By Mike Swift
Mercury News
Posted: 03/24/2009 06:52:49 AM PDT
Published: 03/25/2009
The number of tuberculosis cases dropped in Santa Clara County and much of the Bay Area in 2008, but the region remains a TB hot spot, and public health officials warned Monday that budget cuts and the recession put the region at risk of a surge in the dangerous disease.
Santa Clara County saw the number to TB cases drop to 197 in the 2008 fiscal year, from 241 cases in 2007, according to new data from the California Department of Public Health. But the county had the third-highest TB rate among public health jurisdictions, behind San Francisco and Madera County.
Overall, California's TB rate is the lowest since at least the early 1960s. Bay Area TB officials said they don't know why the number of cases declined last year, but one worrisome possibility is that officials are missing cases in people who have lost health coverage due to the economy. Those people might unknowingly infect others.
"We don't want to be complacent," said Dr. Julie Higashi, the TB control officer for Santa Clara County. "We're worried about people losing their access to health care, so we are just being vigilant."
Overall, California had 2,696 TB cases in 2008 — down 1.1 percent from the previous year, and about half the number of cases in 1992, when the HIV epidemic caused a surge in TB among people infected with both diseases. TB is an airborne bacterial disease that generally attacks the lungs, causing coughing, fever, weight loss and chest pains.
TB an lie latent in a person's body, until a weakening of the immune system such as HIV causes TB to multiply, potentially causing the victim to become highly contagious or die.
The Bay Area has a large reservoir of latent TB infection, partly due to its foreign-born population who might have been exposed to the disease in their home countries. The San Jose metro area had the highest TB rate among the nation's large metropolitan areas in 2007, according to the U.S. Centers for Disease Control and Prevention.
Santa Clara County's rate of 10.9 TB cases per 100,000 people in 2008 was two and a half times higher than the U.S. rate of 4.2 cases. TB continues to be predominantly a disease of immigrants, with 20 cases per 100,000 people for foreign-born Californians, compared to 2.5 cases for the U.S.-born population.
There were fewer TB cases in Santa Clara, San Francisco, Alameda, San Mateo, Marin and Solano counties in 2008, but cases were up 55 percent in Contra Costa County.
"It could be a one-year blip, because our numbers have been going down quite steadily," said Dr. Charles Crane, medical director of Contra Costa's TB program. "But I think the news just wasn't as good as it had been looking."
Despite the overall decline, the Bay Area continues to deal with outbreaks. Alameda County is battling two TB outbreaks, Contra Costa has long been fighting an outbreak among crack cocaine users in Richmond and San Pablo, and San Francisco in the past 18 months has been dealing with a TB outbreak among gay men, several of whom are HIV-positive, who frequented bars in the Castro. The state imposed a 10 percent cut in funding last year, and public health officials worry additional budget cuts could lead to a TB spike.
"While the numbers may be down, the clusters and the outbreaks and the need for staff to do the case-contact investigation doesn't go down with the numbers," said Dr. Robert Benjamin, TB control officer for Alameda County.
Nineteen health jurisdictions had a TB increase in 2008, including several in the Central Valley. Among ethnic groups in California, the highest rate was among Asian/Pacific Islanders, with 22.9 cases per 100,000 people, followed by African-Americans, with 8.7 cases.
A grave threat is that TB strains resistant to antibiotics — some are virtually untreatable with available drugs — are growing more prevalent around the globe, and could migrate here.
While the recent case numbers look good, "buried in that is the risk of complacency and that's the single most dangerous thing that could happen to us," Higashi said.
Contact Mike Swift at (408) 271-3648 or at mswift@mercurynews.com.
While public health officials are happy to see TB rates dropping in many parts of California, they worry budget cuts and the recession could trigger an increase. Here are the public health jurisdictions with the highest TB rates in 2008 . | ||
Jurisdiction |
2008 Rate (cases per 100,000 pop.) |
Change from 2007 |
|---|---|---|
San Francisco | 14.6 | -17.5% |
Madera County | 13.6 | n/a* |
Santa Clara County | 10.9 | -18.7% |
Imperial County | 10.6 | -36.1% |
Long Beach (city) | 9.5 | +20.3% |
Alameda County | 9.3 | -11.4% |
California Department of Public Health
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