Minnesota Department of Health Tuberculosis Prevention and Control Program (651) Tuberculosis surveillance data for Minnesota are available on the Web at:

Year No. CasesRate* * Cases per 100,000 population. Rates were calculated using state population estimates from the U.S. Census Bureau.

Year of Diagnosis Percentage of Cases

Year No. CasesNo. Deaths * (%) (1%) (1%) (2%) (7%) (2%) *Represents only deaths due to TB disease or TB drug-induced toxicity

59 (5.0) 31 (6.0) 12 (0.7) 9 (6.2) 26 (1.1) 137 (2.6) 61 (5.3) 41 (8.1) 26 (2.2) 8 (5.6) 25 (1.1) 161 (3.1) Hennepin County Ramsey County Suburban Twin Cities Metro † Olmsted County Other Counties Total 67 (5.8) 34 (6.7) 16 (1.3) 6 (4.2) 12 (0.5) 135 (2.5) 2010 No. (rate)* 97 (8.5) 44 (8.8) 23 (2.0) 4 (2.8) 43 (1.9) 211 (4.0) 2008 No. (rate)* Location of Residence * Rate per 100,000 population. Rates were calculated using population estimates from U.S. Census Bureau data. † Anoka, Carver, Dakota, Scott, and Washington counties 2009 No. (rate)* 2011 No. (rate)* 71 (6.1) 39 (7.6) 27 (2.2) 3 (2.1) 22 (1.0) 162 (3.0) 2012 No. (rate)*

Hennepin: 71 Ramsey: 39 Suburban metro: 27 Greater MN: 25 Total: 162

Hennepin: 355 Ramsey: 189 Suburban metro: 104 Greater MN: 158 Total: 806

59 (43) 31 (22) 12 ( 9) 9 ( 7) 26 (19) 137 (100) 61 (38) 41 (25) 26 (16) 8 ( 5) 25 (16) 161 (100) Hennepin County Ramsey County Suburban Twin Cities Metro* Olmsted County Other Counties Total 2010 No. (%) 67 (50) 34 (25) 16 (12) 6 ( 4) 12 ( 9) 135 (100) 2008 No. ( %) 97 (46) 44 (21) 23 (11) 4 ( 2) 43 (20) 211 (100) * Anoka, Carver, Dakota, Scott, and Washington counties Location of Residence 2009 No. ( %) 2011 No. (%) 71 (44) 39 (24) 27 (17) 3 ( 2) 22 (13) 162 (100) 2012 No. (%)

Place of Birth Percentage of Cases

13 ( 0.3) 66 (23.0) 40 (18.0) 3 ( 4.4) 0 ( 0.0) 15 ( 5.8) 137 (2.6) 19 ( 0.4) 80 (32.3) 43 (21.5) 2 ( 2.9) 0 ( 0.0) 17 ( 7.5) 161 (3.1) White Black Asian American Indian Multi-racial Hispanic/Latino Total 2010 No. (rate) † 11 ( 0.2) 66 (26.7) 41 (20.5) 4 ( 5.8) 0 ( 0.0) 13 ( 5.7) 135 (2.5) 2008 No. (rate) † 16 ( 0.4) 112 (47.9) 48 (25.2) 4 ( 6.9) 0 ( 0.0) 31 (14.2) 211 (4.0) Race/Ethnicity* * Race categories do not include persons of Hispanic/Latino origin. † Rate per 100,000 population. Rates were calculated using mid-year population estimates from the U.S. Census Bureau No. (rate) † 2011 No. (rate) † 12 ( 0.3) 90 (29.4) 42 (17.8) 2 ( 3.1) 0 ( 0.0) 16 ( 6.2) 162 (3.0) 2012 No. (rate) †

55 (34) 56 (35) 14 ( 9) 15 ( 9) 0 ( 0) 20 (13) 160 (100) 16 ( 2) 358 (55) 200 (31) 0 ( 0) 72 (11) 646 (100) White Black Asian American Indian Multi-racial Hispanic/Latino Total Race/Ethnicity* U.S.-Born Cases † No. (%) Foreign-Born Cases No. (%) *Race categories do not include persons of Hispanic/Latino origin. † Includes U.S.-born children of foreign-born parents

155 (73) 21 (10) 11 ( 5) 23 (11) 5 ( 2) 3 ( 1) 2008 (N=211) No. (%) 110 (81) 7 ( 5) 3 ( 2) 6 ( 4) 23 (17) 4 ( 3) 3 ( 2) 2010 (N=135) No. (%) * Risk categories are not mutually exclusive Risk Category* Foreign-born Substance abuse † Homeless HIV-infected Other medical condition** Inmate Long-term care resident Cumulative (N=806) No. (%) 646 (80) 52 ( 6) 22 ( 3) 33 ( 4) 116 (14) 14 ( 2) 10 ( 1) † Alcohol abuse and/or illicit drug use ** Silicosis, diabetes, prolonged corticosteroid therapy or other immunosuppressive therapy, hematologic/ reticuloendothelial disease, end-stage renal disease, substantial weight loss (not TB-related) or undernutrition 2009 (N=161) No. (%) 129 (80) 10 ( 6) 4 ( 2) 7 ( 4) 23 (14) 3 ( 2) 1 ( 1) 2011 (N=137) No. (%) 116 (85) 7 ( 5) 2 ( 1) 3 ( 2) 27 (20) 2 ( 1) 2012 (N=162) No. (%) 136 (84) 7 ( 4) 2 ( 1) 6 ( 4) 20 (12) 0 ( 0) 1 ( 1)

* Risk categories are not mutually exclusive. † Alcohol abuse and/or illicit drug use ** Conditions or therapies that increase risk for progression from latent TB infection to active TB disease

Medical conditions* Cases (N=806) No. ( %) Diabetes Other Immunosuppressive Therapy End Stage Renal Disease Prolonged Corticosteroid Therapy Weight loss/Undernutrition Hematologic/Reticuloendothelial Disease 65 ( 8) 41 ( 5) 13 ( 2) 2 (<1) 6 ( 1) 1 (<1) *Patients could have > 1 medical condition.

