[Tuberculosis elimination in the United States; why, how, and what will it take?]

This overview of tuberculosis elimination in the United States consists of three parts. First I will briefly overview the neglect and related factors during 1970's and early 80's which resulted in the 1985-1992 unprecedented resurgence of tuberculosis following thirty years of a steady decline in the United States. Second, I will review what we did in response and the resulting trends. Third, I will focus on the Institute of Medicine (IOM) report entitled "Ending Neglect", and identify the challenges to elimination and what will it take to finishing the job. The IOM report recommends the United States to pursue and accelerate the elimination of tuberculosis, addressing the following; 1) maintain control while adapting to declining incidence of tuberculosis, 2) speed the decline through the increased treatment of persons with latent infection, 3) invest in research and development to develop new tools needed for ultimate elimination, with a focus on new reliable and rapid diagnostic tools for latent infection, new drug regimens, especially in light of the emergence of extensively drug-resistant tuberculosis, and a safe and effective vaccine for tuberculosis, 4) increase the United States engagement in global efforts, recognizing that the global reality is directly reflected in the United States, 5) mobilize support and measure progress towards elimination. Each of these recommendations will be translated into the agenda for action with the illustrations for the real situations of the United States. It is important to recognize that in spite of all this progress much work needs to be done and in order to finish the job on tuberculosis elimination we have the blueprints, we have the partners, and we must keep working to make the effective use of our resources. I would like to close by quoting one of the favorite phrases in "Ending Neglect"; "The issue now confronting the nation, that is the United States, is whether we will allow another cycle of neglect to begin or instead whether we will take decisive action to eliminate tuberculosis."