An epidemiological method to improve tuberculosis control.

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An account is given of the prevalence, incidence and decline of tuberculosis in Scotland with particular regard to the West. It is concluded that there is still considerable morbidity from the disease as measured by a persisting annual attack rate of post-primary tuberculosis of 1 per thousand in Mantoux positive (5 to 20 mm. and exclusive of larger reactors) male and female schoolchildren aged 14 to 15 years with negative chest radiographs 1 year previously. It is predicted that in 1975 there may still be 160 deaths and 927 new notifications of tuberculosis in Scotland, 460 of which could be detected by the mass radiography service. A predictive epidemetric model is described whereby the annual radiological surveillance of 18,596 older residents of Paisley would be tested over two years in relation to tuberculin status at initial examination, as a method of intervening in the intergenerational cycle of infection. If resources are available it is considered that the model is feasible and should be implemented without delay if the present epidemiological situation, particularly in regard to the attack rate in schoolchildren, is unchanged over the next 2 years. If the model should prove successful then mass radiography resources could concentrate on the annual or bi-annual prophylactic radiological surveillance of older urban populations with positive reactions to tuberculin testing at or just before the critical age for change in tuberculin reactivity.