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Article ; Online: Association between Birth Region and Time to Tuberculosis Diagnosis among Non-US-Born Persons in the United States.

Talwar, Amish / Li, Rongxia / Langer, Adam J

2021 Volume 27, Issue 6, Page(s) 1645–1653

Abstract: Approximately 90% of tuberculosis (TB) cases among non-US-born persons in the United States are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated whether birthplace is associated with time to ... ...

Abstract	Approximately 90% of tuberculosis (TB) cases among non-US-born persons in the United States are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated whether birthplace is associated with time to disease progression among non-US-born persons in whom TB disease developed. We derived a Cox regression model comparing differences in time to TB diagnosis after US entry among 19 birth regions, adjusting for sex, birth year, and age at entry. After adjusting for age at entry and birth year, the median time to TB diagnosis was lowest among persons from Middle Africa, 128 months (95% CI 116-146 months) for male persons and 121 months (95% CI 108-136 months) for female persons. We found time to TB diagnosis among non-US-born persons varied by birth region, which represents a prognostic indicator for progression of latent TB infection to TB disease.
MeSH term(s)	Africa ; Emigrants and Immigrants ; Female ; Humans ; Latent Tuberculosis ; Male ; Mass Screening ; Tuberculosis ; United States
Language	English
Publishing date	2021-05-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2706.203663
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Article ; Online: Decrease in Tuberculosis Cases during COVID-19 Pandemic as Reflected by Outpatient Pharmacy Data, United States, 2020.

Winglee, Kathryn / Hill, Andrew N / Langer, Adam J / Self, Julie L

Emerging infectious diseases

2022 Volume 28, Issue 4, Page(s) 820–827

Abstract: We analyzed a pharmacy dataset to assess the 20% decline in tuberculosis (TB) cases reported to the US National Tuberculosis Surveillance System (NTSS) during the coronavirus disease pandemic in 2020 compared with the 2016-2019 average. We examined the ... ...

Abstract	We analyzed a pharmacy dataset to assess the 20% decline in tuberculosis (TB) cases reported to the US National Tuberculosis Surveillance System (NTSS) during the coronavirus disease pandemic in 2020 compared with the 2016-2019 average. We examined the correlation between TB medication dispensing data to TB case counts in NTSS and used a seasonal autoregressive integrated moving average model to predict expected 2020 counts. Trends in the TB medication data were correlated with trends in NTSS data during 2006-2019. There were fewer prescriptions and cases in 2020 than would be expected on the basis of previous trends. This decrease was particularly large during April-May 2020. These data are consistent with NTSS data, suggesting that underreporting is not occurring but not ruling out underdiagnosis or actual decline. Understanding the mechanisms behind the 2020 decline in reported TB cases will help TB programs better prepare for postpandemic cases.
MeSH term(s)	COVID-19/epidemiology ; Humans ; Outpatients ; Pandemics ; Pharmacy ; Population Surveillance ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy ; Tuberculosis/epidemiology ; United States/epidemiology
Language	English
Publishing date	2022-03-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2804.212014
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Article: Vaginal Calculus Formation on Exposed Midurethral Sling Mesh.

Langer, Adam J / Saeed, Zenab / Barrett, Elizabeth / Maxwell, Rose A / Dhanraj, David N / Towers, Geoffrey D / Agudu, Eyra A

Case reports in obstetrics and gynecology

2024 Volume 2024, Page(s) 8287400

Abstract: The presence of a vaginal calculus is a rare clinical entity which may develop in the setting of vaginal urinary stagnation. Numerous factors contribute to stone formation, and management can be complicated by variations in size, location of the stone, ... ...

Abstract	The presence of a vaginal calculus is a rare clinical entity which may develop in the setting of vaginal urinary stagnation. Numerous factors contribute to stone formation, and management can be complicated by variations in size, location of the stone, and location of adjacent structures. Generally, once diagnosed, vaginal calculi should be removed and surrounding anatomy should be evaluated thoroughly for secondary fistula, erosion, or presence of an instituting foreign body. This report presents a case of vaginal calculus formation on exposed midurethral sling mesh in an elderly patient with hemorrhagic cystitis. This report emphasizes contributing pathophysiology, diagnostic factors, and treatment.
Language	English
Publishing date	2024-03-16
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627654-9
ISSN	2090-6692 ; 2090-6684
ISSN (online)	2090-6692
ISSN	2090-6684
DOI	10.1155/2024/8287400
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Article ; Online: Tuberculosis in Indigenous Persons - United States, 2009-2019.

Springer, Yuri P / Kammerer, J Steve / Silk, Benjamin J / Langer, Adam J

Journal of racial and ethnic health disparities

2021 Volume 9, Issue 5, Page(s) 1750–1764

Abstract: Background: Populations of indigenous persons are frequently associated with pronounced disparities in rates of tuberculosis (TB) disease compared to co-occurring nonindigenous populations.: Methods: Using data from the National Tuberculosis ... ...

