Tuberculosis Control in the 21st Century

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´╗┐Tuberculosis Control in the 21st Century
In response to tuberculosis (TB) outbreaks in the United States in the late 1980s and early 1990s, U.S. hospitals spent tremendous resources to ensure a safer workplace. A remarkable decrease in nosocomial transmission resulted, along with a decrease in TB cases nationally. Federal standards have been promulgated to ensure a safer work environment for all U.S. workers potentially exposed to TB. However, these measures may prove costly and burdensome and thus may compromise the ability to deliver care.

A consensus that caring for patients with tuberculosis (TB) posed a risk to health-care workers did not emerge until the 1950s and 1960s, when studies established that Mycobacterium tuberculosis infection was transmitted by the airborne route. However, occupational transmission received little attention until numerous outbreaks of TB and multidrug-resistant tuberculosis (MDRTB) occurred in U.S. and European hospitals in the 1980s and 1990s.

More than 20 health-care workers became ill with MDRTB, and at least 10 died. Hundreds of health-care workers may be latently infected with MDRTB and thus represent a large repository at risk for future reactivation of disease. Thus, although the MDRTB and drug-sensitive TB outbreaks in the United States and Europe have largely been controlled, the consequences of these outbreaks are still being felt. This article reviews current approaches to TB control in hospitals and prospects for improved control.

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