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Updated: Apr 28, 2026
Author Spotlight: Optimizing CFU Determination for Efficient Assessment of TB Vaccine Efficacy and Antigen Presentation Analysis
Published on: July 28, 2023
Eliminating tuberculosis one neighborhood at a time
J Peter Cegielski1, David E Griffith, Paul K McGaha
1J. Peter Cegielski, Melanie Wolfgang, and Valerie A. Robison are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. David E. Griffith, Patricia A. Clark, and Willis L. Hassell are with the University of Texas Health Science Center, Tyler. Paul K. McGaha and Celia B. Robinson are with the Texas Department of State Health Services, Tyler. Kerfoot P. Walker Jr is with the Smith County Public Health District, Tyler. Charles Wallace is with the Texas Department of State Health Services, Austin.
Objectives:
We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it.
Methods:
In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project.
Results:
Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County.
Conclusions:
Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States.
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