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Index

A

Acid-fast smears (AFB), see Sputum testing Action Plan to Combat Multidrug Resistant Tuberculosis , 143 Advisory Council for the Elimination of Tuberculosis , 43, 117, 123, 143, 205 strategic national plan, viii, 14, 44-45, 53-54, 88, 143, 175 Advocacy, xi, 12, 42, 68, 69, 82, 155, 159, 165, 166, 189 see also Social mobilization Africa, 13, 35, 198, 235, 236-237, 240-241 Agency for International Development, 10, 11, 123, 142, 146, 150, 153, 156, 157 AIDS, 2, 9, 34-35, 43, 45, 69, 101, 124, 125, 142, 187, 199, 202, 227 contact investigation, 102, 104, 105, 111-115 (passim), 117 global effects, 151 historical perspectives, 27, 34 incidence, 34-35 latent tuberculosis infections, 19 multidrug-resistant tuberculosis, 34 patient education, 62, 64 social mobilization, 161 tuberculin skin testing, 9, 18, 34, 35, 43, 87 tuberculosis treatment, 19, 34, 35, 43 American Academy of Pediatrics, 161 American Lung Association (ALA), 27, 110, 161, 162-163, 165, 188 American Public Health Association, 162 American Thoracic Society (ATS), 58, 59, 88, 93, 96, 110, 143, 161, 162, 213, 220, 226 American Tuberculosis Association, 161 Amikacin, 244 Arden House Conference Report, 14 Association of Laboratory Directors (ALD), 221, 223, 226 Association of Practitioners of Infection Control, 203 Association of State and Territorial Public Health Laboratory Directors, 221, 228 Atlanta, Georgia, 184-185

B

Bacille Cameta Guerin (BCG), 18, 106, 129-130 Behavioral factors, 10, 64, 123 drug abusers, ix, 9, 33, 64-65, 102, 105, 112, 123, 132, 190, 197 drug treatment adherence and nonadherence, 10, 20, 39, 56, 65, 66, 78-79, 88, 102, 106-107, 114, 123, 130-131, 192, 203


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Page 257 Index A Acid-fast smears (AFB), see Sputum testing Action Plan to Combat Multidrug Resistant Tuberculosis , 143 Advisory Council for the Elimination of Tuberculosis , 43, 117, 123, 143, 205 strategic national plan, viii, 14, 44-45, 53-54, 88, 143, 175 Advocacy, xi, 12, 42, 68, 69, 82, 155, 159, 165, 166, 189 see also Social mobilization Africa, 13, 35, 198, 235, 236-237, 240-241 Agency for International Development, 10, 11, 123, 142, 146, 150, 153, 156, 157 AIDS, 2, 9, 34-35, 43, 45, 69, 101, 124, 125, 142, 187, 199, 202, 227 contact investigation, 102, 104, 105, 111-115 (passim), 117 global effects, 151 historical perspectives, 27, 34 incidence, 34-35 latent tuberculosis infections, 19 multidrug-resistant tuberculosis, 34 patient education, 62, 64 social mobilization, 161 tuberculin skin testing, 9, 18, 34, 35, 43, 87 tuberculosis treatment, 19, 34, 35, 43 American Academy of Pediatrics, 161 American Lung Association (ALA), 27, 110, 161, 162-163, 165, 188 American Public Health Association, 162 American Thoracic Society (ATS), 58, 59, 88, 93, 96, 110, 143, 161, 162, 213, 220, 226 American Tuberculosis Association, 161 Amikacin, 244 Arden House Conference Report, 14 Association of Laboratory Directors (ALD), 221, 223, 226 Association of Practitioners of Infection Control, 203 Association of State and Territorial Public Health Laboratory Directors, 221, 228 Atlanta, Georgia, 184-185 B Bacille Cameta Guerin (BCG), 18, 106, 129-130 Behavioral factors, 10, 64, 123 drug abusers, ix, 9, 33, 64-65, 102, 105, 112, 123, 132, 190, 197 drug treatment adherence and nonadherence, 10, 20, 39, 56, 65, 66, 78-79, 88, 102, 106-107, 114, 123, 130-131, 192, 203

