Tuberculosis in the Bay Area

Sabin Russell, San Francisco Chronicle, March 25, 2008

Tuberculosis cases in the Bay Area are increasing after a decade of decline, a worrisome change that local public health officials believe is linked to years of eroding financial support for TB control efforts.

In 2007, the number of TB cases in the nine Bay Area counties rose 10 percent over the prior year, while cases statewide dropped 1.9 percent. At a press conference at San Francisco International Airport on Monday, TB control officers attributed the increase to a drop in the resources they have available to prevent the spread of the disease.

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Because the Bay Area has a high level of immigration from Asia, where tuberculosis is endemic, it has long had high rates of tuberculosis compared with other parts of California. With 17.7 cases per 100,000 in its population, San Francisco has one of the highest per capita TB rates in the nation.

Federal tuberculosis funding formulas steer money toward cities with the highest number of cases—such as Los Angeles, with 816 new active cases in 2007—rather than San Francisco, which has a higher rate of TB but a lower number of people with the disease. There were 143 new active cases recorded in San Francisco last year, compared with 120 the year before.

Santa Clara County, which receives no direct CDC funding for TB control, is particularly hard hit by the state budget cuts, and is actively seeking help from the federal government. Health officer Dr. Martin Fenstersheib noted that Santa Clara County has both a high number of TB cases (241) and the third-highest rate of infection (13.4 per 100,000) but lacks the kind of CDC support provided to San Francisco, Los Angeles and San Diego.

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Dr. Robert Benjamin, TB controller for Alameda County, said that state-mandated budget cuts threaten to shut down one of California’s most important weapons against the disease—a test that can be conducted at the state lab in Richmond that has the ability to identify multi-drug resistant TB in 36 hours, rather than the eight weeks it can take using traditional, lower-cost tests.

“The timing of these cuts could not be worse for communicable disease control in general and TB prevention in particular,” he said.

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