New York City had 613 verified cases of tuberculosis (TB) in 2017, up 10% from 556 the year before, the largest spike in 26 years, according to a new report by the city’s Department of Health and Mental Hygiene.
The department said it was the first increase since 2003 and the largest rise since 1992, but offered no specific explanation.
However, the department stated in a press release announcing the increase that the city’s budget to fight and treat tuberculosis has been cut in half in the past decade.
14 Patients Have Multidrug-Resistant TB
Fourteen of the 613 patients had multidrug-resistant (MDR) TB. MDR tuberculosis was defined as resistant to isoniazid and rifampin, the two most effective TB drugs. One of the patients had extensive drug resistance and five were classified as one drug away from that level of resistance. The US Centers for Disease Control and Prevention defines extensive drug resistance to TB as resistant to rifampicin and isoniazid in addition to any fluoroquinolone and at least one injectable second-line drugs.
As previously reported by Medscape Medical News, drug-resistant TB strains have been a growing threat worldwide. According to the World Health Organization, more than half a million new cases of multidrug resistant TB are detected each year.
Health Commissioner Mary T. Bassett, MD, MPH, said in the press release, “Tuberculosis is a deadly, yet curable disease. The Health Department is the leading provider of tuberculosis care in New York City, and we are concerned about these new data.”
The release continues, “While the current City administration has maintained funding for TB control efforts, over the last decade, New York City’s TB budget has been halved, including a staggering 65 percent reduction in federal funds. These funding cuts have resulted in reduced clinical services, decreased public health activities, and significantly reduced staffing.”
In a letter to colleagues included with the latest TB report, Joseph N. Burzynski, MD, MPH, assistant commissioner of the Bureau of Tuberculosis Control, writes, “TB cases were identified in almost every neighborhood in NYC in 2017 and the disease continues to affect patients across races, nationalities, ages and income levels.”
The report notes that 106 New York City healthcare facilities reported at least one TB case, but 49% of all cases were reported by 14 sites.
Largest Age Group 18-44
The largest cluster by age was in the 18-44 group which had 41% of the cases. The next highest was 45-64 (31%); 65 and older (24%); and 0-17 (3%).
Among those with TB, 86% were born outside the US and came from 75 countries. The most common countries of birth were China (116); the US (83); Mexico (42); India (38) and Ecuador (36).
Among the patients born in the US, non-Hispanic blacks had the largest numbers of TB cases at 43%, followed by Hispanics (28%), and non-Hispanic whites (19%).
Most of the cases (80%) had a pulmonary site of infection and most (83%) had a positive culture.
New York City has tracked deaths attributable to TB in the city for more than a century. In 1960 there were 824 deaths from tuberculosis (10.6 per 100,000 population) and in 2015, the last year for which data were available, there were 20 TB deaths (0.2 per 100,000).
However, much more work needs to be done, Mark Harrington, executive director of Treatment Action Group, an advocacy group whose agenda includes better treatment and prevention of TB, said in the press release.
“All New Yorkers should know where these unwise budget cuts to our TB program will lead us,” Harrington says. “Savage cuts to TB programs in the 1980s led to a deadly outbreak of multi-drug resistant tuberculosis, hundreds of avoidable deaths, and thousands of unnecessary cases of difficult-to-treat TB. Citizens, activists, public health officials, and political leaders must unite to ensure that New York’s TB program is fully funded and can provide the high-quality preventive, diagnostic, and treatment services which will save thousands of lives.”
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