Tuberculosis Control

Tuberculosis Control - The path of TB epidemics is clearly determined not only by the biological and social phenomena discussed above under Risk Factors, but also by explicit efforts to control the disease. Prior to the development of antibiotic therapy for TB, the main methods of control available were reducing transmission by isolating infectious patients, and increasing the likelihood of spontaneous recovery by providing patients with rest and improved nutrition. Both these aims were achieved by treating TB patients in sanatoria, where case-fatality rates were about 50%.

providing patients with rest 

improved nutrition

Modern TB control is based on early detection and treatment, particularly of infectious cases. Treatment is generally effective; the average global cure rate was 84.7% for smear-positive cases treated in 2005 by programmes following international recommendations.Treatment has, therefore, a direct impact on the prevalence of disease and on mortality. Furthermore, transmission is reduced, as infectious cases quickly become non-infectious once treatment is started. In addition to the primary goal of TB control (early diagnosis and treatment), national TB programmes or health authorities can (and, to varying degrees, do) influence the flow of individuals along the paths shown in in the following ways: by implementing appropriate ‘infection control’ strategies (ensuring adequate ventilation in healthcare centres, minimizing contact between infectious and susceptible individuals in order to reduce transmission; by providing preventive treatment (isoniazid preventive therapy, IPT) to infected individuals who do not have TB disease (thus returning them from the latently infected pool to the pool of susceptibles); by collaborating with national acquired immunodeficiency syndrome (AIDS) programmes to identify and provide appropriate care for HIV-infected TB patients; and by providing nutritional support to TB patients and their families, thus improving their nutritional status and perhaps increasing the likelihood of recovery for patients, decreasing the likelihood of infection for family members and encouraging patients to complete treatment.

Finally, roughly 100 million infants (>80% of the annual cohort) are vaccinated each year with Bacillus Calmette- Gue´rin (BCG), the effect of which is mainly to prevent serious forms of disease in children: meningitis and miliary TB. The potential of existing and possibly future tools for reducing the burden of TB, particularly with reference to international targets, is discussed further below.