Tuberculosis Cases on Rise in the County : Health: Aggressive measures to curb the disease are started with federal aid. The number of cases is rising at more than three times the national rate.

After at least three decades of decline, San Diego County is experiencing a steady climb in the number of tuberculosis cases, prompting health officers to launch an aggressive new program against the disease.

The number of TB cases in the county is rising by more than three times the national rate, statistics show. Nationally, tuberculosis cases increased 18% from 1985 to 1991, according to the federal Centers for Disease Control in Atlanta. By contrast, the number of cases in San Diego County rose by 64% from 1987 to 1991.

Four hundred cases are expected in San Diego County by year’s end, the largest number of cases since the new TB wave began.

The county’s new tuberculosis screening and treatment program focuses on prisoners, the HIV-infected and other groups that are especially susceptible to the potentially deadly illness.

Using a $485,000 federal grant, by far the largest the county has ever received, the county Health Department will hire three nurses and an outreach worker whose sole job is to screen and treat tuberculosis patients; buy a mobile X-ray unit to serve the homeless and other hard-to-reach groups; equip its laboratory to evaluate TB tests more quickly; and add other services, said physician Kathleen Moser, the county’s tuberculosis control officer.

Health Department officials say they hope the new measures will help reverse an upturn in the disease that began in 1985.

About 10% of the grant will go to fight TB in the county’s seven jails, Moser said, where the airborne disease can spread easily among a population that is more likely to suffer from HIV-infection, drug addiction, poor general health and other conditions that weaken the body against tuberculosis.

Tuberculosis is an airborne bacterial disease that multiplies inside bodily organs and replaces healthy tissue. It usually attacks the lungs, but can get into the brain, kidneys, bone and other areas of the body. The symptoms can include coughing up blood, fever and fatigue. Medication can cure it within six months to two years.

Only about 10% of the people exposed to the bug develop the disease; a healthy immune system usually can fend it off. To test for TB, a protein extracted from the bacteria is injected under the skin of the forearm. If a small bump appears later, the test is positive.

Experts blame TB’s resurgence on the rise of AIDS, which weakens the immune system and gives TB a foothold, and on immigrants arriving with tuberculosis from areas of the world where the disease is more prevalent--especially Mexico, Africa and Southeast Asia.

“TB was always around, but it generally, year by year, was on the wane in this county,” Moser said. “That march toward the end of TB turned around.”

Nationally, 26,283 cases were reported in 1991.

The national statistics also show an alarming rise in TB cases among minorities. From 1985 to 1990, the number of cases rose 27% among blacks and 55% among Latinos, but dropped 7% among whites.

Outbreaks of “multi-drug-resistent tuberculosis” also are occurring much more often, and frequently in HIV-infected patients, the CDC said.

Despite its rise, tuberculosis is still far less of a threat than in 1953 when 84,304 cases were reported and nearly 20,000 people died of the disease. But worldwide, TB remains one of the most prevalent infections, the CDC said, killing 3 million people a year.

“In the mid ‘80s, we projected being able to eliminate tuberculosis (in the U.S.) by 2010, and then we began to see a rise,” said Kay Golan, CDC spokeswoman. “Based on this increase in the problem, the CDC has requested additional funding every year and the Congress has approved it.”

Using that additional money, the county assigned a full-time nurse to the county’s jails this month to develop better ways to sift out high-risk prisoners for testing, test a greater volume of prisoners, and train jail staff to quickly isolate those who are sick.

“We’ve been working for three years to improve the TB screening at the jails, but it’s slow going without a person to take care of it,” Moser said. “This is a great step forward for us because we haven’t had the capability of assigning a person to be liaison with our jail system.”

Up until now the jails have lacked a well-organized system for processing TB patients, as well as personnel dedicated solely to that task, said Rolland Ray, medical services administrator for the county’s jails.

The grant-funded program also will eliminate the need to transport patients from the jail for treatment--which some view as a security risk--and buy computers to track patients after they leave jail to make sure they’re taking their medicine.

“With the decline of TB, jails have dismantled their TB treatment and screening systems,” Ray said. “Now we have to go through a process for restructuring them.”

Although tuberculosis seems like a plague of the past, Ray said, people are entering the county’s jails with advanced cases. On average, the jails have a total of 10 to 15 prisoners sick with TB.

“Most of our crowd hasn’t been able to afford medical care on the outside,” he said. “Usually, when they have TB, they have several other things wrong with them as well.”

Major expenditures from the county’s grant include:

* $50,000 for a nurse practitioner to start a screening, treatment and prevention program for residential drug treatment facilities.

* $70,000 for a mobile X-ray unit and a technician.

* $25,000 for an outreach worker to monitor homeless TB patients or those with other unstable living arrangements. Moser said those patients are often “extremely difficult and need a period of time to be convinced to take their medicine.”

* $60,000 to staff the county TB office with a full-time nurse and clerical workers. In the past, Moser said, patients have had trouble reaching a medical professional when they call the office seeking help.

The grant also will buy computers, X-ray film, laboratory equipment and other supplies, Moser said.

Ethnic Breakdown of San Diego TB Cases

1987 1988 1989 1990 1991 Hispanic 76 76 110 140 183 Asian 89 67 97 100 102 Black 21 14 23 27 35 White 58 49 61 75 70 Other -- 1 3 4 1