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India
17.8%
China
15.6%
Philippines
14.8%United
States
9.6%
Vietnam
8.1%
Guatemala
6.7%
Mexico
5.2%
Other
22.2%
PATIENT DEMOGRAPHICS
Similar to previous years, men comprised a majority
of TB cases (64.0%), and the greatest proportion of
TB cases occurred among adults age 65 years and
older (33.8%) (Table 1). In 2016, three cases of TB
occurred in children younger than five years of age
(Table 1).
OVERVIEW
During 2016, 136 tuberculosis (TB) cases were re-
ported to Alameda County (excluding the City of
Berkeley). The 2016 TB case rate in Alameda County
was 9.1 cases per 100,000 residents, a 4% decrease
from the 2015 rate. The 2016 rate ranks third among
all jurisdictions in California and is 71.6% higher than
the California state rate of 5.3 cases per 100,000 resi-
dents. Compared to other Bay Area jurisdictions, the
Alameda County rate ranks lower than San Francisco
(11.6 per 100,000) and higher than Santa Clara (8.3
per 100,000), San Mateo (6.8 per 100,000), Solano
(5.5 per 100,000), and Contra Costa (3.5 per 100,000)
counties.
Figure 2: Incident TB Cases (2016)
by Place of Birth, Alameda County
149
134
156
178
132 136
114 108
139 136
10.5
9.4
10.9
12.3
9.4 9.5
7.9 7.4
9.5 9.1
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2.0
4.0
6.0
8.0
10.0
12.0
14.0
0
20
40
60
80
100
120
140
160
180
200
20
0
7
20
0
8
20
0
9
20
1
0
20
1
1
20
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# Cases Alameda County California U.S.
Figure 1. Tuberculosis Cases and Rate per 100,000
in Alameda County, 2007-2016
The majority of 2016 TB cases (93.4%) occurred among non-White residents (Table 1). Cases occurred most frequently
among Asians/Pacific Islander (72.8%), followed by Hispanic/Latino (14.0%) and Black/African American residents
(5.1%). From 2014 to 2016, White residents in Alameda County had the lowest the average annual case rate of 2.1 per
100,000; rates were ten times higher among Asian/Pacific Islander (21.2 per 100,000), three times higher among Black/
African American (6.8 per 100,000), and two times higher among Hispanic/Latino (4.7 per 100,000) residents.
During 2016, 89.7% of Alameda County TB cases were born outside of the U.S. (Figure 2). The most frequent places
of birth remain China, India, Mexico, Philippines, the U.S., and Vietnam. The 2014-2016 average annual case rate for
cases born outside of the U.S. was 22.3 per 100,000, almost 15 times the rate for cases born in the U.S. (1.5 per
100,000). For cases born outside of the U.S., 65.8% had resided in the U.S for 10 years or more before being diagnosed
with TB. A majority of 2016 cases occurred among Asian/Pacific Islander residents, regardless of place of birth (50.0%
among cases born in the U.S. and 76.2% among cases born outside of the U.S.).
Number of
Cases
(N=136)Percent
Average Case
Rate per
100,000
Sex Males 87 64.0%10.1
Females 49 36.0%7.2
Age Group 0-4 yrs 3 2.2%*
5-14 yrs 1 0.7%*
15-24 yrs 13 9.6%10.7
25-44 yrs 32 23.5%6.9
45-64 yrs 41 30.1%18.5
65+ yrs 46 33.8%23.8
Black / African American 7 5.1%6.8
Asian / Pacific Islander 101 74.3%21.2
Amer Ind / Native AK 0 0.0%*
Hispanic / Latino 19 14.0%4.7
White 9 6.6%2.1
Birthplace United States 13 9.6%1.5
Outside of United States 122 89.7%22.3
Unknown 1 0.7%*
* 2014-2016 rates for categories with <10 cases are unstable and not presented
Race /
Ethnicity
Table 1. Incident TB Cases (2016) and Annual Average Case
Rates per 100,000 (2014-2016), Alameda County
Tuberculosis Fact Sheet
Alameda County 2016
PLACES OF RESIDENCE
The largest proportion of 2016 TB cases oc-
curred among residents of Oakland (30.9%), fol-
lowed by Fremont (18.4%) and Union City
(12.5%). The five-year average TB rate continues
to be highest in Downtown, Uptown and East
Oakland (over twice the five-year county average
of 8.7 per 100,000) (Figure 3).
