The Epidemiology of Tuberculosis Among ForeignBorn Persons in Minnesota, 20012005

1
The Epidemiology of Tuberculosis Among
Foreign-Born Persons in Minnesota, 2001-2005
Minnesota Department of Health Tuberculosis
Prevention and Control Program (651)
201-5414 Tuberculosis surveillance data for
Minnesota are available on the Web
at www.health.state.mn.us/tb
2
Number of Tuberculosis Cases by Placeof Birth,
Minnesota, 1996-2005
3
Percentage of Tuberculosis Cases Born Outside the
U.S., Minnesota, 1996-2005
Percentage of Cases
Year of Diagnosis
4
Tuberculosis Cases by Age Group and Place of
Birth, Minnesota, 2001-2005
Percentage of Cases
Place of Birth
Includes U.S.-born children of foreign-born
parent(s)
5
Tuberculosis Cases by Race/Ethnicity and Place of
Birth, Minnesota, 2001-2005
U.S.-Born Cases
Foreign-Born Cases
Race/Ethnicity
No. ()
No. ()
White Black Asian American Indian Multi-racial H
ispanic/Latino Total
80 (39) 62 (30) 20 (10) 27 (13)
1 (lt1) 14 ( 7) 204 (100)
22 ( 2) 511 (58) 261 (30) 0 (
0) 0 ( 0) 90 (10) 884 (100)
Race categories do not include persons of
Hispanic/Latino origin.
Prior to 2003, data were reported as
single-race only.
6
Foreign-Born Tuberculosis Cases by Region of
Birth and Year of Diagnosis, Minnesota, 2001-2005
Number of Cases
Region of Birth
7
Foreign-Born Tuberculosis Cases by
Region of Birth, Minnesota, 2001-2005
2001
2002
2003
2004
2005
Region of Birth
No. ()
No. ()
No. ()
No. ()
No. ()


11 ( 6) 1 ( 1) 20 (12) 2 ( 1) 47
(27) 92 (53) 0 ( 0)
11 ( 6) 5 ( 3) 15 ( 9) 0 ( 0)
42 (24) 100 (58) 0 ( 0)
12 ( 6) 2 ( 1) 14 ( 7) 1 ( 1)
47 (24) 118 (61) 0 ( 0)
7 ( 4) 2 ( 1) 20 (11) 2 ( 1)
49 (27) 101 (56) 0 ( 0)
11 ( 7) 5 ( 3) 24 (15) 1 ( 1) 24
(15) 96 (59) 2 ( 1)
East Asia/Pacific



Eastern Europe
Latin America/Caribbean
North Africa/Middle East


South/Southeast Asia
Sub-Saharan Africa
Western Europe
181 (100)
163 (100)
173 (100)
194 (100)
Total
173 (100)
8
Foreign-Born Tuberculosis Cases by Country of
Birth, Minnesota, 2001-2005
Other Countries (26)
Somalia (34)
India (5)
Liberia (5)
Mexico (6)
Ethiopia (10)
Vietnam (7)
Laos (7)
9
Black Tuberculosis Cases by Place ofBirth,
Minnesota, 2001-2005
Foreign-Born Cases
U.S.-Born Cases
Total Black Cases
Year
No. ()
No. ()
132 120 107 103 111 573

• 119 (90)
• (84)
• 93 (87)
• 96 (93)
• 102 (92)
• 511 (89)

