Tuberculosis elimination--what's to stop us?

ABSTRACT

It is well recognized and has oft been stated that tuberculosis (TB) is the largest cause of death from a single infection worldwide; it infects fully one-third of the world's population, is fully 100% curable and 100% preventable and yet is nowhere near being eliminated in any area of the globe, including the most developed nations. The failure to eliminate this, possibly the most easily eliminatable of all scourges, must rank as one of mankind's most serious ongoing blunders. After all, we know the pathogenesis, we know the transmission, we know how to diagnose, treat and prevent almost all cases, yet TB killed more individuals in 1996 than it did when Robert Koch discovered the bacillus that causes TB more than a century ago. TB is different from almost any other disease in that cases of TB must be actively sought and treated to keep them from spreading to others. In most diseases the untreated case dies and harms nobody. In TB the untreated or improperly treated case becomes resistant and spreads drug-resistant TB until it is found and properly treated. We physicians love to blame our patients for noncompliance in taking drugs. However, our failure to deal with TB clearly and documentedly rests with a lack of compliance on several levels. TB will nerve be eliminated until this lack of compliance on all levels is addressed and corrected.