1. speeding the decline in disease incidence and moving toward elimination of the disease by focusing on targeted skin testing and treatment of latent infection;

  2. developing additional diagnostic, treatment, and vaccination tools;

  3. increasing U.S. involvement in efforts to eliminate tuberculosis worldwide; and

  4. mobilizing public support and measuring progress toward the goal of tuberculosis elimination.

The strategy emphasizes the importance of early diagnosis of latent tuberculosis infection and active tuberculosis, especially among immigrants from countries with a high-prevalence of the disease. It also stresses appropriate treatment of latent tuberculosis infection with the use of directly observed therapy, when indicated, to ensure the completion of treatment.

Although workers’ risk of tuberculosis is not explicitly discussed in the earlier IOM report, the success of a national tuberculosis elimination strategy would clearly benefit health care and other workers. Eliminating a hazard is much more effective than trying to control exposure to it a known or suspected danger.

Eliminating Tuberculosis Worldwide

With more than 40 percent of the tuberculosis cases in the United States involving people born in other countries, policymakers and public health authorities cannot ignore the global problem of tuberculosis. As noted above, a key recommendation of the recent IOM report on tuberculosis elimination in the United States was that this country should “expand and strengthen its role in global tuberculosis control efforts” (IOM, 2000, p. 11). Another recommendation was that those applying for immigration visas from countries with high rates of tuberculosis be tested for tuberculosis and that those with positive tests be evaluated and, if indicated, treated before being issued a permanent residency card.

Eliminating tuberculosis in the United States is a challenge that pales beside the challenge of eliminating tuberculosis worldwide. According to the World Health Organization (WHO), approximately one-third of the world’s population is infected with M. tuberculosis (WHO, 1996, 2000b). Each year about 8 million people are newly diagnosed with the disease, and about 95 percent of these people live in developing countries (WHO, 1996, 2000b). Worldwide, tuberculosis kills about 2 million people yearly. It accounts for more deaths among adults than AIDS, malaria, and all other infectious diseases combined.

In 1993, the WHO declared a global tuberculosis emergency, and it has stated that “poorly managed TB programmes are threatening to make



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