13 (10) 19 (16) 14 (13) 7 ( 7)
9 ( 8) 62 (11)
2001 2002 2003 2004 2005 Total
10
Asian Tuberculosis Cases by Place ofBirth,
Minnesota, 2001-2005
Foreign-Born Cases
U.S.-Born Cases
Total Asian Cases
Year
No. ()
No. ()
2001 2002 2003 2004 2005 Total
63 61 65 39 53 281
59 ( 94) 56 ( 92) 59 ( 91) 34 (
87) 53 (100) 261 ( 93)
4 ( 6) 5 ( 8) 6 ( 9) 5
(13) 0 ( 0) 20 ( 7)
11
White (Non-Hispanic) Tuberculosis Cases byPlace
of Birth, Minnesota, 2001-2005
U.S.-Born Cases
Foreign-Born Cases
Total White Cases
Year
No. ()
No. ()
2001 2002 2003 2004 2005 Total
21 30 15 24 12 102
3 (14) 5 (17) 2 (13) 8
(33) 4 (33) 22 (22)
18 (86) 25 (83) 13 (87) 16 (67) 8
(67) 80 (78)
12
Hispanic/Latino Tuberculosis Cases by Place of
Birth, Minnesota, 2001-2005
Total Hispanic/Latino Cases
Foreign-Born Cases
U.S.-Born Cases
Year
No. ()
No. ()
2001 2002 2003 2004 2005 Total
4 (24) 4 (17) 1 ( 5) 1 ( 4) 4
(22) 14 (13)
17 23 21 26 18 105
13 (76) 19 (83) 20 (95) 25 (96) 14
(78) 91 (87)
13
Tuberculosis Cases Born inEast Asia/Pacific by
Country of Birth,Minnesota, 2001-2005
Cases No. ( )
Country of Birth
18 (35) 16 (31) 8 (15) 5 (10) 5
(10) 52 (100)
China/Tibet Philippines South Korea Nepal Other To
tal
14
Tuberculosis Cases Born inEastern Europe by
Country of Birth,Minnesota, 2001-2005
Cases No. ( )
Country of Birth
Russia Ukraine Moldova Other Total
3 (20) 3 (20) 2 (13) 7 (47) 15
(100)
15
Tuberculosis Cases Born in Latin
America/Caribbean by Country of Birth, Minnesota,
2001-2005
Cases No. ( )
Country of Birth
Mexico Ecuador Guatemala Other Total
50 (54) 20 (22) 10 (11) 13 (14)
93 (100)
16
Tuberculosis Cases Born in North Africa/Middle
East by Country of Birth, Minnesota, 2001-2005
Cases No. ( )
Country of Birth
Iran Iraq Oman United Arab Emirates Yemen Total
2 (33) 1 (17) 1 (17) 1 (17) 1 (17) 6
(100)
17
Tuberculosis Cases Born in South/Southeast Asia
by Country of Birth, Minnesota, 2001-2005
Cases No. ( )
Country of Birth
Laos Vietnam India Cambodia Thailand Other Total
64 ( 31) 64 ( 31) 41 ( 20) 18 ( 9)
15 ( 7) 7 ( 3) 209 (100)
18
Tuberculosis Cases Born in Sub-Saharan Africa by
Country of Birth, Minnesota, 2001-2005
Cases No. ( )
Country of Birth
Somalia Ethiopia Liberia Kenya Sudan Cameroon Nige
ria Other Total
303 ( 60) 88 ( 17) 43 ( 8) 29 ( 6)
8 ( 2) 7 ( 1) 6 ( 1) 23 (
5) 507 (100)
19
Tuberculosis Cases by Site of Disease andPlace
of Birth, Minnesota, 2001-2005
Foreign-Born Cases
U.S.-Born Cases
Total
No. ()
Site of Disease
No. ()
No. ()
568 (52) 417 (38) 103 ( 9) 1,088
(100)
Pulmonary Extrapulmonary Both Total
436 (49) 360 (41) 88 (10) 884 (100)
132 (65) 57 (28) 15 ( 7) 204 (100)
TB cases with both pulmonary and
extrapulmonary sites of disease, including
miliary TB
20
Tuberculosis Cases by Site of Disease and Place
of Birth, Minnesota, 2001-2005
(65)
(51)
(49)
(35)
Includes cases with both extrapulmonary and
pulmonary sites of disease
21
Cases of Drug-Resistant Tuberculosis by Place of
Birth and Year, Minnesota, 2001-2005
U.S.-Born Cases
Foreign-Born Cases
Cases with Susceptibility Results
Cases with Susceptibility Results
Resistant No. ()
Resistant No. ()
Year
2001 2002 2003 2004 2005 Total
156 147 143 118 131 695
28 (18) 27 (18) 26 (18) 21 (18) 13
(10) 115 (17)
39 40 29 21 20 149
5 (13) 4 (10) 4 (14) 1 ( 5) 2
(10) 16 (11)
Culture-confirmed cases with drug
susceptibility results available
Resistance to at least one first-line anti-TB
drug i.e., isoniazid (INH), rifampin,
pyrazinamide (PZA), or ethambutol
22
Tuberculosis Cases by Drug Susceptibility
Patterns and Place of Birth, Minnesota, 2001-2005
Cases With
Any Drug
INH-

