Essential components of a tuberculosis prevention and control program. Recommendations of the Advisory Council for the Elimination of Tuberculosis.

Tuberculosis (TB) rates declined steadily for decades in the United States, but several complex social and medical factors caused TB morbidity to increase 14% from 1985 through 1993. The recent increases in TB morbidity have placed additional demands on state and local TB control programs, which already had been substantially weakened by inadequate staffing and funding support. TB programs throughout the nation must be revitalized if they are to provide core TB control activities that enable effective responses to this public health challenge. This report describes a model for TB control programs and the essential components of a successful TB control program, including three priority strategies for TB prevention and control: a) identifying and treating persons who have active TB, b) finding and screening persons who have had contact with TB patients to determine whether they are infected with Mycobacterium tuberculosis or have active TB and providing appropriate treatment, and c) screening populations at high risk for TB infection and the development of TB disease to detect infected persons and providing therapy to prevent progression to active TB. State and local health departments have primary responsibility for preventing and controlling TB. To meet this challenge successfully, TB control programs should be able to administer activities that include the following core components: conducting overall planning and development of policy, identifying persons who have clinically active TB, managing persons who have or who are suspected of having disease, identifying and managing persons infected with M. tuberculosis, providing laboratory and diagnostic services, collecting and analyzing data, and providing training and education. The Advisory Council for the Elimination of Tuberculosis has prepared this report to provide a national standard by which policymakers, TB control program managers, and others evaluating TB programs can assess individual TB control programs. The report may also help local programs to obtain and maintain adequate resources for TB control activities. In addition to defining the essential components of a TB control program, this report emphasizes the importance of a) prioritizing TB control activities; b) coordinating care with other health-care providers, facilities, and community organizations; c) using alternative approaches to TB control (e.g., the expanded use of directly observed therapy); d) targeting screening and prevention programs to high-risk populations; and e) following current recommendations for the treatment of TB. TB control program managers should make every effort to incorporate each of these components into their program activities. TB programs may perform these activities directly, or programs may coordinate with other providers to ensure the implementation of these activities. TB programs may perform these activities directly, or programs may coordinate with other providers to ensure the implementation of these activities. Failure to meet these core standards can decrease a TB program's effectiveness in controlling this reemergent public health risk.