       Document 1126
 DOCN  M9591126
 TI    Tuberculosis in New York City--turning the tide.
 DT    9509
 AU    Frieden TR; Fujiwara PI; Washko RM; Hamburg MA; New York City Department
       of Health, New York, USA.
 SO    N Engl J Med. 1995 Jul 27;333(4):229-33. Unique Identifier : AIDSLINE
       MED/95312037
 AB    BACKGROUND. From 1978 through 1992, the number of patients with
       tuberculosis in New York City nearly tripled, and the proportion of such
       patients who had drug-resistant isolates of Mycobacterium tuberculosis
       more than doubled. METHODS. We reviewed, confirmed, and analyzed data
       obtained during the surveillance of patients with tuberculosis. RESULTS.
       From 1992 through 1994, there was a 21 percent decrease in reported
       cases of tuberculosis in New York City. An evaluation of the
       surveillance system revealed very few unreported cases. The number of
       cases decreased by more than 20 percent among blacks and Hispanics,
       persons with documented human immunodeficiency virus infection, homeless
       persons, and patients with multidrug-resistant tuberculosis; in all
       these groups, tuberculosis is likely to result from recent transmission.
       In contrast, the number of cases of tuberculosis increased among elderly
       and foreign-born persons, in whom the disease is likely to result from
       the reactivation of an infection acquired many years earlier. Enrollment
       in a program of directly observed therapy, in which health workers watch
       patients take their medications, increased from fewer than 100 patients
       to nearly 1300, with more than 32,000 patient-months of observation from
       1992 through 1994. CONCLUSIONS. Epidemiologic patterns strongly suggest
       that the decrease in cases resulted from an interruption in the ongoing
       spread of M. tuberculosis infection, primarily because of better rates
       of completion of treatment and expanded use of directly observed
       therapy. Another contributing factor may have been efforts to reduce the
       spread of tuberculosis in institutional settings, such as hospitals,
       shelters, and jails. Expansion of measures to prevent and control
       tuberculosis and support of international control efforts are needed to
       ensure continued progress.
 DE    Adolescence  Adult  Child  Child, Preschool  Communicable Disease
       Control/METHODS  Female  Human  Infant  Male  Medication Systems  Middle
       Age  New York City/EPIDEMIOLOGY  Tuberculosis, Multidrug-Resistant/DRUG
       THERAPY/*EPIDEMIOLOGY/  PREVENTION & CONTROL  Tuberculosis,
       Pulmonary/DRUG THERAPY/*EPIDEMIOLOGY/PREVENTION &  CONTROL  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

