Failure of Tuberculosis Control

The dramatic increase in tuberculosis (TB) incidence¹is testimony to the failure of the United States to coordinate its medical care provision, disease surveillance, and societal will to consistently provide TB therapy and monitor TB control.²In this issue ofThe Journal, Bloch and colleagues³demonstrate a remarkable shift in the epidemiology of TB in the United States. In the 1970s, US health officials believed that indigenous TB was coming under control, its ultimate elimination possible with only an occasional case reactivating in the elderly. Transient increases in TB incidence were attributed to immigrants, such as the Indochinese refugees in the mid 1970s⁴and Philippine national World War II veterans in Hawaii in the 1990s.⁵These foreign cases brought with them the peril of drug resistance as a result of the indiscriminate and inconsistent use of TB medications in the immigrants' countries of origin. Bloch