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Scientific Data Documentation

Public Health Laboratory Information System


BACKGROUND INFORMATION

 The Public Health Laboratory Information System (PHLIS) is a PC-
 based software application designed for use in Public Health
 Laboratories for the reporting and analysis of a variety of
 conditions of public health importance which have a significant
 laboratory testing component.  PHLIS provides easy-to-use data
 collection screens, pre-formatted data analysis tools, programmed
 telecommunications functions for transmitting data to CDC and
 state locations, and data management utilities.  Among its
 advantages, PHLIS can import data from existing state-based
 databases and can export data to other state-based statistical,
 mapping or reporting software tools.  Further, PHLIS data is
 maintained in a format compatible with data maintained in the
 State Epidemiologist's office to facilitate communication of the
 data within state health departments.

 PHLIS reports standard demographic data associated with a
 laboratory isolate as well as laboratory test results,
 information about laboratory procedures and outbreak-related
 information.  After removal of personal identifiers, PHLIS will
 transmit data directly to CDC and to other state health
 department offices.  Public use data collected by PHLIS will be
 available through CDC's WONDER system.

 The National Center for Infectious Diseases and the Association
 of State and Territorial Public Health Laboratory Directors began
 developing PHLIS in 1988.  By summer, 1989, nine states were
 participating in a pilot program to report laboratory confirmed
 Salmonella sp. isolates electronically to CDC and to the State
 Epidemiologist.  In addition to salmonellosis, the current
 version of PHLIS reports Campylobacter sp., Mycobacteria sp., and
 Shigella sp. isolates.  As of December 1992, PHLIS was in use in
 over 40 states.  Plans call for the addition of several diseases
 for laboratory-based reporting in 1993.

 PHLIS is menu-driven and designed to be used by novice computer
 users.  HELP is always provided on the computer screen.  A User's
 Guide is available, and the PHLIS Help Desk accepts calls from
 9:00 - 5:00 Eastern Time, Monday through Friday.  Please call the
 Help Desk at 404-639-3365 to request further information about
 PHLIS.
DESCRIPTION

 The PHLIS Mycobacterium sp. file contains data on mycobacteria
 isolated and identified in state public health laboratories.  The
 data are electronically transmitted from the state public health
 laboratories to the National Center for Infectious Diseases,
 Centers for Disease Control and Prevention.  The operation of the
 PHLIS Mycobacterium module is facilitated by agreements between
 CDC and the Association of State and Territorial Public Health
 Laboratory Directors on system content, protocols for formatting
 and transmitting data, and standard case definitions.  Designated
 staff members in each participating agency provide and prepare
 the data for transmission, and designated CDC staff are
 responsible for editing and compilation of data into the
 accompanying tables.  In WONDER, two tables are available, which
 list Mycobacterium species by region of the country, and
 antituberculosis drug susceptibility patterns of M. tuberculosis
 isolates by region of the country.  Line-listed data are not
 available from this file, nor are state-specific data.
INTERPRETIVE INFORMATION

     The PHLIS Mycobacterium module tracks mycobacterial
 isolates, not individual patients or specific cases of
 mycobacterial disease.  Many mycobacteria are commonly isolated
 from the environment (especially water), and may colonize
 normally nonsterile body sites, such as sputum and wounds.  Some
 mycobacterial species are considered nonpathogenic to humans, but
 may contaminate specimens and cultures or may colonize the
 respiratory tract.  Some of these nonpathogenic mycobacteria are
 among the more common species processed in mycobacteriology
 laboratories.  For other nontuberculous mycobacteria
 (mycobacteria other than M. tuberculosis) reported in PHLIS, it
 is not possible to determine if an isolate was obtained from a
 patient with mycobacterial illness, or was simply colonizing a
 nonsterile site.  As an example, studies have demonstrated that
 isolation of M. avium complex from respiratory specimens is
 associated with M. avium pulmonary disease less than 50% of the
 time.
     Since PHLIS tracks isolates rather than persons, multiple
 isolates from the same individual may appear in the dataset.
 Laboratories participating in PHLIS use uniform reporting
 criteria to determine which isolates should be reported, and CDC
 analyzes the data before presentation to eliminate possible
 duplicates.  For species other than M. tuberculosis, the
 following criteria are used as the basis for including multiple
 mycobacterial isolates from the same person in the PHLIS dataset:

     -  isolates that are different species (example:
          M. tuberculosis and M. avium complex isolated from the
          same person)
     -  isolates of the same species that are from different body
          sites (example: isolates of M. avium complex isolated
          from the blood and sputum of the same person)
     -  isolates from the same body site that are identified more
          than three months apart.  For a single body site, only
          one isolate of the same species should be reported per
          three month interval (example: when M. avium complex is
          isolated from sputum in January and February, only the
          January isolate is included; if M. avium complex is
          isolated from sputum in January and May, both isolates
          are included)

     For M. tuberculosis, the same reporting criteria are used.
 However, one additional criterion is used:

     -  isolates from the same body site which change
          susceptibility patterns against first line
          antituberculosis drugs from sensitive to resistant are
          both reported

