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Tuberculosis Among Africans Living in the United States, 2000–2009

Journal of Immigrant and Minority Health volume 15, pages 381–389 (2013)Cite this article

Abstract

The incidence of tuberculosis (TB) has declined steadily in the United States; however, foreign-born persons are disproportionately affected. The aim of our study was to describe characteristics of TB patients diagnosed in the United States who originated from the African continent. Using data from the U.S. National Tuberculosis Surveillance System, we calculated TB case rates and analyzed differences between foreign-born patients from Africa compared with other foreign-born and U.S.-born patients. The 2009 TB case rate among Africans (48.1/100,000) was 3 times as high as among other foreign-born and 27 times as high as among U.S.-born patients. Africans living in the United States have high rates of TB disease; they are more likely to be HIV-positive and to have extrapulmonary TB. Identification and treatment of latent TB infection, HIV testing and treatment, and a high index of suspicion for extrapulmonary TB are needed to better address TB in this population.

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Notes

  1. Gender was not significant at an alpha <0.01 but was retained in the model due to its clinical and epidemiologic relevance.

  2. HIV results for TB patients were provided by all reporting jurisdictions for the entirety of the study period, except for California and Vermont, both of which stopped transmitting HIV data in 2005 and 2007, respectively. Through 2004, California reported only state AIDS registry matched TB cases as HIV infected; all other California TB patients have missing HIV status.

  3. North: Algeria, Egypt, Libya, Morocco, Tunisia, Mauritania, Western Sahara

    Eastern: Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Tanzania, Uganda, Comoros, Seychelles, Sudan, Burundi, Rwanda

    West: Benin, Cape Verde, the Gambia, Ghana, Guinea, Cote d'Ivoire, Liberia, Mali, Niger, Nigeria, Guinea-Bissau, Senegal, Sierra Leone, Togo, Sao Tome and Principe, Burkina Faso

    Central: Chad, Republic of the Congo, Democratic Republic of the Congo (formerly Zaire), Central African Republic, Cameroon, Equatorial Guinea, Gabon

    Southern: Angola, Botswana, Lesotho, Malawi, Mozambique, South Africa, Namibia, Swaziland, Zambia, Zimbabwe, Madagascar, Mauritius, Europa Island

    Available at http://www.afdb.org/en/countries/.

  4. The WHO African region includes Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Cote d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome e Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia, and Zimbabwe.

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Acknowledgments

The authors thank Kevin Cain, Michael Chen, Maryam Haddad, Carla Jeffries, Steve Kammerer, Thomas Navin, Robert Pratt, and Jim Tobias in the Division of Tuberculosis Elimination at the Centers for Disease Control and Prevention. The authors also acknowledge state and local health departments who collected the data used in these analyses.

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Affiliations

  1. Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA

    Bisrat K. Abraham

  2. Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS E-10, Atlanta, GA, 30333, USA

    Bisrat K. Abraham, Carla A. Winston, Elvin Magee & Roque Miramontes

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  1. Bisrat K. Abraham
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  2. Carla A. Winston
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  3. Elvin Magee
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Correspondence to Bisrat K. Abraham.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Abraham, B.K., Winston, C.A., Magee, E. et al. Tuberculosis Among Africans Living in the United States, 2000–2009. J Immigrant Minority Health 15, 381–389 (2013). https://doi.org/10.1007/s10903-012-9624-4

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Keywords

  • Tuberculosis
  • HIV infection
  • Surveillance
  • United States
  • Africa