in 2016 to 613 in 2017.

New York City’s incidence of active TB compares unfavorably to the rest of the country. Out of every 100,000 residents of the city, 7.5% were diagnosed with active TB in 2017, compared to the national average of 2.8 out of every 100,000 residents in 2017.

Eighty-six percent of all active TB cases reported in 2017 in New York City were foreign-born, a slight increase from the 85 percent of the city’s 2016 cases, and 17  percent higher than the 69 percent of all TB cases reported across the country in 2017 that were foreign-born.

The percentage of TB cases in the United States that are foreign-born has more than tripled in 30 years, increasing from 22 percent in 1986 to 69 percent in 2017.

In 2015, for the first time in 23 years, the number of reported cases of active TB increased by 1.5 percent over the previous year, to 9,654. In 2016, the number of reported cases declined slightly to 9,272. In 2017, that number declined even further to 9,093, according to the CDC.

The ten percent increase in active TB cases reported in New York City marked the first annual increase in reported TB cases in the city since 2003.

The top four countries of origin for foreign-born residents of New York City who were diagnosed with active TB in 2017 were China (116), Mexico (42), India (38), and Ecuador (36).

In contrast, “As in previous years, in 2017, the top five countries of birth of non–U.S.-born persons with TB were Mexico (1,204; 19.0% of all non–U.S.-born persons with TB), Philippines (783; 12.3%), India (595; 9.4%), Vietnam (526; 8.3%), and China (400; 6.3%),” according to the CDC.

The median number of years foreign-born residents diagnosed with active TB in New York City in 2017 had been in the United States prior to diagnosis was seven.


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