     The PHLIS system uses a computer program to automatically
 scan records for potential duplicates based on coded patient
 name, age, sex, county of residence, species, and date of
 submission.  Duplicate records which do not meet the above
 criteria are removed from the dataset before tabulations are
 performed and data are uploaded to WONDER.
     Laboratories often receive minimal or incomplete demographic
 and clinical information to accompany specimens or isolates
 submitted for processing.  Although the module asks laboratories
 whether a report represents the first isolation or repeated
 isolation of an organism from the patient, usually this
 information is unknown.   The dataset includes both types of
 isolates except when they are removed after fulfilling
 duplication criteria.  This factor is especially important in
 interpreting M. tuberculosis drug susceptibility data.
     Not all mycobacteria isolated in a state's clinical
 laboratories are forwarded to public health laboratories for
 further identification or susceptibility testing.  Therefore, in
 many states data in PHLIS are likely to provide an incomplete
 picture of all mycobacteria in that state, and are likely to
 provide an incomplete picture of susceptibility patterns of M.
 tuberculosis.  The probability that isolates are submitted to the
 state lab for further study is likely to vary between states.
     Not all states within a geographic region have begun to
 participate in PHLIS.  Thirty eight state laboratories were using
 the Mycobacterium module of the system as of December 1, 1992.
VARIABLES

 Mycobacterium species

 The following mycobacterium species are included in PHLIS:
     M. africanum
     M. asiaticum
     M. avium complex
     M. bovis
     M. chelonae
     M. flavescens
     M. fortuitum
     M. gastri
     M. gordonae
     M. haemophilum
     M. kansasii
     M. leprae
     M. malmoense
     M. marinum
     M. scrofulaceum
     M. shimodei
     M. simiae
     M. szulgai
     M. terrae complex (including M. triviale)
     M. tuberculosis
     M. ulcerans
     M. xenopi

 In addition, unspeciated photochromogens, nonphotochromogens,
 scotochromogens, rapid growers, and unspeciated isolates can be
 separately reported.

 Geographic Region

     Northeast:     Connecticut, Delaware, D.C., Maine, Maryland,
                    Massachusetts, New Hampshire, New Jersey, New
                    York City, New York State, Pennsylvania,
                    Rhode Island, Vermont
     Southeast:     Alabama, Florida, Georgia, Kentucky,
                    Mississippi, North Carolina, Puerto Rico,
                    South Carolina, Tennessee, Virginia, Virgin
                    Islands, West Virginia
     North Central: Illinois, Indiana, Iowa, Michigan, Minnesota,
                    Nebraska, North Dakota, Ohio, South Dakota,
                    Wisconsin
     South Central: Arkansas, Kansas, Louisiana, Missouri,
                    Oklahoma, Texas
     Mountain:      Arizona, Colorado, Idaho, Montana, Nevada,
                    New Mexico, Utah, Wyoming
     Pacific:       Alaska, American Samoa, California, Guam,
                    Hawaii, Northern Marianas, Oregon, Washington

 Drug Susceptibilities of M. tuberculosis isolates
 Results are recorded as:
     Sensitive
     Resistant
     Not tested
     Unknown

     Susceptibilities are listed for the following agents:

     Isoniazid (INH)
     Rifampin (RIF)
     Ethambutol (ETH)
     Pyrazinamide (PZA)
     Streptomycin (STR)
Table 1 (Mycobacterial species)

 November 1992 - April 1993
 Table 1
 Cumulative total of Mycobacterial species identified in state public health
 laboratories by geographic region from November 30, 1992 - April 30, 1993
                                       Region
 Species          NE     SE       NC       SC       MT       PC      Total
 --------------------------------------------------------------------------
 M.avium        \ 648    \ 848    \ 644    \ 802    \135     \  241  \3318
                \19.5%   \25.6%   \19.4%   \24.2%   \4.1%    \  7.3% \
 --------------------------------------------------------------------------
 M.chelonae     \  30    \  76    \  63    \  92    \  8     \  18   \ 287
                \10.5%   \26.5%   \22.0%   \32.1%   \2.8%    \ 6.3%  \
 --------------------------------------------------------------------------
 M.fortuitum    \  28    \ 119    \  98    \ 148    \  7     \  30   \ 430
                \ 6.5%   \27.7%   \22.8%   \34.4%   \1.6%    \ 7.0%  \
 --------------------------------------------------------------------------
 M.gordonae     \ 170    \ 384    \ 497    \ 294    \ 64     \ 147   \1556
                \10.9%   \24.4%   \31.9%   \18.9%   \4.1%    \ 9.4%  \
 --------------------------------------------------------------------------
 M.kansasii     \  34    \  53    \  44    \ 138    \ 10     \   4   \ 283
                \12.0%   \18.7%   \25.5%   \48.8%   \3.5%    \ 1.4%  \
 --------------------------------------------------------------------------
 M.marinum      \  12    \   6    \  18    \  19    \  3     \   1   \  59
                \20.3%   \10.2%   \30.5%   \32.2%   \5.1%    \ 1.7%  \
 --------------------------------------------------------------------------
 M.scrofulaceum \   6    \  42    \   4    \   3    \  2     \   2   \  59
                \10.2%   \71.2%   \ 6.8%   \ 5.1%   \3.4%    \ 3.4%  \
 --------------------------------------------------------------------------
 M.terrae       \  11    \  62    \  28    \  37    \  4     \   4   \ 146
                \ 7.5%   \42.5%   \19.2%   \25.3%   \2.7%    \ 2.7%  \
 --------------------------------------------------------------------------
 M.tuberculosis \ 831    \ 601    \ 346    \ 639    \ 90     \ 443   \2950
                \28.2%   \20.4%   \11.7%   \21.7%   \3.1%    \15.0%  \
 --------------------------------------------------------------------------
 M.xenopi       \  26    \   6    \  81    \  16    \  1     \   9   \ 139
                \18.7%   \ 4.3%   \58.3%   \11.5%   \ <1%    \ 6.5%  \
 --------------------------------------------------------------------------
 TOTAL*         \1813    \2231    \1837    \2276    \332     \ 905   \9394
                \19.3%   \23.7%   \19.6%   \24.2%   \3.5%    \ 9.6%  \
 --------------------------------------------------------------------------
 The first line is the total number of isolates of a given species identified
    within a region.
 The second line is the percent of isolates of a given species identified
    within a region (i.e., number of M. avium in Northeast/total number
    of M. avium).