Abstract	Background: Populations of indigenous persons are frequently associated with pronounced disparities in rates of tuberculosis (TB) disease compared to co-occurring nonindigenous populations. Methods: Using data from the National Tuberculosis Surveillance System on TB cases in U.S.-born patients reported in the United States during 2009-2019, we calculated incidence rate ratios and risk ratios for TB risk factors to compare cases in American Indian or Alaska Native (AIAN) and Native Hawaiian or other Pacific Islander (NHPI) TB patients to cases in White TB patients. Results: Annual TB incidence rates among AIAN and NHPI TB patients were on average ≥10 times higher than among White TB patients. Compared to White TB patients, AIAN and NHPI TB patients were 1.91 (95% confidence interval (CI): 1.35-2.71) and 3.39 (CI: 1.44-5.74) times more likely to have renal disease or failure, 1.33 (CI: 1.16-1.53) and 1.63 (CI: 1.20-2.20) times more likely to have diabetes mellitus, and 0.66 (CI: 0.44-0.99) and 0.19 (CI: 0-0.59) times less likely to be HIV positive, respectively. AIAN TB patients were 1.84 (CI: 1.69-2.00) and 1.48 (CI: 1.27-1.71) times more likely to report using excess alcohol and experiencing homelessness, respectively. Conclusion: TB among U.S. indigenous persons is associated with persistent and concerning health disparities.
MeSH term(s)	Alaska Natives ; Humans ; Incidence ; Indigenous Peoples ; Native Hawaiian or Other Pacific Islander ; Tuberculosis/epidemiology ; United States/epidemiology
Language	English
Publishing date	2021-08-26
Publishing country	Switzerland
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2760524-3
ISSN	2196-8837 ; 2197-3792
ISSN (online)	2196-8837
ISSN	2197-3792
DOI	10.1007/s40615-021-01112-6
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Article ; Online: Tuberculosis - United States, 2019.

Schwartz, Noah G / Price, Sandy F / Pratt, Robert H / Langer, Adam J

MMWR. Morbidity and mortality weekly report

2020 Volume 69, Issue 11, Page(s) 286–289

Abstract: Since 1989, the United States has pursued a goal of eliminating tuberculosis (TB) through a strategy of rapidly identifying and treating cases and evaluating exposed contacts to limit secondary cases resulting from recent TB transmission (1). This ... ...

Abstract	Since 1989, the United States has pursued a goal of eliminating tuberculosis (TB) through a strategy of rapidly identifying and treating cases and evaluating exposed contacts to limit secondary cases resulting from recent TB transmission (1). This strategy has been highly effective in reducing U.S. TB incidence (2), but the pace of decline has significantly slowed in recent years (2.2% average annual decline during 2012-2017 compared with 6.7% during 2007-2012) (3). For this report, provisional 2019 data reported to CDC's National Tuberculosis Surveillance System were analyzed to determine TB incidence overall and for selected subpopulations and these results were compared with those from previous years. During 2019, a total of 8,920 new cases were provisionally reported in the United States, representing a 1.1% decrease from 2018.* TB incidence decreased to 2.7 cases per 100,000 persons, a 1.6% decrease from 2018. Non-U.S.-born persons had a TB rate 15.5 times greater than the rate among U.S.-born persons. The U.S. TB case count and rate are the lowest ever reported, but the pace of decline remains slow. In recent years, approximately 80% of U.S. TB cases have been attributed to reactivation of latent TB infection (LTBI) acquired years in the past, often outside the United States (2). An expanded TB elimination strategy for this new decade should leverage existing health care resources, including primary care providers, to identify and treat persons with LTBI, without diverting public health resources from the continued need to limit TB transmission within the United States. Partnerships with health care providers, including private providers, are essential for this strategy's success.
MeSH term(s)	Adult ; Centers for Disease Control and Prevention, U.S. ; Disease Eradication ; Emigrants and Immigrants/statistics & numerical data ; Ethnic Groups/statistics & numerical data ; Goals ; Humans ; Incidence ; Population Surveillance ; Tuberculosis/epidemiology ; Tuberculosis/ethnology ; Tuberculosis/prevention & control ; United States/epidemiology
Language	English
Publishing date	2020-03-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm6911a3
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Article ; Online: US Tuberculosis Rates among Persons Born Outside the United States Compared with Rates in Their Countries of Birth, 2012-2016

Tsang, Clarisse A / Langer, Adam J / Kammerer, J Steve / Navin, Thomas R

Emerging infectious diseases

2020 Volume 26, Issue 3, Page(s) 533–540

Abstract: The US Centers for Disease Control and Prevention recommends screening populations at increased risk for tuberculosis (TB), including persons born in countries with high TB rates. This approach assumes that TB risk for expatriates living in the United ... ...

