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. 2014 Mar 11;9(3):e90664.
doi: 10.1371/journal.pone.0090664. eCollection 2014.

The road to tuberculosis (Mycobacterium tuberculosis) elimination in Arkansas; a re-examination of risk groups

Anna Berzkalns  1 , Joseph Bates  2 , Wen Ye  3 , Leonard Mukasa  2 , Anne Marie France  4 , Naveen Patil  5 , Zhenhua Yang  1
Affiliations

The road to tuberculosis (Mycobacterium tuberculosis) elimination in Arkansas; a re-examination of risk groups

Anna Berzkalns et al. PLoS One. .

Abstract

Objectives: This study was conducted to generate knowledge useful for developing public health interventions for more effective tuberculosis control in Arkansas.

Methods: The study population included 429 culture-confirmed reported cases (January 1, 2004-December 31, 2010). Mycobacterium tuberculosis genotyping data were used to identify cases likely due to recent transmission (clustered) versus reactivation (non-clustered). Poisson regression models estimated average decline rate in incidence over time and assessed the significance of differences between subpopulations. A multinomial logistic model examined differences between clustered and non-clustered incidence.

Results: A significant average annual percent decline was found for the overall incidence of culture-confirmed (9%; 95% CI: 5.5%, 16.9%), clustered (6%; 95% CI: 0.5%, 11.6%), and non-clustered tuberculosis cases (12%; 95% CI: 7.6%, 15.9%). However, declines varied among demographic groups. Significant declines in clustered incidence were only observed in males, non-Hispanic blacks, 65 years and older, and the rural population.

Conclusions: These findings suggest that the Arkansas tuberculosis control program must target both traditional and non-traditional risk groups for successful tuberculosis elimination. The present study also demonstrates that a thorough analysis of TB trends in different population subgroups of a given geographic region or state can lead to the identification of non-traditional risk factors for TB transmission. Similar studies in other low incidence populations would provide beneficial data for how to control and eventually eliminate TB in the U.S.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Estimated incidence of culture-confirmed, clustered, and non-clustered tuberculosis cases.
Estimated incidence and 95% confidence intervals of culture-confirmed, clustered, and non-clustered cases of tuberculosis reported in Arkansas from 2004 to 2010. A case was included in a time-restricted cluster if it had identical spoligotype and 12 loci MIRU to another isolate diagnosed within the 1-year period prior to its diagnosis date.
Figure 2
Figure 2. Comparison of culture-confirmed, clustered, and non-clustered tuberculosis cases by age group.
Comparison of incidence trends of culture-confirmed, clustered, and non-clustered cases of tuberculosis reported in Arkansas from 2004 to 2010 between two major age groups. a: among individuals 20 to 64 years of age; b: among individuals 65 years or older.
Figure 3
Figure 3. Comparison of culture-confirmed, clustered, and non-clustered tuberculosis cases by sex.
Comparison of incidence trends of culture-confirmed, clustered, and non-clustered cases of tuberculosis reported in Arkansas from 2004 to 2010 between two sexes. a: among males; b: among females.
Figure 4
Figure 4. Comparison of culture-confirmed, clustered, and non-clustered tuberculosis cases by race/ethnicity.
Comparison of incidence trends of culture-confirmed, clustered, and non-clustered cases of tuberculosis reported in Arkansas from 2004 to 2010 between two major race/ethnic groups. a: among non-Hispanic whites; b: among non-Hispanic blacks.
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References

    1. Centers for Disease Control and Prevention (2010). Reported tuberculosis in the United States, 2010. Available: http://www.cdc.gov/tb/statistics/reports/2010/pdf/report2010.pdf. Accessed 25 August 2012.
    1. Centers for Disease Control and Prevention (2012) Trends in tuberculosis–United States, 2011. MMWR 61 (11) 181–5. - PubMed
    1. Taylor Z, Nolan CM, Blumberg HM (2005) American Thoracic Society, Centers for Disease Control and Prevention, (2005) et al. Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control 54 (RR-12) 1–81. - PubMed
    1. Burzynski J, Schluger NW (2008) The epidemiology of tuberculosis in the United States. SeminRespirCrit Care Med 29 (5) 492–498. - PubMed
    1. Borgdorff M, van der Werf M, de Haas P, Kremer K, van Soolingen D, et al. (2005) Tuberculosis elimination in the Netherlands. Emerg Infect Dis 11 (4) 597–602. - PMC - PubMed

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