 Other species:

 Northeast:     M. bovis/BCG (11), M. simiae (2), M. szulgai (3),
                M. vaccae (1);
 Southeast:     M. asiaticum (1), M. bovis/BCG (1), M. flavescens (13),
                M. malmoense (8), M. simiae (3), M. szulgai (8);
 North Cent:    M. bovis/BCG (2), M. flavescens (7), M. simiae (2),
                M. szuglai (3);
 South Cent:    M. asiaticum (11), M. bovis/BCG (5), M. flavescens (9),
                M. malmoense (3), M. simiae (41), M. smegmatis (1),
                M. szulgai (14), M. vaccae (4);
 Mountain:      M. flavescens (5), M. simiae (3);
 Pacific:       M. bovis/BCG (2), M. flavescens (1), M. malmoense (2),
                M. simiae (2).
 *Includes all other mycobacterial species and unknowns.

 April 1993

  Table 1
       Cumulative total of Mycobacterial species identified in state public
         health laboratories by geographic region through April 30, 1993
                                      Region
 Species          NE     SE       NC       SC       MT       PC      Total
 --------------------------------------------------------------------------
 M.avium        \1361    \2678    \1957    \1421    \ 220    \ 407   \ 8035
                \16.9%   \33.3%   \24.4%   \17.6%   \ 2.7%   \ 5.1%  \
 --------------------------------------------------------------------------
 M.chelonae     \  49    \ 245    \ 230    \ 185    \  11    \  22   \  742
                \ 6.6%   \33.0%   \31.0%   \24.9%   \ 1.5%   \ 3.0%  \
 --------------------------------------------------------------------------
 M.fortuitum    \  83    \ 477    \ 292    \ 263    \  13    \  35   \ 1163
                \ 7.1%   \41.0%   \25.1%   \22.6%   \ 1.1%   \ 3.0%  \
 --------------------------------------------------------------------------
 M.gordonae     \ 415    \1248    \1584    \ 557    \ 112    \ 213   \ 4129
                \10.0%   \30.2%   \38.4%   \13.5%   \ 2.7%   \ 5.2%  \
 --------------------------------------------------------------------------
 M.kansasii     \ 101    \ 167    \ 192    \ 214    \  16    \   4   \  694
                \14.6%   \24.1%   \27.7%   \30.8%   \ 2.3%   \  <1%  \
 --------------------------------------------------------------------------
 M.marinum      \  37    \  19    \  55    \  22    \   4    \   4   \  141
                \26.2%   \13.5%   \39.0%   \15.6%   \ 2.8%   \ 2.8%  \
 --------------------------------------------------------------------------
 M.scrofulaceum \  12    \   84   \  23    \  14    \   3    \   6   \  142
                \ 8.5%   \59.2%   \16.2%   \ 9.9%   \ 2.1%   \ 4.2%  \
 --------------------------------------------------------------------------
 M.terrae       \  22    \ 138    \ 102    \  86    \   5    \   5   \  358
                \ 6.1%   \38.5%   \28.5%   \24.0%   \ 1.4%   \ 1.4%  \
 --------------------------------------------------------------------------
 M.tuberculosis \1299    \2299    \1504    \1669    \ 213    \ 603   \ 7587
                \17.1%   \30.3%   \19.8%   \22.0%   \ 2.8%   \ 7.9%  \
 --------------------------------------------------------------------------
 M.xenopi       \  48    \  23    \ 152    \  23    \   2    \   9   \  257
                \18.7%   \ 8.9%   \59.1%   \ 8.9%   \  <1%   \ 3.5%  \
 --------------------------------------------------------------------------
 TOTAL*         \3449    \7528    \6138    \4546    \ 611    \1317   \23589
                \14.6%   \31.9%   \26.0%   \19.3%   \ 2.6%   \ 5.6%  \
 --------------------------------------------------------------------------
 The first line is the total number of isolates of a given species identified
 within a region.
 The second line is the percent of isolates of a given species identified
 within a region (i.e., number of M. avium in Northeast/total number of M.
 avium).

