Prevention of Tuberculosis in Older Adults in the United States: Obstacles and Opportunities

摘要: An estimated 32% of the world's population, or 1.86 billion people, is infected with Mycobacterium tuberculosis, and >8 million new cases tuberculosis disease occur annually [1]. Older adults (persons ≥65 years age) comprise fastest-growing sector global represent 12% current US a proportion that expected to increase 20% by year 2050 [2]. Molecular studies patients in Florida found compared younger persons, older were significantly less likely be part case cluster; this suggests their was due reactivation latent infection [3]. Some researchers have theorized waning immunity predisposes an increased rate progression from [4], but such declines immunocompetence age not been convincingly demonstrated [5]. Older living long-term care facilities historically had higher rates than those community [4, 6]. In 1984–1985 29 states, incidence 39.2 per 100 000 persons for 21.5 community, 9.2 all groups 1984 [7, 8]. Arkansas at time, occurred 5% [5]. United States, approximately reside 9]. Because resident population risk disease, other residents setting are therefore outbreaks primary consequence transmission source 10]. Tuberculosis particular concern given high mortality group. Hong Kong, reported ranged 4.8% aged 60–69 (compared 0.2% 20–39 up 19.9% ≥80 years; others report 50% [11, 12]. States 1979 1998 alike, death ≥85 10 times as whole [13]. Between 1993 2008, 7% 21% (including 42% facilities) died while receiving therapy [10]. This underscores importance preventing adults. The need predicted rise 8 2000 19 [14]. Although there decreasing successive birth cohorts, prevent particular, will remain important over coming decades [15]. report, we calculate ratios subgroups examine trends time gain clearer understanding factors elucidate potential intervention strategies.