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Page 258 completion rates, 46 enablers, 19-20, 77-78, 161 incentives programs, 20, 41, 48, 64, 66-67, 76, 78, 144, 161, 197 social and cultural factors, 10, 20, 39, 64-65, 123, 130-131 see also Directly observed therapy; Mandated completion of therapy health belief model, 64; see also Social and cultural factors Block grants, 36-37, 186 Blueprint for Tuberculosis Vaccine Development, 10, 123, 143-144 Bolivia, 237 Bosnia, 98, 198, 203 Boston, Massachusetts, 188-190 Bovine tuberculosis, 13, 25 Budgetary factors, see Funding C California, 31, 33, 37, 40, 70, 72-73, 154-155, 161-162 Cancer patients, 18 Capreomycin, 244 Case management, ix, 6, 55, 67-68 health departments, 7, 19-20, 52, 55-56, 59, 60-61, 189, 192, 196, 199-200, 201-202 patient-centered treatment, 5, 6, 17, 19-20, 30, 51, 77-79, 189 private sector, 55, 199-200 professional training, 60-61 site visits, 189, 192, 196, 199-200, 201-202 standardized, 6, 52, 58, 59 state government role, 7, 52, 77-79 see also Contacts and contact investigation ; Directly observed therapy ; Managed care; Mandated completion of therapy Categorical grants, vii, xi, 2, 6, 7, 14, 36-37, 52, 68-69, 167, 182-183, 186, 192, 194, 197 Centers for Disease Control and Prevention (CDC) , viii, x, 55, 56, 58, 59, 88, 134, 136, 143, 145, 173 adherence to drug regime, 106 community health centers, 81-82 contact investigation, 101, 106, 109, 111, 113, 114 drug testing, 123 funding, 10, 14, 36, 37, 69, 81-82, 134, 182-183, 186, 190, 197 high performance liquid chromatography, 211 historical perspectives, 25 immigrants, 3, 8, 93, 94-95 information management systems, 67 international efforts, 11, 123, 150, 153, 154; see also “immigrants” supra laboratories, 67, 71, 75, 223, 224, 227-228 managed care, model contracts, 75 population-based research, 10 professional training, 60-61, 223, 227-228 program standards, 6, 52, 65-66, 76 protocols and action plans, 7, 52, 58, 59 Public Health Prevention Service, 182, 183 regionalization of interventions, 71 research budget, 10, 134 site visits, summaries, 182-185, 186, 188, 190, 197, 202 social mobilization, 12, 159-160, 161, 164, 165 strategic national plan, viii, 44-45, 61, 143, 164 vaccine research, 205-206 see also Advisory Council for the Elimination of Tuberculosis Chest radiographs, see Radiographs Children, 20, 81, 124, 129, 132, 163 American Academy of Pediatrics, 161 contact investigation, 38, 102, 103, 110, 112, 116, 117, 119 immigrant, 38, 106 school-based screening, 97, 117 China, 31, 240 Christmas Seal Campaign, 161 Clinical interventions, general, ix, 56-57, 58-59, 184, 189, 201-202 latent tuberculosis, 18 multistate initiatives, 7, 52 performance standards, x, 2, 6, 65-66, 68 see also Drug treatment; Laboratories Clinical Laboratories Improvement Amendment, 219-220, 222, 223 College of American Pathologists, 220 Colorado, 79 Community health centers, 61, 70, 73, 80-82, 190

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Page 259 Confidentiality, 46, 100, 137 contact investigation, 106, 116 Contacts and contact investigation, 8, 9, 20, 37, 57, 86-87, 88, 101-117, 198 AIDS patients, 102, 104, 105, 111-115 (passim), 117 CDC role, 101, 106, 109, 111, 113, 114 children, 38, 102, 103, 110, 112, 116, 117, 119 confidentiality, 106, 116 costs, 103, 104, 116 cultural factors, 88, 104, 112-113, 115, 116 drug treatment for contacts, 89, 102, 106-107, 114, 117 funding, 103, 107-108, 113, 183, 198 health departments, 102, 103-108, 114, 116 immigrants, 102, 106, 111 incidence and, 103, 107-108, 114 multidrug-resistant tuberculosis, 102 patient education and, 112-113 private providers, 108-110 professional education for, 103, 106, 109-110, 111-112, 116 skin testing, 103, 106, 113, 114 standards, 110-111, 112 state government, 105, 107-108, 110 Correctional populations, ix, 8, 9, 27, 29, 31, 33, 70, 87, 88, 97, 99-101, 190, 197 incidence, 99 legal issues, 97, 99-101 multidrug resistance, 99, 100 skin testing, 9, 87, 88, 100-101 Cost factors, see Economic factors Cultural factors, see Social and cultural factors CURE-TB Binational Referral System, 154-155, 195 Cycloserine, 244 D Dahlem Conference, 44 Databases contact investigation, 111 National Practitioner Data Bank, 62 public health data systems, 6, 52, 224 registries, 25, 27, 187-188, 196 see also Information management systems Demographic factors historical epidemiology, 13-14 see also Children; Correctional populations ; Homeless persons; Immigration and immigrants; Migrant and seasonal workers; Minority groups; Rural areas; Urban areas Department of Agriculture, 25 Department of Health and Human Services, 12, 130, 160, 165 Food and Drug Administration, 10, 128, 142-143, 213, 244, 245 Occupational Safety and Health Administration (OSHA), 203 Public Health Service, 14, 64, 133, 164 see also Centers for Disease Control and Prevention ; National Institutes of Health Department of State, see Agency for International Development ; Immigration and Naturalization Service Developing countries, 15, 23, 46, 48, 150-151, 227-228, 236-237 see also specific countries Diagnosis, 7, 16-17, 53, 55, 56, 65-66, 186-187, 205, 207-229 Amplified Direct Test (Gen-Probe), 212-213, 225 BACTEC system, 206, 207, 212, 216, 217-218, 225, 229 costs, 9, 56, 69-70, 77, 225 immigrants, 9, 56, 69-70, 77, 91, 92, 93-94, 95, 225, 239, 242 DNA techniques, 17, 38, 105, 115, 124-125, 214-215, 229 ethical issues, 46-48 FDA approved, 213 funding, 37, 52 global markets, 10-11, 155-156 high performance liquid chromatography, 211-212, 229 information management systems, 212 latent tuberculosis, 18, 46-47, 124-126, 144, 213 DNA techniques, 17, 38, 105, 115, 124-125, 214-215, 229 radiometric techniques, 124, 206, 207, 212, 216, 217-218, 225, 229 RNA techniques, 17, 213 see also Tuberculin skin testing LCx assay, 212, 213

