A.S.T.E.R.O.I.D.   Study 37

Assessment of Safety Tolerablitiy & Effectivness of Rifapentine given Daily for Latent Tuberculosis Infection.

Study Status and Enrolling
Number of Participants to Date
Tuberculosis (TB) is one of the world’s deadliest diseases:
One third of the world’s population is infected with TB.
In 2016, 10.4 million people around the world became sick with TB disease. There were 1.7 million TB-related deaths worldwide.
TB is a leading killer of people who are HIV infected.
A total of 9,272 TB cases (a rate of 2.9 cases per 100,000 persons) were reported in the United States in 2016. This is a decrease from the number of cases reported in 2015 and the lowest case count on record in the United States. The case rate of 2.9 per 100,000 persons is a 3.6% decrease from 2015. While the United States continues to make slow progress, current strategies are not enough to reach the goal of TB elimination in this century.
CDC estimates that about 14% of U.S. TB cases with genotype data are attributed to recent transmission. Distinguishing the numbers of cases attributed to recent transmission from those likely due to reactivation of longstanding, untreated latent TB infection is one of many tools state and local TB programs can use to design and prioritize effective public health interventions.

Among foreign-born persons, the highest TB incidence in 2016 was among Asians (26.9 cases per 100,000), followed by non-Hispanic blacks (22.3) and Hispanics (10.0), and most foreign-born racial/ethnic groups have experienced gradual decreases between 2013 and 2016. The top five countries of origin for foreign-born persons reported with TB disease in the United States were Mexico (1,194 cases, 18.9% of all foreign-born cases), the Philippines (795, 12.6%), India (593, 9.4%), Vietnam (496, 7.9%), and China (383, 6.1%). Cases in persons born in these countries accounted for 54.9% of all cases among foreign-born persons.
HIV status was known for 86.7% of TB cases reported in 2016; among these patients, 5.8% had documented HIV co-infection. Living in congregate settings such as shelters, long-term care facilities, and correctional facilities is a known risk factor for TB exposure (4), and complete data on these risk factors were available for >93% of cases. Among these, 4.6% of patients reported having experienced homelessness in the year preceding diagnosis. In addition, 1.8% were reported as residing in a long-term care facility, and 3.5% were reported as being confined in a correctional facility at the time of diagnosis.
The most recent year for which complete drug-susceptibility data are available is 2015; the data include test results for 98.7% of culture-confirmed TB cases. In 2015, 88 cases of multidrug-resistant TB¶ occurred; multidrug-resistant TB accounted for 0.4% and 1.2% of culture-confirmed TB cases among U.S.-born and foreign-born persons, respectively. Among the 88 multidrug-resistant TB cases, 72 (81.8%) occurred in persons with no reported prior history of TB disease. In 2015, one case of extensively drug-resistant TB** was reported.

 
In 2016, a total of 9,287 new tuberculosis (TB) cases were reported in the United States; this provisional* count represents the lowest number of U.S. TB cases on record and a 2.7% decrease from 2015 (1). The 2016 TB incidence of 2.9 cases per 100,000 persons represents a slight decrease compared with 2015 (-3.4%) (Figure). However, epidemiologic modeling demonstrates that if similar slow rates of decline continue, the goal of U.S. TB elimination will not be reached during this century (2). Although current programs to identify and treat active TB disease must be maintained and strengthened, increased measures to identify and treat latent TB infection (LTBI) among populations at high risk are also needed to accelerate progress toward TB elimination.
Health departments in the 50 states and District of Columbia (DC) electronically report to CDC† verified cases of TB that meet the CDC and Council of State and Territorial Epidemiologists case definition for TB. Reports include demographic and clinical information, as well as medical and social risk factors for TB disease. Persons reported with TB are classified as U.S.-born or foreign-born persons based on established criteria§; race/ethnicity is self-reported. U.S. Census Bureau midyear population estimates provide the denominators used to calculate TB incidence overall (3). The Current Population Survey (https://www.census.gov/programs-surveys/cps.html) provides the population denominators used to calculate TB incidence according to national origin and racial/ethnic group.
State-specific TB incidence in 2016 ranged from 0.2 cases per 100,000 persons in Wyoming to 8.3 in Hawaii (median state incidence = 1.9). Twelve states (Alaska, Arkansas, California, Florida, Georgia, Hawaii, Maryland, Minnesota, New Jersey, New York, North Dakota, and Texas) and DC reported incidence higher than the national incidence (Table 1). As in previous years, four states (California, Florida, New York, and Texas) reported >500 cases each in 2016, accounting for 50.9% of reported cases nationwide.
Among 9,287 TB cases reported in 2016, U.S.-born persons accounted for 2,935 (31.6%) cases, and 6,307 (67.9%) cases occurred among foreign-born persons; 45 (0.5%) cases occurred among persons whose national origin was not known (Table 2). TB incidence among U.S.-born persons (1.1 cases per 100,000) decreased 8.4% from 2015 (Figure). Incidence among foreign-born persons (14.6 cases per 100,000) decreased 3.2% from 2015, but was approximately 14 times the incidence among U.S.-born persons.
Among U.S.-born persons, TB incidence remained stable among non-Hispanic whites (0.5 cases per 100,000) and Asians (2.1), but decreased from 2015 in all other racial/ethnic groups including Hispanics (1.6 [-11.4%]), non-Hispanic blacks (3.0 [-6.8%]), American Indian/Alaska Natives (5.0 [-28.8%]), and Native Hawaiian/Pacific Islanders (9.2 [-27.3%]) (Table 2). TB incidence has decreased or remained stable since 2013 in all U.S.-born racial/ethnic groups except American Indian/Alaska Natives and Native Hawaiian/Pacific Islanders, which experienced increases during this period before decreasing in 2016.

source page : Center for Disease Control