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CDC's Response to Ending Neglect

How to Eliminate TB? - The IOM Report

The IOM report Ending Neglect: The Elimination of Tuberculosis in the United States11 reviewed the lessons learned from the neglect of TB between the late 1960s and early 1990s and reaffirmed the necessity of a commitment to the goal of TB elimination. The IOM emphasized, however, that TB elimination will require a new level of resources and intersector collaboration. The authors called on the federal government to "set the pace in fostering efforts to manage and prevent tuberculosis" and identified five areas for decisive action.

Maintain Control of TB
"...without question the major reason for the resurgence of tuberculosis was the deterioration of the public health infrastructure essential for the control of tuberculosis." p. 2

In the 1970s and early 1980s, the country became complacent about TB, and many states and cities redirected TB prevention and control funds to other programs. Consequently, the trend toward elimination was reversed, and the nation experienced a TB resurgence. To maintain control of TB, the IOM recommended

  • Mandating completion of therapy for all patients with active TB
  • Evaluating case-management systems used in TB control efforts in new ways
  • Regionalizing TB control activities
  • Retaining federal categorical funding for TB control
  • Educating the public, and training health care providers to maintain excellence in TB services

Accelerate the Decline
"At the current rate of decline, approximately 6 percent per year, it will take more than 70 years to reach the target for elimination of tuberculosis of 1 case of tuberculosis per million population." p. 122

Maintaining control of TB is not enough to eliminate it. People can unknowingly carry TB organisms for years. Finding and treating the estimated 10 million to 15 million Americans with latent TB infection before they become sick and infectious is essential to eliminating TB. To speed the decline of TB, the IOM recommended

  • Developing better ways to find persons who have been in close contact with someone with infectious TB and, if needed, treat them for latent infection
  • Performing TB skin testing as part of the medical examination for immigrants from countries with high rates of TB
  • Performing TB skin testing in inmates of correctional facilities
  • Increasing targeted TB testing and treatment of latent TB infection in other high-risk groups

Develop New Tools
"...the greatest needs in the United States are new diagnostic tools for the more accurate identification of individuals who are truly infected and who are also at risk of developing tuberculosis." p. 122

The goal of TB elimination cannot be reached with currently available tools. State-of-the-art tools are needed, such as

  • Effective tests for latent TB infection and improved methods to determine who will progress from latent TB infection to TB disease
  • New drugs to shorten and simplify treatment of both latent TB infection and active TB
  • An effective vaccine to prevent infection and active disease
  • Behavior-change models to influence at-risk persons and their health care providers

Increase Involvement in Global Efforts
"Although an altruistic argument for promoting the global control of tuberculosis can easily be advanced, worldwide control of this disease is also in the nation's self-interest." p. 149

The United States will never be able to eliminate TB until the global epidemic is under control. The IOM therefore recommended

  • Supporting training in TB control in countries with high rates of disease
  • Supporting WHO's TB-control initiative
  • Targeting resources by development and use of a multiagency strategic plan

Mobilize and Sustain Public Support
"Only an aggressive effort aimed at building political commitment can prevent the elimination of funding for tuberculosis research...before the elimination of the disease, leading to yet another period of neglect." p. 4

Underlying all of these actions must be a concerted effort to educate the public that TB elimination is achievable, promote scientific consensus on what needs to be done, establish partnerships with leaders of affected groups, and use the media to create public interest. The IOM recommended

  • Increasing resources for activities designed to secure and sustain public understanding of and support for TB elimination
  • Securing the participation of nontraditional partners
  • Tracking progress toward elimination


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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