 Other species:

 Northeast:     M.bovis/BCG (13), M.flavescens (1), M.simiae (2),
                M.szulgai (5), M.vaccae (1);
 Southeast:     M.asiaticum (9), M.bovis/BCG (2), M.flavescens (54),
                M.gastri (2), M.malmoense (54), M.simiae (7), M.szulgai (22);
 North Cent:    M.bovis/BCG (7), M.flavescens (21), M.gastri (1),
                M.haemophilum (5), M.simiae (8), M.szuglai (5);
 South Cent:    M.asiaticum (15), M.bovis/BCG (6), M.flavescens (11),
                M.malmoense (3), M.simiae (42), M.smegmatis (1),
                M.szulgai (19), M.vaccae (4);
 Mountain:      M.flavescens (8), M.simiae (3), M.szulgai (1);
 Pacific:       M.bovis/BCG (2), M.flavescens (2), M.malmoense (1),
                M.simiae (3), M.szulgai (1).
 *Includes all other mycobacterial species and unknowns.

 December 1993

   Table 1
     Cumulative total of Mycobacterial species identified in state public
      health laboratories by geographic region through December 31, 1993

                                Region

 Species        NE       SE       NC       SC       MT       PC      Total
 --------------------------------------------------------------------------
 M.avium        \2215    \5517    \2904    \2739    \644     \ 739   \14758
                \15.0%   \37.4%   \19.7%   \18.6%   \ 4.4%   \ 5.0%  \
 --------------------------------------------------------------------------
 M.chelonae     \  80    \ 461    \ 389    \ 360    \ 31     \  60   \ 1381
                \ 5.8%   \33.4%   \28.2%   \26.1%   \ 2.2%   \  4.3% \
 --------------------------------------------------------------------------
 M.fortuitum    \ 152    \ 928    \ 420    \ 459    \ 58     \  97   \ 2114
                \ 7.2%   \43.9%   \19.9%   \ 21.7%  \ 2.7%   \ 4.6%  \
 --------------------------------------------------------------------------
 M.gordonae     \ 750    \2803    \2350    \1131    \ 309    \ 379   \ 7722
                \ 9.7%   \36.3%   \30.4%   \14.7%   \ 4.0%   \ 4.9%  \
 --------------------------------------------------------------------------
 M.kansasii     \ 189    \ 290    \ 283    \ 384    \  47    \  18   \ 1211
                \15.6%   \24.0%   \23.4%   \31.7%   \ 3.9%   \ 1.5%  \
 --------------------------------------------------------------------------
 M.marinum      \  55    \  60    \  79    \  35    \  10    \   7   \  246
                \22.4%   \24.4%   \32.1%   \14.2%   \ 4.1%   \ 2.9%  \
 --------------------------------------------------------------------------
 M.scrofulaceum \  21    \ 201    \  34    \  30    \  19    \  15   \  320
                \ 6.6%   \62.8%   \10.6%   \ 9.4%   \ 5.9%   \ 4.7%  \
 --------------------------------------------------------------------------
 M.terrae       \  37    \ 352    \ 149    \ 163    \  16    \  17   \  734
                \ 5.0%   \48.0%   \20.3%   \22.2%   \ 2.2%   \ 2.3%  \
 --------------------------------------------------------------------------
 M.tuberculosis \2524    \4782    \2383    \2675    \ 596    \1497   \14457
                \17.5%   \33.1%   \16.5%   \18.5%   \ 4.1%   \10.4%  \
 --------------------------------------------------------------------------
 M.xenopi       \  68    \  40    \ 278    \  38    \  12    \  16   \  452
                \15.0%   \ 8.9%   \61.5%   \ 8.4%   \ 2.7%   \ 3.5%  \
 --------------------------------------------------------------------------
 TOTAL*         \6216    \16068   \9476    \8421    \1872    \2998   \45051
                \13.8%   \35.7%   \21.0%   \18.7%   \ 4.1%   \ 6.7%  \
 --------------------------------------------------------------------------


 The first line is the total number of isolates of a given species
 identified within a region.  The second line is the percent of isolates
 of a given species identified within a region (i.e, number of M. avium in
 Northeast/total number of M. avium).  *Includes all other mycobacterial
 species and unknowns.

 Other less commonly reported mycobacterial species:

 Northeast:     M.bovis/BCG (14), M.flavescens (3), M.malmoense (1), M.simiae
                (7), M.szulgai (7), M.vaccae (3);

 Southeast:     M.africanum (2), M. asiaticum (15), M.bovis/BCG (5),
                M.flavescens (111), M.gastri (2), M.haemophilum (13),
                M.malmoense (74), M.simia (15), M.smegmatis (1),
                M.szulgai (35);

 North Cent:    M.bovis/BCG (13), M.flavescens (32), M.gastri (2),
                M.haemophilum (5), M.simiae (10), M.smegmatis (2),
                M.szuglai (16);

 South Cent:    M.asiaticum (18), M.bovis/BCG (12), M.flavescens (13),
                M.gastri (1), M.malmoense (6), M.simiae (49),
                M.smegmatis (3), M.szulgai (24), M.vaccae (4);

 Mountain:      M.bovis/BCG (4), M.flavescens (26), M.haemophilum (1),
                M.simiae (72), M.smegmatis (1), M.szulgai (5);

 Pacific:       M.bovis/BCG (8), M.flavescens (50), M.gastri (1),
                M.malmoense (2), M.simiae (10), M.szulgai (4).

