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

In 1947, the PHS organized and supported
mass x-ray screening in communities with
populations greater than 100,000. Over a
period of 6 years more than 20 million people
were examined; the program ended in 1953.
The mobile x-ray
vans continued to be
used in the communities
into the mid-
1960s. It was common
use to show
well-known figures
such as Santa Claus
posing for x-ray
pictures, stimulating
the population’s
compliance with
being tested.
A new era was advancing with the introduction
of TB drugs, resulting in a declining
morbidity. The mainstreaming of TB treatment
to general hospitals and local community
clinics reduced the need for and dependency
on sanatoriums. In 1959 at the Arden House
Conference, sponsored by the National Tuberculosis
Association and the U.S. Public Health
Service, recommendations were made for
mobilizing community resources and applying
the widespread use of chemotherapy as a
public health measure along with other casefinding
activities under the control of public
health authorities. With the natural decline in
disease and the introduction of chemotherapy
in the 1940s and 1950s, TB disease started to
take on a dramatic decline in the United
States. Morbidity declined at a rate of about
5% per year until 1985, when 22,201 cases
were reported in the U.S. for a case rate of 9.3
per 100,000 population. By 1970, only a
handful of sanatoriums still remained in the
United States and by 1992 there were only
four TB hospitals with 420 beds providing
care.
Between 1953 and 1979, along with the declining
morbidity came declining funding from
state, local, and federal agencies responsible for
TB Control at the Millennium
6
TB control. The cutback in TB control programs
across the country left a dismantled and
frail public health infrastructure, too weak to
ward off the emergence of a new epidemic
wave that was brewing. Little did the experts
know that a new illness that was first observed
among gay men in New York City and San
Francisco (HIV/AIDS) would have a dramatic
impact on TB morbidity.
The mid-1980s and early 1990s saw an increase
in TB morbidity. It was not long before the
country started to see TB and HIV
coinfections as well as cases with multidrug
resistance. Facilities with poor or no infection
control measures experienced numerous
nosocomial outbreaks, and there were high
death rates in hospital wards and correctional
facilities throughout the country.
The unprecedented
media coverage of TB,
a disease barely noticed
for more than 20
years, gave rise to
increased funding by
state, local, and federal
agencies for TB
control activities.
With the infusion of
funds came the task of
rebuilding a national
infrastructure to control TB and the introduction
to TB control programs of a concept that
was old, yet new: that of directly observed
therapy (DOT), in which the TB patients
ingest or take their therapy in the presence of
a health care worker.
As the numbers of TB cases continue to
decline in the United States, nearly half of the
new cases reported are occurring in people
who have immigrated to the United States. In
1998, of the 18,361 cases reported in the
United States, 7,591 or 41.3% occurred in
foreign-born persons. Most of these persons
came to the United States from countries
where TB is still endemic (e.g., Mexico, the