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Page 260 MB/BacT system, 212 multidrug-resistant TB, 30, 215-218 Mycobacteria Growth Indicator Tube, 212 polymerase chain reaction (PCR), 125, 212, 218, 223 private industry efforts, 136-137 quality assurance, 219-220 radiographs, 9, 16, 17, 38, 87, 90, 92, 101, 124, 199, 206, 239 radiometric techniques, 124, 206, 218 BACTEC system, 206, 207, 212, 216, 217-218, 225, 229 recently acquired TB, 9, 18 research, 1, 3, 5, 9, 10, 122, 123, 124-126, 133, 136-137, 144, 145-146, 167, 206-207 RNA techniques, 17, 213 serologic tests, 214 see also Laboratories; Screening; Sputum testing Directly observed therapy (DOT), 5, 17, 20, 30, 37, 41, 56, 58, 63, 70, 71, 72, 77, 78, 79, 80, 104, 108, 109, 155, 157, 176, 239 site visits, 186, 190, 193, 197, 199, 200 District of Columbia, 33, 176, 185-188 DNA diagnostic tools, 17, 38, 105, 115, 124-125, 214-215, 218, 229 vaccines, 140-141, 143, 245 Drug abusers, ix, 9, 33, 64-65, 102, 105, 112, 123, 132, 190, 197 Drug treatment, 17, 19-21, 53, 55-57, 183 adherence and nonadherence, 10, 20, 39, 56, 65, 66, 78-79, 88, 102, 106-107, 114, 123, 130-131, 192, 203 completion rates, 46 enablers, 19-20, 77-78, 161 incentives programs, 20, 41, 48, 64, 66-67, 76, 78, 144, 161, 197 social and cultural factors, 10, 20, 39, 64-65, 123, 130-131 see also Directly observed therapy; Mandated completion of therapy AIDS patients with TB, 19, 34, 35, 43 amikacin, 244 capreomycin, 244 contact investigation and, 89, 102, 106-107, 114, 117 costs, 4, 37, 38, 45, 55, 56-57, 58, 59, 69-70 immigrants, 91, 93-94, 95, 96, 239, 242 cycloserine, 244 ethambutol, 59, 127, 139, 141, 154, 216, 217, 244 ethionamide, 216, 244 fluoroquinolones, 146, 244 funding, 37, 52 global markets, 10-11, 123, 155-156 historical perspectives, 12, 14, 127, 206, 244 immigrants, 88-89, 90, 93-98 (passim), 130-131, 203 costs, 91, 93-94, 95, 96, 239, 242 incidence and, 27, 206 information management systems, 68 isoniazid, 19, 30, 33, 58, 79, 88-89, 96, 127, 129, 216, 239, 242, 244 kanamycin, 244 latent tuberculosis, ix, 18-19, 21, 37, 47-48, 55-59, 68, 77, 88-89, 93-94, 95-96, 97-101, 102, 106, 117, 129, 144, 167, 202, 239-240 liver toxicity, 19, 89, 95, 96, 126-127, 128 nitroimidizopyrene, 139 ofloxacin, 139, 244 oxazolidinones, 139, 146, 245 para-aminosalicylic acid, 244 patient-centered therapy, 5, 6, 17, 19-20, 30, 51, 77-79, 189; see also Directly observed therapy performance standards, 65, 77 pyrazinamide, 19, 89, 95, 129, 244 research, 1, 10, 122, 123, 126-130, 138-141, 144, 146 private sector, 10-11, 123, 128, 138-141, 145, 245-249 see also Food and Drug Administration rifabutin, 139, 244 rifampin, 19, 30, 33, 79, 89, 95, 127, 129, 216, 239, 244 rifapentine, 146, 244, 245 social mobilization, 160 thiacetazone, 244 see also Multidrug resistance; Vaccines

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Page 261 E Economic factors, viii, 2, 35, 68, 131, 177 contact investigation, 103, 104, 116 global efforts, 4, 10-11, 53, 155-156 health department program organization, 68-70, 184 high performance liquid chromatography, 211 performance monitoring, 66 public/private cooperation model, 58 research, other than funding, 10-11, 123, 128, 131-132, 140, 146 testing costs, 9, 56, 69-70, 77, 225 immigrants, 9, 56, 69-70, 77, 91, 92, 93-94, 95, 225, 239, 242 treatment costs, 4, 37, 38, 45, 55, 56-57, 58, 59, 69-70 immigrants, 91, 93-94, 95, 96, 239, 242 see also Cost factors; Developing countries ; Funding; Health care financing ; Private sector Edinburgh Coordinated Scheme, 34 Education, see Patient education; Professional education; Public education Employment, see Green card requirements; Workplace screening Enablers, drug treatment adherence, 19-20, 77-78, 161 Epidemiology, ix, 3, 10, 31-33, 136, 153, 173 active tuberculosis, 16-17 contact investigation, 103, 113 health departments, use of, 20-21 historical perspectives, 13-15, 23, 24, 26-31, 151 multistate initiatives, ix, 7, 52 registries, 25, 27, 187-188, 196 see also Demographic factors; Incidence and prevalence ; Surveillance Ethambutol, 59, 127, 139, 141, 154, 216, 217, 244 Ethical issues, x, 46-48, 175, 179-180 confidentiality, 46, 100, 106, 116, 137 correctional inmate testing, 100 global efforts, 152-153 immigrant testing, 95-96 see also Legal issues Ethionamide, 216, 244 Ethnic groups, see also Minority groups Etiology, 2, 8, 15-16, 133 see also Latent infection Europe, 13-14, 23, 240-241 F Federal government, general, vii, 54 committee task, 171 contact investigation, 107, 110-111 immigrants, 89-92, 96; see also Immigration and Naturalization Service strategic national plan, viii, 14, 44-45, 53-54, 61, 88, 143, 175 see also Department of Agriculture; Department of Health and Human Services ; Funding; Legislation Florida, 31 Fluoroquinolones, 146, 244 Fogarty International Center, 156 Food and Drug Administration diagnostic tests approved, 213 drugs approved, 128, 244, 245 research budget, 10, 142-143 Foreign-born persons, see Immigration and immigrants ; specific countries Foreign countries, see International perspectives ; specific countries Foundations, 141-142, 165 Funding, 6, 7, 14, 35-39, 51, 92, 96, 227 block grants, 36-37, 186 categorical, vii, xi, 2, 6, 7, 14, 36-37, 52, 68-69, 167, 182-183, 186, 192, 194, 197 CDC, 10, 14, 36, 37, 69, 81, 134, 182-183, 186, 190, 197 community health centers, 81-82 contact investigation, 103, 107-108, 113, 183, 198 diagnosis, general, 37, 52 drug treatment, 37, 52 FDA research budget, 10, 142-143 foreign aid, 153 foundations, 141-142 global efforts, 11, 53, 150 historical perspectives, vii, xi, 2, 6, 36-37, 68 incidence, maintenance of funding during decreases, 39, 45, 51, 53, 68-73

