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Core Curriculum on Tuberculosis, 2000
What the Clinician Should Know
4th. Ed., 2000
In 1989, the Centers for Disease Control and Prevention (CDC) announced
the goal of eliminating tuberculosis (TB) from the United States
by the year 2010. The Strategic Plan for the Elimination of Tuberculosis
in the United States was published at that time, and reassessed
in 1999, to identify the actions necessary to achieve elimination.
In 1992, a special federal task force was convened to address the
problem of increasing case rates and outbreaks of drug-resistant
TB. This task force developed the National Action Plan to Combat
Multidrug-Resistant Tuberculosis, which enhanced the original
Strategic Plan. Both plans stress the need to increase clinical
knowledge about TB disease and infection.
Since 1993, TB case rates have been declining, suggesting that
the nation is recovering from the resurgence of TB that occurred
in the mid-1980s, and is back on track toward TB elimination. While
the decrease in TB case rates is encouraging, there are several
areas of concern that will require expanded efforts:
- TB cases continue to be reported in every state
- Drug-resistant TB cases continue to be reported in almost every
- An estimated 10 to 15 million persons in the U.S. are infected
with Mycobacterium tuberculosis. Without intervention,
about 10 % of these persons will develop TB disease at some point
An update on TB for clinicians is critical today. The occurrences
of several outbreaks of multidrug-resistant TB have pointed to the
need for new treatment regimens and the more effective use of current
ones. New methods of diagnosis have been introduced, and guidelines
for patient management and public health practice have been revised.
This curriculum was designed to present basic information about
TB for health care professionals. It is intended for use as a reference
manual for clinicians caring for persons with or at high risk for
TB disease or infection. In addition, it was designed to be useful
in developing educational programs. It is not meant to provide
detailed answers to all public health or clinical questions about
TB, nor is it meant as a substitute for any specific guidelines.
Information contained in this document is current as of April 2000.
In preparing this document, our aim was to meet the following goals:
- To increase clinicians knowledge of the current TB trends.
- To assist clinicians with identifying those at highest risk
for TB infection and disease.
- To increase clinicians index of suspicion for TB in high-risk
- To increase clinicians use of treatment for high-risk
persons with latent TB infection.
- To increase clinicians knowledge about appropriate and
effective treatment regimens.
- To increase clinicians use of directly observed therapy
(DOT) and other adherence-promoting methods.
- To assist clinicians with identifying appropriate measures to
prevent TB transmission in health care settings.
- To assist clinicians with identifying resources for patients
This document was originally developed by the 1989 National Tuberculosis
Training Initiative, 1
cosponsored by the American Thoracic Society and CDC. Because the
guidelines for treating and controlling TB continue to evolve, it
has been necessary to periodically revise this curriculum. The current
document is the fourth edition of the Core Curriculum on Tuberculosis.
education credits [continuing medical education (CME)
credits, continuing nursing education (CNE) credits, and
continuing education unit (CEU)] are available for this