Trends in the epidemiology of tuberculosis--a physician's view

It is likely that the incidence of tuberculosis will continue to decline, although there will be problems in areas with large numbers of immigrants from Third World countries. They will present problems only if they come from countries with high incidence of primary drug resistance. In the indigenous population there is one problem group--middle aged and elderly men often with sputum positive disease. Diagnosis tends to be delayed, they may not co-operate with treatment and there is a significant death rate. Despite the very substantial decline in incidence, it is probably premature to abandon BCG vaccination, although this will have to be reconsidered within the next 10 years.