The Epidemiology of Tuberculosis in Minnesota, 20022006

1
The Epidemiology of Tuberculosis in Minnesota,
2002-2006
Minnesota Department of Health Tuberculosis
Prevention and Control Program (651)
201-5414 Tuberculosis surveillance data for
Minnesota are available on the Web
at www.health.state.mn.us/tb
2
Number of Tuberculosis Cases by Placeof Birth,
Minnesota, 1997-2006
3
Number of Cases and Incidence of Tuberculosis by
Location of Residence, Minnesota, 2002-2006
2002 No. (rate)
2003 No. (rate)
2004 No. (rate)
2005 No. (rate)
2006 No. (rate)
Location of Residence
Hennepin County Ramsey County Suburban Twin
Cities Metro Olmsted County Other Counties Total
99 (8.6) 36 (7.0) 30 (2.6) 10 (7.3) 24
(1.1) 199 (3.9)
128 (11.3) 39 ( 7.6) 17 ( 1.6) 17 (13.1)
36 ( 1.6) 237 (4.7)
114 (10.0) 29 ( 5.6) 26 ( 2.4) 22 (16.7)
23 ( 1.0) 214 (4.2)
104 (9.1) 27 (5.2) 26 (2.3) 13 (9.7) 29
(1.3) 199 (3.9)
95 (8.2) 44 (8.5) 27 (2.3) 15
(10.8) 36 (1.6) 217 (4.2)

Rate per 100,000 population. County-specific
rates for 2002-2005 were calculated using
population estimates from the Minnesota State
Demographic Center rates for 2006 were
calculated using population estimates
extrapolated from U.S. Census 2000 data and the
Minnesota State Demographic Centers estimates
for 2001-2005. Statewide total rates (all
counties) were calculated using state population
estimates from the U.S. Census Bureau.
Anoka, Carver, Dakota, Scott, and Washington
counties
4
Number of Cases of Tuberculosis by Location of
Residence, Minnesota, 2002-2006
2002 No. ()
2003 No. ()
2005 No. ( )
2006 No. ( )
2004 No. ()
Location of Residence

Hennepin County Ramsey County Suburban Twin
Cities Metro Olmsted County Other Counties Total
128 (54) 39 (16) 17 ( 7) 17 ( 7)
36 (15) 237 (100)
114 (53) 29 (14) 26 (12) 22 (10)
23 (11) 214 (100)
104 (52) 27 (14) 26 (13) 13 ( 7)
29 (15) 199 (100)
95 (44) 44 (20) 27 (12) 15 ( 7)
36 (17) 217 (100)
99 (50) 36 (18) 30 (15) 10 ( 5)
24 (12) 199 (100)
Anoka, Carver, Dakota, Scott, and Washington
counties
5
Tuberculosis Cases by Age and Placeof Birth,
Minnesota, 2002-2006
U.S.-Born Cases
Foreign-Born Cases
Total
Age (years)
No. ()
No. ()
No. ()
lt 5 5-14 15-24 25-44 45-64 gt 65 Total
33 (16) 16 ( 8) 15 ( 8) 43
(21) 51 (25) 43 (21) 201 (100)
49 ( 5) 66 ( 6) 285 (27)
395 (37) 155 (15) 116 (11) 1,066 (100)
16 ( 2) 50 ( 6) 270 (31) 352
(41) 104 (12) 73 ( 8) 865 (100)
Includes U.S.-born children of foreign-born
parent(s)
6
Number of Cases and Incidence of Tuberculosis by
Race/Ethnicity, Minnesota, 2002-2006
2003 No. (rate)
2005 No. (rate)
2004 No. (rate)
2002 No. (rate)
2006 No. (rate)
Race/Ethnicity
12 ( 0.3) 111 (52.3) 53 (30.3) 5 (
8.9) 0 ( 0.0) 18 ( 9.6) 199 (3.9)
30 ( 0.7) 120 (62.8) 61 (38.5)
3 ( 5.6) N/A 23 (14.1) 237
(4.7)
24 ( 0.5) 103 (50.0) 39 (22.9) 7
(12.7) 0 ( 0.0) 26 (14.5) 199 (3.9)
26 ( 0.6) 110 (50.1) 49 (27.1) 8
(14.1) 1 ( 1.4) 23 (11.8) 217 (4.2)
White Black Asian American Indian Multi-racial Hi
spanic/Latino Total
15 ( 0.3) 107 (53.9) 65 (39.6) 6
(11.0) 1 ( 1.6) 20 (11.7) 214 (4.2)

