Fast Facts Top 5 Countries with New Tuberculosis Cases Tuberculosis in Children Tuberculosis in Women Tuberculosis in the Elderly Tuberculosis Cases by Race and Ethnicity Tuberculosis in Refugees HIV and Tuberculosis Tuberculosis in Prisons References Tuberculosis is a deadly disease that affects millions worldwide. It is more prominent among immigrants and refugees in the U.S., women, and those with compromised immune systems. Tuberculosis is curable and inexpensive medications exist, though access to those medications differ worldwide. Fast Facts: Tuberculosis accounts for 2 million deaths a year, including the deaths of over 250,000 children.(1) It is estimated that between 2002 and 2020, approximately 1 billion people will be newly infected, over 150 million people will get sick, and 36 million will die of TB.(1) About 2 million TB cases per year occur in sub-Saharan Africa. Around 3 million TB cases per year occur in Southeast Asia. Over a quarter of a million TB cases per year occur in Eastern Europe.(2) In the United States, nearly 40% of TB cases are among foreign-born people.(1) TB causes more deaths among women worldwide than all causes of maternal mortality combined.(2) Someone in the world is newly infected with TB every second.(1)    Top 5 Countries with new TB cases in 2002 (1) India            1,761,000 China           1,459,000 Indonesia      557,000 Nigeria          368,000 Bangladesh   318,000 Children It has been estimated that as many as one third of the world’s population is infected with TB with an estimated 20-50% of children who live in households with active tuberculosis become secondarily infected.(2) The risk for children in high-burden tuberculosis countries in the developing world ( where family size is large, living quarters are crowded and more than half the population are children) is particularly great.  Five to ten percent of people who are infected with TB (but who are not infected with HIV) become sick or infectious at some time during their life.(2)    The largest decline in number of TB cases by age group occurred in children under age 15 and among 25 to 44 year old adults. These groups had decreases of 43% and 46.5%, respectively, from 1992 to 2000.(3) Back to Top Women  TB causes more deaths among women worldwide than all causes of maternal mortality combined. (2) Over 900 million women are infected with TB worldwide;1 million will die and 2.5 million will get sick this year from the disease, mainly women between the ages of 15 and 44 years. In many places, the stigma attached to TB leads to isolation, abandonment and divorce. (2)   Elderly Tuberculosis case rates are higher for people 65 years of age or older than for any other age group in the U.S.(4) Elderly nursing home residents are at a greater risk for tuberculosis than elderly people living in the community.(4) Nursing home employees are also at an increased risk for tuberculosis compared with other employed adults.(4) There was a 45% decrease in rate of TB between 1992 and 2000.  Although the case rate among those over age 65 has also decreased significantly, the elderly still have the highest rate among all age groups.The elderly account for 23% of all cases of TB.(3) In a study by Stead et al., the risk of TB infection was higher among nursing home residents than among the elderly residing in the community. The length of stay in the nursing home was associated with a greater likelihood of a positive tuberculin skin test.(3) It has been suggested that pulmonary TB in the elderly might differ from the disease presenting in younger patients and that it should be classified separately. (3,5)  It has also been suggested that these differences might account for a delay in diagnosis, which in turn leads to increased morbidity and mortality in this age group. (3,5)  Back to Top Tuberculosis by Race/Ethnicity In 2003, Asians in the U.S. had the highest TB rate (29.3 per 100,000) which was down (from 45.0 per 100,000) in 1993.(6) Asians also had the smallest percentage decline over the decade (35%).(6) Rates declined more than 50% in the 1990s among other racial/ethnic groups: among non-Hispanic blacks from 29.1 per 100,000 in 1993 to 11.6 per 100,000 in 2003, among Hispanics from 20.6 to 10.3, among American Indians and Alaska Natives from 14.5 to 8.1, and among non-Hispanic whites from 3.6 to 1.4.(6) For the first time, Hispanics (28%) equaled blacks (28%) as the racial/ethnic group with the largest percentage of TB cases in the U.S.(6) Refugees In the United States, nearly 40% of TB cases are among foreign-born people. (1) Untreated TB spreads quickly in crowded refugee camps and shelters; it is difficult to treat mobile populations because they lack continuity of care.(1) As many as 50% of the world's refugees may be infected with TB; each year, 17,000 get sick with the disease. (1) Other displaced people (such as homeless people in industrialized countries) are also at increased risk. In 1995, almost 30% of San Francisco's homeless population and approximately 25% of London's homeless were reported to be infected with TB.(1)  Back to Top HIV and TB Almost 30% of people with HIV are also infected with tuberculosis.(2) Tuberculosis is the most common opportunistic infection among people with HIV and is a leading cause of death among people who are HIV positive.(2) In more and more countries, the epidemic of tuberculosis and HIV are fueling each other. TB/HIV affects economic development and poses new challenges to health and social systems that increasingly must address issues such as integrating HIV and TB services, facilitating access to drugs and treatment, and caring for infected people. (2) For an interesting multimedia presentation on the affects of TB, please visit the www.stoptb.org website. Prisons The level of TB in prisons has been reported to be up to 100 times higher than in the civilian population.(1)  Cases of TB in prisons may account for up to 25% of a country's burden of TB.(1) Back to Top References: 1. World Health Organization(WHO). Tuberculosis Fact Sheet. Geneva, Switzerland: WHO, April 2005. http://www.who.int/mediacentre/factsheets  2. www.stoptb.org 3. Zevallos M, Justman JE. Tuberculosis in the elderly. Clin Geriatr Med 2003;19(1):121-38. 4. Prevention and control of tuberculosis in facilities providing long-term care to the elderly. Recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR Recomm Rep 1990;39(RR-10):7-13. 5. Morris CD. Pulmonary tuberculosis in the elderly: a different disease? Thorax 1990;45(12):912-3. 6. CDC. Reported Tuberculosis in the United States, 2003. Atlanta, GA: U.S. Department of Health and Human Services, CDC, September 2004. This research was supported by a National Library of Medicine (NLM) Publication Grant #5G08 LM07653-02 in support of the creation of a web site titled Factline: Tracking Health in Underserved Communities, www.factline.org. Saqi S. Maleque, MSPH, Researcher, Principal Investigator: Virginia Brennan, PhD.