Tuberculosis Elimination, Research, and Respect for Persons

• Published in: American journal of respiratory and critical care medicine 2019-03, Vol.199 (5), p.560-563
• Main Author: Schluger, Neil W
• Format: Article
• Language: English
• Subjects: Biomedical Research - ethics; Biomedical Research - methods; Consortia; Disease Eradication - methods; Emigrants and Immigrants; Global Health - ethics; Global Health - statistics & numerical data; HIV; Human immunodeficiency virus; Humans; Infections; Prevention; Tuberculosis; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - prevention & control; United States - epidemiology
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201809-1623ED

The mode of disease development in the United States is generally not community transmission but, rather, progression of infections that were most likely acquired by persons before immigration to the United States, or perhaps on repeated trips outside the country (4, 5). [...]the path to TB elimination seems relatively clear: [...]14/100,000 is far lower than the incidence of TB in the countries from which persons move to the United States, a possible reflection of the so-called "healthy immigrant" effect (10), or of the fact that after many years of living in the United States without exposure, the risk of developing disease is very low. [...]most people identified with current tools as having TB infection have a very low chance of ever developing active TB and would not benefit from treatment (In fact, some may have cleared their infection and just retain immunoreactivity). [...]there must be increased efforts to improve diagnosis and treatment of TB in medium- and high-burden countries to stop transmission and prevent propagation of infection in communities.