effective methodologies for the identification of persons with recently acquired tuberculosis infection, especially persons exposed to patients with new cases of tuberculosis, be developed and efforts be increased to evaluate appropriately and treat latent infection in all persons who meet the criteria for treatment for such infections.

Recommendation 4.2 To prevent the development of tuberculosis among individuals with latent tuberculosis infection, the committee recommends that

• Tuberculin skin testing be required as part of the medical evaluation for immigrant visa applicants from countries with high rates of tuberculosis, a Class B4 immigration waiver designation be created for persons with normal chest radiographs and positive tuberculin skin tests, and all tuberculin-positive Class B immigrants be required to undergo an evaluation for tuberculosis and, when indicated, complete an approved course of treatment for latent infection before receiving a permanent residency card (“green card”). Implementation should be in a step wise fashion, and pilot programs should evaluate strategies and assess costs.

• Tuberculin testing be required of all inmates of correctional facilities and completion of an approved course of treatment, when indicated, be required, with referral to the appropriate public health agency for all inmates released before completion of treatment.

• Programs of targeted tuberculin skin testing and treatment of latent infection be increased for high-incidence groups, such as HlV-infected individuals, undocumented immigrants, homeless individuals, and intravenous drug abusers, as determined by local epidemiological circumstances.

Recommendation 5.1 To advance the development of tuberculosis vaccines, the committee recommends that the plans outlined in the Blueprint for Tuberculosis Vaccine Development, published by NIH [National Institutes of Health] in 1998, be fully implemented.

Recommendation 5.2 To advance the development of diagnostic tests and new drugs for both latent infection and active disease, action plans should be developed and implemented. CDC should then exploit its expertise in population-based research to evaluate and define the role of promising products.

Recommendation 5.3 To promote better understanding of patient and provider nonadherence with tuberculosis treatment recommendations and guidelines, a plan for a behavioral and social science research agenda should be developed and implemented.