CDC History of Tuberculosis Control - Medical and Public Health ...

Lung Dis, 1998). Only 5%-10% of admissions
to our nursing homes are TST positive now.
Perhaps the principal discovery that has come
from these data is that there is a significant
difference in innate resistance to TB infection
between whites and blacks. In addition, study
of our TB case data base from 1976-1997
shows that blacks with active TB are 50%
more likely than whites to be sputum-smear
positive and thus highly infectious.
I am now preparing a paper to show the
important public health implications of such a
difference in TB risk. While health departments
routinely try to identify all close contacts
with infectious cases of TB, a particularly
great effort should be made among the African
American and Native American contacts
because of their greater risk both of infection
and of becoming infectious. It is important
for such reactors to take the full course of
chemoprophylaxis to prevent development of
TB and further spread. This applies especially
to exposures in close living quarters, i.e.,
dormitories, nursing homes, shelters, and
prisons.
It has been an interesting half century. The
best part was the quarter century in public
health in Arkansas from 1973-1998.
Notable Events in TB Control
9
TB Control in New York City:
A Recent History
by Paula I. Fujiwara, MD, and
Thomas R. Frieden, MD, MPH
Current and former Directors of the
NYC TB Control Program
Many of the tenets of modern TB control
were developed more than a century ago in
New York City by Dr. Hermann Biggs, a
physician working for the Department of
Health. These included the policies of free,
high-quality sputum examination, the mandatory
reporting of cases, health department
supervision of isolation and treatment, education
of the public regarding TB, and the
fostering of a social movement for control of
the disease. The City’s TB control program
waxed and waned over the next 100 years,
with the lowest number of reported TB cases
in the city occurring in 1978.
During the 1980s, the rapid rise in TB was
fueled by the human immunodeficiency virus
(HIV) epidemic; growing poverty,
homelessness, and incarceration rates; and
immigration from countries with high TB
prevalence. In this context, the infrastructure
of TB control had been dismantled, the victim
of a one-two knockout punch of a fiscal crisis
in the City and a change to a system of block
grants for federal funding. One long-time
employee, when asked how it felt to see the
increase in cases year after year, said, “We
thought that’s just the way it was.” Staff were
trapped in a cycle of reporting cases, starting
treatment on those they could locate, but
losing many of them. Staff knew they should
be searching for the lost patients but were
distracted by the overwhelming number of
new infectious cases. Citywide, less than half
of the patients completed treatment. Repeated
warnings from experts and panels did not lead
to increased concern or funding.