TUBERCULOSIS IN NEW-YORK-CITY - TURNING THE TIDE

Background. From 1978 through 1992, the number of patients with tuberc ulosis in New York City nearly tripled, and the proportion of such pat ients who had drug-resistant isolates of Mycobacterium tuberculosis mo re than doubled. Methods. We reviewed, confirmed, and analyzed data ob tained during the surveillance of patients with tuberculosis. Results. From 1992 through 1994, there was a 21 percent decrease in reported c ases of tuberculosis in New York City. An evaluation of the surveillan ce system revealed very few unreported cases. The number of cases decr eased by more than 20 percent among blacks and Hispanics, persons with documented human immunodeficiency virus infection, homeless persons, and patients with multidrug-resistant tuberculosis; in all these group s, tuberculosis is likely to result from recent transmission. In contr ast, the number of cases of tuberculosis increased among elderly and f oreign-born persons, in whom the disease is likely to result from the reactivation of an infection acquired many years earlier. Enrollment i n a program of directly observed therapy, in which health workers watc h patients take their medications, increased from fewer than 100 patie nts to nearly 1300, with more than 32,000 patient-months of observatio n from 1992 through 1994. Conclusions. Epidemiologic patterns strongly suggest that the decrease in cases resulted from an interruption in t he ongoing spread of M. tuberculosis infection, primarily because of b etter rates of completion of treatment and expanded use of directly ob served therapy. Another contributing factor may have been efforts to r educe the spread of tuberculosis in institutional settings, such as ho spitals, shelters, and jails. Expansion of measures to prevent and con trol tuberculosis and support of international control efforts are nee ded to ensure continued progress.