CLINICAL & LABORATORY CHARACTERISTICS
Of all 2016 TB cases, 80.9% had any pulmonary
involvement and 19.1% were extrapulmonary
only (Table 2). Of all pulmonary cases, a majority
(56.4%) were smear-negative and 73.6% did not
have evidence of cavitary disease on chest radiog-
raphy. Only 2.2% of 2016 TB cases were co-
infected with HIV, a decrease from 3.7%-5.3% in
the previous three years. The most common
comorbidity was diabetes (22.8%). Among TB
cases with any pulmonary disease, a higher pro-
portion of patients with positive smears received
nucleic acid amplification (NAA) testing at diag-
nosis compared to patients with negative smears
(89.1% vs. 29.0%).
DRUG RESISTANCE
Fewer drug resistant isolates were identified dur-
ing 2016 compared to 2015. During 2016, nine
(6.6%) TB cases demonstrated resistance to at
least one first-line TB treatment drug (isoniazid,
rifampin, ethambutol and pyrazinamide). Of
those, six of nine were resistant to isoniazid only.
There were no multi-drug resistant TB cases
(resistant to both isoniazid and rifampin) in Ala-
meda County in 2016, compared to three in 2015.
SUMMARY
P a ge 2 T u b e r c u l o s i s F a c t S h e e t
1000 San Leandro Blvd, First Floor, San Leandro, CA 94577
Phone: (510) 667-3096 | Fax: (510) 273-3916
http://www.acphd.org/tb.aspx
Last updated March 22, 2017
For questions or additional information, contact:
Alameda County Public Health Department
Tuberculosis Control Unit
TB remains an important public health problem in Alameda County. In recent years, California and national TB reports
have estimated that 80%-85% of TB cases occur due to reactivation of latent TB infection (LTBI) rather than recent
transmission. Alameda County cases may reflect this trend: while TB cases continue to be reported among children
younger than five years old (an indicator of recent transmission), the highest rates of disease occur among residents that
are 65 years and older, born outside of the U.S., and have resided in the U.S. for 10 years or more (indicators of LTBI
reactivation). Lastly, although NAA tests are available for TB diagnosis, they are used more often for smear positive
cases. Increased use of diagnostic NAA tests for all cases may lead to earlier diagnosis and reduced TB transmission.
Number
of Cases Percent
Pulmonary only 93 68.4%
Extrapulmonary only 26 19.1%
Both 17 12.5%
Sputum smear Positive 46 41.8%
Negative 62 56.4%
Not done 2 1.8%
Cavitary disease Present 29 26.4%
Absent 81 73.6%
Comorbidities HIV/AIDS 3 2.2%
Diabetic 31 22.8%
End-stage renal disease 6 4.4%
Other immunosuppresion 11 8.1%
Any drug resistance 9 6.6%
INH resistance 6 4.4%
Resistance to INH only 6 4.4%
Multi-drug resistance 0 0.0%
Sputum smear positive (N=46)NAAT performed 41 89.1%
NAAT positive 40 97.6%
Sputum smear negative (N=62)NAAT performed 18 29.0%
NAAT positive 7 38.9%
Drug
resistance
Among cases with any pulmonary disease (N=110)
Site of
disease
Among cases with any pulmonary disease and sputum smear
performed (N=108)
Nucleic Acid
Amplification
Testing
(NAAT)
practice at
diagnosis
Table 2: Clinical and Laboratory Characteristics of TB Cases (2016),
Alameda County
Figure 3: Average Annual TB Rates per 100,000 by Zip Code
(2012-2016), Alameda County