Restriction fragment length polymorphism (RFLP) analysis to identify
specific Mycobacterium tuberculosis strains, in combination
with epidemiologic investigation, has shattered old dogmas and yielded new
insights into the transmission dynamics of tuberculosis. In several cities
in the United States, RFLP studies and epidemiologic analysis have shown that
19% to 54% of tuberculosis cases probably result from recent infection.1- 4 Effective
tuberculosis control measures should reduce this percentage. Yet, in this
issue of THE JOURNAL, Bishai and colleagues5
suggest that recent transmission accounted for 32% of tuberculosis cases in
Baltimore, Md, where an excellent tuberculosis control program has used community-based
directly observed therapy (DOT) since 1981.
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