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Controlling the Resurgent Tuberculosis Epidemic A 50-State Survey of TB Statutes and Proposals for Reform

Lawrence O. Gostin, JD
JAMA. 1993;269(2):255-261. doi:10.1001/jama.1993.03500020089038.
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A LONG-STANDING annual decline in the number of cases of tuberculosis (TB) in the United States led the Department of Health and Human Services to establish an Advisory Council for the Elimination of Tuberculosis (ACET) in 1987.1 Yet, even before the Council was established, the decline in tuberculosis had ended, and from 1985 through 1991 there were some 39 000 more cases than would have been expected had the downward trend continued.2,3

More worrisome still is the serious increase in the rate of multidrug-resistant (MDR) tuberculosis, which is much more difficult, and more costly, to treat than nonresistant strains. The course of treatment of MDR-TB increases from approximately 6 months to 18 to 24 months or longer, and the cure rate decreases from nearly 100% to 60% or less.4,5 A 1992 survey in New York City (NY) found that 33% of patients were infected with organisms resistant


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