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

Where We’ve Been and
Where We’re Going:
Perspectives from CDC
Early History of the CDC TB Division,
1944 - 1985
by John Seggerson
Associate Dir. for External Relations, DTBE
In 1944, Congress passed the Public Health
Service Act, which authorized grants to the
states for TB control and established the
“Division of Tuberculosis Control,” then
located in Washington, DC. At the time of the
creation of the TB Division, TB drugs were
not available, and the primary method of TB
control was the isolation of persons with
active disease in TB sanatoria where they were
“treated” with healthful living, bed rest,
calorie-laden meals, fresh air, sunshine, and
sometimes with surgery and/or collapsed lung
therapy.
PHS mobile x-ray unit
From the beginning of the 20th century, the
National Tuberculosis Association (later the
American Lung Association), and its state and
local affiliates, played a major role in establishing
and supporting the TB sanatorium movement
in the US. During the post-WW II
period and into the 1950s, TB associations and
health departments employed small-film x-ray
units to conduct TB screening in general
populations, with one x-ray unit often screening
as many as 500 persons per day. The
TB Control at the Millennium
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screening did not effectively cover large city
populations and by 1947, the PHS Division of
TB Control was operating mobile x-ray unit
teams in some 20 cities of more than 100,000
population which participated in this PHS big
city program. By 1953, after some 20 million
people had been x-rayed for TB, the program
was discontinued owing to declining yield and
high cost. Many health department and TB
association community x-ray screening programs
were also discontinued, although some
continued until the late 1960s.
In 1959, a group of nationally recognized TB
experts was convened in Harriman, New
York, to review the status of US TB control,
and they issued the “Arden House Report,”
which recommended the eradication of TB
with effective treatment programs to cure
disease and prevent spread. The Arden House
group also recommended isoniazid treatment
of latent TB infection based on extensive PHS
chemoprophylaxis trials.
In late 1960, the PHS TB program, by then
renamed the “Tuberculosis Branch,” was
transferred from Washington, DC, to Atlanta,
to what was then called the Communicable
Disease Center. The TB research activity
remained in Washington for the time being,
then was also transferred to Atlanta in the
early 1970s.
In the 1960s it became increasingly obvious
that long-term hospitalization of patients with
active TB was no longer necessary because of
the availability of effective chemotherapy, and
the TB Branch began to advocate that patients
receive most or all of their care on an outpatient
basis. The sanatoria began to close,
with most of them being closed by the end of
the 1970s. It has been estimated that the
closing of the sanatoria represented a savings
of more than $400 million to state and local
governments.
In 1963, in response to a special Surgeon
General’s Task Force report on TB, categori-