Maryland is a high-incidence state for tuberculosis (TB) with a five-year average (2019-2023) of 183 cases annually. Excluding 2020 (impacted by COVID-19) the five-year annual average is 195 (2018-2023).The incidence rate consistently remains above the overall US rate at 3.3 per 100,000 (2023) compared to the national rate of 2.9. Over the past five years, there have been fluctuations in incidence rate ranging from 2.4 to 3.3 per 100,000 likely due to the COVID-19 pandemic.
While TB occurs across the state, 56% of cases in 2023 occurred in just two high morbidity jurisdictions. Shifting demographics of the region has resulted in an increase in cases in formerly low and medium jurisdictions around the DC and Baltimore metropolitan areas. In recent years there has also been a shift among HIV-TB coinfected individuals (6.8% five-year average, 2019-2023) from US-born African Americans to non-US-born individuals (77% five-year average, 2019-2023). Lastly, in 2023, Maryland reported a total of 201 TB cases. Of those, 20.1% (42/201) had diabetes, 4.5% (9/201) reported heavy alcohol consumption, 4.5% (9/201) reported non-HIV/AIDS immunocompromising conditions, 4.0% (8/201) reported homelessness and 1.5% (3/201) were multi-drug resistant.
This award will support Maryland Department of Health (MDH)’s Center for TB Control and Prevention (CTBCP) efforts through 23 local health department (LHD) programs and Baltimore City to a) prevent transmission of TB from infectious persons to others, b) prevent persons with latent TB infection (LTBI) from progressing to active disease, c) strengthen state public health laboratory capacity, d) increase workforce capacity at state and local health department levels through education and training based on assessment of needs/program evaluation outcomes, and e) leverage current resources through public and private partnerships to ensure ongoing sustainable support for TB elimination efforts statewide.
Similar to many programs nationally, the Maryland Center for TB Control and Prevention continues to face challenges with local health department workforce capacity, medication shortages, and uninsured /underinsured patients who face numerous socioeconomic challenges creating barriers to health care access, challenging local health department staff in efforts to provide quality case management services.
This funding will support CTBCP efforts to improve technical assistance to local programs through increased education/training, continued direct surveillance and epidemiologic support and continued close working relationships with the MDH TB Laboratory. Access to infectious disease consultants with extensive infectious disease expertise in TB will continue as the program implements new treatment regimens and serves increasingly complex patients.
Efforts will continue to strengthen the programs/s technical assistance capacity , in addition to initiating new efforts to improve targeted testing in conjunction with health equity initiatives. Continued partnerships with other MDH programs, the CDC Center of Excellence and local academic centers will continue.
