disease. If tuberculosis case rates continue to decline, the maintenance of expertise and vigilance will not be easy.
Ending Neglect laid out a strategy for maintaining long-term vigilance and moving toward the elimination of tuberculosis in the United States. This strategy stresses (1) better methods for identifying people with recently acquired tuberculosis infection, (2) stronger efforts to effectively treat people who could benefit from treatment of infection, (3) research to develop effective vaccines, (4) more active product development initiatives focused on diagnostic and treatment technologies, and (5) research to tackle the problem of patient and provider failure to follow treatment recommendations.
If implemented, many of the recommendations from that IOM report—especially those related to better diagnostic tests and treatments for latent infection—would benefit workplace as well as community-based tuberculosis control programs. Ending Neglect also calls for the United States to increase its support for global tuberculosis control. With more than 40 percent of the tuberculosis cases in the United States (and in health care facilities in particular) involving people born in other countries, policymakers and public health authorities cannot ignore the international aspect of tuberculosis.
In summary, just as the risk of tuberculosis in the workplace is linked to the risk of tuberculosis in the surrounding community, the risk in American communities is affected by that elsewhere in the world and by the migration of infected persons within and across U.S. borders. Effective tuberculosis control measures in the workplace are one element of much broader national and international strategies to prevent and eventually eliminate the disease. The resurgence of the disease in the United States in the mid-1980s and early 1990s and the rise of multidrug-resistant disease demonstrate that tuberculosis remains a threat that public health programs cannot afford to ignore.