The Core Curriculum on Tuberculosis is accompanied by a slide series for use in presentations and training programs. To order the Core Curriculum Slide Series, call CDC Voice Information System at (404) 639-1819.
In 1989, the Centers for Disease Control and Prevention 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 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.
An update on TB for clinicians is critical today. After a decades-long decrease in the number of TB cases reported in the United States, TB has reemerged as a serious national problem. From 1985 through 1993, the number of new TB cases increased by 14% -- from 22,201 to 25,313. We can attribute this recent increase to at least four factors:
Moreover, the recent occurrence of several outbreaks of multidrug-resistant TB has pointed to the need for new treatment regimens. New methods of diagnosis have been introduced, and guidelines for patient management and public health practice have been revised. In addition, studies have shown that the appropriate diagnosis and management of patients with TB disease and infection continue to present problems for clinicians. Especially disturbing is the fact that approximately 25% of patients who start treatment do not complete a recommended regimen within 12 months.
This curriculum was designed to present basic information about TB that could be useful in developing educational programs 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. It is not meant to provide detailed answers to all public health or clinical questions about TB.
In preparing this document, our aim was to meet the following objectives:
This document was originally developed by the National Tuberculosis Training Initiative, cosponsored by the American Thoracic Society and the Centers for Disease Control and Prevention. The current document is the third edition of the Core Curriculum on Tuberculosis. Because the guidelines for treating and controlling TB continue to evolve, it has been necessary to revise this curriculum periodically.
This curriculum is based on documents published by the American Thoracic Society, the Advisory Council for the Elimination of Tuberculosis, and the Centers for Disease Control and Prevention. We recognize that documents prepared by other professional organizations may contain minor differences in recommendations.
Advisory Committee for the Elimination of Tuberculosis. A strategic plan for the elimination of tuberculosis in the United States. MMWR. 1989;38(Suppl S-3).
Advisory Committee for the Elimination of Tuberculosis. Screening for tuberculosis and tuberculosis infection in high-risk populations; and The use of preventive therapy for tuberculosis infection in the United States. MMWR. 1990;39(RR-8):1-12.
American Thoracic Society. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med. 1994;149:1359-1374.
American Thoracic Society and Centers for Disease Control. Control of tuberculosis in the United States. Am Rev Respir Dis. 1992;146:1623-1633.
American Thoracic Society and Centers for Disease Control. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis. 1990;142:725-735.
Centers for Disease Control. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities. MMWR. 1994;43(RR-12).
Centers for Disease Control. Management of persons exposed to multidrug-resistant tuberculosis. MMWR. 1992;41(RR-1):59-71.
Centers for Disease Control. National action plan to combat multidrug-resistant tuberculosis. MMWR. 1992;41(RR-11).
Centers for Disease Control. Purified protein derivative (PPD)-tuberculin anergy and HIV infection: guidelines for anergy testing and management of anergic persons at risk of tuberculosis. MMWR. 1991;40(RR-5):27-32.
Centers for Disease Control. Tuberculosis and human immunodeficiency virus infection: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR. 1989;38:236-239,243-250.
Centers for Disease Control. Use of BCG vaccines in the control of tuberculosis: a joint statement by the Immunization Practices Advisory Committee and the Advisory Committee for Elimination of Tuberculosis. MMWR. 1988;37:663-664,669-675.
Centers for Disease Control and Prevention. Approaches to improving adherence to antituberculosis therapy. MMWR. 1993;42:74-75.
Centers for Disease Control and Prevention. Expanded tuberculosis surveillance and tuberculosis morbidity--United States, 1993. MMWR. 1994;43(RR-20):361-366.
Centers for Disease Control and Prevention. Initial therapy for tuberculosis in the era of multidrug resistance. MMWR. 1993;42(RR-7):1-8.
Centers for Disease Control, National Institute for Occupational Safety and Health. Recommended guidelines for personal respiratory protection of workers in health care facilities potentially exposed to tuberculosis. Washington, DC: Department of Health and Human Services; 1992.
Snider DE, Hutton MD. Improving patient compliance in tuberculosis treatment programs. Atlanta: Centers for Disease Control; 1989.
For more information on TB, contact the following organizations:
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