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Fulton County TB Trends | Print |

In step with the rest of the United States, Fulton County has continued to see a decline in the number of new Tuberculosis (TB) cases reported within its' borders in the past decade (2006 – 2016). Though it has remained one of the highest contributors to Georgia State's TB case numbers, very significant progress has been made in reducing the scourge of TB amongst the inhabitants of the County.

TB incidence
According to preliminary reports, a total of 44 new TB cases were counted in Fulton County in the immediate past year (2016), constituting about 15% of the total number of new TB cases in Georgia State for 2016. In comparison to previous years, the number of new TB cases in 2016 was a 32% decrease from the number reported in 2015 (n= 63) and a 77% decrease from the number of cases reported by the county in 2000 (n = 183). Figure 1 below shows the trend in TB incidence in the county between 2006 and 2016.

Similar to the trend in the number of new cases diagnosed in the county, the TB incidence rate for Fulton County has seen decline in the past decade. Between 2014 and 2015 (the most recent years with verified TB reports), the incidence rate of Tuberculosis in Fulton County declined from 7.7 (per 100,000 population) to 6.2 (per 100,000 population), reflecting an 18% decline in TB incidence rate in the County between 2014 and 2015. The TB case rate for 2016 has also been projected to decline even further in step with the record low number of new cases diagnosed in the county in 2016. When compared to Georgia State as a whole and the rest of the United States, Fulton County's TB incidence rate still remains appreciably higher than the case rate in the Georgia state and the country (2015 Georgia State Case rate – 3.1 and United States case rate 3.0).

tb-chart-1a

Demographics
TB in Fulton County continues to occur more among males than females [2016: Males – 27 (61%), Females – 17 (39%)]. About 77% (n = 34) of the new TB cases in 2016 were between 25 and 65 years of age and no new TB diagnosis was reported in a child under 5 years of age (Age range for 2016 new TB cases: 5 – 93 years). Following the trend observed in previous years in Fulton County, US born persons constituted the larger proportion (70%) of TB cases in 2016 with 31 persons out of the 44 new TB cases diagnosed in the County being US born. Among the 13 persons who were born outside of the United States, there was no uniformity in the countries of origin. Overall, African Americans (Blacks) constituted 61% (n = 27) of the newly diagnosed TB cases while Asians and Caucasians constituted 21% (n = 9) and 18% (n = 8) respectively.  

HIV and TB
In 2016, 13 (30%) persons among the 43 persons diagnosed with TB in the County also had personal history of prior HIV diagnosis. Among those who are homeless, HIV infection has historically been a strong risk factor for developing active TB disease in Fulton County. About 55% (n = 6) of homeless persons diagnosed with active TB disease in 2016 were also HIV infected compared to 21% (n = 7) of non-homeless persons diagnosed with TB disease in same year.

Homelessness and TB
Homelessness has historically been a strong risk factor for developing active TB disease in Fulton County. Over the past decade, an average of 29% of persons with TB disease in Fulton County reported experiencing homelessness within the 12 months prior to their TB diagnosis. This is appreciably higher than the proportion of new TB cases reporting homelessness in Georgia State as a whole (9% on average) and the United States in general (6% on average) within in the time period (See Figure 2).

In the spring of 2008, there was an increase in the occurrence of a strain of Isoniazid resistant TB among homeless persons in Fulton County. While it initially started at one transitional housing facility for the homeless, it was soon found to occur in both sheltered and unsheltered homeless persons. To date, a total of 105 cases (both culture-confirmed and clinical cases) in Fulton County have been associated with the outbreak since its' onset in 2008, while 59 cases total have been reported in other Georgia counties and the states in the country since 2008. Strategic outbreak control measures by the Fulton County TB program such as – mandatory TB screening of all Metro-Atlanta shelter residents, use of the research-proven DOT (Directly Observed Treatment) method to administer Latent TB Infection treatment to homeless persons and diligent implementation of transmission-reducing administrative controls in collaboration with the shelter managements – have proved very effective tools in controlling this outbreak among Fulton's homeless.  

tb-chart-2a

 

Fulton County.

 
 

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