The face of tuberculosis (TB) in Texas is global, bi-national, multiracial, multi-cultural and multi-drug resistant. This disease does not discriminate by age or gender. TB is a condition that impacts all Texans, regardless of social standing, political persuasion, education level, religious denomination or income status. The face of TB in Texas is the face of all Texans. In 2008, there were 1,501 TB cases reported to the Texas Department of State Health Services. This is the lowest number of tuberculosis cases reported in Texas in over forty years. Like the rest of the US, Texas has seen a decline in total tuberculosis cases in recent years. In 2008, Texas ranked second out of fifty states and the District of Columbia in the number of TB cases reported. Two of its major metropolitan cities, Houston and Dallas, ranking second and sixth in number of cases US-wide, respectively. Most of the TB cases reported in Texas in 2008 were male and the majority were Hispanic and African American. Tuberculosis in Texas is disproportionately represented by racial and ethnic minorities. The racial breakdown of the citizens of Texas is about 48% nonHispanic Whites, 11% African Americans and 37% Hispanics. In contrast, 14.9% of tuberculosis cases were non-Hispanics Whites, 22.1% were African Americans, 11.6% were Asian and 50.5% were Hispanics. In 1995, only 28% of the TB cases reported in Texas were born outside the United States. Looking at 2008, 48.6% of the 1,501 Texas TB cases were born outside the United States. The overall decline in tuberculosis cases has occurred primarily in the US born population. Immigrants from other countries frequently bring the endemic rates of tuberculosis from their homeland. There were 56 countries represented among the foreign born persons with TB reported in Texas. Of the 773 foreign born TB cases, 49.0% reported Mexico as their country of origin, 7.8% reported Vietnam, 6.1% reported Honduras, 4.0% reported India. 3.4% reported Philippines, 3.2% reported El Salvador, 2.7% reported Guatemala, and 1.9% reported Ethiopia. In Texas, TB cases are found primarily in the state’s major metropolitan areas and its fourteen border counties. In 2008, the large urban areas of the state and several counties along its border with Mexico continued to report the greatest percentage of the state’s TB cases. The majority of TB cases reported in Texas came from its five major population centers. These counties and their corresponding largest cities were Harris County (Houston), Dallas