Tuberculosis cases in the Negev 1978-1987: Ethnicity, sex, and age

Background: The incidence of tuberculosis (TB) in Sub-Sahara Africa is considered to be one of the highest in the world. During the past decade thousands of Jewish refugees from Ethiopia were settled in the Negev and might constitute a potential reservoir of infection for the indigenous populations. This study provides some baseline information about TB in the Negev just prior to and after an Ethiopian immigration peak. Methods: The files of every case of TB diagnosed during the decade 1978-1987 at Soroka Medical Center were reviewed and each diagnosis was validated by rigorous clinical and microbiological criteria. The age, gender, and ethnic background of each case were recorded, and approximate population denominators were estimated from Ministry of Health and Census data. Annual and decade incidence rates were then calculated for the different demographic categories. Results: 279 cases of TB were verified. The main 10-year incidence rate per 10,000 Israeli Jews was 0.28; for the Negev Beduins it was 1.52; for the Ethiopian Jews, 91.9. In the Jewish population, cases among males (59) far exceeded those among females (7), but the reverse was observed, both among the Beduins (47 female and 31 male cases) and the Ethiopian immigrants (79 female and 56 male cases). In all three groups TB incidence increased with age, ranging from 0.03 per 10,000 for young non-Ethiopian Jews to a remarkable 623.8 per 10,000 for elderly Ethiopian Jews. Conclusions: The results of this study indicate the existence of a potentially large TB reservoir in the Negev. Health workers must be alerted to the importance of continued case finding, effective case management, and the control of infection transmission. The unique integration of the Negev Health Delivery System should help monitor intervention strategies.