Notifiable Infectious Diseases Among People with Tuberculosis (TB) in New York City, 2000-2010

BACKGROUND:  Linking infectious disease surveillance data is the most thorough and accurate way to understand the impact of other infectious diseases on people with TB.  In 2010, the NYC Department of Health and Mental Hygiene (DOHMH) implemented CDC’s Program Collaboration and Service Integration (PCSI) initiative with the goal of increased data sharing between HIV, STD, TB, and viral hepatitis disease programs. We matched HIV, STD, TB, and viral hepatitis surveillance data to measure co-infection. 

METHODS:  We conducted a retrospective, deterministic cross-match of the HIV, STD, TB, and chronic hepatitis B and C registries for the period 1/1/2000-12/31/2010. For HIV, hepatitis B, and hepatitis C, persons alive and reported as of 2000 and persons reported between 2000 and 2010 were included in the dataset.  Incident chlamydia, gonorrhea, syphilis, and TB cases reported between 2000 and 2010 were included. Descriptive analyses were conducted using SAS 9.2.

RESULTS:  In the 11 year study period, 11,875 persons were reported to have TB disease. HIV was the most common infection among people with TB (14%). Four percent of TB cases had hepatitis B, and 6% had hepatitis C. STDs were rare among TB cases (<1% syphilis, 1% gonorrhea, 2% chlamydia).  TB patients with HIV were more likely to be US-born (79% vs. 47%), male (69% vs. 59%), and non-Hispanic black (63% vs. 25%) than those without HIV (p<0.05 for all comparisons). TB patients with hepatitis C were also more likely to be US-born (66% vs. 33%), male (71% vs. 60%) and non-Hispanic black (51% vs. 29%) than those without hepatitis C (p<0.05 for all comparisons). Twenty-four percent of cases with TB and hepatitis C were homeless at the time of TB report.  The top four countries of origin for TB cases with hepatitis B were: China (32%), US (23%), Haiti (3.5%), and Philippines (3.5%).

CONCLUSIONS:  People with TB in New York City are also at risk for other infectious diseases, including HIV, hepatitis B, and hepatitis C, which can impact TB treatment. TB cases at risk for hepatitis B are demographically different than the population at risk for HIV and hepatitis C. This information can be used to inform medical providers diagnosing TB about the importance of testing for HIV and viral hepatitis before initiating TB treatment.