 July 1993 - December 1993

  Table 1

 Cumulative total of Mycobacterial species identified in state public health
 laboratories by geographic region from July 1, 1993 - December 31, 1993

                                Region

 Species        NE       SE       NC       SC       MT       PC      Total
 --------------------------------------------------------------------------
 M.avium        \ 649    \1999    \ 770    \1266    \ 346    \ 239   \5269
                \12.3%   \37.9%   \14.6%   \24.0%   \ 6.6%   \ 4.5%  \
 --------------------------------------------------------------------------
 M.chelonae     \  21    \ 153    \ 115    \ 163    \  15    \  26   \ 493
                \ 4.3%   \31.0%   \23.3%   \33.1%   \ 3.0%   \ 5.3%  \
 --------------------------------------------------------------------------
 M.fortuitum    \ 58     \ 344    \ 105    \ 179    \  35    \  49   \ 770
                \ 7.5%   \44.7%   \13.6%   \23.2%   \ 4.5%   \ 6.4%  \
 --------------------------------------------------------------------------
 M.gordonae     \ 246    \1219    \ 598    \ 490    \ 149    \ 107   \2809
                \ 8.8%   \43.4%   \21.3%   \17.4%   \ 5.3%   \ 3.8%  \
 --------------------------------------------------------------------------
 M.kansasii     \  71    \  94    \  69    \ 170    \  25    \   9   \ 438
                \16.2%   \21.5%   \15.8%   \38.8%   \ 5.7%   \ 2.1%  \
 --------------------------------------------------------------------------
 M.marinum      \  12    \  31    \  10    \  10    \   5    \   1   \  69
                \17.4%   \44.9%   \14.5%   \14.5%   \ 7.2%   \ 1.4%  \
 --------------------------------------------------------------------------
 M.scrofulaceum \   5    \  82    \  11    \  13    \  10    \   8   \ 129
                \3.9%    \63.6%   \ 8.5%   \10.1%   \ 7.8%   \ 6.2%  \
 --------------------------------------------------------------------------
 M.terrae       \  10    \ 152    \  39    \  68    \   9    \  11   \ 289
                \ 3.5%   \52.6%   \13.5%   \23.5%   \ 3.1%   \ 3.8%  \
 --------------------------------------------------------------------------
 M.tuberculosis \ 953    \2309    \ 721    \ 968    \ 343    \ 722   \6016
                \15.8%   \38.4%   \12.0%   \16.1%   \ 5.7%   \12.0%  \
 --------------------------------------------------------------------------
 M.xenopi       \  14    \  16    \  96    \  12    \  10    \   6   \ 154
                \ 9.1%   \10.4%   \62.3%   \ 7.8%   \ 6.5%   \ 3.9%  \
 --------------------------------------------------------------------------
 TOTAL*         \2070    \6648    \2600    \ 3440   \1031    \1275   \17064
                \12.1%   \39.0%   \15.2%   \20.2%   \ 6.0%   \ 7.5%  \
 --------------------------------------------------------------------------
 The first line is the total number of isolates of a given species identified
 within a region.  The second line is the percent of isolates of a given
 species identified within a region (i.e., number of M. avium in
 Northeast/total number of M. avium).

 *Includes all other mycobacterial species and unknowns.


 Other species:

 Northeast:     M.bovis/BCG (1), M.simiae (2), M.szulgai (1), M.vaccae (1);
 Southeast:     M.africanum (1), M.asiaticum (4), M.bovis/BCG (3),
                M.flavescens (33), M.haemophilum (8), M.malmoense (14),
                M.simiae (7), M.smegmatis (1), M.szulgai (10);
 North Cent:    M.bovis/BCG (6), M.flavescens (11), M.gastri (1),
                M.simiae (2), M.smegmatis (1), M.szuglai (10);
 South Cent:    M.asiaticum (2), M.bovis/BCG (6), M.flavescens (2),
                M.gastri (1), M.malmoense (3), M.simiae (7), M.smegmatis (2),
                M.szulgai (6);
 Mountain:      M.bovis/BCG (3), M.flavescens (16), M.simiae (46);
                M.smegmatis (1), M.szulgai (3);
 Pacific:       M.bovis/BCG (5), M.flavescens (47), M.gastri (1),
                M.simiae (6), M.szulgai (2);

 March 31, 1994

  Table 1
     Cumulative total of Mycobacterial species identified in state public
       health laboratories by geographic region through March 31, 1994

