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Worst state for women to live in the U. Persons using assistive technology might not be able to fully access information in this file. Type 508 Accommodation and the title of the report in the subject line of e-mail. To view the erratum, please click here. Blumberg, MD, Emory University School of Medicine, Atlanta, Georgia.
The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. TB, TB disease, and infectious TB disease are used. LTBI is used to designate a condition in which an individual is infected with Mycobacterium tuberculosis but does not currently have active disease.
Such patients are at risk for progressing to tuberculosis disease. The TB resurgence was attributable to the expansion of HIV infection, nosocomial transmission of M. TB, and increasing immigration from counties with a high incidence of TB. Decision makers also realized that the U. The development of optimal strategies to guide continuing efforts in TB control depends on understanding the challenges confronting the effort. Once a disease that predominately affected U. Approaches to contact investigations vary widely from program to program, and traditional investigative methods are not well adapted to certain populations at high risk.
Persistent social problems such as crowding in homeless shelters and detention facilities are contributing factors to the upsurge in TB outbreaks. The majority of jurisdictions lack the expertise and resources needed to conduct surveillance for TB outbreaks and to respond effectively when they occur. This pool of persons with latent infection is continually supplemented by immigration from areas of the world with a high incidence of TB and by ongoing person-to-person transmission among certain populations at high risk. Detecting a TB case, curing a person with TB, and protecting contacts of such persons requires that clinicians and the staff members of public health agencies responsible for TB have specific expertise. However, as TB becomes less common, maintaining such expertise throughout the loosely coordinated TB-control system is challenging. Further improvements in the control and prevention of TB in the United States will require a continued strong public health infrastructure and involvement of a range of health professionals outside the public health sector.