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The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal.
This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB.
This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States.
Although drafted to apply to TB control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB.
This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB.
The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB The recommendations contained in this statement see Graded Recommendations for the Control and Prevention of Tuberculosis were rated for their strength by use of a letter grade and for the quality of the evidence on which they were based by use of a Roman numeral Table 1 7.
No rating was assigned to recommendations that are considered to be standard practice i. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this seriesand other sources 2, 10 into a coherent and practical approach to the control of TB in the United States.
LTBI is used to designate a condition in which an individual is infected with Mycobacterium tuberculosis but does not currently have active disease.
Such patients are at risk for progressing to tuberculosis disease. Treatment of LTBI previously called preventive therapy or chemoprophylaxis is indicated for those at increased risk for progression as described in the text. Persons with LTBI are asymptomatic and have a negative chest radiograph.
Positive culture results for M. Decision makers also realized that the U. This success in responding to the first resurgence of TB in decades indicates that a coherent national strategy; coordination of local, state, and federal action; and availability of adequate resources can result in dramatic declines in TB incidence.
This success also raised again the possible elimination of TB, and inACET reaffirmed the goal of tuberculosis elimination in the United States 1. The prospect of eliminating tuberculosis was critically analyzed in an independent study published by IOM in 2.
Calling for greater levels of effort and resources than were then available, the IOM report proposed a comprehensive plan to 1 adjust control measures to the declining incidence of disease; 2 accelerate the decline in incidence by increasing targeted testing and treatment of LTBI; 3 develop new tools for diagnosis, treatment, and prevention; 4 increase U.
The report also noted the cyclical nature of the U. Whereas institutional resources targeted specific problems such as transmission of TB in health-care facilities, public resources were earmarked largely for public health agencies, which used them to rebuild the TB-control infrastructure 13, A primary objective of these efforts was to increase the rate of completion of therapy among persons with TB, which was achieved by innovative case-management strategies, including greater use of directly observed therapy DOT.
Continued progress in the control of TB in the United States will require consolidation of the gains made through improved cure rates and implementation of new strategies to further reduce incidence of TB. Challenges to Progress Toward TB Elimination The development of optimal strategies to guide continuing efforts in TB control depends on understanding the challenges confronting the effort.
The five most important challenges to successful control of TB in the United States are 1 prevalence of TB among foreign-born persons residing in the United States; 2 delays in detecting and reporting cases of pulmonary TB; 3 deficiencies in protecting contacts of persons with infectious TB and in preventing and responding to TB outbreaks; 4 persistence of a substantial population of persons living in the United States with LTBI who are at risk for progression to TB disease; and 5 maintaining clinical and public health expertise in an era of declining TB incidence.
These five concerns Box 1 serve as the focal point for the recommendations made in this statement to control and prevent TB in the United States.
Duringas TB incidence in the United States declined sharply, incidence among foreign-born persons changed little Lack of access to medical services because of cultural, linguistic, financial, or legal barriers results in delays in diagnosis and treatment of TB among foreign-born persons and in ongoing transmission of the disease Successful control of TB in the United States and progress toward its elimination depend on the development of effective strategies to control and prevent the disease among foreign-born persons.
Delays in Detection and Reporting of Cases of Pulmonary TB New cases of infectious TB should be diagnosed and reported as early as possible in the course of the illness so curative treatment can be initiated, transmission interrupted, and public health responses e.
However, delays in case detection and reporting continue to occur; these delays are attributed to medical errors and to patient factors e. In addition, genotyping studies have revealed evidence of persistent transmission of M.
Improvements in the detection of TB cases, leading to earlier diagnosis and treatment, would bring substantial benefits to affected patients and their contacts, decrease TB among children, and prevent outbreaks. Deficiencies in Protecting Contacts of Person with Infectious TB and in Preventing and Responding to TB Outbreaks Although following up contacts is among the highest public health priorities in responding to a case of TB, problems in conducting contact investigations have been reported Approaches to contact investigations vary widely from program to program, and traditional investigative methods are not well adapted to certain populations at high risk.
Only half of at-risk contacts complete a course of treatment for LTBI Reducing the risk of TB among contacts through the development of better methods of identification, evaluation, and management would lead to substantial personal and public health benefits and facilitate progress toward eliminating TB in the United States.Celebrating Latino leaders in Greater New Haven.
Coordinator of Parent Engagement, New Haven Public Schools. Hometown: Cayey, Puerto Rico Danny Diaz and his family left Puerto Rico to head to the mainland, arriving in New Haven in just after Diaz completed eighth grade. Timeline of Legislative and other changes or concerns or factors affecting seniors.
November A plan to make it easier for people to stay on at work after their 65th birthday (currently, employers in Bermuda both public and private can legally require staff over 65 to end their employment) was welcomed yesterday. After fourteen (14) years, Joe Parisi has decided to put the Inquirer to bed.
Replacing the Inquirer will be a publication that will continue to provide all the positive news . One nurse sharing his or her perspective helps formulate strategies that groups use in an effort to influence policy and make changes.
“Every nurse should be a ‘political nurse because we are such a caring, large constituency for people,” Vance said. Health Care Policy: The Nurse's Crucial Role As the legislative liaison for the AAACN Board of Directors, I recently had the privilege of attending the Nurse in Washington Internship (NIWI) workshop sponsored by the Nursing Organizations Alliance (NOA) and coordinated by Kathleen Smith, RN, BS, CNN.
Explain how nurse leaders can use professional organizations to stay aware of political actions in the nursing and health care industry and the importance of doing so.
POLITICAL ACTION AWARENESS IN NURSING. Select a professional organization in the nursing industry. Research a current political issue addressed through the .