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Page 262 international efforts, 11, 53, 123, 153-157; see also Agency for International Development local, 7, 52, 69, 186, 192, 200 Medicaid, 5, 70, 72-73, 185, 193, 194 NIH research budget, 10, 132-134 patient education, 7, 190 professional education, 7, 53, 190 public hospitals, 184-185 regionalization of interventions, 71 research, 10, 130, 132-134, 140, 143-146, 153-156, 167 site visits, 182-183, 186, 190-191, 192, 194, 196-197, 200, 202, 204 social mobilization, 162-163, 167 taxation, 164, 196-197 urban areas, general, 37 vaccine research, 130, 144, 167 WHO, 15 The Future of Public Health, 21, 54, 58, 152, 157-158 G Genomes, 4, 125-126 Georgia, 185-185 Global Surveillance for Antituberculosis Drug Resistance, 30 Global Tuberculosis Research Initiative, 130 Government role, see Federal government; Health departments; Legal issues ; Legislation; Local government ; State government Green card requirements, 9, 87, 94, 239, 242 Guide to Clinical Prevention Services, 97 H Haiti, 187, 240 Health Alert Network, 62 Health belief model, 64 Health care financing, 5 Medicaid, 5, 70, 72-73, 74, 75, 81, 185, 193-194 Medicare, 5, 72-73 see also Health insurance; Managed care Health departments, 2-3, 7, 19-21, 55, 56-57, 58, 220 case management, 7, 19-20, 52, 55-56, 59, 60-61,189, 192, 196, 199-200, 201-202 contact investigation, 102, 103-108, 114, 116 immigrants, 3, 8, 91, 92, 95, 187, 192, 194-196, 198, 203 information management systems, 79-80 integration of TB efforts with other programs, 68-69, 184 privatization of services, 51, 52, 55, 56, 73-75, 199, 200, 224-226 professional training for staff, 60-62, 116, 183-184, 198, 202 protocols and action plans, 7, 20, 58, 59, 65 public health laboratories, 67, 71, 132, 184, 205-229 public/private cooperation model, 58-59 published guidelines, 58-59, 66-67 site visits, 182-204 (passim) social mobilization, 164, 166, 189 surveillance, 5, 19, 21 telephone services, 62, 63, 195 Health insurance, 1, 7, 51, 52, 61-62, 184 committee task, 171 managed care, 1, 2, 5, 7, 52, 61-62, 72-82, 171 Medicaid, 5, 70, 72-73, 74, 75, 81, 185, 193-194 Medicare, 5, 72-73 uninsured patients, 56, 81 Health maintenance organizations, see Managed care High performance liquid chromatography, 211-212, 229 Historical perspectives, vii-viii, 2, 23-27, 220 AIDS, 27, 34 CDC, 25 drug treatment, 12, 14, 127, 206, 244 epidemiology, 13-15, 23, 24, 26-31, 151 funding, vii, xi, 2, 6, 36-37, 68 immigrants, 13, 27, 151 incidence, vii-viii, 2, 6, 23, 24, 26-30, 151-152, 206 Medline publications, 135 multidrug resistance, 15, 30 public health laboratories, 206-207 social mobilization, 162-163, 164 strategic national plan, viii, 143 surveillance, 23, 25 treatment, vii, 2 HIV, see AIDS

