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

skin test. All 11 contacts with positive TST
who were on the April flights and 2 of 3
contacts with positive TST on the Baltimoreto-Chicago
flight in May had other risk factors
for tuberculosis. More contacts on the 8.75
hour flight from Chicago to Honolulu had a
positive TST than on the other three flights.
Of 15 contacts with a positive TST on the
Chicago-to-Honolulu flight, six (four with
skin-test conversions) had no other risk
factors; all six sat in the same section as the
index patient. Passengers seated within two
rows of the index patient were more likely to
have a positive TST than those in the rest of
the section. Transmission of M. tuberculosis in
this setting involved a highly infectious
passenger, a long flight, and close proximity of
contacts to the index patient.
The Division of TB Elimination and our
partners in state and local health departments
have benefitted tremendously from what has
been learned from these and other outbreaks.
Our continued cooperation, diligence, and
timely systematic response to future outbreaks
are critical to our eventual success in
eliminating TB from the United States.
International Activities
by Nancy Binkin, MD, MPH,
Chief, International Activity and
Michael Iademarco, MD, MPH
International Activity
As the rate of tuberculosis (TB) cases falls in
the United States (US), an increasing
percentage of TB cases occur among US
residents born in countries with a higher
burden of TB. The US rate of TB cases is
relatively low compared with the rate in 22
high-burden countries where 80% of global TB
cases occur and where 62% of the world’s
population resides. Given the latency period
between TB infection and disease, continued
immigration into the US, and increasing
international travel, efforts to eliminate TB in
the US must extend beyond our geographical
borders. Recognition of the public health
Notable Events in TB Control
65
impact of the global TB epidemic led CDC to
officially organize an International Activity
within the Division of TB Elimination
(DTBE) in 1994 as international efforts are
part of the overall strategic plan of DTBE.
The mission of the International Activity is,
first, to provide leadership and coordination
for CDC activities related to improving TB
prevention and control efforts among foreignborn
persons in the US. Its mission is, second,
to contribute to global TB prevention and
control efforts by conducting operations
research and providing technical support to
high-priority countries, i.e., those that have a
major TB burden or that are of strategic
interest for TB control efforts in the US.
Coordination and collaboration with other
international public health partners are critical
to accomplish our mission.
Immigrants from Mexico, the Philippines, and
Viet Nam are the leading contributors to the
US foreign-born TB case burden and therefore
constitute a high priority for TB control
efforts in the US. The aim of International
Activity efforts in these countries is to reduce
the burden of TB by improving the TB
control capacity of the respective national
programs, by providing technical assistance
and contributing to human resource
development.
Historically
efforts in
Mexico and
the
Philippines
have been
hampered by
ongoing
political and
social changes. More recently, however,
progress has been made.
Mexico
Because of their proximity and our shared
border, persons born in Mexico represent the
single largest group of foreign-born persons in