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Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination
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Page 1: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Epidemiology of Tuberculosis in Correctional Facilities, United States,

1993-2011

Surveillance, Epidemiology and Outbreak Investigations BranchDivision of Tuberculosis Elimination

Centers for Disease Control and Prevention (CDC)

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of Tuberculosis Elimination

Page 2: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

The National Tuberculosis (TB) Surveillance System

Database of all confirmed cases of TB disease reported to CDC A confirmed case is one that is laboratory confirmed,

meets the clinical case definition, or is confirmed by the provider (in absence of adequate laboratory or clinical information)

Since 1993, CDC has collected demographic, risk factor, clinical, and laboratory information on TB cases residing in correctional facilities at the time of diagnosis

Page 3: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Surveillance Reporting forResidence of a Correctional Facility

Resident of correctional facility at the time of TB diagnosis (Yes, No, or Unknown)

Types of correctional facilities: Federal Prison State Prison Local Jail Juvenile Correctional Facility Other Correctional Facility Unknown

A separate question about “Immigration and Customs Enforcement” (ICE) custody was added in 2009 Persons in ICE custody can be housed in stand-alone ICE detention

centers or other correctional facilities. Questions pertaining to TB patients diagnosed in ICE facilities were

80% complete in 2009; 95% complete in 2011.

Page 4: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases in Correctional Facilities

In 2011, a total of 9,946 TB cases ≥ 15 years old were reported in the United States 9,884 of those (99.4%) had information on residence in

correctional facilities 424 (4.3%) cases were reported as residents of correctional

facilities at time of TB diagnosis

Between 1993 and 2011, 3.8% (n=11,721) of TB cases reported in the U.S. were residents of correctional facilities at the time of diagnosis.

* http://www.cdc.gov/tb/topic/populations/correctional/default.htm

Page 5: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Counts of TB Cases in Correctional Facilities Compared to All TB cases,

1993-2011

0

5,000

10,000

15,000

20,000

25,000

30,000

TB Cases in Correctional Facilities

Total TB Cases

Year of Report

TB

Cas

es (

Cou

nt)

Page 6: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

1

2

3

4

5

6

7

8

9

TB Cases in Correctional Facilities, Percentage of All Reported TB Cases, 1993-

2011

Year of Report

Per

cent

age

of a

ll T

B C

ases

Page 7: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Percent of TB Cases in Correctional Facilities by Type of Facility, 1993-2011

Juvenile Facility 1%

Federal Prison7%

Local Jail51%Other

10%

State Prison31%

Unknown0.4%

Page 8: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases in Correctional Facilities inU.S.-born and Foreign-born Persons, 1993-2011

30%

1%69

%

Foreign BornUnknown Origin of BirthU.S. Born

Page 9: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Year

Num

ber

of

TB

Case

sNumber of TB Cases in Correctional

Facilities inU.S.-born and Foreign-born Persons,

1993-2011

0

100

200

300

400

500

600

700

800

900

1000

U.S. BornForeign Born

Page 10: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases in Correctional Facilities by Race/Ethnicity and Percent of Foreign Born,

1993–2011

Race/Ethnicity

Num

ber

of

TB

Case

s

Black Hispanic White Asian Other*0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

U.S. BornForeign Born

4% 74% 4% 95% 12%

Note: Percentage indicates the proportion of foreign-born TB cases. Persons identified as white, black, Asian, or of other race are all non-Hispanic. Persons identified as Hispanic might be of any race.* Persons included in this category are American Indian/Alaska Native, Native Hawaiian or other Pacific Islander, multiple race, or unknown race and comprise <2% of all incarcerated TB cases.

Percent Foreign Born

Page 11: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Percent of TB Cases in Correctional Facilities

by Immigration and Customs Enforcement (ICE) Status, 2011

63%

37%

Not in ICE CustodyIn ICE Custody

Page 12: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases in Correctional Facilities by Type of Facility and Immigration and Customs

Enforcement (ICE) Status, 2011C

ount

of

Case

s b

y IC

E S

tatu

s

Type of Correctional Facility

Local Jail State Prison

Other Federal Prison

0

20

40

60

80

100

120

140

160

In ICE CustodyNot in ICE Custody

Page 13: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

15-24 25-44 45-64 65+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

In ICE

Not in ICE

Age Group (years)

TB Cases in Correctional Facilities by Age Group and Percent in Immigration and Customs

Enforcement (ICE), 2011

ICE S

tatu

s

Page 14: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases in Correctional Facilities by Age Group, 1993-2011

0.1%12.5%

62.7%

23.2%

1.5%

Age 0-14

Age 15-24

Age 25-44

Age 45-64

Age 65+

Unknown

NOTE: Data for ages missing/unknown each accounted for <0.1% of outcomes.

