TABLE C-1. Tuberculin Surveys in the United States and ARI with M. tuberculosis Calculated from Them

Year of Study

Population (Reference)

Tuberculin*

Calculated ARI (%/year)

1930

New York City, schoolchildren (17)

OT, 10 TU

11.14

1957

Pamlico County, GA, general population (18)

PPD-S, 5 TU

0.25

1957–60

Chicago nursing students (19)

OT, 2 TU

0.75

1958–65

White naval recruits (20)

PPD-S, 5 TU

0.14

1963

Pennsylvania high school students (21)

PPD, 5 TU

0.19

1964–65

Air force recruits (14)

Tine test

0.16

1965–69

First grade children in United States (21)

Probably PPD-S

0.08–0.05

1964–67

CDC surveys at selected sites (22)

PPD, 5 TU

0.16

1971–72

National health survey (HANES) (12)

PPD-S, 5 TU

0.58

1973–74

New York City Board of Education employees (16)

PPD, 5 TU

0.23

1975–79

CDC-reported data from selected sites (1)

Variable

0.20–0.15

1980–81

New York City school children (23)

PPD, 5 TU

0.45

*Tuberculins used for skin testing have included old tuberculin (OT), a crude preparation, and purified protein derivative (PPD), a somewhat purified preparation made from OT. PPD has been made by many manufacturers. PPD-S refers to a single large batch of PPD prepared by Florence Seibert, of which half was deposited as the reference standard against which all other PPDs are standardized and half was given to the U.S. Public Health Service for use in research studies. Tine tests use OT. The dose of tuberculin used for testing is expressed in tuberculin units (TU), which are based upon bioequivalent standardization with PPD-S. The usual dose, for which the largest amount of validation data are available, is 5 TU.

It is evident that ARIs are larger in urban populations—specifically, New York City—than elsewhere. Unfortunately, the available data often are not sufficient to make generalizations with respect to geography nor with respect to such demographic factors as ethnicity or socioeconomic status. Two studies of military recruits allow one to examine race and ethnicity (14, 15). The annual risks of infection calculated from these studies are shown in Table C-2. Data from a single study in New York City school board employees allow one to examine race and ethnicity in the urban setting (16). The calculated ARIs from this study are shown in Table C-3. The ARI calculated for African American and Hispanic military recruits for 1990 was approximately six times that for whites. For Asian recruits the calculated ARI was approximately 36 times that for whites. For New York City, calculation from the 1973 data yielded an ARI for African Americans 8.6 times those in whites and for Puerto Ricans 6.5 times those in whites.



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