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Why Is TB Still Such a Big Threat in the United States?

The history of Mycobacterium tuberculosis is intertwined with the history of human kind. There is evidence of tuberculosis (TB) in humans going back to 8000 BC.1 However, it wasn’t until 1882 that the pathogen causing the disease was discovered by Robert Koch, MD.2  
The first World TB Day, which was developed to raise awareness of the devastating disease and its impact on global health was observed 100 years later in 1982.2 Approximately 11 years later, in 1993, WHO declared TB a global public health emergency.3
The disease has such a great propensity to cause significant morbidity and mortality that WHO launched “The End TB Strategy” last year.3 This article outlines a framework for a post-2015 global strategy to end the global TB epidemic with specific milestones and targets set for 2025 and 2035.3
The complex disease is one that progresses slowly, is easily spread, and affects many. One-third of the world’s population is infected with M. tuberculosis and approximately 9 million new cases and 2 million deaths occur each year due to this pathogen. The top 10 countries with TB (based on available reporting) are Bangladesh, China, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Pakistan, the Philippines, Nigeria, and South Africa. Unfortunately, there are still areas of the world where this disease is still not reported. Tuberculosis is also the leading killer in individuals who are infected with HIV.4 Concurrent with the HIV epidemic in the 1980s in the United States, TB rose back into the American consciousness.
Given the massive movement of people between and within continents on a daily basis and the rapidity of travel in today’s modern world, TB needs to be in the forefront of infection control efforts in the United States and around the world. Although the trend in cases in the United States has shown a steady decline over the past 20 years (due to infection-control efforts, directly observed therapy, and antiretroviral therapy), the number of documented cases has been approximately 10,000 per year for the last 5 years. The most recent statistics from 2014 demonstrated 9,421 cases, with a rate of 3 cases per 100,000 individuals.5 In addition to Washington, DC, the states where the TB rate is ≥3 per 100,000 include Alaska, Arkansas, California, Hawaii, Maryland, New York, New Jersey, and Texas. Unfortunately, the progress in decreasing the rate of TB in the United States has stalled based on the 2013-2015 statistics.6 One of the more recent outbreaks occurred in Alabama.7

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