Page 15: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases ≥ Age 15 in Correctional Facilities

by Age Group, 1993-2011

Num

ber

of

TB

Case

s

Year of Report

19931995

19971999

20012003

20052007

20092011

0

200

400

600

800

1,000

1,200

Age 65+

Age 45-64

Age 25-44

Age 15-24

NOTE: For any year depicted, missing/unknown data accounted for <0.1% of outcomes.

Page 16: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

82%

9%

9%

Juvenile Correc-tion Facility

Local Jail

Unknown

TB Cases < Age 15 in Correctional Facilities by Correctional Facility Type,

1993-2011

Page 17: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Year of Report

Number of TB Cases in Correctional Facilities

by Sex, 1993-2011

Num

ber

of

TB

Case

s

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

200

400

600

800

1,000

1,200

MaleFemale

Page 18: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases in Correction Facilities by Race/Ethnicity, 1993-2011

2.8%

42.2%

36.6%

16.8%

1.3% 0.3%

Asian

Black

Hispanic

White

Other

Unknown

*

* “Other” includes groups comprising <2% of total incarcerated TB cases (American Indian, Native Hawaiian/Pacific Islander, or Multiple Races)

Page 19: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases in Correctional Facilities by Race/Ethnicity, 1993-2011

Num

ber

of

TB

Case

s

Year of Report* “Other” includes groups comprising <2% of total incarcerated cases (American Indian, Native Hawaiian/Pacific Islander, or Multiple Races). Incarcerated TB cases of unknown race/ethnicity are 0.3% of total cases and are not shown.

19931995

19971999

20012003

20052007

20092011

0

200

400

600

800

1,000

1,200

AsianBlackHispanicWhiteOther *

Page 20: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

65%

35%

HIV Status Known

HIV Status Unknown

Percent of TB Cases in Correctional Facilities by Whether HIV Test Results

Known*, 1993-2011

*

*Known HIV status includes positive, negative and indeterminate results.

Page 21: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Percent of TB Cases by HIV Status and Correctional Facility Status,

1993–2011

HIV Status

Perc

en

t

Positive Negative Indeterminate Refused Not offered Unknown0

5

10

15

20

25

30

35

40

45

50

TB Cases not in Correctional Facil-ities

TB Cases in Correctional Facilities

Page 22: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Treatment of TB Cases in Correctional Facilities by Use of

Directly Observed Therapy (DOT), 1993-200918%

71%

9%

2%

Both Directly Observed and Self Administered Totally Directly ObservedTotally Self AdministeredUnknown

Page 23: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Percent of TB Cases in Correctional Facilities at the Time of Diagnosis by Treatment

Completion, 1993-2009

73%

6%

11%

8%2% 1%

Completed Therapy

Died

Lost

Moved

Other

Refused

NOTE: Data for “Adverse Treatment Event” and “Unknown” each accounted for <0.1% of outcomes.

Page 24: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Percent of TB Cases by Treatment Completion Status and Correctional

Facility Status, 1993-2009

NOTE: Data for “Adverse Treatment Event” and “Unknown” each accounted for <0.1% of outcomes.

Treatment Status

Perc

en

t

Com-pleted

Therapy

Died Lost Moved Other Refused0

10

20

30

40

50

60

70

80

90

All TB CasesAll TB Cases in Correc-tional Facilities

Page 25: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Percent of TB Cases in Correctional Facilities by Reported History of Excess Alcohol Use Status,

1993-2011

57%28%

16%

No History of Excess Alcohol Use

History of Excess Alcohol Use

Page 26: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

Percent of TB Cases in Correctional Facilities by Reported History of Injection Drug Use, 1993-

2011

73%

11%

16% No History of Injection Drug

Use

History of Injection Drug Use

Unknown History of Injection Drug Use

Page 27: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

TB Cases in Correctional Facilities by ReportedHistory of Non-Injection Drug Use Status, 1993-

2011

57%

26%

17%

No History of Non-Injection Drug UseHistory of Non-Injection Drug UseUnknown History of Non-In-jection Drug Use

Page 28: Epidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2011 Surveillance, Epidemiology and Outbreak Investigations Branch Division.

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for HIV/AIDS, Viral Hepatitis, STD , and TB Prevention

Division of Tuberculosis Elimination


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