Tuberculosis Control in Low-Prevalence Countries
Tuberculosis remains one of the world's major public health challenges, causing more than 2 million (mostly young) adult deaths per year. The scale of the problem is such that in 1993 the World Health Organization (WHO) was forced to declare tuberculosis a "global emergency." This somber picture hides the overall success of tuberculosis-control efforts in most of the industrialized countries. After the Second World War, most industrialized countries successfully moved from high to low tuberculosis prevalence in little more than a generation by effectively treating infectious cases in well-established tuberculosis networks. For example, in the Netherlands the decline in the risk of infection was 4-5% per year between the two world wars, and with the introduction of modern chemotherapy this decline further increased to 13% per year after World War II (Fig. 1) (1). Case rates followed suit (Fig. 2) (1 b,2).