Tuberculosis in City and County of San Francisco, 2023

The mission of San Francisco Tuberculosis Prevention and Control Program is to control, prevent, and finally eliminate tuberculosis in San Francisco by providing compassionate, equitable, and supportive care of the highest quality to all persons affected by this disease.

In 2023, 69 new cases with active tuberculosis (TB) were reported in San Franciscans (8.1 cases per 100,000 persons). The rate of TB in San Francisco is nearly triple the national rate of 2.9 cases per 100,000 persons, and 1.5 times the California rate of 5.4 cases per 100,000 persons.

**Denominators for computing rates are taken from the California Department of Public Health Tuberculosis Control Branch, the California Department of Finance, E-2 California County Population Estimates and Components of Change by Year.

Demographics

In 2023, San Francisco reported 63 cases among non-U.S.-born residents and an incidence rate of 8.8 cases per 100,000 persons, compared with 6 U.S.- born residents and an incidence rate of 1.3 cases per 100,000 persons. In terms of race/ethnicity, Asian/Pacific Islander residents had the highest TB incidence rate reported (15.9 cases per 100,000 persons), which was nearly 10 times the rate among Non-Hispanic White residents (1.6 cases per 100,000 persons). Incidence rates were 6.5 times higher among Hispanic/Latino residents and more than 3.6 times higher among Non-Hispanic Blacks compared with Non-Hispanic White residents.

Among 69 cases reported in 2023, 40 (58%) were identified in male residents. The median ages in years at time of TB reporting were 63 in 2019, 62 in 2020, 66.5 in 2021, 61 in 2022 and 63.5 in 2023 (range: 24-96 years). One pediatric case (0-14 years old) was reported, and 47.8% of the cases reported were in individuals ages 65 and older.

The country of birth among San Franciscans with TB disease was diversely represented.

Other countries of birth included Burma, Cuba, El Salvador, France, Georgia, Guatemala, India, Indonesia, South Korea, Macau, Nepal, Nicaragua, Nigeria, Pakistan, Peru, Samoa, South Africa, Ukraine, United Kingdom.

Site of Disease

In 2023, 46 cases were pulmonary TB, 14 were extrapulmonary TB, and 9 were both pulmonary and extrapulmonary TB. Extrapulmonary sites included lymph node (cervical, axillary, and mediastinal), bone, joint, spine, eye, and genitourinary system.

Comorbidities and Risk Factors

Two or more medical comorbidities were present in 33 of 69 residents with a reported case of TB. Specifically, 20 cases (29%) had diabetes mellitus, 7 (10%) had viral hepatitis, 4 (5.7%) had chronic kidney disease, and 6 (8.6%) were immunocompromised (HIV and non-HIV).

Mortality

At the time of this publication, there were 9 deaths among San Francisco residents with a case of TB reported in 2023, representing a 13% mortality. One died before TB diagnosis, and 8 deaths were directly related to TB disease.

Drug Resistance to Standard Medications

The proportions of drug resistance remained low. Two cases were mono-resistant to isoniazid, 2 cases were mono-resistant to pyrazinamide, and 1 case was resistant to isoniazid and streptomycin. Three cases of multidrug resistant TB (resistant to isoniazid and rifampin) were reported in 2023.

Incidence Map