Race categories do not include persons of
Hispanic/Latino origin.
Rate per 100,000 population. Rates by
race/ethnicity for 2002-2005 were calculated
using mid-year population estimates from the U.S.
Census Bureau rates for 2006 were calculated
using population estimates extrapolated from the
U.S. Census Bureaus mid-year estimates for
2000-2005. Statewide total rates (all
races/ethnicities) were calculated using state
population estimates from the U.S. Census Bureau.
Not applicable prior to 2003, tuberculosis
data were reported as single-race only.
7
Cases of Tuberculosis by Risk Category,Minnesota,
2002-2006
2006 (N217) No. ()
2002 (N237) No. ()
2003 (N214) No. ()
2004 (N199) No. ()
Cumulative (N1,066) No. ()
2005 (N199) No. ()
Risk Category
Foreign-born Substance abuse Homeless HIV-infecte
d Other medical condition Inmate Nursing home
resident
173 (81) 19 ( 9) 10 ( 5) 8 ( 4) 14 (
7) 4 ( 2) 1 (lt1)
173 (87) 14 ( 7) 4 ( 2) 12 ( 6) 16 (
8) 4 ( 2) 1 ( 1)
865 (81) 70 ( 7) 38 ( 4) 51 ( 5) 111
(10) 14 ( 1) 7 ( 1)
181 (76) 14 ( 6) 15 ( 6) 10 ( 4)
30 (13) 3 ( 1) 2 ( 1)
163 (82) 10 ( 5) 4 ( 2) 13 ( 7) 19
(10) 0 ( 0) 2 ( 1)
175 (81) 13 ( 6) 5 ( 2) 8 ( 4) 32
(15) 3 ( 1) 1 (lt1)
Risk categories are not mutually exclusive.
Alcohol abuse and/or illicit drug use
Silicosis, diabetes, prolonged corticosteroid
therapy or other immunosuppressive therapy,
hematologic/ reticuloendothelial disease, end
stage renal disease, substantial weight loss (not
TB-related) or undernutrition
8
Foreign-Born Tuberculosis Cases by Region of
Birth and Year of Diagnosis, Minnesota, 2002-2006
Number of Cases
Region of Birth
9
Tuberculosis Cases by Site of Disease andPlace
of Birth, Minnesota, 2002-2006
Foreign-Born Cases
U.S.-Born Cases
Total
No. ()
Site of Disease
No. ()
No. ()
562 (53) 392 (37) 112 (11) 1,066
(100)
Pulmonary Extrapulmonary Both Total
431 (50) 343 (40) 91 (11) 865 (100)
131 (65) 49 (24) 21 (10) 201 (100)
TB cases with both pulmonary and
extrapulmonary sites of disease, including
miliary TB
10
Tuberculosis Cases with Pulmonary Involvement by
Chest X-Ray Result, Minnesota, 2002-2006
Cases No. ( )
Chest X-Ray Result
13 ( 2) 151 (22) 501 (74) 8 (
1) 1 (lt1) 674 (100)
Normal Abnormal, cavitary Abnormal, non-cavitary
(TB) Abnormal, non-TB Not done/unknown Total
11
Tuberculosis Cases with Pulmonary Involvement by
Sputum AFB Smear Result,Minnesota, 2002-2006
Cases No. ( )
Sputum AFB Smear
241 (36) 357 (53) 76 (11) 674 (100)
Positive Negative Not done/unknown Total
12
Tuberculosis Cases by Mycobacterial Culture
Result, Minnesota, 2002-2006
Cases No. ( )
Mycobacterial Culture
826 (77) 214 (20) 26 (
2) 1,066 (100)
Positive Negative Not done/unknown Total
13
Tuberculosis Cases by Drug Susceptibility
Patterns and Year, Minnesota, 2002-2006
Cases With Susceptibility Results
Any Drug Resistance No. ()
INH- Resistant No. ()
MDR-TB No. ()
Year

