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  • The United States contribute to global tuberculosis control efforts through targeted use of financial, technical, and human resources and research, all guided by a carefully considered strategic plan.

  • The United States work in close coordination with other government and international agencies. In particular, the United States should continue its active role in and support of the Stop TB Initiative.

  • The U.S. Agency for International Development (AID), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) should jointly develop and publish strategic plans to guide U.S. involvement in global tuberculosis control efforts.

  • GLOBAL CONTEXT OF TUBERCULOSIS

    Even from the perspective of a developed country, such as the United States, it is increasingly clear that tuberculosis must be viewed in a global context to have a full understanding of the epidemiology of the disease and to develop effective strategies for its control. In the United States, as well as in other countries in which the incidence of tuberculosis is low (less than 25 cases per 100,000 population per year), increasing proportions of the new cases are occurring among individuals born in countries with a high incidence of tuberculosis. Although it is frequently stated that tuberculosis has undergone a resurgence in industrialized countries, at least in part it would be more accurate to view the increases that occurred in the late 1980s and early 1990s as a consequence of shifting global patterns of the disease. No longer are populations and the diseases prevalent within them forced by circumstances to remain in the countries or areas where they originate. Diseases such as tuberculosis are not constrained by national boundaries any more than people are constrained by national boundaries. Thus, in addition to the factors that influence rates of disease in a given country, the global distribution of tuberculosis is also influenced by the factors that determine the movements of populations in general. This is true for at least two reasons. First, in many areas of the world the majority of adults, not just a small subgroup, have latent tuberculosis infection. Second, tuberculosis infection causes no symptoms and results in no alteration in activities; consequently, movement is not limited.

    A number of the factors that have been identified as predispositions to the emergence of “new” pathogens have also influenced the spread of tuberculosis (Stephens et al., 1998). Population movements within and between countries both shift persons from high- to low-incidence coun



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