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July 14, 1993

Infectious Diseases

Author Affiliations

Cornell University Medical College, New York, NY; Merck & Co, Inc, Whitehouse Station, NJ

JAMA. 1993;270(2):223-224. doi:10.1001/jama.1993.03510020091028

The resurgence of tuberculosis (TB) in the United States and the spread of multidrug-resistant strains of TB (MDR-TB) are serious public health threats. As recently as 1989 it seemed possible to plan for the elimination of TB from the United States.1 Decades of successful control efforts had resulted in a steady decline in the incidence of TB, from more than 84000 cases in 1953 to 22000 in 1984. However, this favorable trend ended in 1985: from 1985 to 1991, there were 39000 more cases than expected, and the annual case rate is increasing. In response to the current epidemic, major efforts in TB infection control and patient care have been initiated.

The human immunodeficiency virus (HIV) epidemic seems to be a significant factor in the recent increase in TB cases. The risk of active TB among persons with HIV is exceedingly high. For those with latent tuberculous infection, 7%