                                      Region

 Species          NE     SE       NC       SC       MT       PC      Total
 --------------------------------------------------------------------------
 M.avium        \2523    \6646    \3261    \3886    \ 635    \1078   \18029
                \14.0%   \36.9%   \18.1%   \21.6%   \ 3.5%   \ 6.0%  \
 --------------------------------------------------------------------------
 M.chelonae     \  93    \ 618    \ 468    \ 524    \  37    \  94   \ 1834
                \ 5.1%   \33.7%   \25.5%   \28.6%   \ 2.0%   \ 5.1%  \
 --------------------------------------------------------------------------
 M.fortuitum    \ 169    \1087    \ 476    \ 731    \  58    \ 168   \ 2689
                \ 6.3%   \40.4%   \17.7%   \27.2%   \ 2.2%   \ 6.2%  \
 --------------------------------------------------------------------------
 M.gordonae     \ 884    \3409    \2684    \1667    \ 306    \ 561   \ 9511
                \ 9.3%   \35.8%   \28.2%   \17.5%   \ 3.2%   \ 5.9%  \
 --------------------------------------------------------------------------
 M.kansasii     \ 218    \ 351    \ 330    \ 586    \  62    \  23   \ 1570
                \13.9%   \22.4%   \21.0%   \37.3%   \ 3.9%   \ 1.5%  \
 --------------------------------------------------------------------------
 M.marinum      \  63    \  82    \  89    \  48    \  11    \   8   \  301
                \20.9%   \27.2%   \30.0%   \15.9%   \ 3.7%   \ 2.7%  \
 --------------------------------------------------------------------------
 M.scrofulaceum \  26    \ 221    \  42    \  37    \  19    \  21   \  366
                \ 7.1%   \60.4%   \11.5%   \10.1%   \ 5.2%   \ 5.7%  \
 --------------------------------------------------------------------------
 M.terrae       \  44    \ 450    \ 175    \ 195    \  12    \  35   \  911
                \ 4.8%   \49.4%   \19.2%   \21.4%   \ 1.3%   \ 3.8%  \
 --------------------------------------------------------------------------
 M.tuberculosis \2765    \5681    \2731    \3920    \ 627    \2031   \17755
                \15.6%   \32.0%   \15.4%   \22.1%   \ 3.5%   \11.4%  \
 --------------------------------------------------------------------------
 M.xenopi       \  75    \  57    \ 318    \  56    \   9    \  34   \  549
                \13.7%   \10.4%   \57.9%   \10.2%   \ 1.6%   \ 6.2%  \
 --------------------------------------------------------------------------
 TOTAL*         \6958    \19127   \10749   \12547   \1883    \4266   \55530
                \12.5%   \34.4%   \19.4%   \22.6%   \ 3.4%   \ 7.7%  \
 --------------------------------------------------------------------------


 The first line is the total number of isolates of a given species
 identified within a region.  The second line is the percent of isolates of
 a given species identified within a region (i.e., number of M. avium in
 Northeast/total number of M. avium).  *Includes all other mycobacterial
 species and unknowns.

 Other less commonly reported mycobacterial species:

 Northeast:     M.bovis/BCG (17), M.flavescens (3), M.malmoense (1),
                M.simiae (7), M.szulgai (8), M.vaccae (3);

 Southeast:     M.africanum (3), M. asiaticum (16), M.bovis/BCG (8),
                M.flavescens (126), M.gastri (2), M.haemophilum (13),
                M.malmoense (77), M.simiae (15), M.smegmatis (1), M.szulgai
                (45);

 North Cent:    M.bovis/BCG (15), M.flavescens (36), M.gastri (2),
                M.haemophilum (5), M.simiae (11), M.smegmatis (2),
                M.szuglai (21), M.vaccae (1);

 South Cent:    M.asiaticum (26), M.bovis/BCG (20), M.flavescens (25),
                M.gastri (1), M.haemophilum (1), M.malmoense (12), M.simiae
                (132), M.smegmatis (4), M.szulgai (35), M.vaccae (18);

 Mountain:      M.asiaticum (1), M.bovis/BCG (4), M.flavescens (32),
                M.haemophilum (3), M.simiae (47), M.smegmatis (1),
                M.szulgai (6);

 Pacific:       M.bovis/BCG (10), M.flavescens (93), M.gastri (1),
                M.malmoense (2), M.simiae (19), M.szulgai (7).

 October 1, 1993 - March 31, 1994

  Table 1

 Cumulative total of Mycobacterial species identified in state public health
 laboratories by geographic region from October 1, 1993 - March 31, 1994

                                      Region

 Species          NE     SE       NC       SC       MT       PC      Total
 --------------------------------------------------------------------------
 M.avium        \ 701    \1991    \ 772    \1427    \ 264    \ 407   \5562
                \12.6%   \35.8%   \13.9%   \25.7%   \ 4.7%   \ 7.3%  \
 --------------------------------------------------------------------------
 M.chelonae     \  25    \ 165    \ 121    \ 219    \  18    \  38   \ 586
                \ 4.3%   \28.2%   \20.6%   \37.4%   \ 3.1%   \ 6.5%  \
 --------------------------------------------------------------------------
 M.fortuitum    \  57    \ 308    \ 109    \ 316    \  27    \  74   \ 891
                \ 6.4%   \34.5%   \12.2%   \35.5%   \ 3.0%   \ 8.3%  \
 --------------------------------------------------------------------------
 M.gordonae     \ 287    \1059    \ 665    \ 684    \ 120    \ 215   \3030
                \ 9.5%   \35.0%   \21.9%   \22.6%   \ 4.0%   \ 7.1%  \
 --------------------------------------------------------------------------
 M.kansasii     \  75    \ 109    \  88    \ 235    \  34    \   7   \ 548
                \13.7%   \19.9%   \16.1%   \42.9%   \ 6.2%   \ 1.3%  \
 --------------------------------------------------------------------------
 M.marinum      \  12    \  41    \  14    \  14    \   6    \   1   \  88
                \13.6%   \46.6%   \15.9%   \15.9%   \ 6.8%   \ 1.1%  \
 --------------------------------------------------------------------------
 M.scrofulaceum \   8    \  46    \  16    \  11    \   6    \   7   \  94
                \ 8.5%   \48.9%   \17.0%   \11.7%   \ 6.4%   \ 7.4%  \
 --------------------------------------------------------------------------
 M.terrae       \  13    \ 167    \  40    \  57    \   4    \  20   \ 301
                \ 4.3%   \55.5%   \13.3%   \18.9%   \ 1.3%   \ 6.6%  \
 --------------------------------------------------------------------------
 M.tuberculosis \ 756    \1922    \ 752    \1502    \ 283    \ 898   \6113
                \12.4%   \31.4%   \12.3%   \24.6%   \ 4.6%   \14.7%  \
 --------------------------------------------------------------------------
 M.xenopi       \  15    \  25    \  87    \  20    \   5    \  18   \ 170
                \ 8.8%   \14.7%   \51.2%   \11.8%   \ 2.9%   \10.6%  \
 --------------------------------------------------------------------------
 TOTAL*         \1974    \5973    \2725    \5048    \ 813    \1788   \18321
                \10.8%   \32.6%   \14.9%   \27.6%   \ 4.4%   \ 9.8%  \
 --------------------------------------------------------------------------
 The first line is the total number of isolates of a given species identified
    within a region.
 The second line is the percent of isolates of a given species identified
    within a region (i.e., number of M. avium in Northeast/total number
    of M. avium).

