TB on the rise in Bay Area as funding shrinks
Sabin Russell, Chronicle Medical Writer

Tuesday, March 25, 2008

Tuberculosis cases in the Bay Area are increasing after a decade of decline, a worrisome change that local public health officials believe is linked to years of eroding financial support for TB control efforts.

In 2007, the number of TB cases in the nine Bay Area counties rose 10 percent over the prior year, while cases statewide dropped 1.9 percent. At a press conference at San Francisco International Airport on Monday, TB control officers attributed the increase to a drop in the resources they have available to prevent the spread of the disease.

"It is an issue of funding," said Dr. Masae Kawamura, director of TB control for the San Francisco Department of Public Health. "We've been losing funding for prevention for more than a decade."

She was joined by TB control officers from four other Bay Area counties that also experienced an uptick in cases last year.

Kawamura said Gov. Arnold Schwarzenegger's plan to cut state spending 10 percent across the board will trim the money available for TB surveillance and control by nearly $1 million - a big blow to counties that rely on state grants.

San Francisco won't feel the state pinch as much as most other counties because much of its $2.8 million local TB control efforts are paid for by grants from the federal Centers for Disease Control and Prevention. However, the CDC has been trimming its spending by 25 percent over a five-year period.

As a result of belt-tightening measures at the federal and state level, Kawamura said her own program faces a nearly 8 percent budget cut in the coming year, despite a nearly 20 percent increase in the number of active TB cases diagnosed in the city in 2007.

"We are reaching the breaking point," she said. Prior federal budget cuts have forced the city to scale back its TB control program in Chinatown, in city jails and in the Tenderloin.

Because the Bay Area has a high level of immigration from Asia, where tuberculosis is endemic, it has long had high rates of tuberculosis compared with other parts of California. With 17.7 cases per 100,000 in its population, San Francisco has one of the highest per capita TB rates in the nation.

Federal tuberculosis funding formulas steer money toward cities with the highest number of cases - such as Los Angeles, with 816 new active cases in 2007 - rather than San Francisco, which has a higher rate of TB but a lower number of people with the disease. There were 143 new active cases recorded in San Francisco last year, compared with 120 the year before.

Santa Clara County, which receives no direct CDC funding for TB control, is particularly hard hit by the state budget cuts, and is actively seeking help from the federal government. Health officer Dr. Martin Fenstersheib noted that Santa Clara County has both a high number of TB cases (241) and the third-highest rate of infection (13.4 per 100,000) but lacks the kind of CDC support provided to San Francisco, Los Angeles and San Diego.

"The funding for this epidemic is not keeping pace with the epidemic," he said.

Dr. Charles Crane, medical director of Contra Costa County, also fears that budgetary pressure will harm his TB control efforts.

With 51 cases last year and a new infection rate of 4.9 per 100,000 - almost the same as the rate for the United States as a whole, the county faces less of a problem than other Bay Area jurisdictions. But the combination of state budget cuts and a local financial crisis brought on by pension costs has Crane worried. TB cases have fallen 50 percent since 1998 in Contra Costa County, but rose 2 percent last year. He fears the start of a disturbing and expensive new trend.

"We're losing 25 percent of our staff," he said. "It won't be long before we have an increasing rate of tuberculosis."

Dr. Robert Benjamin, TB controller for Alameda County, said that state-mandated budget cuts threaten to shut down one of California's most important weapons against the disease - a test that can be conducted at the state lab in Richmond that has the ability to identify multi-drug resistant TB in 36 hours, rather than the eight weeks it can take using traditional, lower-cost tests.

"The timing of these cuts could not be worse for communicable disease control in general and TB prevention in particular," he said.

E-mail Sabin Russell at srussell@sfchronicle.com.

This article appeared on page B - 1 of the San Francisco Chronicle

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