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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 a reality.

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 outcomes.

  • Ensure that healthcare facilities maintain infection-control precautions.

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 persons.

  • 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 of TB.


  • 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 and prevention. 

  • 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 into practice.

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 -

Please send comments/suggestions/requests to:, or to
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333