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Page 263 Homeless persons, ix, x, 9, 27, 31, 33, 87, 97, 112, 176 site visits, 187, 190, 197, 198, 202 Hospitals and hospitalization, 184-185, 223 nosocomial transmission, 29, 34, 185 performance standards, 65 physician competence, 62 Housing, 187, 192-193 I Illinois, 31 Immigration and immigrants, ix, x, 3-4, 8, 9, 39, 58, 72, 86, 89-97, 151-152, 173, 177, 180-181 BCG, 18, 106 CDC role, 3, 8, 93, 94-95 children, 38, 106 committee task, 171 contact investigation, 102, 106, 111 cultural factors, 96, 98, 198-199, 200-201, 203-204 CURE-TB Binational Referral System, 154-155, 195 drug treatment, 88-89, 90, 93-98 (passim), 130-131, 203 costs, 91, 93-94, 95, 96, 239, 242 health departments, 3, 8, 91, 92, 95, 187, 192, 194-196, 198, 203 high-risk countries defined, 234 historical epidemiology, 13, 27, 151 incidence, ix, x, 1, 3, 8, 11, 31, 32, 48, 72, 89, 91, 93, 96, 149, 150-151, 234-239 specific countries, tables, 236-237, 240-241 latent infection, general, 93-94, 95-96, 98, 131, 239-242 legal issues, 3-4, 89-91, 95-96, 97, 177, 180 green card requirements, 9, 87, 94, 239, 242 local government role, 8, 91, 98, 187, 191-192, 194-196, 198-199, 200-201 multidrug resistance, 128, 157, 199 screening, ix, 3-4, 8, 9, 48, 87-95 (passim), 126, 180-181, 199, 234-239, 242 costs, 9, 56, 69-70, 77, 91, 92, 93-94, 95, 225, 239, 242 ethical issues, 95-96 green card requirements, 9, 87, 94, 239, 242 professional training for, 3, 94-95, 192, 242 research, 3, 9, 126 skin testing, ix, 3, 8, 9, 87-95 (passim), 126, 180, 235, 239, 242 costs, 9, 91, 92, 93-94, 95, 239, 242 site visits, 187, 192, 194-196, 198, 203 state government, 91, 95 urban areas, 150-151 vignettes, 154-155 see also specific countries and regions of origin Immigration and Naturalization Service, 3, 8, 94, 95, 192, 235, 242 Incentives programs, drug therapy adherence, 20, 41, 48, 64, 66-67, 76, 78, 144, 161, 197 Incidence and prevalence, 18 AIDS and, 34-35 Boston, Massachusetts, 189 contact investigation, 103, 107-108, 114 “control” and “elimination” of disease, defined, 44 correctional populations, 99 decreases, maintenance of control during, 39, 45, 51, 53, 55, 56, 60-68, 103, 186 District of Columbia, 185 drug treatment and, 27, 206 Georgia, 185 historical perspectives, vii-viii, 2, 23, 24, 26-30, 151-152 immigrants, ix, x, 1, 3, 8, 11, 31, 32, 48, 72, 89, 91, 93, 96, 149, 150-151, 234-239 specific countries, tables, 236-237, 240-241 Maine, 201 multidrug-resistant tuberculosis, 30, 33, 34 multistate initiatives, ix, 7, 25, 27, 52 projections and goals, viii, 3, 4-5, 44, 45, 89, 122, 201 strategic national plan, viii, 14, 44-45, 54, 143 recent trends, 31-33 regional factors, 7, 31, 32, 52, 54, 70-71; see also “multistate initiatives” supra

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Page 264 India, 128, 187, 240 Infectious Diseases Society, 161 Information management systems, 52, 67-68, 79-80 diagnostic techniques, 212 Internet, 62, 137, 212, 224, 226 performance monitoring, 65-66 registries, 25, 27, 187-188, 196 see also Databases Inmates, see Correctional populations International Conference on Tuberculosis, 14 International perspectives Agency for International Development, 10, 11, 123 BCG vaccine, 18, 106, 129-130 bilateral initiatives, 4, 11, 149 CURE-TB Binational Referral System, 154-155, 195 CDC, 11, 123, 150, 153, 154 committee task, 171 diagnosis, general, 10-11, 155-156 education and training, funding, 53, 156 funding, 11, 53, 123, 153-157; see also Agency for International Development global approaches, 4, 5, 10-11, 12, 46, 123, 149-158, 167, 174-175, 178 historical, 14-15 incidence, 48, 236-237, 240-241 multidrug-resistant tuberculosis, 30-31, 149-150 NIH, 11, 123, 150, 153-154, 156 nongovernmental organizations, 153-156 (passim), 166 Organization for Economic Cooperation and Development, 153 political factors, 14-15 private sector, 10-11, 123, 155-156 research, 11, 123, 150, 153-156 vaccine development, 10-11, 48, 130 World Bank, 4 World Health Organization, 12, 15, 35, 124, 130, 136, 156, 157, 160-161, 184 see also Agency for International Development ; Developing countries ; Immigration and immigrants ; specific countries International Union Against Tuberculosis and Lung Disease, 30-31, 111, 156 Internet, 62, 137, 212, 224, 226 Intravenous drug abusers, see Drug abusers Isoniazid, 19, 30, 33, 58, 79, 88-89, 96, 127, 129, 216, 239, 242, 244 K Kanamycin, 244 L Laboratories, ix, 79, 183-184, 186-187, 202 CDC role, 67, 71, 75, 223, 224, 227-228 quality control, 219-220, 222 performance standards, 76-77, 145, 222, 223 private sector, 183-184, 224-226 public health laboratories, 67, 71, 132, 184, 205-229 regionalization, 71, 226 staff training, 76-77, 209, 222-224 see also Diagnosis Latent infection, 4, 8, 10, 38 AIDS patients, 19 correctional populations, 99 definition, 145 diagnosis, 18, 46-47, 124-126, 144, 213; see also Tuberculin skin testing DNA techniques, 17, 38, 105, 115, 124-125, 214-215, 229 radiometric techniques, 124, 206, 207, 212, 216, 217-218, 225, 229 elimination efforts, 46, 122 immigrants, general, 93-94, 95-96, 98, 131, 239-242 information management systems, 68 pathogenesis, 15-16 screening for, 47-48, 55, 86-87; see also “diagnosis” supra treatment of, ix, 18-19, 21, 37, 47-48, 55-59, 68, 77, 88-89, 93-94, 95-96, 97-101, 102, 106, 117, 129, 144, 167, 202, 239-240 see also Contacts and contact investigation ; Screening Latvia, 31 LCx assay, 212, 213 Legal issues, 39-44, 47, 54, 175-176, 179-180 confidentiality, 116 contact investigation, 105, 114 correctional populations, 97, 99-101

