While tuberculosis cases in the United States have reached an all-time low, health officials say they still need to work to reduce TB among blacks and immigrants. CDC said yesterday that 15,078 TB cases were reported in 2002, a 5.7 percent drop from 2001. Four states -- California, Texas, New York and Florida -- account for 48 percent of the nation's cases.

CDC said the national TB rate -- 5.2 cases per 100,000 people -- is the lowest recorded in the United States since the start of reporting in 1953. The health officials attributed the decline to a better public health infrastructure and to services to prevent TB's spread.

However, TB rates among blacks are nearly eight times higher than among whites and are twice those of Hispanics, said Dr. Kenneth Castro, CDC's director of the division of TB elimination. "Closing the gap in tuberculosis rates is essential if tuberculosis is to be eliminated in our country," he said.

In 2002, for the first time, foreign-born residents accounted for more than 50 percent of US TB cases. While the TB rate for US natives is 2.8 cases per 100,000 people, the rate for foreign-born persons is 23.6 cases per 100,000.

Of additional concern: TB rates increased slightly in 10 states and showed no change in six, noted Dr. Lee Reichman, executive director of New Jersey Medical School's National TB Center and a past president of the American Lung Association. "These are harbingers that things are not hunky-dory," Reichman said. "TB should be going down. If it's level or it's going up that means we're not doing our job and we can't pat ourselves on the back."

Health officials worry that a lack of attention to TB could prompt a repeat of the mid-1980s, when US TB rates rose dramatically after funding was cut. It took until the early 1990s for state and federal officials to rebuild TB programs and drive rates down again. Now, state budget crunches are forcing health departments to stretch resources, officials say.

The full report, "Trends in Tuberculosis Morbidity -- United States, 1992-2002," is published in Morbidity and Mortality Weekly Report (2003;52(11);217-222).

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