Abstract
Every year, approximately 2 million persons in India develop tuberculosis (TB), accounting for one fourth of the world's new TB cases. Organized TB control activities have existed in India for 40 years; however, the quality of diagnosis and treatment of TB in the public and private sectors has been variable, and TB incidence and prevalence trends have not changed substantially over this time. In 1992, the Indian government established a Revised National Tuberculosis Control Programme (RNTCP) using the directly observed treatment, short-course (DOTS) strategy recommended by the World Health Organization (WHO) (3). The DOTS strategy consists of sustained government commitment, effective laboratory-based diagnosis, standard treatment given under direct observation, secure drug supply, and systematic monitoring and evaluation. RNTCP was implemented in pilot areas beginning in 1993; large-scale implementation of the program began in late 1998. This report summarizes the process, outcomes, and challenges of RNTCP in India. RNTCP has implemented DOTS rapidly and has yielded positive results in TB control; however, continued commitment from Indian government authorities and the international community is needed to sustain and expand this ongoing program.
Highlights
CHAGAS DISEASE (AMERICAN TRYPANOsomiasis) is caused by the protozoan parasite Trypanosoma cruzi
Chagas disease following solid-organ transplantation has occurred in Latin America, where Chagas disease is endemic, but has not been reported previously in the United States
CDC and the U.S organ transplantation organizations will consider whether to recommend screening of potential donors for T. cruzi infection and, if so, which donors to screen, how to screen, and what to do if the screening tests are positive
Summary
CHAGAS DISEASE (AMERICAN TRYPANOsomiasis) is caused by the protozoan parasite Trypanosoma cruzi. This report describes three cases in the United States of T. cruzi infection associated with transplantation of organs from a single donor. The recipients were treated with nifurtimox provided by the CDC Drug Service, which provides U.S.-licensed physicians with drugs that otherwise would not be available in the United States. Transmission of T. cruzi infection by solid-organ transplantation ( renal transplants) has been reported in Latin America, where serologic screening of organ donors and recipients for antibody to T. cruzi is standard practice. In two instances, both recipients of a kidney from the same donor became infected with T. cruzi.. UNOS, which develops guidelines and policies for organ procurement, will consider whether to recommend screening of potential donors for T. cruzi infection and, if so, which donors to screen, how to screen, and what to do if the screening tests are positive
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