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Page 265 immigrants, 3-4, 89-91, 95-96, 97, 177, 180 green card requirements, 9, 87, 94, 239, 242 mandated screening, 43, 89-97, 99-101 patents, 137, 156 see also Correctional populations; Ethical issues; Mandated completion of therapy Legislation, specific, 39-40 Clinical Laboratories Improvement Amendment, 219-220, 222, 223 Medicaid Act, 70 Orphan Drug Act, 156 Public Health Service Act, 162-163, 164 Liver toxicity, 19, 89, 95, 96, 126-127, 128 Local government, 7, 8, 55-56, 58-59, 65-66, 154-155 community health centers, 61, 70, 73, 81-82, 190 contact investigation, 104 funding, 7, 52, 69, 186, 192, 200 immigrants, 8, 91, 98, 187, 191-192, 194-196, 198-199, 200-201 Medicaid, 70, 72-73 protocols and action plans, 7, 20, 58, 59, 65 site visits, 182-183, 184, 185-201 social mobilization, 12, 160, 165, 166 see also Health departments; Urban areas M Maine, 201-204 Managed care, 1, 2, 5, 7, 52, 61-62, 72-82, 171 Mandated completion of therapy, viii-ix, x, 6, 20, 40-43, 47-48, 51, 90-91, 97, 99-101, 167, 187, 191, 192-193 Mandated screening, 43, 89-97, 99-101 Mass media, 161, 166, 201 Massachusetts, 188-191 MB/BacT system, 212 Medicaid, 5, 70, 72-73, 74, 75, 81, 185, 193-194 Medicare, 5, 72-73 Medline, 135 Mexico, 31, 48, 93, 128, 176, 180, 187, 191-192, 194-196, 234-235, 237, 240-241 Migrant and seasonal workers, xi, 61, 69, 70, 73, 81, 176 Minority groups, 69, 81, 131 see also Immigrants and immigration Missouri, 56 Model Tuberculosis Centers, 113 Multidrug resistance (MDR), viii, 1, 2, 6, 17, 30-31, 39, 45, 51, 127-128, 149-150 AIDS and, 34 contact investigation, 102 correctional populations, 99, 100 diagnosis, 30, 215-218 historical perspectives, 15, 30 immigrants, 128, 157, 199 incidence, 30, 33, 34 international perspectives, 30-31, 149-150; see also “immigrants” supra mandated therapy, 41 nonadherence to drug therapy and, 79 vignette, 58 N National Action Plan to Combat Multidrug-Resistant Tuberculosis, 30 National Association for the Study and Prevention of Tuberculosis, 163-164 National Coalition for the Elimination of Tuberculosis, 12, 160, 165, 166 National Committee on Quality Assurance, 75-76 National Health Examination Survey, 114 National Institutes of Health, 132-134, 143 Blueprint for Tuberculosis Vaccine Development, 10, 145 international efforts, 11, 123, 150, 153-154, 156 research budget, 10, 132-134 social mobilization, 165 vaccines, 10, 123 National Practitioner Data Bank, 62 National Tuberculosis Association, 27 National Tuberculosis Centers, 61 National Tuberculosis Controllers Association, 111 National Vaccine Program, 130, 143 New Jersey, 113, 220 New York City, 42-43, 176 New York State, 31, 33, 77, 99, 100-101, 220

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Page 266 Nitroimidizopyrene, 139 Nongovernmental organizations, 153-156 (passim), 166 Nosocomial transmission, 29, 34, 185 North Dakota, 38 O Occupational Safety and Health Administration (OSHA), 203 Office of Management and Budget (OMB), 182 Ofloxacin, 139, 244 Oregon, 33 Organization for Economic Cooperation and Development, 153 Orphan Drug Act, 156 Outreach, 20, 69, 78, 97, 98, 104, 184, 187, 197, 200 see also Contacts and contact investigation ; Public education Oxazolidinones, 139, 146, 245 P Para-aminosalicyclic acid, 244 Patents, 137, 156 Patient-centered treatment, 5, 6, 17, 19-20, 30, 51, 77-79, 189 see also Directly observed therapy Patient education, 12, 62, 64-65, 154-155, 189, 198, 204 AIDS, 62, 64 contact investigation, 112-113 funding, 7, 190 Pharmaceuticals, see Drug treatment; Vaccines Philippines, 31, 187, 237, 240-241 Pittsfield Antituberculosis Association, 143 Political factors and policy, xi, 4, 12, 33-35, 54, 71, 160, 238-239 advocacy, xi, 12, 42, 68, 69, 82, 155, 159, 165, 166, 189 international, 14-15 Medicaid, 185 site visits, 186, 188 social mobilization, 12, 159-167 see also Legal issues; Legislation Polymerase chain reaction (PCR), 125, 212, 218, 223 Prisoners, see Correctional populations Private sector, 2, 7, 70, 136-137, 145, 167 case management, 55, 199-200 diagnosis efforts, general, 136-137 drug treatment research, 10-11, 123, 128, 138-141, 145, 245-249 foundations, 141-142, 165 global markets, 10-11, 123, 155-156 health care/social services privatization, 51, 52, 55, 56, 73-75, 199, 200, 224-226 laboratories, 183-184, 224-226 public/private model for control, 58-59 vaccine and treatment drug development, 10-11, 123, 128, 138-141, 145, 245-249 see also Health insurance; Managed care Professional education, x, 2, 7, 12, 61-62, 167, 178-179, 183-184, 198, 202 CDC role, 60-61, 223, 227-228 contact investigation, 103, 106, 109-110, 111-112, 116 funding, 7, 53, 190 health department staff, 60-62, 116, 183-184, 198, 202 immigrants, screening of, 3, 94-95, 192, 242 laboratory personnel, 76-77, 209, 222-224 researchers, 133 Strategic Plan for Tuberculosis Training and Education, 53, 61 Program for Tuberculosis Project Grants, 163 Project Grants for Tuberculosis Preventive Health Projects, 164 Public education, 4, 7, 12, 53, 160, 165, 166, 179, 204 mass media, 161, 166, 201 see also Outreach Public Health Laboratory Information System, 224 Public Health Prevention Service, 182, 183 Public Health Service, 14, 64, 133, 164 Public Health Service Act, 162-163, 164 Public opinion, ix, xi, 4, 12, 160, 161 Puerto Rico, 220 Pyrazinamide, 19, 89, 95, 129, 244

