title: Revisiting rates of reactivation tuberculosis: a population-based approach.
abstract: BACKGROUND
  Reactivation tuberculosis (TB) occurs as a result of reactivation of latent TB infection (LTBI), and was reported to occur in the United States at a rate of 0.10 to 0.16 cases per 100 person-years in the 1950s; it has not been measured since.
  
  
  OBJECTIVE
  To calculate the rate of reactivation TB in a U.S. community.
  
  
  METHODS
  A population-based tuberculin skin test survey for LTBI was performed in western Palm Beach County, Florida, from 1998 to 2000 along with a cluster analysis of TB case isolates in the same area from 1997 to 2001. Reactivation (unclustered) TB was presumed to have arisen from the population with LTBI.
  
  
  RESULTS
  The rate of reactivation TB among persons with LTBI without HIV infection was 0.040 cases per 100 person-years (95% confidence interval [CI], 0.024-0.067) using the n method and 0.058 cases per 100 person-years (95% CI, 0.038-0.089) using the n-1 method. HIV infection was the strongest risk factor for reactivation (rate ratio [RR], 57; 95% CI, 27-120; P < 0.001). Among persons without HIV infection, reactivation was increased among those older than 50 years (RR, 3.8; 95% CI, 1.3-11) and among those born in the United States (RR, 3.2; 95% CI, 1.1-9.3).
  
  
  CONCLUSIONS
  Rates of reactivation TB in this area have declined substantially since the 1950s. The greatest part of this decline may be attributed to the disappearance of old, healed TB in the population. If similar declines are seen in other areas of the United States, the cost-effectiveness of screening and treatment of LTBI may be substantially less than previously estimated.
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA. rhorsbu@bu.edu
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
authors.forename: Max
authors.initials: M
authors.lastname: O'Donnell
authors.forename: Sandra
authors.initials: S
authors.lastname: Chamblee
authors.forename: Janet L
authors.initials: JL
authors.lastname: Moreland
authors.forename: Johnny
authors.initials: J
authors.lastname: Johnson
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Marsh
authors.forename: Masahiro
authors.initials: M
authors.lastname: Narita
authors.forename: Linda Scoles
authors.initials: LS
authors.lastname: Johnson
authors.forename: C Fordham
authors.initials: CF
authors.lastname: von Reyn
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000367:Age Factors; D016000:Cluster Analysis; D005260:Female; D005431:Florida / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012008:Recurrence; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology*
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