The epidemiology of tuberculosis in the United States.

Effective control of tuberculosis (TB) requires an understanding of the changing epidemiology of the disease. An understanding of the epidemiology is needed for public health departments to respond with appropriate program-planning decisions. Following a marked decline in the incidence of tuberculosis in the United States over several decades, the incidence escalated dramatically and peaked in 1992. The resurgence of TB reflected several factors, including deteriorating social conditions, dismantling of the public health infrastructure, dwindling support for tuberculosis clinics and services, the new epidemic of HIV/AIDS with highly susceptible individuals at risk, and immigration of individuals from countries with high rates of TB. Since 1992, there has been a substantial decline in new cases. The success in reducing the tuberculosis burden reflects several factors, including improved public health efforts, physician and patient education, infection control measures, and the use of directly observed therapy (DOT). By 2006, cases of TB in the United States had reached historic lows. Currently, a majority of cases of TB occur in foreign-born individuals, reflecting immigration from countries with high endemic rates of TB. Future efforts to curtail the incidence of TB will require vigilant public health efforts, improving education of patients and health care personnel, identifying mechanisms and routes of transmission, and assuring adequate treatment and prophylactic regimens among infected individuals.