Completeness and timeliness of tuberculosis case reporting - A multistate study

Background: Tuberculosis (TB) control activities are contingent on the time ly identification and reporting of cases to public health authorities to en sure complete assessment and appropriate treatment of contacts: and identif ication of secondary cases. We report the results of a multistate evaluatio n of completeness and timeliness of reporting of TB cases in the United Sta tes during 1993 and 1994. Methods: To determine completeness of TB reporting, laboratory log books, d eath certificates, hospital discharge, Medicaid databases, and pharmacy dat abases were reviewed in seven states to identify possible unreported cases. Timeliness of TB reporting was calculated using the number of days between date of TB diagnosis and date of report to the local or state health depar tment. Cases reported >7 days after diagnosis were considered to have delay ed reporting. Results: Of 2711 cases identified through review of secondary data sources, 14 (0.5%) were previously unreported to public health. The largest yield o f unreported cases was identified through review of laboratory records; 13 of the 14 unreported cases were identified, of which eight were found only through this method. Timeliness of reporting varied between sites from a me dian of 7 days to a median of 38 days. The number of cases with delayed rep orting varied from 5% to 53% between sites. Factors associated with delayed reporting included infectiousness, type of provider, diagnosing provider, and reporting source. Conclusions: Through a review of several different secondary data sources, few unreported TB cases were detected; however, timeliness of reporting was poor among the reported cases.