TUBERCULOSIS IN SAN-DIEGO COUNTY - A BORDER COMMUNITY PERSPECTIVE

Objectives. To describe the epidemiology of active disease caused by M ycobacterium tuberculosis in San Diego County from 1989 to 1993 and to identify the specific subgroups for whom the impact of the disease wa s most pronounced. Method. The authors reviewed all 1860 reports of ve rified tuberculosis (TB) cases included in the surveillance database m aintained by the San Diego County Health Department's TB Control Progr am. Data were analyzed by age, gender, ethnicity, nativity, HIV co-inf ection, major site of infection, and drug resistance. Results. Between 1989 and 1993, San Diego County witnessed a greater increase (77.7%) in the number of incident TB cases than the state of California as a w hole (22.8%) or the United States (9.9%). The local resurgence of TB w as reflected in increasing case counts among specific subpopulations-i mmigrants from countries with high endemic rates of TB (62.5% of the n ew cases), U.S.-born members of minority groups, the elderly, and youn g adult males. Conclusions. Tuberculosis cases in San Diego County hav e increased each year since 1989, with certain population subgroups ex hibiting more dramatic increases in case rates than those reported nat ionally. San Diego County is one of the principal entry points for the western United States and a popular travel destination. These factors have led to a dramatic increase in the incidence of TB in the county. A range of tailored surveillance, treatment, and control strategies-s ome of which have already been implemented-will be needed to control t he spread of the disease.