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Page 267 Q Quality control, x, 2, 3, 7, 219-221 managed care, 7, 75-76 public health laboratories, 219-220, 222 see also Standards R Race/ethnicity, see also Minority groups Radiographs, 9, 16, 17, 38, 87, 90, 92, 101, 116, 124, 195-196, 199, 206, 239 Radiometric techniques, 124, 206, 218 BACTEC system, 206, 207, 212, 216, 217-218, 225, 229 Rainbow Reports, 182 Regional factors committee task, 171 contact investigation, 107 incidence, 7, 31, 32, 52, 54, 70-71 information management systems, 67-68 intervention measures regionalized, ix, 1, 7, 52, 70-71, 107, 167, 183, 226; see also “multistate initiatives” infra Mexico-U.S. border states, 195 multistate initiatives, ix, 7, 12, 25, 27, 52, 71, 107, 195 Registries, 25, 27, 187-188, 196 Research, vii, x-xi, 3-4, 9-11, 122-146, 174 behavioral and social, 10, 123 CDC budget, 10, 134 contact investigation, 113-114, 116-117 diagnostics, 1, 3, 5, 9, 10, 122, 123, 124-126, 133, 136-137, 144, 145-146, 167, 206-207 drug treatment, 1, 10, 122, 123, 126-130, 138-141, 144, 146 private sector, 10-11, 123, 128, 138-141, 145, 245-249 see also Food and Drug Administration economic factors, other than funding, 10-11, 123, 128, 131-132, 140, 146 FDA budget, 10, 142-143 funding, 10, 130, 132-134, 140, 143-146, 153-156, 167 genome, 4, 125-126 immigrant screening, 3, 9, 126 international efforts, 11, 123, 150, 153-156 latent infection, 10 NIH budget, 10, 132-134 professional education for researchers, 133 public health laboratories, 67, 205-206, 223-224 study at hand, methodology, 1, 171-172 see also Epidemiology; Vaccines Restriction fragment length polymorphism, 115-116, 218-219 Rifabutin, 139, 244 Rifampin, 19, 30, 33, 79, 89, 95, 127, 129, 216, 239, 244 Rifapentine, 146, 244, 245 RNA, 17, 213 Robert Wood Johnson Foundation, 165 Royal Netherlands Antituberculosis Association, 156 Rural areas, 39, 56, 63, 81, 105, 201-204 migrant and seasonal workers, xi, 61, 69, 70, 73, 81, 176 Russia, 31, 198 S San Diego, California, 191-196 School-based screening, 97, 117 Screening, 37, 53, 55, 57-59, 88, 167 ethical issues, 46-48 health belief model, 64 immigrants, ix, 3-4, 8, 9, 48, 87-95 (passim), 126, 180-181, 199, 234-239, 242 costs, 9, 56, 69-70, 77, 91, 92, 93-94, 95, 225, 239, 242 ethical issues, 95-96 green card requirements, 9, 87, 94, 239, 242 professional training for, 3, 94-95, 192, 242 research, 3, 9, 126 information management systems, 68 latent infection, 47-48, 55, 86-87; see also “diagnosis” under Latent infection mandated, 43, 89-97, 99-101 school-based, 97, 117 workplace, 97, 115, 116, 176-177, 203-204 worldwide, 124 see Contacts and contact investigation; Diagnosis; Tuberculin skin testing