 *Includes all other mycobacterial species and unknowns.

 Other species:

 Northeast:     M.bovis/BCG (5), M.szulgai (1);
 Southeast:     M.africanum (1), M.asiaticum (5), M.bovis/BCG (3),
                M.flavescens (21), M.malmoense (9), M.simiae (4), M.szulgai
                (14);
 North Cent:    M.bovis/BCG (8), M.flavescens (9), M.gastri (1), M.simiae
                (2), M.smegmatis (1), M.szuglai (10), M.vaccae (1);
 South Cent:    M.asiaticum (9), M.bovis/BCG (11), M.flavescens (13),
                M.haemophilum (1), M.malmoense (9), M.simiae (84),
                M.smegmatis (1), M.szulgai (12), M.vaccae (14);
 Mountain:      M.asiaticum (1), M.bovis/BCG (1), M.flavescens (15),
                M.haemophilum (2), M.simiae (16); M.smegmatis (1), M.szulgai
                (3);
 Pacific:       M.bovis/BCG (2), M.flavescens (54), M.simiae (10), M.szulgai
                (4);
Table 2 (M. tuberculosis Drug Susceptibilities)

 November 1992 - April 1993

                      M. tuberculosis Drug Susceptibilities
                   Public Health Laboratory Information System
             Cumulative total from November 30, 1992 - April 30, 1993


           INH         RIF         ETH         PZA          STR
 Region  T     %R   T     %R     T    %R    T     %R      T     %R

  NE    559  10.9   559   5.7   544   1.1   319   2.8    559    7.0
  SE    217   7.4   218   2.8   218   1.4     2     0    217    3.7
  NC    259  10.8   259   4.2   259   1.9    11  18.2    257    3.5
  SC    548   9.9   547   7.5   548   4.0   141   7.8    547   10.8
  MT     73  15.1    73   9.6    73   4.1    15     0     73    6.8
  PC    368  12.5   369   4.9   366   3.6    42   2.4    354    8.8
 TOT   2024  10.7  2025   5.7  2008   2.6   530   4.3   2007    7.5


 Number of strains INH and RIF resistant:

 Northeast       22
 Southeast        6
 North Central    9
 South Central   31
 Mountain         6
 Pacific         17
 Total           91

   T = Number tested
  %R = Percent of tested strains found to be resistant
 INH = Isoniazid
 RIF = Rifampin
 ETH = Ethambutol
 PZA = Pyrazinamide
 STR = Streptomycin

 April 1993

 Table 2
                     M. tuberculosis Drug Susceptibilities
                   Public Health Laboratory Information System
                     Cumulative total through April 30, 1993


          INH          RIF      ETH         PZA          STR
 Region  T   %R     T   %R    T    %R     T    %R      T   %R

  NE   952  10.4   949  5.5   935  1.0   479   3.1    952  5.6
  SE  1371  10.0  1371  5.1  1371  1.2   236   3.0   1370  3.6
  NC  1222   8.9  1203  5.7  1198  2.8    28  10.7   1201  5.2
  SC  1466  10.9  1465  7.0  1465  3.8   462   6.7   1464  9.9
  MT   178  12.4   178  4.5   178  1.7    54   5.6    178  5.6
  PC   510  12.0   511  4.7   508  3.9    85   1.2    470  8.3
 TOT  5699  10.1  5677  5.7  5655  2.5  1344   4.5   5635  6.4


 Number of strains INH and RIF resistant:

 Northeast       41
 Southeast       59
 North Central   44
 South Central   86
 Mountain         7
 Pacific         23
 Total          260

   T = Number tested
  %R = Percent of tested strains found to be resistant
 INH = Isoniazid
 RIF = Rifampin
 ETH = Ethambutol
 PZA = Pyrazinamide
 STR = Streptomycin

 December 1993

  Table 2
        M. tuberculosis Drug Susceptibilities
        Public Health Laboratory Information System
        Cumulative total through December 31, 1993


            INH           RIF           ETH            PZA          STR
 Region  T     %R      T     %R      T      %R      T     %R      TT    %R

