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

cal TB grant programs were established and
funds were utilized to address the two newly
emerging major challenges in TB control:
establishing outpatient TB control services and
designing ways to effectively identify and treat
TB and asymptomatic latent TB infection.
Long before the hospitals all closed, sanatorium
clinicians began lowering the hospitalization
period from the entire treatment period
of 18-24 months gradually down to only the
first 6 months or less. This meant that patients
with uncomplicated TB were treated on an
outpatient basis for up to 18 months. There
literally were no outpatient clinic programs in
most of the country; and in many places,
when patients were discharged to outpatient
care, they had to return frequently to the
sanatorium for outpatient exams and medication
refills. Public health nurses had for years
been doing routine contact investigations in
the field, but most health departments did not
have the outreach staff needed for all these TB
patients suddenly being treated on an outpatient
basis. Acquired drug resistance due to
outpatient treatment lapse became an important
problem. So as TB sanatoria began to
increasingly discharge patients early, health
departments had to provide both the TB
clinics and the follow-up staff needed to ensure
completion of treatment and preventive
therapy. The TB branch consulted with health
departments in this undertaking which included
establishing or improving TB registers
needed to effectively monitor and track TB
treatment and follow-up for TB patients.
INH had been introduced in 1952, but its
prevention possibilities were not realized until
Edith Lincoln in New York noted that children
with primary TB treated with INH had a
much lower incidence of serious TB complications.
She suggested controlled trials to look at
the possibility of using INH as preventive
therapy for TB. Soon, the controlled trials
conducted by TB Research Section staff
(Shirley Ferebee, Carol Palmer, George
Comstock, Lydia Edwards, and others) and
other institutions began demonstrating that
Notable Events in TB Control
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INH could be effectively and inexpensively
used to prevent TB infection from progressing
to disease. In the mid-1960s, the TB Branch
began to promote and fund the implementation
of the “Child-Centered Program,” which
prioritized the screening of school children to
identify TB infection and ensure that identified
children completed a preventive course of
INH. Part of the “Child-Centered Program”
was a concerted effort to conduct “cluster
testing” or follow-up of contacts to children
with TB infection to identify the infecting
“source case” and also to identify other infected
children who may have been exposed to
and infected by the same source case.
In addition to providing health department
categorical funding to help address these
challenges, the TB Control Branch and the
ALA’s American Thoracic Society regularly
updated and widely disseminated guidelines
for the diagnosis, treatment, prevention, and
control of TB.
Almost since its inception, the TB Branch had
collected, analyzed, and reported national
morbidity, hospitalization, and screening data,
and has also provided consultative staff to
support and review TB prevention and control
efforts at the state and local levels. During the
early 1960s, the TB Branch also began working
with health departments to establish the
TB program management reports to evaluate
the effectiveness of TB prevention and control
efforts. Program management reports continue
to be an important component for evaluation
of national, state, and local TB prevention and
control efforts. Don Brown managed this
activity from the early 1960s until the mid-
1990s. A new concept in the type of assistance
provided by the TB Branch was initiated in
the mid-1960s with the assignment of CDC
TB Public Health Advisors to assist health
departments in the operation and evaluation of
TB prevention and control programs. The TB
Branch also began recruiting and assigning TB
Medical Officers to health departments for 2year
periods. These Medical Officers, along
with CDC Public Health Advisors, began