Abstract	The US Centers for Disease Control and Prevention recommends screening populations at increased risk for tuberculosis (TB), including persons born in countries with high TB rates. This approach assumes that TB risk for expatriates living in the United States is representative of TB risk in their countries of birth. We compared US TB rates by country of birth with corresponding country rates by calculating incidence rate ratios (IRRs) (World Health Organization rate/US rate). The median IRR was 5.4. The median IRR was 0.5 for persons who received a TB diagnosis <1 year after US entry, 4.9 at 1 to <10 years, and 10.0 at >10 years. Our analysis suggests that World Health Organization TB rates are not representative of TB risk among expatriates in the United States and that TB testing prioritization in the United States might better be based on US rates by country of birth and years in the United States.
MeSH term(s)	Emigrants and Immigrants ; Humans ; Incidence ; India/ethnology ; Mexico/ethnology ; Philippines/ethnology ; Tuberculosis, Pulmonary/epidemiology ; Tuberculosis, Pulmonary/ethnology ; Tuberculosis, Pulmonary/etiology ; United States/epidemiology
Language	English
Publishing date	2020-03-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2603.190974
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Article ; Online: Outbreak of Mycobacterium orygis in a Shipment of Cynomolgus Macaques Imported from Southeast Asia - United States, February-May 2023.

Swisher, Samantha D / Taetzsch, Sara J / Laughlin, Mark E / Walker, William L / Langer, Adam J / Thacker, Tyler C / Rinsky, Jessica L / Lehman, Kimberly A / Taffe, Anne / Burton, Nancy / Bravo, Doris M / McDonald, Emily / Brown, Clive M / Pieracci, Emily G

MMWR. Morbidity and mortality weekly report

2024 Volume 73, Issue 7, Page(s) 145–148

Abstract: Nonhuman primates (NHP) can become infected with the same species of Mycobacteria that cause human tuberculosis. All NHP imported into the United States are quarantined and screened for tuberculosis; no confirmed cases of tuberculosis were diagnosed ... ...

Abstract	Nonhuman primates (NHP) can become infected with the same species of Mycobacteria that cause human tuberculosis. All NHP imported into the United States are quarantined and screened for tuberculosis; no confirmed cases of tuberculosis were diagnosed among NHP during CDC-mandated quarantine during 2013-2020. In February 2023, an outbreak of tuberculosis caused by Mycobacterium orygis was detected in a group of 540 cynomolgus macaques (Macaca fascicularis) imported to the United States from Southeast Asia for research purposes. Although the initial exposure to M. orygis is believed to have occurred before the macaques arrived in the United States, infected macaques were first detected during CDC-mandated quarantine. CDC collaborated with the importer and U.S. Department of Agriculture's National Veterinary Services Laboratories in the investigation and public health response. A total of 26 macaques received positive test results for M. orygis by culture, but rigorous occupational safety protocols implemented during transport and at the quarantine facility prevented cases among caretakers in the United States. Although the zoonotic disease risk to the general population remains low, this outbreak underscores the importance of CDC's regulatory oversight of NHP importation and adherence to established biosafety protocols to protect the health of the United States research animal population and the persons who interact with them.
MeSH term(s)	United States/epidemiology ; Animals ; Humans ; Macaca fascicularis ; Mycobacterium ; Disease Outbreaks ; Tuberculosis ; Asia, Southeastern
Language	English
Publishing date	2024-02-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm7307a2
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Article ; Online: Noncountable Tuberculosis Case Reporting, National Tuberculosis Surveillance System, United States, 2010-2014.

Pratt, Robert H / Manangan, Lilia P / Cummings, Charisse Nitura / Langer, Adam J

Public health reports (Washington, D.C. : 1974)

2019 Volume 135, Issue 1, Page(s) 18–24

Abstract: Objectives: Supplemental federal funding is allocated to state and local tuberculosis (TB) programs using a formula that considers only countable cases reported to the National Tuberculosis Surveillance System (NTSS). Health departments submit reports ... ...

