Tuberculosis remains an important infectious disease in the world today. It is the leading infectious cause of death in people older than 5 years and is estimated to cause 6 percent of deaths worldwide.1 In the United States, new cases of tuberculosis steadily declined from the late 1800s until 1984. From 1984 to 1992, tuberculosis cases increased at alarming rates. Factors believed to be responsible for this resurgence of tuberculosis include an increase in the number of homeless persons, the human immunodeficiency virus (HIV) epidemic, drug abuse, increased immigration, the inability of local and state governments to maintain tuberculosis control programs, and the increase of multidrug-resistant tuberculosis.2
From 1993 to 1997, tuberculosis was once again on the decline, primarily due to stronger tuberculosis control programs, which targeted high-risk individuals. During 1997, there was a 7 percent decrease in reported cases compared with 1996, and a 26 percent decrease from 1992, when tuberculosis cases peaked. 3 Tuberculosis remains more common in urban areas. The case rate for foreign-born persons remains four to five times higher than that for US-born persons.3
Continued improvement in tuberculosis control and prevention requires recognition and treatment of high-risk populations ( Tab!e 61-1), continued funding of programs for surveillance and treatment of noncompliant patients, continued basic research into the pathogenesis and immunologic response, and continued development of new pharmacologic agents.23
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