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

Notable Events in TB Control
rifamycins have come into use. Short-course
therapy has been further abbreviated to a
standard of 6 months’ duration by adding
pyrazinamide during the first 2 months of
treatment. Moreover, the proven efficacy of
intermittent treatment has facilitated the
widespread use of directly observed or
supervised therapy (“DOT”) as a means of
improving adherence to treatment and is a
major factor in treatment success.
Unfortunately, drug resistance has become an
additional issue contributing to treatment
problems. Moreover, resistance is increasingly
a problem with the rifamycins (almost
unheard of 25 years ago), and outbreaks and
sporadic cases of multidrug-resistant TB (MDR
TB) represent a major concern for clinicians
and public health officials alike.
Perhaps nowhere has change been more
dramatic than in the area of diagnostics.
Although skin testing is fundamentally
unchanged, the microbiologic approach to TB
diagnosis has been revolutionized by the
application of molecular biologic techniques.
Thus, laboratories are now capable of
obtaining genetic material from small numbers
of tubercle bacilli in
specimens, amplifying or
multiplying that
material, and then
testing the resulting
“soup” for specific
segments of DNA or
RNA that are unique to
TB. Refinements of
these techniques also
permit the identification
of resistant strains in
some cases and the
tracking of outbreaks or
mini-epidemics, and help
us better understand the
epidemiology of the disease as it currently
exists. Such techniques hold the very real
promise of rapid, highly sensitive, and
specific diagnostic tests for TB disease.
Powerful tools indeed!
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Preventive treatment of latent TB infection
still emphasizes the use of INH. However,
because of occasional concerns about resistance
to INH, and also in an effort to reduce the
time required to complete a course of
preventive therapy, other regimens —
particularly those using rifampin — have been
increasingly used and shown to be effective
(though more costly) alternatives to INH.
Although additional studies have documented
the limitations of BCG vaccination, there is
increasing interest, in the US and abroad, that
through the technical developments of recent
years, more effective vaccines are feasible.
Given the worldwide problems I have noted,
application of a truly effective vaccine would
be a logical strategy for dealing with this
disease.
So what has happened in TB in the last 25
years? Lots of change and technologic
development but fundamental challenges
remain. Worldwide the number of cases is
rising and treatment is becoming more
difficult in some regions. In the US, numbers
have declined but current cases often require
more resources and sophistication to treat than
they did even just a few years ago.
History of the IUATLD
by Donald A Enarson, MD
and Annik Rouillon, MD
International Union Against TB and Lung Disease
68 boulevard Saint-Michel, 75006 Paris FRANCE
The International Union Against Tuberculosis
and Lung Disease (known to its members as
“the Union”) is the only international
voluntary organization dealing specifically
with TB. It is very special in terms of its
structure, membership, and diversity of
activities.
Roots of the Union, 1867-1914
TB was presented as a communicable disease
in the first international conference of
medicine specialists convened in Paris in 1867.