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Communications to the Editor |

Longitudinal Data on Positive Tuberculin Skin Tests From Three US States FREE TO VIEW

Behzad Razavi, MD; Douglas Hornick, MD; Larry Schlesinger, MD; Jim Goodrich, PhD
Author and Funding Information

University of Iowa Hospitals and Clinics Iowa Department of Public Health, TB Control Program Iowa City, IA

Correspondence to: Behzad Razavi, MD, Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242; e-mail: Razavib@mail.medicine.uiowa.edu



Chest. 2000;117(2):608. doi:10.1378/chest.117.2.608
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To the Editor:

Tuberculosis (TB) is a global health problem. In characterizing the epidemiology of TB in the United States, emphasis has mostly been placed on identifying the number of active cases, because of their threat to the public health. However, these active cases only represent a small subset of the total reservoir of TB infection, and steps toward effective eradication would also require a better assessment of the total reservoir of TB in the United States.

While US national reporting of active TB began in 1953,1 there are only four states that require reporting of a positive tuberculin skin test (TST). These are South Dakota (SD), Missouri (MO), Indiana (IN; Indianapolis excluded), and Arkansas (nursing homes and prisons). We investigated the annual positive TST rate in these states. The Department of Health TB control programs of all four states were contacted. Longitudinal data were available from three states: SD, MO, and IN. These were accumulated and analyzed for patterns and relationship to demographic characteristics. Positive TST rate increased in all three states: in SD from 715 to 795 cases (11% increase) from 1994 to 1997; in MO from 1,095 to 4,083 cases (270% increase) from 1991 to 1997; and in IN from 4,612 to 4,624 cases from 1996 to 1997. Denominator data were not available.

Active TB has declined in the United States due to increased public health effort, better diagnostic tools, directly observed therapy, and increased awareness of the association between HIV and TB. However, our limited data suggest that despite this declining trend of active TB, the number of positive TSTs is increasing or not changing. This may have two possible explanations. It could simply reflect improved reporting methods, or it may represent an increased population with latent, potentially drug-resistant TB. In order to better delineate the disease potential for TB, we favor a more complete prospective analysis of TST data in defined populations throughout the United States.

References

McCombs, SB, Onorato, IM, McCray, E, et al (1996) Tuberculosis surveillance in the United States: case definitions used by state health departments.Am Public Health86,728-731. [CrossRef]
 

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References

McCombs, SB, Onorato, IM, McCray, E, et al (1996) Tuberculosis surveillance in the United States: case definitions used by state health departments.Am Public Health86,728-731. [CrossRef]
 
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