This is an archived document. The links are no longer being updated.
TB Notes 3, 2001
Update on CDCís Response to Ending Neglect:
the Elimination of Tuberculosis in the United States
As you know, the Institute of Medicine (IOM) released
a report entitled Ending Neglect: the Elimination of Tuberculosis
in the United States in May of 2000. CDC had commissioned the report,
asking the IOM to determine the feasibility of TB elimination as
a national goal. If feasible, then the IOM had been further asked
to provide specific recommendations as to how to make elimination
The IOM determined that TB elimination in the United States was
feasible, but stated that ďto meet this goal aggressive and decisive
actions beyond what is now in effect will be required.Ē Furthermore,
ďelimination of TB is not possible with the tools we currently have
available. An effective elimination campaign will require additional
financial resources and a strong, durable commitment by policy makers.Ē
CDC agrees with these conclusions.
The Division of TB Elimination (DTBE) is leading CDCís effort to
develop a plan of action in response to the IOM report. This document,
CDCís Plan to Eliminate Tuberculosis from the United States, reflects
the scientific, programmatic, and health-sector developments of
the last decade and supercedes the 1989 Strategic Plan for the Elimination
of Tuberculosis in the United States. The goals, objectives, and
action steps that comprise CDCís new strategy for TB elimination
will serve as a guide for CDCís work, in collaboration with its
partners, to finally rid the nation of the human suffering and societal
harm caused by TB infection and disease.
The plan is organized around six goals that frame TB elimination
efforts in the context of the IOMís recommendations. The goals and
corresponding objectives are as follows:
Goal I: Maintain control of TB incidence
Maintain the decline in TB incidence through timely diagnosis of
active TB disease, appropriate treatment and management of persons
with active disease, investigation and appropriate evaluation and
treatment of contacts of infectious cases, and prevention of transmission
through infection control.
Maintain and enhance local, state, and national
public health surveillance for TB.
Support the infrastructure needed for laboratory-based
identification and treatment of TB.
Ensure that patient-centered case management and
monitoring of treatment outcomes are the standard of care for
all TB patients.
Develop community partnerships, and strengthen
community involvement in TB control.
Improve the timely investigation and appropriate
evaluation and treatment of contacts with active TB disease
and latent TB infection.
Ensure appropriate care for patients with MDRTB,
and monitor their response to treatment and their treatment
Ensure that healthcare facilities maintain infection-control
Goal II: Accelerate the decline
Advance toward TB elimination through targeted testing and treatment
of persons with latent TB infection, appropriate regionalization
of TB control activities, rapid recognition of TB transmission using
DNA fingerprinting methods, and rapid outbreak response.
Increase the capacity of TB control programs to
implement targeted testing and treatment programs for high-risk
Promote the appropriate regionalization of TB
control activities in high, intermediate, and low TB-incidence
areas of the United States.
Characterize circulating M. tuberculosis strains
using DNA fingerprinting methods.
Develop national, state, and local capacity to
respond to outbreaks of TB.
Goal III: Create new tools
Develop and assess new tools for the diagnosis, treatment, and prevention
Develop a coordinated plan for TB research.
Develop new methods to diagnose persons with latent
TB infection and to identify infected persons who are at high
risk for developing active TB.
Develop and assess new drugs to improve TB treatment
Develop a new and effective TB vaccine.
Develop and implement a program of research on
behavioral factors related to TB treatment and prevention.
Rapidly transfer findings from research studies
Goal IV: Reduce the global reservoir of TB
Increase involvement in international TB control activities.
Provide leadership in public health advocacy for
TB prevention and control.
Provide technical support and build capacity for
implementation of DOTS.
Develop models for the diagnosis and treatment
of patients with MDRTB.
Provide technical, programmatic, and research
support to reduce the incidence of TB as an opportunistic disease
in high HIV-burden countries.
Goal V: Summon and sustain support
Mobilize and sustain support for TB elimination by engaging political
leaders, opinion leaders, policy makers, organizational partners,
health care providers, affected communities, and the public. Implement
a comprehensive health communication campaign that supports elimination
strategies and ensures the development and delivery of effective
TB control messages.
Develop and implement a media communications campaign
focusing on the resources and support needed to eliminate TB.
Help communities foster nontraditional, multisectoral,
public-private partnerships to improve the effectiveness of
their communications activities, with particular attention to
culturally appropriate materials.
Support the development of state- or area-specific
TB elimination plans that contain communications activities
to build support for TB elimination.
Goal VI: Track progress
Monitor progress toward the goal of TB elimination, and make regular
reports on progress to all target audiences.
Develop innovative analyses for examining surveillance
data to help focus elimination efforts.
Develop novel indicators of progress toward elimination.
Conduct periodic evaluations of TB program performance
at federal, state, and local levels.
Conduct an annual progress review.
CDCís Plan to Eliminate Tuberculosis in the United
States complements a more comprehensive federal plan, under development
by the multiagency TB Task Force, to respond to the IOMís recommendations.
Implementation of these plans will set in motion the activities
needed to arrest TB in the United States.
The CDC plan has been presented to the Advisory Council for the
Elimination of TB (ACET) for review and comment. State and local
TB controllers have also provided comments through the National
TB Controllers Association (NTCA). We will keep you informed as
work progresses on the plan and make copies of the plan available
to you when it is finalized.
óReported by Paul Poppe
Deputy Director, DTBE
Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333