Evaluating New York City's Tuberculosis Reporting System

BACKGROUND: Timely reporting of patients with suspected tuberculosis (TB) allows for prompt case management and contact investigation—key elements of TB control and prevention. In New York City (NYC), healthcare providers and laboratories are required to report patients with laboratory evidence or clinical suspicion of TB disease to the health department within 24 hours. As part of a larger surveillance system evaluation, we conducted a preliminary analysis of reporting facilities and reporting delays for patients initially reported in 2013.

METHODS: We conducted a retrospective cohort study among patients initially reported to the NYC health department in 2013 for suspected TB disease. Information from the initial report for each patient was abstracted from the NYC TB registry. The health department defines a report as late if received seven or more days after collection of a pathology specimen consistent with TB or four or more days after start of anti-TB treatment, initiation of airborne infection isolation, or collection date for a positive acid-fast bacillus smear or nucleic acid amplification result. The proportion of late initial reports was calculated for patients meeting one or more reporting criteria.

RESULTS: In 2013, 3,387 patients were initially reported by 185 facilities to the health department for suspected TB disease. Of these, 2,366 (70%) patients were reported by one of the 20 most frequent reporting facilities. The number of patients reported per facility ranged from 1 to 343, with a median of 1. Among all reported patients, 2,408 (71%) met at least one reporting criteria, of whom 827 (34%) were reported to the health department late. Among the 20 most frequent reporting facilities, the proportion of late reports ranged from 2% to 74%. 

CONCLUSIONS: In 2013, 3,387 patients were reported to the NYC health department for suspected TB disease. While initial patient reports were submitted by 185 facilities, 70% of patients were reported by one of the 20 most frequent reporting facilities. The majority of patients who met at least one of the city’s mandatory TB reporting criteria were reported in a timely manner. However, reporting delays persist in NYC; 34% of eligible patients were reported late, with the proportion of late reports varying considerably by reporting facility. Additional analysis is ongoing to further investigate characteristics of patients and reporting facilities and to assess the impact of reporting delays on patient care, case management, and other TB control activities.