Tuberculosis in the Workplace (2001) / Chapter Skim
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1 Introduction
1 Introduction
Pages 13-23
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From page 13... ...
Consistent with most recent literature, this report treats "infection with Mycobacterium tuberculosis," "latent tuberculosis infection," and "tuberculous infection" as synonyms. The first two terms are used, for example, in the recent statement from the American Thoracic Society and the Centers for Disease Control and Prevention on the classification of tuberculosis in adults and children (ATS/CDC, 2000a)
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described tuberculosis as a deadly and highly contagious disease "that you could catch from the person next to you in a movie theater or classroom" (Califano cited in OTA, 1993, p.
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[1999~. Most such outbreaks have been linked to lapses in infection control practices, delays in diagnosis and treatment of infectious individuals, and the presence of high-risk populations including people with HIV infection or AIDS and recent immigrants from countries with high rates of tuberculosis.
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Reports on facilities that experienced tuberculosis outbreaks in the late 1980s and early 1990s describe lapses in tuberculosis control measures followed by the implementation of new protective measures, and the subsequent reduction of worker exposures and new infections.
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RESPONSES TO RESURGENT TUBERCULOSIS Responses to Tuberculosis in the Community The increase in tuberculosis case rates in the mid-1980s and early 1990s prompted public health authorities to revive and adapt traditional strategies to prevent and control tuberculosis in the community. Specific federal funding for tuberculosis control programs, which had virtually disappeared in the 1970s, resumed in the 1980s and increased substantially in the 1990s, as shown in Figure 1-2 (IOM, 2000~.
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From page 18... ...
, but physician awareness of and adherence to tuberculosis treatment guidelines remain concerns (DeRiemer et al., 1999; Evans et al., 1999~. Other elements of the attack on drug resistant disease have included faster laboratory identification of drug-resistant strains of the disease (Tenover et al., 1993)
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In 1993, it asked OSHA to issue a permanent standard (Labor Coalition, 1993~.3 In addition to citing the 1990 CDC guidelines, the coalition cited enforcement guidelines issued by Region II of the Occupational Safety and Health Administration and by the state of California's occupational safety and health agency. The Secretary of Labor announced in 1994 that OSHA would initiate a rulemaking process to establish formal standards to prevent workplace transmission of the disease.
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Altogether, the agency received approximately 1,500 comments on the proposed rule including testimony at the four hearings and comments submitted when the record was reopened in 1999 (Amanda Edens, OSHA, personal communication, December 6,2000~. THE BROADER PUBLIC HEALTH CONTEXT: ELIMINATING TUBERCULOSIS IN THE UNITED STATES AND WORLDWIDE Today, tuberculosis is a largely preventable and curable disease.
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Eliminating Tuberculosis Worldwide With more than 40 percent of the tuberculosis cases in the United States involving people born in other countries, policymakers and public health authorities cannot ignore the global problem of tuberculosis. As noted above, a key recommendation of the recent IOM report on tuberculosis elimination in the United States was that this country should "expand and strengthen its role in global tuberculosis control efforts" (IOM, 2000, p.
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For example, crowded, underfunded homeless shelters may, when weather permits, have people with suspected tuberculosis wait outside in fresh air until transportation and treatment can be arranged. CONCLUSION Although tuberculosis is still a major killer in poor countries, 50 years of effective drug treatment has greatly reduced the toll that the disease takes in the United States.
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