• 26 (14)
• 30 (17)
• (12)
• 14 ( 9)
• 18 (10)
• 105 (13)

2002 2003 2004 2005 2006 Total
187 172 139 151 177 826
6 (3) 5 (3) 5 (4) 4 (3) 2 (1) 22
(3)

• 31 (17)
• 30 (17)
• 22 (16)
• (10)
• 25 (14)
• 123 (15)

Culture-confirmed cases with drug
susceptibility results available
Resistance to at least one first-line anti-TB
drug i.e., isoniazid (INH), rifampin,
pyrazinamide (PZA), or ethambutol
INH-resistant cases (also may have resistance
to other drugs)
Multi-drug resistant TB, with resistance to at
least INH and rifampin
Ten of these cases were resistant to INH,
rifampin, PZA, and ethambutol.
14
Cases of Drug-Resistant Tuberculosis by Place of
Birth and Year, Minnesota, 2002-2006
U.S.-Born Cases
Foreign-Born Cases
Cases with Susceptibility Results
Cases with Susceptibility Results
Resistant No. ()
Resistant No. ()
Year
2002 2003 2004 2005 2006 Total
147 143 118 131 144 683
27 (18) 26 (18) 21 (18) 13 (10) 23
(16) 110 (16)
40 29 21 20 33 143
4 (10) 4 (14) 1 ( 5) 2 (10) 2 (
6) 13 ( 9)
Culture-confirmed cases with drug
susceptibility results available
Resistance to at least one first-line anti-TB
drug i.e., isoniazid (INH), rifampin,
pyrazinamide (PZA), or ethambutol
15
Tuberculosis Cases by Drug Susceptibility
Patterns and Place of Birth, Minnesota, 2002-2006
Cases With
Any Drug
INH-

MDR-TB
Resistant

Susceptibility
Resistance
No. ()
Place of Birth
Results
No. ()
No. ()
683
110 (16)
94 (14)
17 ( 2)
Foreign-Born Cases
U.S.-Born Cases
13 ( 9)
11 ( 8)
143
5 ( 3)
Total

826
123 (15)
105 (13)
22
( 3)


Culture-confirmed cases with drug
susceptibility results available

Resistance to at least one first-line anti-TB
drug i.e., isoniazid (INH), rifampin,
pyrazinamide (PZA), or ethambutol
INH-resistant cases (also may have resistance
to other drugs)

Multi-drug resistant TB, with resistance to at
least INH and rifampin


Ten of these cases were resistant to INH,
rifampin, PZA, and ethambutol.
16
Tuberculosis Cases by Method of Case
Identification, Minnesota, 2002-2006
2002 No. ()
2003 No. ()
2005 No. ( )
2006 No. ( )
2004 No. ()
How Identified

Presented with symptoms TB contact
investigation Refugee health exam
(domestic) Pre-immigration exam
(overseas) Other Total
210 (89) 16 ( 7) 0 ( 0) 0 (
0) 11 ( 5) 237 (100)
186 (87) 18 ( 8) 0 ( 0) 0 (
0) 10 ( 5) 214 (100)
168 (84) 10 ( 5) 11 ( 6) 1 (
1) 9 ( 5) 199 (100)
170 (78) 10 ( 5) 17 ( 8) 5 (
2) 15 ( 7) 217 (100)
156 (78) 8 ( 4) 15 ( 8) 6 (
3) 14 ( 7) 199 (100)
e.g., occupational screening, other targeted
tuberculin skin testing, etc.
17
Tuberculosis Cases by Mode of Treatment
Administration, Minnesota, 2002-2006
18
Tuberculosis Cases by Mode of Treatment
Administration and Type of Health CareProvider,
Minnesota, 2002-2006
Type of Provider
19
Completion and Length of Therapy Among
Tuberculosis Cases by Type of Health Care
Provider, Minnesota, 2005
Completed Within 12 mos.
Completed
Overall
Started
Type of Provider
Treatment
No. ()
No. ()
111 (97)
114
107 (94)
Public
69
67 (97)
63 (91)
Private
Total
183
170 (93)
178 (97)
Patients for whom lt 12 months of therapy is
indicated - - i.e., excluding patients with
rifampin resistance or meningeal TB and patients
15 years of age or younger with miliary TB.