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

Yokoe DS, Sharnprapai S, Nardell E, McCray
E, and Platt R. Emerging Infectious Diseases
1999; 5:788-791). Administrative data sets
provided useful information in both studies.
To assist health departments, State Medicaid
Agencies, and managed care organizations in
the development of written agreements to
ensure the provision of quality patient care
and public health TB prevention and control
practice, DTBE has collaborated with the
Office of Health Care Partnerships of the
Epidemiology Program Office, CDC, and
with the George Washington University
Medical Center’s Center for Health Policy
Research to develop model contract specifications.
(Refer to the article “Tuberculosis
control in a changing health care system:
Model contract specifications for managed
care organizations.” Miller B, Rosenbaum S,
Stange PV, Solomon SL, and Castro KG.
Clin Infect Dis 1998;27:677-686.) These
specifications can be accessed on the internet
at the following website: http://
www.gwu.edu/~chsrp.
Early Research Activities of the TB
Control Division
By George W. Comstock, MD, DrPH, FACE
Alumni Centennial Professor of Epidemiology
Johns Hopkins University
School of Hygiene and Public Health
Herman E. Hilleboe was the first Chief of the
Tuberculosis Control Division of the United
States Public Health Service, with Carroll E.
Palmer as director of the Field Studies Section,
the unit responsible for most of the
Division’s research. This review is based
largely on perusal of the 70 Tuberculosis
Control Issues, published during the first week
of every month as special issues of Public
Health Reports. This arrangement continued
from March 1, 1946, to December 7, 1951,
when Public Health Reports changed to a
monthly schedule.
Notable Events in TB Control
49
The Student Nurse Study was initiated by
Palmer, and was supported by the National
Tuberculosis Association until the foundation
of the Tuberculosis Control Division. During
the period from 1943 to 1949, some 22,000
student nurses in 76 schools were given tuberculin
tests every six months by a specially
trained team. On one of these occasions,
approximately 10,000 nurses were also given
chest radiographs. Comparison of skin test and
radiographic findings showed that many
pulmonary calcifications were due to histoplasmosis,
that histoplasmosis was concentrated in
certain areas of this country, and that many
positive tuberculin reactions were due to
nontuberculous mycobacteria.
Confirmation of these results came from a
research unit established in 1945 in Kansas
City, Missouri, to study the epidemiology of
histoplasmosis. Two little-known findings
deserve emphasis. In two midwestern counties,
there was remarkable local variability in the
frequency of histoplasmin reactions among
cattle. Farms with histoplasmin-positive cattle
were interspersed irregularly among those with
no reactors. (This marked small-area variability
was later found in Maryland among high
school students, suggesting that risk factors for
endemic and outbreak histoplasmosis are
different.)
Studies of tuberculin, histoplasmin, and various
nontuberculous mycobacterial antigens reached
their peak with the testing of more than a
million US Navy recruits from 1958 to 1969. A
detailed report of the results of the first halfmillion
tests delineated the extent of these
infections in cities, counties, and states. Other
important findings were as follows: a) in any
area with nontuberculous mycobacterial
infections, the larger the tuberculin reaction,
the greater the probability that its cause was
tubercle bacilli; b) the risk of developing TB
after infection was high among underweight
persons and low among the obese; c) there was
a suggestion that nontuberculous mycobacterial
infections conferred some resistance against