1. Suzanne J. Keller, MA Division of Disease Prevention Virginia Department of Health Tuberculosis in Virginia and the United States, 2007 November 2008

2. Overview of Presentation Sketch trends in US and Virginia Describe the epidemiology of TB in Virginia Compare US and Virginia data on key variables

3. Key National Highlights in Tuberculosis, 2007 13,299 TB cases reported for a case rate of 4.4 per 100,000 58% of all TB cases in the US occurred among foreign-born persons All racial and ethnic groups except whites have case rates higher than the national average

4. Reported TB Cases* United States, 1982–2007 Year Number of Cases *Updated as of April 23, 2008.

5. Reported TB Cases Virginia 1980-2007 309

6. Key Virginia Highlights in Tuberculosis, 2007 309 cases reported in 2007 for a case rate of 4.0 per 100,000 74.4% of cases reported among the foreign-born For the second year in a row, cases among the US- born declined substantially

7. TB Case Rates,* United States, 2007 < 3.5 (year 2000 target) 3.6–4.4 > 4.4 (national average) D.C. *Cases per 100,000.

8. TB Case Rates by Region Virginia, 2007 1.4 9.3 1.52.4 2.6 Total Rate: 4.5

9. Percent of Reported TB Cases by Age Virginia, 1998-2007

10. Reported TB Cases by Age and Sex Virginia, 2007 Number of Cases Age Group

11. Percent of TB Cases by Race/Ethnicity Virginia, 2007

12. TB Cases By Region Virginia, 2003-2007

13. Percentage of TB Cases Among Foreign-born Persons, United States* >50% 25%–49% <25% 19972007 DC *Updated as of April 23, 2008.

14. Foreign vs. US Born TB Cases Virginia 1998-2007

15. Trends in TB Cases in Foreign-born Persons, United States, 1987–2007* No. of CasesPercentage *Updated as of April 23, 2008.

16. Foreign-born TB Cases Top Five Countries of Birth: US and Virginia Mexico Philippines Vietnam India China El Salvador Philippines India Bolivia Mexico US (2007)Virginia (2007)

17. Estimated HIV Coinfection in Persons Reported with TB, United States, 1993–2006 * % Coinfection *Updated as of April 23, 2008. Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group. 2006

18. Number of Reported TB/AIDS Cases Virginia, 2003-2007

19. Primary MDR TB United States, 1993–2007* *Updated as of April 23, 2008. Note: Based on initial isolates from persons with no prior history of TB. MDR TB defined as resistance to at least isoniazid and rifampin. No. of Cases Percentage

20. MDR Cases & Percent of Cases with Resistance to Any First Line Drugs: VA, 2003-2007

21. Thanks National Data Slides from CDC