HIV Status Foreign-Born Cases U.S.-Born Cases Negative Positive Refused Not Offered Unknown Total 573 (89) 28 ( 4) 11 ( 2) 34 ( 5) 0 ( 0) 646 (100) 129 (81) 5 ( 3) 3 ( 2) 22 (14) 1 (<1) 160 (100) No. (%) 702 (87) 33 ( 4) 14 ( 2) 56 ( 7) 1 (<1) 806 (100) No. (%) Total

School No. (%) Preschool 1 (<1) Elementary40 ( 5) Secondary51 ( 6) Post-secondary48 ( 6) Other49 ( 6) Not a student 617 (77) Total 806 (100)

Region of Birth Number of Cases * “Other” includes: Eastern Europe, Latin America/Caribbean, Western Europe

N = 646

N = 81 * Per results of pre-immigration screening performed overseas

N = 646

% of foreign-born cases

N = 806

* Includes cases with both extrapulmonary and pulmonary sites of disease

Sites of Disease Cases (N=491) No. ( %) Lymphatic Bone/joint Pleural Peritoneal Genitourinary Meningeal Other 243 (49) 45 ( 9) 41 ( 8) 27 ( 5) 19 ( 4) 16 ( 3) 58 (12) * Includes TB cases with or without concurrent pulmonary disease; patients may have multiple extrapulmonary sites of disease

N = 491 * Chest x-ray or chest CT scan results

*67% of cases without sputum smear results were under 15 years of age N = 491

N = 806

N = 595 *Based on the public health surveillance definition for TB [CDC. (2009, June) CDC Tuberculosis Surveillance Data Training: Report of Verified Case of Tuberculosis (RVCT) Instruction Manual. Atlanta, GA: U.S. Department of Health and Human Services, CDC. (Appendix A - Tuberculosis Case Definition for Public Health Surveillance)]

17(11) 12 (10) 5 ( 5) 12 (12) 12 (10) 58 (10) 23(15) 20 (17) 13 (12) 22 (22) 24 (19) 102 (17) Year Total Cases With Susceptibility Results* Any Drug Resistance † No. (%) INH- Resistant** No. (%) MDR-TB ‡ No. (%) 2 (1) 2 (2) 0 (0) 3 (3) 1 (1) 8 (1) § * 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 may also be resistant to other drugs ‡ Multi-drug resistant TB, defined as resistance to at least INH and rifampin § One of these cases was resistant to INH, rifampin, PZA, and ethambutol

Place of Birth * Culture-confirmed cases with drug susceptibility results available Total Cases With Susceptibility Results * Any Drug Resistance † No. (%) 94 (19) 9 ( 8) 103 (17) INH- Resistant ** No. (%) 54 (11) 5 ( 5) 59 (10) MDR-TB ‡ No. (%) 7 ( 1) 1 ( 1) 8 ( 1) § U.S.-Born Cases Foreign-Born Cases † Resistance to at least one first-line anti-TB drug [i.e., isoniazid (INH), rifampin, pyrazinamide (PZA), or ethambutol] ** INH-resistant cases may also be resistant to other drugs. ‡ Multi-drug resistant TB, defined as resistance to at least INH and rifampin § One of these cases was resistant to INH, rifampin, PZA, and ethambutol.

Percentage * * Percentage among culture-confirmed cases with isoniazid susceptibility results available by place of birth

131 (81) 10 ( 6) 1 ( 1) 3 ( 2) 17 (11) 161 (100) Presented with symptoms TB contact investigation Refugee health exam (domestic) Pre-immigration exam (overseas) Other* Total 2010 No. (%) 113 (84) 1 ( 1) 19 (14) 135 (100) 2008 No. ( %) 163 (77) 27 (13) 6 ( 3) 5 ( 2) 9 ( 5) 211 (100) * e.g., occupational screening, other targeted TB testing, etc. How Identified 2009 No. ( %) 2011 No. (%) 109 (80) 6 ( 4) 2 ( 1) 18 (13) 137 (100) 2012 No. ( %) 128 (79) 10 ( 6) 3 ( 2) 11 ( 7) 162 (100)

N = 595 * “Other” includes: pre-immigration exam (overseas) – 1.5%, other immigration exam – 1%, and employment screening – 1%

Type of provider N=796 * DOT = Directly Observed Therapy SA = Self-administered

Started Treatment* 113 Completed Within 12 mos.** No. (%) 106 (94) Completed Overall** No. (%) 108 (96) * Patients for whom < 12 months of therapy is indicated. This excludes: patients with rifampin resistance or meningeal TB, children 14 years of age or younger with disseminated TB, patients who died, and those who moved outside of the U.S. during treatment. ** Treatment completion data as of 7/28/2013

* Some patients are managed by multiple providers throughout disease course N=796