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Tuberculosis rates normalize with increased testing, reporting

World Tuberculosis Day reminds providers, patients of tuberculosis risk
Tuberculosis infection attacks the patient’s lung tissue, causing a persistent cough. (Centers for Disease Control and Prevention)

New Mexico Department of Health marked World Tuberculosis Day, March 24, with a reminder to providers and residents that tuberculosis is still a health concern in the state.

Program manager Brenda Montoya Denison said that although reportable cases of TB significantly dropped nationally and in New Mexico in the past few years, the decrease likely had more to do with missed cases related to pandemic conditions than a true reduction in infection.

Lack of access to medical care during the COVID-19 pandemic kept many people from seeking care. A shift in focus among providers might also have reduced the likelihood of patients being tested for TB, Denison said. She explained that fewer than normal TB specimens were collected to rule out the disease in 2020 and 2021.

On average, New Mexico sees 40 to 50 cases of active TB, but in 2021 only 24 active cases were confirmed, with 347 cases of latent TB infections. San Juan County had two active TB cases and five cases of LTBI. Individuals with LTBI are not capable of spreading the disease, but infection can develop into active TB if left untreated.

Preliminary numbers for reportable TB cases in New Mexico in 2022 are still being processed, but Denison estimated there were about 30 cases in New Mexico. She said specimens are being collected more frequently now and TB is being included in the differential diagnosis process more often, which is helping to provide a more accurate view of TB in New Mexico.

The CDC reported that there were 58 cases of active TB in Colorado in 2022, up from Colorado Department of Public Health and Environment’s report of 52 cases in 2020. As with New Mexico, these rates were lower than prepandemic numbers of 66 cases in 2019.

As of the 2020 CDPHE report, La Plata County’s last confirmed case of tuberculosis was in 2018. Montezuma County had two cases in 2019 and zero cases in 2020.

CDPHE also noted that the decrease in TB rates from 2020 onward was at least partially influenced by the “under- or misdiagnosis of TB due to … COVID-19, individuals delaying care, a decline in travel to and from endemic areas in 2020, and the employment of successful mitigation strategies to slow the spread of COVID-19 such as masking and social distancing.”

In both Colorado and New Mexico, the highest incidences of tuberculosis infection were in population centers and were more common in ethnic and racial minority groups.

NMDOH stated that people living below the poverty line are up to four times more likely to contract TB. In New Mexico, residents who were born outside the U.S. and Hispanics are at highest risk for TB infection.

Other health conditions also increase the risk of TB infection. Diabetes is considered the strongest risk factor for developing tuberculosis, with 17% of all tuberculosis patients in the U.S. having diabetes. In 2021, 27% of New Mexicans with TB infection also had diabetes.

New Mexico is considered a low-incident state, meaning there are less than 50 active cases confirmed each year. Denison said that even with low infection rates, there is still a need for individual awareness that TB still exists in the state and a need for providers to include TB in their differential diagnosis process.

The goal of the Tuberculosis Program is to eradicate the disease from the state through education, treatment and assistance for medical providers. The program provides treatment and nurse case management of all active TB cases in the state. Providers who treat LTBI cases may call NMDOH for consultation as well.

“Eliminating TB relies on the dedicated efforts of clinicians, health care agencies, and community organizations, especially those aiding vulnerable populations,” said DOH Deputy Secretary Dr. Laura Parajon in a news release. “It is essential that we continue strengthening awareness, testing, and treatment of latent TB infection among providers and groups at high risk to make a lasting impact.”

The department’s “Think TB” campaign reminds providers to always consider TB when diagnosing patients with respiratory symptoms and persistent coughs. According to NMDOH, “an estimated 80% of U.S. TB cases are believed to be the result of longstanding, untreated LTBI.” Identifying LTBI early can prevent the infection from developing into active, more severe cases of TB.

Symptoms of TB include a persistent cough, unintentional weight loss, night sweats, fever, chills, bloody sputum and unexplained tiredness. Denison said these symptoms tend to persist for a longer period of time than can be explained by common illnesses or may return after initial treatment.

If someone is suspects they might have TB, Denison said it is important to seek medical care as soon as possible and begin employing the same precautions used to prevent the spread of COVID-19, such as wearing a mask, washing hands frequently and staying away from vulnerable populations like children, elderly and immuno-compromised individuals.