International Journal of Epidemiology 2002;31:894-899
© International Epidemiological Association 2002
Review |
Can tuberculosis be controlled?
Dr TR Frieden, Commissioner of Health, Department of Health, 125 Worth Street, CN28, Room 331, New York, NY 10013, USA. E-mail: tfrieden{at}health.nyc.gov
Background Tuberculosis (TB) is nearly 100% curable. However, the ability of medical and public health interventions to control TB, particularly in developing countries, is often doubted.
Methods We reviewed data for the amenability of TB to control. We considered separately control of deaths, prevalence, rate of infection and incidence.
Results Tuberculosis mortality can be reduced by more than 80% in less than 5 years. The prevalence of TB can be reduced by 30% or more annually; sustained annual decreases of 17% have been documented in a developing country. The TB infection rate can be reduced by 15% annually. In the absence of human immunodeficiency virus (HIV), TB incidence can be decreased by as much as 25% per year and up to 10% annually in developing countries. A high prevalence of untreated HIV infection in the adult population of a developing country will inevitably result in a significant increase in TB incidence despite optimal use of currently available technologies.
Conclusions Tuberculosis can be controlled if appropriate policies are followed, effective clinical and public health management is ensured, and there are committed and co-ordinated efforts from within and outside the health sector. However, in the context of a large epidemic of AIDS, TB incidence will inevitably increase. By 2001, less than 30% of global TB cases were reported to have received effective diagnosis, treatment and monitoring. Rapid expansion of effective TB control services is urgently required, both to avert the continued high burden of morbidity and mortality from TB and because of the HIV pandemic.
Keywords Tuberculosis, short-course chemotherapy, disease control, burden of disease
Accepted 17 January 2002
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