Abstract

PIP: Because the international community neglected tuberculosis, developing countries did not mirror the decline in incidence of the disease seen in the industrialized world following the discovery of antituberculosis drugs. During the 1990s, developing countries will experience an estimated 90 million new cases of tuberculosis and 30 million deaths from the disease. Most new infections and deaths occur in Asia and Africa. In developing countries, socioeconomic conditions foster the spread of the disease, and inadequate health care systems mean that patients are not diagnosed rapidly and are not treated effectively until cured. The HIV epidemic is also contributing to the prevalence of tuberculosis in developing countries because of the large pool of coinfected people. Tuberculosis is the most frequent opportunistic disease in people with HIV/AIDS living in Africa, Latin America, and southeast Asia. A new wave of tuberculosis notifications and deaths has also occurred in the former socialist countries of central and eastern Europe because of war, conflict, impaired nutrition, stress, deterioration of the public health system following the dissolution of the Soviet Union, and a severe lack of drugs. In the US, notification increased during 1985-93 due to factors such as poor control programs. Rates have also increased or failed to decline in western Europe, and this situation has been linked with an increased number of cases among the foreign-born population. The extent and severity of drug resistance is unknown but the high rates of initial drug resistance, acquired drug resistance, and multi-drug resistance have been found. The World Health Organization is attempting to describe the true extent of the problem. Meanwhile the control situation is improving slowly but inadequately, with district-based programs giving the most hope. The extent of multi-drug resistance will have an important effect on the epidemiology of this disease. An effective eradication strategy exists but depends upon sustained political commitment.