Modern tuberculosis control. A six-year follow-up in an Appalacian community.

Abstract

SUMMARy _ This project was conducted over a 6·year period to demonstrate the feasibility of applying modern tuberculosis control methods in a small county in eastern Kentucky. The poverty of the community, the mountainous terrain, and the paucity of health resources all combined to make this rural county a demanding challenge for a university health demonstration team. The approach to the control of tuberculosis in this rural community was planned in 2 steps: (1) identification of all cases of active and suspected tuberculosis in the population by skin testing and radiographs of the entire community and by placing all subjects with definite or suspected disease under therapy; (2) prevention of activation of tuberculosis in those infected but who had no evidence of active disease (normal chest films) by treatment with prophylactic isoniazid, thus preventing the spread of infection to new persons. The effectiveness of these procedures in this rural population was shown by several observations. (1) A total of 92.7 per cent of the total population of the county accepted tuberculin tests either in the schools or at home. (2) A marked increase in the incidence of new active cases of tuberculosis occurred during the course of screening and radiogra.phic examination of the tuberculin reactors. (3) Among the 2,000 susceptible, tuberculin negative children, only 12 instead of the expected 46 became tuberculin reactive in 3.5 years. (4) During a fi-year observation period, 62 new cases of tuberculosis were added to the Tuberculosis Register, 39 from the abnormal chest film group with suspected tuberculosis and 23 newcomers or county residents who returned home after being absent at the time of initial survey. (5) Not a single case of active tuberculosis developed in the target group of 934 persons who received isoniazid prophylaxis because of reactivity to tuberculin, al­ though 6 cases had been expected to occur. (6) In regard to drug taking, 21 per cent of the total group took no drug whatever. The remaining 79 per cent took varying amounts of drugs for as long as one year. Among persons with tuberculosis, approximately one-third did not take drugs; somewhat less of the suspected took drugs. Among the isoniazid prophylaxis target group, 85 per cent took at least some drug; 31 per cent took them for a year or more; 16 per cent, for 6 to 11 months; 11 per cent, for 4 to 5 months; and 27 per cent, for 1 to 3 months. (7) The prophylactic treatment of only 18 persons (1.4 per cent) of the total group was discontinued by clinic physicians because of possible toxic effects. Most persons whose drugs were discontinued by the physicians or who refused to take drugs did so because they considered the taking of drugs too much bother. It is presumed that this record could have been improved had more personnel been available in the course of the study.