Abstract	Objectives: Supplemental federal funding is allocated to state and local tuberculosis (TB) programs using a formula that considers only countable cases reported to the National Tuberculosis Surveillance System (NTSS). Health departments submit reports of cases, which are countable unless another (US or international) jurisdiction has already counted the case or the case represents a recurrence of TB diagnosed ≤12 months after completion of treatment for a previous TB episode. Noncountable cases are a resource burden, so in 2009, NTSS began accepting noncountable case reports as an indicator of program burden. We sought to describe the volume and completeness of noncountable case reports. Methods: We analyzed 2010-2014 NTSS data to determine the number and distribution of noncountable cases reported. We also surveyed jurisdictions to determine the completeness of noncountable case reporting and obtain information on jurisdictions' experience in reporting noncountable cases. In addition, we prepared a hypothetical recalculation of the funding formula to evaluate the effect of including noncountable cases on funding allocations. Results: Of 54 067 TB case reports analyzed, 1720 (3.2%) were noncountable; 47 of 60 (78.3%) jurisdictions reported ≥1 noncountable case. Of 60 programs surveyed, 34 (56.7%) responded. Of the 34 programs that responded, 24 (70.6%) had not reported all their noncountable cases to NTSS, and 11 (32.4%) stated that reporting noncountable cases was overly burdensome, considering the cases were not funded. Conclusions: Complete data on noncountable TB cases help support estimates of programmatic burden. Ongoing training and a streamlined reporting system to NTSS can facilitate noncountable case reporting.
MeSH term(s)	Centers for Disease Control and Prevention, U.S./organization & administration ; Centers for Disease Control and Prevention, U.S./standards ; Humans ; Mandatory Reporting ; Population Surveillance/methods ; Tuberculosis/epidemiology ; United States/epidemiology
Language	English
Publishing date	2019-11-13
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	120953-x
ISSN	1468-2877 ; 0033-3549
ISSN (online)	1468-2877
ISSN	0033-3549
DOI	10.1177/0033354919884302
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Article ; Online: Epidemiology of Tuberculosis in the United States.

Langer, Adam J / Navin, Thomas R / Winston, Carla A / LoBue, Philip

Clinics in chest medicine

2019 Volume 40, Issue 4, Page(s) 693–702

Abstract: Although considerable progress has been made in reducing US tuberculosis incidence, the goal of eliminating the disease from the United States remains elusive. A continued focus on preventing new tuberculosis infections while also identifying and ... ...

Abstract	Although considerable progress has been made in reducing US tuberculosis incidence, the goal of eliminating the disease from the United States remains elusive. A continued focus on preventing new tuberculosis infections while also identifying and treating persons with existing tuberculosis infection is needed. Continued vigilance to ensure ongoing control of tuberculosis transmission remains key.
MeSH term(s)	Humans ; Incidence ; Tuberculosis/epidemiology ; United States
Language	English
Publishing date	2019-11-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	447455-7
ISSN	1557-8216 ; 0272-5231
ISSN (online)	1557-8216
ISSN	0272-5231
DOI	10.1016/j.ccm.2019.07.001
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Article ; Online: Tuberculosis Among Foreign-Born Persons Diagnosed ≥10 Years After Arrival in the United States, 2010-2015.

Tsang, Clarisse A / Langer, Adam J / Navin, Thomas R / Armstrong, Lori R

MMWR. Morbidity and mortality weekly report

2017 Volume 66, Issue 11, Page(s) 295–298

Abstract: The majority of tuberculosis (TB) cases in the United States are attributable to reactivation of latent TB infection (LTBI) (1). LTBI refers to the condition when a person is infected with Mycobacterium tuberculosis without signs and symptoms, or ... ...

Abstract	The majority of tuberculosis (TB) cases in the United States are attributable to reactivation of latent TB infection (LTBI) (1). LTBI refers to the condition when a person is infected with Mycobacterium tuberculosis without signs and symptoms, or radiographic or bacteriologic evidence of TB disease. CDC and the U.S. Preventive Services Task Force (USPSTF) recommend screening populations at increased risk for LTBI, including persons who have lived in congregate settings at high risk and persons who were born in, or are former residents of countries with TB incidence ≥20 cases per 100,000 population (2-4). In 2015, foreign-born persons constituted 66.2% of U.S. TB cases (5). During the past 30 years, screening of persons from countries with high TB rates has focused on overseas screening for immigrants and refugees, and domestic screening for persons who have newly arrived in the United States (6,7). However, since 2007, an increasing number and proportion of foreign-born patients receiving a diagnosis of TB first arrived in the United States ≥10 years before the development and diagnosis of TB disease. To better understand how this group of patients differs from persons who developed TB disease and received a diagnosis <10 years after U.S. arrival, CDC analyzed data for all reported TB cases in the United States since 1993 in the National TB Surveillance System (NTSS). After adjusting for age and other characteristics, foreign-born persons who arrived in the United States ≥10 years before diagnosis were more likely to be residents of a long-term care facility or to have immunocompromising conditions other than human immunodeficiency virus (HIV) infection. These findings support using the existing CDC and USPSTF recommendations for TB screening of persons born in countries with high TB rates regardless of time since arrival in the United States (2,3).
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Emigrants and Immigrants/statistics & numerical data ; Emigration and Immigration/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Time Factors ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology ; United States/epidemiology ; Young Adult
Language	English
Publishing date	2017-03-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm6611a3
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