MDR-TB
Resistant

Susceptibility
Resistance
No. ()
Place of Birth
Results
No. ()
No. ()
695
115 (17)
97 (14)
20 ( 3)
Foreign-Born Cases
U.S.-Born Cases
16 (11)
12 ( 8)
149
4 ( 3)
Total

844
131 (16)
109 (13)
24
( 3)


Culture-confirmed cases with drug
susceptibility results available

Resistance to at least one first-line anti-TB
drug i.e., isoniazid (INH), rifampin,
pyrazinamide (PZA), or ethambutol
INH-resistant cases (also may have resistance
to other drugs)

Multi-drug resistant TB, with resistance to at
least INH and rifampin


Nine of these cases were resistant to INH,
rifampin, PZA, and ethambutol.
23
Foreign-Born Drug-Resistant TuberculosisCases
by Region of Birth, Minnesota, 2001-2005
Cases No. ( )
Region of Birth
Sub-Saharan Africa South/Southeast Asia Latin
America/Caribbean East Asia/Pacific Eastern
Europe Total
52 (45) 44 (38) 10 ( 9) 7 (
6) 2 ( 2) 115 (100)
Resistant to at least one first-line anti-TB
drug i.e., isoniazid (INH), rifampin,
pyrazinamide (PZA), or ethambutol
More detailed region-specific and
country-specific drug susceptibility profiles are
available through the Minnesota Department of
Health TB Prevention and Control Program
(651/201-5414 or 877/676-5414). Current national
guidelines for the treatment of latent TB
infection do not take into account the
implications of regional differences in drug
resistance patterns however, these data may be
empirically useful to guide the treatment of
confirmed/suspected TB disease when
patient-specific drug susceptibility results are
not available.
24
Foreign-Born Tuberculosis Cases byVisa Status
Upon Arrival in the U.S., Minnesota, 2001-2005
Cases No. ( )
Visa Status
Refugee Immigrant Other Unknown Total
441 (50) 200 (23) 67 ( 8) 176 (20) 884
(100)
25
Class B Notifications Among Foreign-Born
Tuberculosis Cases Who Arrived in the U.S. as
Immigrants/Refugees, Minnesota, 2001-2005
Cases No. ( )
Classification
Class A Class B1 Class B2 No Class Unknown Total
2 (lt1) 18 ( 3) 20 ( 3) 234
(37) 366 (57) 641 (100)
Per results of pre-immigration screening
performed overseas
26
Foreign-Born Tuberculosis Cases by
IntervalBetween Arrival in U.S. and Diagnosis
ofTuberculosis, Minnesota, 2001-2005
Cases No. ( )
Interval (years)
lt 1 2 - 5 6 - 10 gt 10 Unknown Total
330 (37) 280 (32) 138 (16) 113 (13) 23
( 3) 884 (100)
27
Foreign-Born Tuberculosis Cases by Status Upon
Arrival and Interval Between Arrival and
Diagnosis of TB, Minnesota, 2001-2005
Other/Unknown Cases
Immigrant/Refugee Cases
Interval (years)
No. ()
No. ()
lt 1 2 5 6 10 gt 10 Unknown
Total
261 (41) 206 (32) 94 (15) 74 (12)
6 ( 1) 641 (100)
69 (28) 74 (30) 44 (18) 39 (16)
17 ( 7) 243 (100)