Review
Tuberculosis in New York city: recent lessons and a look ahead

https://doi.org/10.1016/S1473-3099(04)01004-7Get rights and content

Summary

In the late 1980s and early 1990s, after decades of decline, the incidence of tuberculosis began to rise in New York city, reaching a peak of 3811 cases by 1992. The epidemic took root in a setting of inadequate treatment regimens, homelessness, a diminished public-health system, and the onset of the HIV/AIDS epidemic. In addition, a subepidemic of drug-resistant tuberculosis occurred throughout New York city, most notably in a series of well documented nosocomial outbreaks. By 1994, using broadened initial treatment regimens, directly observed therapy, and improved US Centers for Disease Control and Prevention guidelines for hospital control and disease prevention, New York city began to effectively halt the progression of the epidemic. By 2002, tuberculosis rates in New York city reached an historic low of 1084. However, given the presence of a large reservoir of latently infected individuals in the city and an ongoing tuberculosis pandemic, New York city continues to face significant challenges from this persistent pathogen.

Section snippets

Public health and social disarray

In 1968, the incidence of tuberculosis had so declined in New York city that a mayoral task force was created with the goals of eradicating tuberculosis from the city. The plan the group devised called for the elimination of most tuberculosis beds in New York city, earlier hospital discharge of patients with tuberculosis, and the implementation of community-based drug-treatment programmes.10 Amid the fiscal crisis of the decade, resources for the intended outpatient-care facilities never

DOT and broader therapeutic regimens

By 1992, it was recognised that tuberculosis had reached epidemic proportions in New York city. Initial responses targeted the abysmal rates of treatment compliance and chemotherapeutic drug regimens. The New York City Bureau of Tuberculosis Control and New York city passed regulations compelling an individual to complete treatment, to receive treatment under DOT, or to be detained for treatment. By the end of 1994 more than 1200 people were enrolled in the newly expanded DOT programme in New

Future issues

The epidemic in New York city left countless individuals exposed to and latently infected with M tuberculosis, including strains of MDRTB. In fact, a highly resistant strain of M tuberculosis, strain W, has disseminated widely in New York city and continues to cause disease.53 As these individuals age, the chance of a reactivation of their disease becomes more probable since a substantial number of individuals have never received appropriate prophylaxis for their infection.6 Further increasing

Search strategy and selection criteria

Data for this review were identified through searches of the complete PubMed and Medline databases up to March 19, 2004, using several combinations of the search terms “tuberculosis”, “Mycobacterium tuberculosis”, “multi-drug resistance”, “tuberculin”, “directly observed therapy”, and “HIV-1”, and references from the relevant articles retrieved. Only human studies were selected. Additionally, websites from organisations including the WHO, National Institutes of Health USA, US Centers for

References (64)

  • Nosocomial transmission of multi-drug resistant tuberculosis among HIV-infected persons–Florida and New York

    MMWR

    (1991)
  • TR Frieden et al.

    Tuberculosis in New York City–turning the tide

    N Engl J Med

    (1995)
  • D Alland et al.

    Transmission of tuberculosis in New York City. An analysis by DNA fingerprinting and conventional epidemiologic methods

    N Engl J Med

    (1994)

  • Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities. Centers for Disease Control and Prevention

    MMWR Recomm Rep

    (1994)
  • KA Sepkowitz et al.

    Tuberculosis at the end of the twentieth century

    Eur J Clin Microbiol Infect Dis

    (1994)
  • A Pablos-Mendez et al.

    Global surveillance for antituberculosis-drug resistance, 1994–1997. World Health Organization–International Union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance

    N Engl J Med

    (1998)
  • MA Espinal et al.

    Global trends in resistance to antituberculosis drugs. World Health Organization–International Union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance

    N Engl J Med

    (2001)
  • TA Kenyon et al.

    Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight

    N Engl J Med

    (1996)

  • Report of the Task Force on Tuberculosis in New York City, 1968

    (1968)
  • K Brudney et al.

    Resurgent tuberculosis in New York City. Human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs

    Am Rev Respir Dis

    (1991)

  • New Approach to a resurging crisis

    Report of the task force on tuberculosis in New York, 1980

    (1980)
  • RG Barr et al.

    Neighborhood poverty and the resurgence of tuberculosis in New York City, 1984–1992

    Am J Public Health

    (2001)
  • K Kaye et al.

    Tuberculosis control: the relevance of classic principles in an era of acquired immunodeficiency syndrome and multidrug resistance

    Epidemiol Rev

    (1996)
  • AC Hayward et al.

    Could a tuberculosis epidemic occur in London as it did in New York?

    Emerg Infect Dis

    (2000)
  • SE Buskin et al.

    Tuberculosis risk factors in adults in King County, Washington, 1988 through 1990

    Am J Public Health

    (1994)
  • LN Friedman et al.

    Tuberculosis, AIDS, and death among substance abusers on welfare in New York City

    N Engl J Med

    (1996)

  • HIV surveillance and epidemiology program 4th quarter report

    (2003)
  • KA Sepkowitz

    How contagious is tuberculosis?

    Clin Infect Dis

    (1996)
  • PA Selwyn et al.

    High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy

    JAMA

    (1992)
  • PA Selwyn et al.

    A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection

    N Engl J Med

    (1989)
  • S Allen et al.

    Two-year incidence of tuberculosis in cohorts of HIV-infected and uninfected urban Rwandan women

    Am Rev Respir Dis

    (1992)
  • CL Daley et al.

    An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus. An analysis using restriction-fragment-length polymorphisms

    N Engl J Med

    (1992)

    • Cited by (0)

    View full text
    Copyright © 2004 Elsevier Ltd. All rights reserved.