Tuberculosis control: the relevance of classic principles in an era of acquired immunodeficiency syndrome and multidrug resistance.

Abstract

The estimated 64,000 excess cases of tuberculosis which occurred in the United States between 1985 and 1993 (1) are part of a global pandemic (2). Years before industrialized countries started to experience a resurgence in tuberculosis, the had persisted in neglected groups within their own borders and in developing nations (3). With outbreaks of multidrugresistant tuberculosis in the United States, the threat of casual transmission of a highly fatal disease (4, p. 648) led to a renaissance of interest in, and expansion of funding for, tuberculosis epidemiology, studies on the emergence of multidrug-resistant strains, and control programs in the United States. Global tuberculosis control programs, however, remain woefully underfunded (5) and are often poorly structured.