Aubree Baranowski

Doyle Biol 1610-404

March 7, 2019

Resistance to First-Line Antituberculosis Drugs in Washington State by Region of Birth

Abstract
The US has the lowest number of tuberculosis cases that are drug resistant compared to

other countries around the world. While testing for tuberculosis is somewhat universal, there are

still villages and places where this cannot be done due to economic hardships and lack of

technology. Foreign born residents who tested positive for drug resistant tuberculosis were

categorized based off of factors like age, gender, geographical regions, and some other criteria.

These factors where then analyzed to determine who has the highest potential of bringing over

tuberculosis into the US. More research is needed in order to find out exactly which regions have

the highest cases of the resilient tuberculosis cases. The little research we do have, helps pre-

screenings of people coming into the US and deter those who have the highest potential.

Summary
There have been improvements in the number of people diagnosed with tuberculosis ever

since the use of Directly Observed Therapy (Furukawa, Nathan W.). However, there has also

been a growing number of the positive cases of tuberculosis that are drug resistant or resilient.

Tuberculosis cases tend to come from people of other countries outside of the United States and

North America. With more immigrants and people visiting the United States, there’s a higher

threat of the drug resistant strain of tuberculosis infecting American citizens. Tuberculosis is
becoming more difficult to treat, and the options for treatment are getting worse and worse for

the patient.

Even with the growth of tuberculosis cases, the United States is still one of the lowest in

the world with about 2.96 cases per 100,000 people. 66% of the reported cases however, are

from foreign-born individuals (Furukawa, Nathan W.). To combat this, there has been stricter

protocols in the screening programs for entry into the US because tuberculosis cases are still

coming through. Many people who have tuberculosis test negative, but if they become ill in the

US, it is activated.

Drug resilient tuberculosis is still relatively low in the new cases reported each year, but

it is on a steady rise. Best course of action would be to bring in more vaccines, testings, and

awareness in other parts of the world. New cases of tuberculosis were reported to the CDC to try

and help determine where it is most prevalent in the world. This affects who has higher

screenings due to where they come from geographically when coming into the US.

Epidemiologists are using this data to help identify the exact genome of the drug resistant

tuberculosis. This study and report focused only on those reported in Washington state and is not

a complete study of all tuberculosis cases in the US.

Cases in Washington state were examined from 1994-2014 and were noted which

treatments were most effective, and especially, which treatments were ineffective. World regions

were divided into eight categories depending mainly on resistant rates, political, geographical,

and ethnic similarities (Furukawa, Nathan W.). Ages were also stratified into 20-year categories.

They were then further stratified by gender and region of birth.

 From this data, the CDC is trying to determine which factors are best at analyzing who

has the potential of contracting the resistant tuberculosis. The top cases came from the

Philippines, Vietnam, and Mexico (Furukawa, Nathan W.). They also identified that men tended

to have more resistant tuberculosis, especially those who have had other infections prior to

becoming diagnosed. It was also reported that the highest number who were resistant also had

HIV.

It was also found that the genotype lineage did not correlate as much with US citizens as

it did with foreign born citizens. Because of the improvements of pre-entry screenings, it has

decreased the number of new cases reported in Washington state. However, countries outside of

the US are having higher numbers of cases. This could possibly be a foreshadowing of what

could happen in the US over the next hundred or so years. The study also appeared that the

younger people were more likely to be resistant compared to older people with tuberculosis. As

they get older, there is a higher potential that the prevalence of resistant strains may increase

exponentially compared to previous generations.

Although this study is very eye opening, it only used a sample from Washington state,

and could possibly differ in other states where foreign born populations differ.

Furukawa, Nathan W., et al. “Resistance to First-Line Antituberculosis Drugs in Washington

State by Region of Birth and Implications for Latent Tuberculosis Treatment Among

Foreign-Born Individuals.” The American Journal of Tropical Medicine and Hygiene,

The American Society of Tropical Medicine and Hygiene, 8 Mar. 2017,

www.ajtmh.org/content/journals/10.4269/ajtmh.16-0662#html_fulltext.