    NE  2008  11.2%   2011   5.9%   1983    1.0%   1023   3.8%   2011    5.2%
    SE  3395   7.4%   3394   3.6%   3394    1.0%   1390   1.5%   3393    3.4%
    NC  1965   8.3%   1946   5.1%   1935    2.5%     43  14.0%   1940    4.9%
    SC  2315   9.0%   2312   5.7%   2310    2.9%    748   5.2%   2312    7.1%
    MT   517  11.0%    517   4.8%    517    0.6%    237   0.8%    517    7.0%
    PC  1291  12.7%   1291   4.8%   1287    3.0%    420   2.4%   1219    8.5%
 TOTAL 11491   9.3%  11471   4.9%  11426    1.8%   3861   3.0%  11392    5.5%


 Number of strains INH and RIF resistant:

 Northeast       97
 Southeast       91
 North Central   67
 South Central  111
 Mountain        22
 Pacific         49
 Total  437

  T = Number tested
 %R = Percent of tested strains found to be resistant
 INH = Isoniazid
 RIF = Rifampin
 ETH = Ethambutol
 PZA = Pyrazinamide
 STR = Streptomycin

 July 1993 - December 1993

  Table 2
        M. tuberculosis Drug Susceptibilities
        Public Health Laboratory Information System
        Cumulative total from July 1, 1993 - December 31, 1993


            INH           RIF           ETH           PZA            STR
 Region   T    %R       T    %R       T     %R      T     %R      TT     %R

    NE   849  12.4%    854   6.3%    839   1.2%    449   4.7%    853    5.2%
    SE  1696   6.3%   1699   3.2%   1698   0.8%   1129   1.3%   1698    3.2%
    NC   614   7.3%    614   5.0%    609   2.1%     15  20.0%    609    5.1%
    SC   814   7.7%    812   3.8%    810   1.4%    279   3.2%    813    2.5%
    MT   298  10.1%    298   5.0%    298   0.0%    171   0.0%    298    6.7%
    PC   624  13.8%    623   5.9%    622   2.4%    289   3.1%    594    8.9%
 TOTAL  4895   8.9%   4900   4.6%   4876   1.3%   2332   2.4%   4865    4.6%


 Number of strains INH and RIF resistant:

 Northeast       45
 Southeast       35
 North Central   21
 South Central   26
 Mountain        13
 Pacific         24
 Total          164

   T = Number tested
  %R = Percent of tested strains found to be resistant
 INH = Isoniazid
 RIF = Rifampin
 ETH = Ethambutol
 PZA = Pyrazinamide
 STR = Streptomycin

 March 31, 1994

                      M. tuberculosis Drug Susceptibilities
                   Public Health Laboratory Information System
                    Cumulative total through March 31, 1994


            INH            RIF           ETH         PZA            STR
 Region   T     %R       T    %R       T   %R      T     %R      T      %R

    NE   2225  11.8%   2228  6.3%    2201  1.1%   1137   4.1%   2228    5.3%
    SE   4119   7.2%   4120  3.6%    4120  1.1%   1654   1.6%   4118    3.4%
    NC   2267   8.7%   2248  5.2%    2231  2.6%     69  11.6%   2237    5.4%
    SC   3506  10.0%   3500  6.6%    3492  2.7%    954   5.5%   2837    9.4%
    MT    535  12.1%    535  5.8%     535  1.1%    213   0.9%    535    7.5%
    PC   1792  12.3%   1792  4.6%    1788  3.1%    701   2.6%   1709    9.2%
 TOTAL  14444   9.7%  14423  5.2%   14367  2.0%   4728   3.2%  13664    6.2%


 Number of strains INH and RIF resistant:

 Northeast      117
 Southeast      115
 North Central   76
 South Central  182
 Mountain        28
 Pacific         62
 Total          580

   T = Number tested
  %R = Percent of tested strains found to be resistant
 INH = Isoniazid
 RIF = Rifampin
 ETH = Ethambutol
 PZA = Pyrazinamide
 STR = Streptomycin

 October 1, 1993 - March 31, 1994

  Table 2
                      M. tuberculosis Drug Susceptibilities
                   Public Health Laboratory Information System
               Cumulative total from October 1, 1993 - March 31, 1994


            INH           RIF           ETH           PZA         STR
 Region   T    %R       T    %R       T     %R      T   %R      T     %R

    NE   648  16.7%    652  10.0%    649   1.8%    339  7.7%    652   6.0%
    SE  1382   6.2%   1384   3.5%   1382   1.4%    669  1.9%   1383   3.2%
    NC   656   9.9%    656   5.5%    647   3.1%     34  8.8%    647   7.0%
    SC  1399  11.6%   1396   8.0%   1390   2.3%    302  4.6%    733  15.3%
    MT   235  11.1%    235   6.0%    235   1.3%    123  0.0%    235   5.5%
    PC   809  12.7%    808   5.2%    808   2.8%    335  2.7%    780   9.0%
 TOTAL  5129  10.7%   5131   6.2%   5111   2.2%   1802  3.6%   4430   7.3%


 Number of strains INH and RIF resistant:

 Northeast       59
 Southeast       37
 North Central   24
 South Central   82
 Mountain        13
 Pacific         24
 Total          239

   T = Number tested
  %R = Percent of tested strains found to be resistant
 INH = Isoniazid
 RIF = Rifampin
 ETH = Ethambutol
 PZA = Pyrazinamide
 STR = Streptomycin




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