Priority Area: Infectious Disease - Tuberculosis
The Burden of Infectious Disease - Tuberculosis
Tuberculosis is a disease caused by a bacteria that usually affects the lungs (pulmonary TB), but other parts of the body can be affected (extrapulmonary TB). Tuberculosis is a serious illness, and can affect anyone, including people of any age, nationality or income level. People with TB disease must be treated with at least four different TB drugs, prescribed for six months or more. TB drugs must be taken exactly the way the doctor orders. A person with TB that is not treated adequately can spread TB to other persons, can become severely ill and may even die.
Latent TB infection (LTBI) means TB bacteria are in the body but are not active, the person is not sick, has no TB symptoms, and cannot spread TB to others. The TB bacteria stay in the body, but for most people with LTBI, they will never become active. People with latent TB infection should be evaluated by their doctors, or TB clinics, have examinations and chest x-rays taken. LTBI treatment may be prescribed, which must be taken for four to six months or longer.
By the year 2013, reduce the tuberculosis case rate in New York to no more than 1.0 per 100,000. Baseline: 7.2 per 100,000, Chronic Disease reports, 2003-2005. (Healthy People 2010 Goal)
Indicators for Tracking Public Health Priority Areas
Each community's progress towards reaching these Prevention Agenda Objectives will be tracked so members can see how close each community is to meeting the objectives.
Data and Statistics
- Tuberculosis Annual Data and Statistics.
- Links to New York State Department of Health Tuberculosis data, Annual Reports and the Annual Communicable Diseases Reports.
New York State Department of Health Programs
- Supporting Local Health Departments.
- Financial support for local TB control programs is provided through several mechanisms including Article 6 State Aid for General Public Health Work Reimbursement, for both outpatient and inpatient services for uninsured patients.
- Mycobacteriology Laboratory Services.
- The New York State Department of Health services include Wadsworth Center Services'rapid procedures for identification and drug susceptibility testing on specimens from TB patients; conducting research studies; investigating, developing, and evaluating technical procedures; and, providing consultation and laboratory support to health-care professionals statewide.
- TB Directly Observed Therapy (DOT) Program.
- Medicaid reimbursement is available for eligible TB patients who receive DOT from local health departments enrolled in the program. The NYSDOH funds also support several hospital-based DOT programs.
Strategies – The Evidence Base for Effective Interventions
- Case Detection.
- New cases of infectious TB should be diagnosed and reported as early as possible in the course of illness so appropriate treatment can be initiated, transmission interrupted, and public health responses promptly initiated.
- Case Management.
- TB case management includes assignment of primary responsibility for TB patients to public health staff, systematic regular review of patient progress, and development of plans to address barriers to patient adherence to therapy. An important component of TB case management is directly observed therapy.
- Contact Investigation.
- In contact investigation, persons exposed to someone with infectious TB disease are identified and evaluated for TB disease and latent TB infection. Contacts are at high risk for infection, and if infected recently, are also at high risk for developing TB disease. Contacts can be given treatment to reduce their risk of developing active TB.
- Directly Observed Therapy (DOT).
- Trained health care workers observe TB patients take every dose of the prescribed drugs. DOT is the most effective strategy for ensuring patients take all of their medicine and complete full courses of appropriate therapy. DOT is the standard of care for all TB patients in New York State.
- Laboratory Services.
- Mycobacteriology laboratories confirm the diagnosis in persons with active TB disease and aid in assessing patients' infectiousness and response to TB therapy.
- Targeted Testing and Treatment of Latent TB Infection.
- Targeted testing identifies those at highest risk for progression from latent infection to active TB who may benefit most from treatment. Priorities include persons at risk due to certain medical conditions, as well as those who live in settings or communities, or have immigrated from countries where TB is more prevalent.
- Prevention of TB transmission in Healthcare Settings
- Comprehensive infection control includes administrative controls (procedures for detecting and managing persons with possible active tuberculosis disease and for education and screening of health care workers), environmental controls (appropriate use and maintenance of airborne infection and isolation rooms and other ventilation measures), and respiratory-protection controls (appropriate use of respirators in settings with increased risk for TB exposure).
- Adherence to Treatment for Latent Tuberculosis Infection: A Manual for Health Care Providers, Charles P. Felton National Tuberculosis Center.
- Controlling Tuberculosis in the United States, Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America, 2005. MMWR. 2005; 54:1-81.
- Directly Observed Therapy (DOT) Training Curriculum for TB Control Programs, Francis J. Curry National Tuberculosis Center.
- Guidelines for the Diagnosis of Latent Tuberculosis Infection for the 21st Century, New Jersey Medical School National Tuberculosis Center.
- Guidelines for Initiating a School-Based Directly Observed Therapy Program, New Jersey Medical School National Tuberculosis Center.
- Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis, Recommendations from the National Tuberculosis Controllers Association and CDC, 2005. MMWR. 2005: 54:1-47.
- Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR. 2005; 54:1-141.
- Improving Completion Rates for Treatment of Latent TB Infection in Children and Adolescents, Charles P. Felton National Tuberculosis Center.
- Improving Treatment Completion for Latent Tuberculosis Infection among Health Care Workers, Charles P. Felton National Tuberculosis Center.
- Treatment of Tuberculosis, American Thoracic Society, CDC, and the Infectious Diseases Society of America, 2003. MMWR. 2003; 52:1-77.
- Tuberculosis Case Management for Nurses: Self-Study Modules, New Jersey Medical School National Tuberculosis Center.
Return on Investment
- Disease Control Priorities Project, Cost Effective Interventions.
- Developed by the World Bank, this application allows users to see cost-effectiveness of a number of interventions. For tuberculosis, choose the criteria from the drop down menu.
Partners include federal, state, and local TB programs and community partner organizations that are engaged in TB prevention and control activities.
- American Lung Association of New York State
- CDC Division of TB Elimination
- National Jewish Medical and Research Center
- Francis J. Curry National Tuberculosis Center
- National TB Controller's Association
- New Jersey Medical School Global Tuberculosis Institute
- Wadsworth Center Clinical Mycobacteriology Laboratory
More InformationNew York State Department of Health
Bureau of Tuberculosis Control
Room 840, Corning Tower, Empire State Plaza
Albany, NY 12237-0669
Fax: (518) 473-6164