1. TB Control Program County of San Diego County of San Diego Health and Human Services Agency Tuberculosis Control Branch Trends in Tuberculosis Highlights from 2006

2. TB Case Rates* in San Diego County, California, and the U.S.,1995-2006 Cases per 100,000 *Cases per 100,000. 2006 state and national data are provisional, released March 22, 2007.

3. Reported TB Cases by Age Group San Diego County, 2006 25 - 44 yrs (29%) <15 yrs (10%) 15 - 24 yrs (14%) 45 - 64 yrs (26%) 65+ yrs (22%)

4. TB Case Rates* by Age Group San Diego County, 2006 Cases per 100,000 *Cases per 100,000

5. Reported TB Cases Race/Ethnicity San Diego County vs. U.S. *All races are non-Hispanic. **Other includes American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander and persons reporting two or more races. San Diego, 2006 United States, 2005 White (8%) Black (7%) Hispanic (53%) Asian (31%) Hispanic (29%) Black (28%) Asian (23%) White (18%) Other (2%)

6. Number of TB Cases in U.S.-born vs. Foreign-born Persons San Diego County, 1996-2006 No. of Cases

7. Countries of Birth for Foreign-born Persons with TB, San Diego County vs. United States San Diego, 2006 United States, 2005 China (<1%) India (2%) Philippines (28%) Viet Nam (6%) Mexico (46%) Viet Nam (8%) Philippines (11%) Mexico (25%) Other (44%) China (5%) Other (18%) India (7%)

8. Length of U.S. Residence Prior to TB Diagnosis, San Diego, 2006

9. Completeness of HIV Test Results in Persons with TB by Age Group San Diego County, 1999-2006 All Ages Aged 18-55 % with Test Results

10. Estimated HIV Coinfection in Persons Reported with TB, San Diego County 1999-2006 % Coinfection Note: Minimum estimates based on reported HIV-positive status among all TB cases in the age group.

11. Multidrug-Resistant TB San Diego County, 1999-2006 Multidrug-resistant TB (MDR TB) defined as resistant to at least isoniazid and rifampin.

12. Anti-TB Drug Resistance San Diego County, 1999-2006 % Resistant Isoniazid resistance defined as resistant to isoniazid, susceptible to rifampin but may be resistant to other drugs. MDR TB defined as resistant to at least isoniazid and rifampin.

13. Mycobacterium bovis Modes of transmission: –Most common: consumption of unpasteurized dairy products –Other: person-to-person via inhalation of aerosolized organisms Uniformly resistant to pyrazinamide

14. Mycobacterium bovis San Diego County, 2004-2006 87 (11%) of 782 culture-proven TB cases 85 (98%) were Hispanic 51 (59%) born outside US (all Mexico) 17 (20%) coinfected with HIV 22 (25%) were children less than 15 years old 39 (45%) had only extrapulmonary site

15. Pediatric TB and Mycobacterium bovis San Diego County, 2004-2006 22 of 33 children <15 years old with culture-proven TB had M. bovis –14 had cervical lymphadenopathy – 3 had pulmonary TB (2 also had peritoneal TB) – 2 had disseminated disease – 2 had TB meningitis – 1 had bone/joint TB 21 of 22 were US-born Hispanic children

16. Mode of Treatment Administration in Persons Reported with TB San Diego County, 1993-2005 Directly observed therapy (DOT); Self-administered therapy (SA)

17. Completion of TB Therapy San Diego County, 1998-2004 *Healthy People 2010 target: 90% completed in 1 yr or less. Percentage *

18. Summary TB in San Diego County, 2006 Since 2001, case count and rate fairly stable More than 2/3 of cases occur in persons born outside the U.S. Approximately 10% of cases occur in persons coinfected with HIV 1-2% of cases are multidrug-resistant Approximately 10% of culture-proven cases identified as M. bovis >95% of patients treated with DOT At least 90% of patients complete treatment