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Tuberculosis in New York City--turning the tide
T R Frieden1, P I Fujiwara, R M Washko
1New York City Department of Health, New York, USA.
The New England Journal of Medicine
|July 27, 1995
Summary
Tuberculosis cases in New York City decreased significantly due to improved treatment adherence and directly observed therapy. This public health intervention helped interrupt the spread of Mycobacterium tuberculosis infection.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Control
Background:
- Tuberculosis (TB) cases in New York City nearly tripled between 1978 and 1992.
- Drug-resistant Mycobacterium tuberculosis isolates more than doubled during this period.
Purpose of the Study:
- To analyze the decrease in tuberculosis cases in New York City from 1992 to 1994.
- To evaluate the impact of public health interventions on TB transmission.
Main Methods:
- Review and analysis of surveillance data for tuberculosis patients.
- Evaluation of the TB surveillance system for unreported cases.
- Tracking enrollment and patient-months of observation in directly observed therapy programs.
Main Results:
- Reported TB cases decreased by 21% in New York City from 1992 to 1994.
- Significant decreases in TB cases were observed in high-risk groups, suggesting reduced recent transmission.
- Increased TB cases were noted in elderly and foreign-born populations, indicative of reactivation.
Conclusions:
- The decline in TB cases is attributed to interrupted transmission via improved treatment completion and expanded directly observed therapy (DOT).
- Efforts to control TB in institutional settings likely contributed to the decrease.
- Continued expansion of TB prevention, control measures, and international support are crucial.