 The World Health Organization (WHO) estimates that since 2015, tuberculosis has surpassed

human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS)

as the leading cause of death from an infectious disease worldwide, and that almost one third of
the world’s population (2.5 billion people) is infected with M. tuberculosis.
 In 2015, Tuberculosis was the leading cause of death from an infectious disease worldwide, and
almost one third of the world’s population is infected with M. tuberculosis, according to the
World Health Organization.
 Approximately 95% of TB cases occur in the developing world. The highest numbers of cases are
in Asia, Africa, and the eastern Mediterranean region. An estimated 10.4 million incident cases
and 1.8 million TB-associated deaths occurred worldwide in 2015 (Fig. 242.1).
 The WHO 2016 Global Tuberculosis Report estimates that in 2015 there were 1 million
childhood incident cases:
o 170,000 TB-associated deaths among non–HIV-infected children
o 40,000 TB-associated deaths among HIV-infected children.
 The global burden of tuberculosis is influenced by several factors:
o HIV pandemic
o development of multidrug-resistant (MDR) tuberculosis
o disproportionately low access of populations to both diagnostic tests and effective
medical therapy
 In the United States, TB case rates decreased steadily during the 1st half of the 20th century,
long before the advent of antituberculosis drugs, as a result of improved living conditions and
likely, genetic selection favoring persons resistant to developing disease.
 A resurgence of tuberculosis in the late 1980s was associated primarily with the HIV epidemic,
transmission of the organism in congregate settings including healthcare institutions, disease
occurring in recent immigrants, and poor conduct of community TB control.
 Since 1992, the number of reported TB cases decreased each year until 2015, when it increased
by 1.6% from 2014, to 9,557cases (Fig. 242.2).
 Despite the increase in the number of reported cases in 2015, TB incidence in the United States
has remained stable at 3 cases per 100,000 persons. Of the cases in 2015, 439 (4.6%) occurred in
children <15 yr old (rate: 1.5/100,000 population), 55% of whom were ≤5 yr old.
 Racial and ethnic minorities and foreign-born persons, including children in these groups, are
disproportionately affected by tuberculosis in the United States.
 In 2015 the Centers for Disease Control and Prevention (CDC) reported that 87% of all TB cases
were among ethnic minority populations. The TB case rate among Asian, non-Hispanic black,
and Hispanic children was 27, 13, and 12 times as high, respectively, as among non-Hispanic
white children (Fig. 242.3).
 The TB rate among foreign-born persons in the United States was 13 times higher than among
U.S.-born persons and accounted for 66% of all TB cases in 2015 (Fig. 242.4).
 Foreign-born children accounted for 22% of the total number of childhood TB cases in 2015. Of
U.S.-born children with tuberculosis, 66% have at least 1 foreign-born parent, and 75% of all
pediatric patients have some international connection through a family member or previous
travel or residence in a TB-endemic country.
  Most children are infected with M. tuberculosis in their home by someone close to them, but
outbreaks of childhood tuberculosis also have occurred in elementary and high schools, nursery
schools, daycare centers and homes, churches, school buses, and sports teams.
 Most children are infected with M. tuberculosis in their home, as well as outbreaks that have
occurred in schools, daycare centers, churches, school buses and sports teams.
 HIV-infected adults with tuberculosis can transmit M. tuberculosis to children, and children with
HIV infection are at increased risk for developing tuberculosis after infection. Specific groups are
at high risk for acquiring TBI and progressing to tuberculosis (Table 242.1).
 The incidence of drug-resistant tuberculosis has increased dramatically throughout the world.
 In 2015, the estimate for MDR-TB was 39% of incident cases, but rates as high as 32% have been
reported in countries formerly part of the Soviet Union.
 MDR-TB is defined as resistance to at least isoniazid and rifampin; extensively drug-resistant
tuberculosis includes MDR-TB plus resistance to any fluoroquinolone and at least 1 of 3
injectable drugs (kanamycin, capreomycin, amikacin).
 In 2015 the estimate for MDR-TB was 3.9% of incident cases, but rates as high as 32% have been
reported in countries formerly part of the Soviet Union. In 2015 in the United States, a total of
89 patients with MDR-TB were reported, 70.8% of whom were foreign-born (Fig. 242.5). The
CDC reported that among children with culture-confirmed tuberculosis in the United States in
2014, 17.4% had resistance to at least 1 first-line drug, and 0.9% had MDR-TB.
 --

EPIDEMIOLOGY

 According to the WHO, in 2015, Tuberculosis was the leading cause of death from an infectious
disease worldwide, and almost one third of the world’s population is infected with M.
tuberculosis.
 The WHO 2016 Global Tuberculosis Report estimates that in 2015 there were 1 million
childhood incident cases:
o 170,000 TB-associated deaths among non–HIV-infected children
o 40,000 TB-associated deaths among HIV-infected children.
 The global burden of tuberculosis is influenced by several factors:
o HIV pandemic
o Development of multidrug-resistant (MDR) tuberculosis
o Disproportionately low access of populations to both diagnostic tests and effective
medical therapy
 The incidence of drug-resistant tuberculosis has increased dramatically throughout the world. In
2015, the estimate for MDR-TB was 39% of incident cases, but rates as high as 32% have been
reported in countries formerly part of the Soviet Union.