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Page 268 Seasonal workers, see Migrant and seasonal workers Seattle, Washington, 90, 97, 98, 196, 197-199 Serologic tests, 214 Skin testing, see Tuberculin skin testing Social and cultural factors, 10, 57, 66-67, 78, 175-176 contact investigations, 88, 104, 112-113, 115, 116 drug treatment nonadherence, 10, 20, 39, 64-65, 123, 130-131 historical epidemiology, 13-14 immigrants, 96, 98, 198-199, 200-201, 203-204 outreach, 20, 69, 78, 97, 98, 187 see also Behavioral factors; Demographic factors ; Ethical issues; Legal issues ; Political factors and policy ; Public education; Public opinion Social mobilization, 12, 159-167 advocacy, xi, 12, 42, 68, 69, 82, 155, 159, 165, 166, 189 AIDS, 161 CDC role, 12, 159-160, 161, 164, 165 drug treatment, 160 funding, 162-163, 167 health departments, 164, 166, 189 historical perspectives, 162-163, 164 local government, 12, 160, 165, 166 NIH role, 165 political factors, 12, 159-167 state government, 160, 161-162, 165, 166 urban areas, 161-162 South Carolina, 161 Southeast Asians, 27, 58, 151, 198, 235, 237, 240-241 Sputum testing, 16, 17, 20, 38, 80, 90, 92, 99, 104, 110, 124, 154, 206, 207-208, 209-210, 212-214, 220, 221, 225, 229 Standards case management, 6, 52, 58, 59 managed care, 71-72, 75-76, 77-79 clinical interventions, general, x, 2, 6, 65-66, 68 contact investigation, 110-111, 112 drug treatment, 65, 77 laboratories, 76-77, 145, 222, 223 patient-centered treatment, 6, 51, 77-79 performance, x, 2, 6, 7, 65-66, 68, 70, 71-72, 75, 76-80, 145, 222, 223 program, 6, 52, 65-66, 76 protocols and action plans, 7, 20, 52, 58, 59, 65 State government, 55-56, 59, 69 case management plans, 7, 52, 58, 59, 77-79 contact investigation, 105, 107-108, 110 correctional populations, 100-101 directly observed therapy, 41 immigrants, 91, 95 legal/regulatory systems, 39-43 immigrants, 91 laboratory performance standards, 76-77 mandated screening, 100-101 mandated therapy, viii-ix, x, 6, 20, 40-43, 47-48, 51, 100-101, 167, 187, 191, 192-193 physician licensing, 62 program standards, 6, 52, 65-66, 76-77, 79 multistate initiatives, ix, 7, 12, 25, 27, 52, 71, 107, 195 protocols and action plans, 7, 52 public laboratory standards, 222 registries, 25, 27, 187-188, 196 site visits, 182-183, 185, 188, 190-191, 196-197, 200, 201-204 social mobilization, 160, 161-162, 165, 166 see also Health departments; specific states Stop TB Initiative, 4, 11, 142, 150 Strategic Plan for the Elimination of Tuberculosis, 144, 164, 175 Strategic Plan for Tuberculosis Training and Education, 53, 61 Streptomycin, 127, 216, 244 Surveillance, 5, 19, 21, 69, 136, 151, 183, 184 historical perspectives, 23, 25 registries, 25, 27, 187-188, 196 see also Contacts and contact investigation T Tacoma, Washington, 56, 58, 79, 199-200 Taxation, 164, 196-197 Telephone services, 62, 63, 195 Testing, see Diagnosis; Radiographs;

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Page 269 Screening; Sputum testing; Tuberculin skin testing Texas, 31 Thiacetazone, 244 Toxicity, drug treatment, 19, 89, 95, 96, 126-127, 128 Training, see Professional education Travel and tourism, see Immigration and immigrants Treatment, see Drug treatment Tuberculin skin testing, ix, x, 5, 8, 9, 15, 38, 60, 64-65, 86-88 AIDS patients, 9, 18, 34, 35, 43, 87 cancer patients, 18 cattle, 25 contact investigation, 103, 106, 113, 114 correctional population, 9, 87, 88, 100-101 costs, 9, 56, 69-70, 77, 225 immigrants, 9, 91, 92, 93-94, 95, 239, 242 immigrants, ix, 3, 8, 9, 87-95 (passim), 126, 180, 235, 239, 242 isoniazid users, 19 Medicaid/Medicare reimbursement, 5, 70 performance standards, 65 published guidelines, 58-59 site visits, 202, 203 weaknesses, 18, 106 Tuberculosis Core Curriculum, 109 Tuberculosis Diagnostics Initiative, 136 Tuberculosis Information Management System, 67 Tuberculosis Trials Consortium, 145-146 U Urban areas, 2, 31, 58-59, 60, 69, 79 adherence to drug regime, 106 Atlanta, Georgia, 184-185 Boston, Massachusetts, 188-190 contact investigation, 106, 111 District of Columbia, 33, 176, 185-188 funding, 37 immigration, 150-151 New York City, 42-43 Seattle, Washington, 90, 97, 98, 196, 197-199 social mobilization, 161-162 Tacoma, Washington, 56, 58, 79, 199-200 V Vaccines, ix, xi, 4, 5, 10, 48, 87, 122, 123, 129-130, 143-144, 167, 205-206 BCG, 18, 106, 129-130 CDC role, 205-206 DNA, 140-141, 143, 245 funding, 130, 144, 167 global markets, 10-11, 48, 130 international perspectives, 10-11, 48, 130 BCG, 18, 106, 129-130 National Vaccine Program, 130, 143 NIH role, 10, 123 private sector role, 10-11, 123, 128, 138-141, 145 prospects for development by company, table, 245-249 Vietnam, 31, 187, 237, 240-241 W Washington, D.C., see District of Columbia Washington State, 162, 196-201 Seattle, 90, 97, 98, 196, 197-199 Tacoma, 56, 58, 79, 199-200 Wisconsin, 220 World Bank, 4 World Health Organization, 12, 15, 35, 124, 130, 136, 154-155, 156, 157, 160-161, 184 World Wide Web, see Internet Working Group on Tuberculosis Among the Foreign-Born, 91 Workplace screening, 97, 115, 116, 176-177, 203-204 X X rays, see Radiographs