The tuberculosis pandemic today: routes of transmission and new target groups

Tuberculosis, a disease that has been with us since the dawn of time, shows little sign of disappearing. Declines in death rates observed for several centuries prior to 1960 have been reversed in recent decades. This is in spite of the fact that efficient means of controlling the disease have been available during this period. This article reviews experience in 3 communities: among the Inuit, who live in the region of the North Pole; in the Beijing Municipality in the People's Republic of China; and in a socially isolated community in South Africa. In the first 2 communities, dramatic declines in the burden of disease have been observed: in the Inuit community, this occurred after substantial intervention; in the Beijing Municipality it was done with limited resources. The third community in South Africa illustrates an alarming trend, with tuberculosis being seen in a variety of locations but in the absence of external agents such as HIV infection. Clearly we need to refocus our efforts to control this disease, making use of the new tools that are rapidly becoming available. This must be done without delay, before influences such as HIV infection put the possibility of control completely out of reach.