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BACKGROUND: While reported active tuberculosis (TB) cases reached a record low nationwide in 2013, with a case rate of 3.2 per 100,000, Santa Clara County (SCC) in California had 181 cases with a case rate of 9.8 per 100,000. Of SCC’s 1.8 million people, 37% are foreign-born and an estimated 180,000 have latent TB infection (LTBI). Current Centers for Disease Control and Prevention (CDC) guidelines for TB screening prioritize recent immigrants (in the U.S.≤5 years) and those in the U.S. >5 years who have certain medical risk factors. Given the high burden of TB in SCC, we examined the extent to which these guidelines capture the population of patients who develop active TB.
METHODS: A descriptive epidemiologic analysis was conducted using data from the Report of Verified Case of Tuberculosis (RVCT) and SCC’s Public Health Integrated Health System (PHIHS), a local database used for TB case management. PHIHS collects variables not included on the RVCT. All foreign-born, adult (≥18 years at time of diagnosis), active TB cases reported from 2009—2013 in SCC were included in this analysis. Length of time in the U.S. was calculated by subtracting the date of entry into the U.S. from diagnosis date. Medical and other risk factors included in the analysis were those cited in CDC guidelines.
RESULTS: From 2009—2013, 926 TB cases were reported in SCC, of whom 815 were foreign-born adults; length of time in U.S. could be calculated for 759. Of these 759, 22% (n=165) were recent immigrants with a median age of 32 years at TB diagnosis and 78% (n= 594) were U.S. residents for >5 years at TB diagnosis with a median age of 55 years. Individuals from Vietnam, the Philippines, India, Mexico, and China accounted for 85% (n=671) of TB cases. Among recent immigrants, 28% (n=46) had a documented risk factor and 72% (n=119) had none. Among those residents in the U.S. for >5 years, 43% (n=255) had one or more documented risk factors and 57% (n=339) had none.
CONCLUSIONS: From 2009—2013, more than three-quarters of TB cases in SCC were among foreign-born adults residing in the U.S. > 5 years. More than half of reported TB cases had no documented risk factor for TB based on current CDC guidelines. This analysis suggests that SCC develop TB screening and treatment guidance that include immigrants regardless of medical or other risk factors.