A Molecular Epidemiologic Analysis of Tuberculosis Trends in San Francisco, 1991–1997
- Robert M. Jasmer, MD;
- Judith A. Hahn, MA;
- Peter M. Small, MD;
- Charles L. Daley, MD;
- Marcel A. Behr, MD, MSc;
- Andrew R. Moss, PhD;
- Jennifer M. Creasman, MSPH;
- Gisela F. Schecter, MD, MPH;
- E. Antonio Paz, MD; and
- Philip C. Hopewell, MD
- From San Francisco General Hospital Medical Center, the University of California, San Francisco, Francis J. Curry National Tuberculosis Center, and Department of Public Health, San Francisco, California; and Stanford University School of Medicine, Stanford, California.
Abstract
Background: To decrease tuberculosis case rates and cases due to recent infection (clustered cases) in San Francisco, California, tuberculosis control measures were intensified beginning in 1991 by focusing on prevention of Mycobacterium tuberculosis transmission and on the use of preventive therapy.
Objective: To describe trends in rates of tuberculosis cases and clustered cases in San Francisco from 1991 through 1997.
Design: Population-based study.
Setting: San Francisco, California.
Patients: Persons with tuberculosis diagnosed between 1 January 1991 and 31 December 1997.
Measurements: DNA fingerprinting was performed. During sequential 1-year intervals, changes in annual case rates per 100 000 persons for all cases, clustered cases (cases with M. tuberculosis isolates having identical fingerprint patterns), and cases in specific subgroups with high rates of clustering (persons born in the United States and HIV-infected persons) were examined.
Results: Annual tuberculosis case rates peaked at 51.2 cases per 100 000 persons in 1992 and decreased significantly thereafter to 29.8 cases per 100 000 persons in 1997 (P < 0.001). The rate of clustered cases decreased significantly over time in the entire study sample (from 10.4 cases per 100 000 persons in 1991 to 3.8 cases per 100 000 persons in 1997 [P < 0.001]), in persons born in the United States (P < 0.001), and in HIV-infected persons (P = 0.003).
Conclusions: The rates of tuberculosis cases and clustered tuberculosis cases decreased both overall and among persons in high-risk groups. This occurred in a period during which tuberculosis control measures were intensified.
Article and Author Information
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Acknowledgments: The authors thank the personnel of the Division of Tuberculosis Control of the San Francisco Department of Public Health, without whom this study would not have been possible; Cristina Agasino, Sangeeta Rane, and Melvin Javonillo for their assistance with DNA fingerprinting; and the personnel of the San Francisco Department of Public Health Laboratory.
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Grant Support: By grants HL 07185, AI 34238, and AI 35969 from the National Institutes of Health and the American Lung Association.
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Requests for Reprints: Robert M. Jasmer, MD, Division of Pulmonary and Critical Care Medicine, Room K1, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110.
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Current Author Addresses: Drs. Jasmer, Daley, and Hopewell: Division of Pulmonary and Critical Care Medicine, Room K1, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110.
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Ms. Hahn and Dr. Moss: Department of Epidemiology and Biostatistics, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143.
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Dr. Small: Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305.
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Dr. Behr: McGill University Health Centre, Division of Infectious Diseases and Medical Microbiology A5-156, Montreal General Hospital, Montreal, Quebec H3G 1A4, Canada.
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Ms. Creasman and Drs. Schecter and Paz: Francis J. Curry National Tuberculosis Center, 3180 18th Street, San Francisco, CA 94110.
- Copyright ©2004 by the American College of Physicians
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