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Tuberculosis in U.S. Hits Record Low: CDC

Improved screening of immigrants contributes to decline

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Homeless people and those infected with HIV also are at an increased risk for TB, the researchers said.

Of particular concern is TB that is resistant to the usual drug treatments, CDC officials said. Without effective treatment, TB can kill.

Although these cases remain infrequent in the United States, they are difficult and expensive to treat and can be fatal, CDC epidemiologist Suzanne Marks said.

"Treatment uses very expensive medications and requires hospitalization for about 75 percent of patients," she said.

On average, the direct cost of treating multi-drug-resistant TB is $134,000, climbing to $430,000 for the most resistant cases, Marks said.

That compares with $17,000 for treating drug-susceptible TB, she said.

"We still have about 1 percent to 2 percent of our TB cases that have significant drug resistance," LoBue said.

Eighty-six cases of drug-resistant TB were reported in the United States in 2012, the most recent year for which complete data is available. In 2013, two cases of extensively drug-resistant TB were reported nationally, the same as in 2012, the researchers said.

"We have a very strong TB control system in the United States, but there is always a potential risk because drug-resistant TB continues to be a major problem throughout the rest of the world," LoBue said.

"There is some evidence that it might be slightly increasing," he said.

Marks said it takes as long as two years to treat drug-resistant TB, compared with six months for drug-susceptible TB.

Although the United States is seeing progress against TB, the disease is epidemic elsewhere. Worldwide, 8.6 million new cases and almost 1 million deaths were reported in 2012, according to the World Health Organization.

Nationally, U.S. health officials know elimination of TB won't happen anytime soon.

Having less than one case per 1 million people would signal elimination, LoBue said. "At the current rate of decline, we wouldn't reach that level for about 100 years," he said.

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