Tuberculosis in San Diego county: a border community perspective.

OBJECTIVES

To describe the epidemiology of active disease caused by Mycobacterium tuberculosis in San Diego County from 1989 to 1993 and to identify the specific subgroups for whom the impact of the disease was most pronounced.

METHOD: The authors reviewed all 1860 reports of verified tuberculosis (TB) cases included in the surveillance database maintained by the San Diego County Health Department's TB Control Program. Data were analyzed by age, gender, ethnicity, nativity, HIV co-infection, 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 whole (22.8%) or the United States (9.9%). The local resurgence of TB was reflected in increasing case counts among specific subpopulations--immigrants from countries with high endemic rates of TB (62.5% of the new cases), U.S.-born members of minority groups, the elderly, and young adult males.

CONCLUSIONS

Tuberculosis cases in San Diego County have increased each year since 1989, with certain population subgroups exhibiting more dramatic increases in case rates than those reported nationally. 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--some of which have already been implemented--will be needed to control the spread of the disease.