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Federal Tuberculosis Task Force Plan in Response to the Institute of Medicine Report, Ending Neglect: The Elimination of Tuberculosis in the United States

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The documents listed below are historical, archived information. The information contained in these documents, while accurate at the time of release, may not be the most current available.

Introduction

Following more than three decades of declining TB trends, TB cases in the United States soared 20% between 1985 and 1992. The Federal TB Task Force was established in December 1991 in response to this unprecedented surge in TB cases. (The fourth chapter of this document lists the members of the Federal TB Task Force.) Some of the serious factors associated with the resurgence included -

  • The HIV epidemic, which increased the number of persons at extraordinary risk of TB disease progression


  • Immigration from countries with a high prevalence of TB or where TB is a substantial public health problem; a reflection of the global nature of the disease


  • Outbreaks in congregate settings such as hospitals and correctional facilities


  • The widespread occurrence and outbreaks of difficult-to-diagnose and treat MDR TB strains


  • A deterioration and dismantling of TB services and of the related public health infrastructure during the earlier periods of TB declines, resulting in inadequate capacity to respond to increased demands during the resurgence

By April 1992, the TB Task Force had responded with a National Action Plan to Combat Multidrug-Resistant Tuberculosis.1 This plan complemented the 1989 ACET document, A Strategic Plan for the Elimination of Tuberculosis in the United States2, and guided the mobilization of new resources for responding to the TB crisis in the United States. Consequently, TB and MDR TB case rates declined annually from 1992 to 2000. However, several elements of the plan could not be implemented due to resource constraints. And although the number of TB cases has declined, achievement of the goal of TB elimination was deemed uncertain.

In 1999, ACET reaffirmed its call for the elimination of TB in the United States3 and the National Academy of Sciences’ Institute of Medicine was commissioned to evaluate the feasibility of TB elimination in the United States. In the summer of 2000, the Institute of Medicine issued its independent report Ending Neglect: The Elimination of Tuberculosis in the United States.4 This report suggests that the resurgence of TB in the United States was the price of neglect reflected in earlier funding reductions for both TB programs and research. The report states that elimination of TB in the United States is feasible but will require social mobilization plus maintenance of public interest and commitment necessary to provide resources for the effort.

The Federal TB Task Force has undertaken the challenge of responding to this landmark IOM report by developing a coordinated federal action plan. The broad membership of the TB Task Force focused heavily on the first three (of five) areas of the IOM report that were considered amenable to federal activity:

  • "Maintaining control of TB: The control of tuberculosis requires the ability to identify and cure individuals with active tuberculosis disease."


  • "Speeding the decline of TB: After ensuring the control of tuberculosis, the second priority is targeted tuberculin skin testing and treatment of latent TB infection, which includes identification and treatment of contacts."


  • "Developing new tools: Tuberculosis elimination is not possible with the tools that are available currently but will require an investment in basic and applied research to develop better diagnostic, treatment, and prevention tools as well as related behavioral and social research targeted toward understanding and improving patient adherence with therapy."

While the larger group of TB Task Force members did not focus heavily on the fourth and fifth areas of the IOM report, they were addressed. A smaller group of Federal TB Task Force members focused on the IOM global TB recommendations to decrease the number of foreign-born individuals with TB in the United States, to minimize the spread and impact of MDR TB, and to improve global health. In addition, the TB Task Force members briefly dealt with the fifth area of the IOM report by referring to the ACET and TB Task Force responsibilities for monitoring the federal responses to the IOM report. Furthermore, ACET has agreed to implement recommendation 7.3 and to monitor and evaluate this plan. To facilitate the process, CDC is working to generate a list of indicators for monitoring progress.

This Federal TB Task Force report is a response to the IOM report Ending Neglect: The Elimination of Tuberculosis in the United States, and is intended to influence and guide federal decision makers charged with planning TB control and elimination activities. The report is organized with reference to the major IOM areas noted above, while recognizing there is potential overlap in the impact of some activities (e.g., improved education to health care providers and to patients will improve both control of current TB burden and accelerate the decline of the disease). The report lays out a series of strategies that need to be undertaken at the federal level. In addition, this report addresses activities to support the Occupational Safety and Health Administration (OSHA) compliance instruction, CPL 2.106, Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis, which provides uniform inspection procedures and guidance for OSHA Compliance Officers to follow when conducting inspections and issuing citations under Section 5(a)(1) of the OSH Act. Priorities will vary from agency to agency, and activities should be undertaken within the time frames indicated, as resources permit. Some of the activities are underway; however, many of the proposed activities will require additional resources. Many activities should and will continue beyond 2003. The report is intended as a plan for action by federal agencies. However, implementation will depend on the cooperation of many sectors of society. Indeed, the success of the plan will depend on a concerted effort and commitment at all levels and will involve collaboration between public health and other government agencies, professional societies, voluntary agencies, health care providers, community and faith-based organizations, and many others.

 
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