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No. 4, 2012


Eliminating TB, One Neighborhood at a Time

This article summarizes a study that evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it.

In 1996, the study investigators mapped reported TB cases (1985–1995) and positive tuberculin skin test (TST) reactors (1993–1995) in Smith County, Texas. They delineated the two largest, densest clusters, identifying two highest-incidence neighborhoods (180 square blocks, with 3,153 residents). After extensive community preparation, trained health care workers went door to door offering TSTs to all residents unless contraindicated. Those persons with TST-positive results were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, the investigators mapped all TB cases in Smith County during the equivalent time period after the project.

Of 2,258 eligible individuals, 1,291 (57.1%) had skin tests placed. Of these, 1,236 (95.7%) had their skin test results read; 229 (18.5%) had positive TST reactions (10 mm induration or more), and 147 were treated for LTBI. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the pre-intervention decade and the continued occurrence of TB in the rest of Smith County.

The investigators conclude that targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States.


  1. Cegielski JP, Griffith DE, McGaha PK, Wolfgang M, Robinson CB, Clark PA, Hassell WL, Robison VA, Walker KP Jr, and Wallace C. Eliminating tuberculosis one neighborhood at a time. Am J Public Health. Published online ahead of print October 18, 2012: e1–e9. doi:10.2105/AJPH.2012.300781.

—Reported by Peter Cegielski, MD
Div of TB Elimination

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