Selective primary health care: strategies for control of disease in the developing world. II. Tuberculosis

Tuberculosis remains a major public health problem throughout the world. Practically all adults in developing countries are infected with the organism Mycobacterium tuberculosis, but only about five percent suffer any ill effects. Morbidity and mortality are greatest during the economically and socially productive young adult years. Treatment requires multiple drugs and many months of compliance. Treatment both reduces transmission of the organism and allays suffering in the diseased individual. The efficacy of vaccination with BCG (bacille Calmette-Guérin) remains controversial, but several trials have demonstrated some reduction in clinical disease. At this point, the ideal disease control program entails several steps of epidemiologic assessment of the problem and resources, development of public health orientation in the professional community, treatment of infectious patients, and BCG vaccination of all those under 15-20 years of age.