183910 Human tuberculosis from Mycobacterium bovis in Southern California: A reemerging disease of globalization

Monday, October 27, 2008: 3:15 PM

Timothy C. Rodwell, MD, PhD, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Marisa Moore, MD, MPH , County of San Diego, Health and Human Services Agency, and Centers for Disease Control and Prevention, San Diego, CA
Kathleen Moser, MD, MPH , San Diego County Health and Human Services Agency, San Diego, CA
Stephanie K. Brodine, MD , Graduate School of Public Health, San Diego State University, San Diego, CA
Steffanie A. Strathdee, PhD , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
     
Background: The epidemiology of tuberculosis (TB) in the United States (U.S.) is changing as the burden of disease shifts to foreign-born individuals. Mycobacterium bovis, a TB pathogen thought almost eradicated in the U.S., appears to be contributing a growing proportion of the TB burden in some binational communities with strong ties to Mexico. We conducted a retrospective analysis of TB case surveillance data from the San Diego region from 1994 to 2005, to estimate M. bovis trends, identify correlates of disease and evaluate risk factors for treatment mortality.

Methods: We used Poisson regression to evaluate TB incidence trends from 1994 to 2005 (n=3291), and investigated demographic and clinical correlates of M. bovis compared with M. tuberculosis (n=1324), as well as risk factors for treatment mortality (n=1119) from 2001 to 2005.

Results: M. bovis accounted for 45% (62/138) of all culture-positive TB cases in children (<15 years) and 6% (203/3,153) of adult culture-positive cases. M. bovis incidence increased significantly (P=0.002) while M. tuberculosis incidence declined (P<0.001). Almost all M. bovis cases were in individuals of Hispanic ethnicity, and 60% were born in Mexico. From 2001 to 2005, 110 TB cases died before treatment completion. M. bovis cases were 2.55 (P=0.01) times as likely to die as M. tuberculosis cases.

Conclusion: M. bovis TB incidence in San Diego is significant and increasing while M. tuberculosis incidence continues to decline. M. bovis is concentrated in Hispanics of Mexican origin and future prevention and control efforts will require customized strategies and binational collaboration.

Learning Objectives:
1) recognize how tuberculosis epidemiology in Mexico can affect the epidemiology of tuberculosis in the U.S. 2) Identify patients at greatest risk for tuberculosis from Mycobacterium bovis 3) Develop appropriate tuberculosis management goals based on regional tuberculosis epidemiology

Keywords: TB, Emerging Health Issues

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: 1) I have been studying TB from M. bovis since 1997 2) I am an MD with a PhD in disease ecology and MPH in epidemiology 3) I have been studying M. bovis TB in California for over 2 years
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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