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The
service provides tuberculosis skin testing to clients who have been
exposed to tuberculosis to provide early detection. TB skin tests are also
provided to persons who are required by their school or occupation to have
annual TB skin tests. The cost of a TB skin test done for purposes other
than exposure to the disease is $20.00. This service is offered daily at
Cabarrus Health Alliance 8:30 a.m. - 4:00 p.m. except on
Thursday. Call 704 920-1205
for an appointment. Clients must return in 48-72 hours for reading
of the skin test. Chest X-rays are ordered for clients who have a positive
TB skin test. Medications for treatment and prevention of TB are provided
free of charge through a state funded program. Call 704
920-1205 for an appointment.
SUMMARY 
At no time in recent history has tuberculosis (TB) been as great a
concern as it is today. TB cases are on the increase, and the most serious
aspect of the problem is the recent occurrence of outbreaks of multidrug-resistant (MDR) TB, which pose an urgent public health problem
and require rapid intervention. A Task Force composed of representatives
of many federal agencies has developed a National Action Plan for
addressing this problem. The Task Force identified a number of objectives
to be met if MDR-TB is to be successfully combated. These objectives fail
under the categories of a) surveillance and epidemiology -- determining
the magnitude and nature of the problem; b) laboratory diagnosis --
improving the rapidity, sensitivity, and reliability of diagnostic methods
for MDR-TB; c) patient management -- effectively managing patients who
have MDR-TB and preventing patients with drug-susceptible TB from
developing drug-resistant disease; d) screening and preventive therapy --
identifying persons who are infected with or at risk of developing MDR-TB
and preventing them from developing clinically active TB; e) infection
control -- minimizing the risk of transmission of MDR-TB to patients,
workers, and others in institutional settings; f) outbreak control; g)
program evaluation -- ensuring that TB programs are effective in managing
patients and preventing MDR-TB; h) information dissemination/ training and
education; and i) research to provide new, more effective tools with which
to combat MDR-TB. The Action Plan lays out a series of activities to be
undertaken at the national level. For each category, the Plan presents
statements of problems to be overcome, followed by a summary of the
objective to be achieved and steps to be carried out. For each
implementation step, responsibility is assigned to the appropriate
organization and startup dates are listed.
INTRODUCTION
Tuberculosis (TB) is an infectious disease caused by the bacterium
Mycobacterium tuberculosis, which is spread almost exclusively by airborne
transmission. Although the disease can affect any site in the body, it
most often affects the lungs. When persons with pulmonary TB cough, they
produce tiny droplet nuclei that contain TB bacteria, which can remain
suspended in the air for prolonged periods of time. Anyone who breathes
air that contains these droplet nuclei can become infected with TB. A
person who becomes infected with the TB bacillus remains infected for
years. Usually a person with a healthy immune system does not become ill,
but is usually not able to eliminate the infection without taking an anti-tuberculosis
drug. This condition is referred to as "latent tuberculous
infection." Persons with latent tuberculous infection are
asymptomatic and cannot spread TB to others. Generally, a positive TB skin
test is the only evidence of infection. About 10-15 million persons in
this country are infected with M. tuberculosis. About 10% of otherwise
healthy persons who have latent tuberculous infection will become ill with
active TB at some time during their lives.
TB Control Programs
Our programs for controlling TB have two major arms. The first
and highest priority is to detect persons with active TB and treat them
with effective anti-tuberculosis drugs. Effective treatment keeps the
patients from dying of TB and stops the transmission of infection to other
persons in the household, at the work site, or in the community. Treatment
of active TB involves taking multiple anti-tuberculosis drugs daily (or
two or three times weekly) for at least 6 months. If the patient does not
take the medications for the full treatment period, the disease may not be
cured and may recur. If medications are not prescribed properly or taken
regularly, the TB organisms can become resistant to the drugs, and
drug-resistant TB may then be transmitted to other persons. Drug-resistant
disease is difficult and expensive to treat. Thus, the most important step
to prevent drug-resistant disease is to ensure that patients take all
their medication. Directly observed therapy is the best way of ensuring
patient compliance. The second major control intervention is to detect and
preventively treat persons who do not have active TB, but who have latent
tuberculous infection and may be at high risk of developing active TB.
With drug-susceptible TB, preventive therapy with isoniazid greatly
reduces the risk of developing active TB. Preventive therapy requires
treatment daily or twice weekly for a minimum of 6 months, and many
patients do not complete a full course of therapy without direct
observation.
Increase in TB Cases
The United States had a significant decline in the number of TB
cases over the past several decades -- from >84,000 cases in 1953 to a
nadir of approximately 22,000 cases in 1984. In 1987, the Department of
Health and Human Services established an Advisory Committee (now Council)
for the Elimination of Tuberculosis (ACET). In 1989, the ACET published
the Strategic Plan for the Elimination of Tuberculosis in the United
States. The Plan established a national goal of TB elimination (i.e., an
incidence of <1 case per 1 million population) by the year 2010. An
interim goal for the year 2000 is an incidence of 3.5 cases per 100,000
population. Since the Strategic Plan was published, dramatic changes in
the incidence and epidemiology of TB have jeopardized the goal of TB
elimination. In 1984, the long-standing annual decline in TB cases
abruptly ended, and from 1985 through 1991, approximately 39,000 more
cases were reported than would have been expected had the previous
downward trend continued. Much of the recent increase in cases is believed
to be due to TB among persons infected with human immunodeficiency virus
(HIV). For HIV-infected persons who have latent tuberculous infection, the
risk of developing active TB is 7%-10% per year. Even more dramatic is the
effect seen when persons who are already infected with HIV become newly
infected with M. tuberculosis. In two outbreaks in which HIV-infected
persons were exposed to cases of infectious TB, 40% of the exposed persons
developed active TB within a few months; thus, among such persons, active
TB develops soon after infection and progresses rapidly, often resulting
in death. Other groups at high risk for TB include persons in group or
institutional settings, such as correctional facilities, shelters for the
homeless, residential care facilities, nursing homes, and hospitals, where
the environments may be conducive to airborne transmission of TB.
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