title: Epidemiology and challenges to the elimination of global tuberculosis.
abstract: Recent epidemiological indicators of tuberculosis (TB) indicate that the Millennium Development Goal of TB elimination by 2050 will not be achieved. The majority of incident cases are occurring in population-dense regions of Africa and Asia where TB is endemic. The persistence of TB in the setting of poor existing health infrastructure has led to an increase in drug-resistant cases, exacerbated by the strong association with human immunodeficiency virus coinfection. Spreading drug resistance threatens to undo decades of progress in controlling the disease. Several significant gaps can be identified in various aspects of national- and international-directed TB-control efforts. Various governing bodies and international organizations need to address the immediate challenges. This article highlights some of the major policies that lawmakers and funding institutions should consider. Existing economic and social obstacles must be overcome if TB elimination is to be a reachable goal.
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Jassal
authors.forename: William R
authors.initials: WR
authors.lastname: Bishai
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods / Q000458:organization & administration*; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D019353:Endemic Diseases; D006801:Humans; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control*
references.citation: Int J Tuberc Lung Dis. 2004 Aug;8(8):1012-6
references.pmid: 15305486
references.citation: BMJ. 2009 Apr 06;338:b1314
references.pmid: 19359306
references.citation: Lancet. 2006 Mar 18;367(9514):952-5
references.pmid: 16546550
references.citation: PLoS Med. 2008 Jul 22;5(7):e143
references.pmid: 18651786
references.citation: Lancet Infect Dis. 2006 Nov;6(11):710-25
references.pmid: 17067920
references.citation: Lancet Infect Dis. 2003 May;3(5):288-96
references.pmid: 12726978
references.citation: BMC Infect Dis. 2006 Jun 13;6:97
references.pmid: 16772037
references.citation: MMWR Morb Mortal Wkly Rep. 2006 Mar 24;55(11):301-5
references.pmid: 16557213
references.citation: Bull World Health Organ. 2006 Sep;84(9):752-8
references.pmid: 17128346
references.citation: AIDS. 2007 Jul 11;21(11):1441-8
references.pmid: 17589190
references.citation: Lancet. 2009 Apr 18;373(9672):1395-7
references.pmid: 19376454
references.citation: Lancet. 2002 Mar 2;359(9308):775-80
references.pmid: 11888605
references.citation: Lancet. 2009 Apr 18;373(9672):1328
references.pmid: 19382292
references.citation: Bull World Health Organ. 2007 May;85(5):364-9
references.pmid: 17639221
references.citation: Nat Med. 2007 Mar;13(3):295-8
references.pmid: 17342143
references.citation: Antimicrob Agents Chemother. 2002 Feb;46(2):267-74
references.pmid: 11796329
references.citation: Health Policy Plan. 2000 Dec;15(4):368-77
references.pmid: 11124239
references.citation: MMWR Recomm Rep. 2009 Feb 13;58(RR-3):1-43
references.pmid: 19214162
references.citation: Bull World Health Organ. 2002;80(6):428
references.pmid: 12131996
references.citation: Lancet. 2007 Jun 16;369(9578):2042-2049
references.pmid: 17574096
references.citation: PLoS One. 2008;3(12):e4057
references.pmid: 19129940
references.citation: Nat Rev Immunol. 2005 Oct;5(10):819-26
references.pmid: 16200083
references.citation: Int J Tuberc Lung Dis. 2009 Apr;13(4):540-4
references.pmid: 19335963
references.citation: Bull World Health Organ. 2007 May;85(5):327
references.pmid: 17639210
references.citation: Int J Tuberc Lung Dis. 2006 Apr;10(4):460-2
references.pmid: 16602414
references.citation: Tuberculosis (Edinb). 2008 Jan;88(1):58-63
references.pmid: 17913585
references.citation: Tuberculosis (Edinb). 2007 Aug;87 Suppl 1:S26-30
references.pmid: 17606407
references.citation: Am J Trop Med Hyg. 2004 Aug;71(2 Suppl):147-55
references.pmid: 15331831
references.citation: Lancet. 2008 Oct 25;372(9648):1473-83
references.pmid: 18835640
references.citation: Int J Tuberc Lung Dis. 2009 Jan;13(1):112-8
references.pmid: 19105888
references.citation: PLoS One. 2008 Sep 08;3(9):e3154
references.pmid: 18776932
references.citation: Trop Med Int Health. 2002 Mar;7(3):210-9
references.pmid: 11903983
references.citation: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006418
references.pmid: 19160285
references.citation: Lancet Infect Dis. 2009 Jan;9(1):19-30
references.pmid: 18990610
references.citation: Lancet. 2004 Feb 7;363(9407):474-81
references.pmid: 14962530
references.citation: N Engl J Med. 1995 Jul 27;333(4):229-33
references.pmid: 7791840
references.citation: MMWR Recomm Rep. 2009 Apr 10;58(RR-4):1-207; quiz CE1-4
references.pmid: 19357635
references.citation: MMWR Recomm Rep. 2005 Dec 30;54(RR-17):1-141
references.pmid: 16382216
references.citation: J Infect Dis. 2007 Aug 15;196 Suppl 1:S108-13
references.pmid: 17624819
references.citation: J Clin Invest. 2008 Apr;118(4):1255-65
references.pmid: 18382738
references.citation: Lancet Infect Dis. 2008 Jun;8(6):359-68
references.pmid: 18450516
references.citation: PLoS One. 2008 Apr 09;3(4):e1933
references.pmid: 18398459
references.citation: Bull World Health Organ. 2007 Aug;85(8):647-8
references.pmid: 17768527
references.citation: PLoS Med. 2006 Sep;3(9):e352
references.pmid: 16968123
references.citation: Health Policy Plan. 2009 Jan;24(1):55-62
references.pmid: 19056804
references.citation: Int J Tuberc Lung Dis. 2007 Oct;11(10):1049-61
references.pmid: 17945060
references.citation: JAMA. 2005 Jun 8;293(22):2767-75
references.pmid: 15941807
references.citation: Int J Tuberc Lung Dis. 2009 Feb;13(2):171-6
references.pmid: 19146743
references.citation: J Acquir Immune Defic Syndr. 2009 Mar 1;50(3):327-30
references.pmid: 19194308
references.citation: Clin Infect Dis. 2005 May 15;40(10):1500-7
references.pmid: 15844073
references.citation: BMC Health Serv Res. 2008 Oct 02;8:202
references.pmid: 18828929
references.citation: Int J Tuberc Lung Dis. 2009 Apr;13(4):421-8
references.pmid: 19335945
references.citation: HIV Clin Trials. 2006 Jul-Aug;7(4):172-83
references.pmid: 17065029
references.citation: Nat Rev Microbiol. 2009 Jan;7(1):81-7
references.pmid: 19079354
references.citation: Bull World Health Organ. 2007 May;85(5):341-7
references.pmid: 17639217
references.citation: Lancet Infect Dis. 2009 Mar;9(3):144-5
references.pmid: 19291896
references.citation: Bull World Health Organ. 2007 Oct;85(10):805-11
references.pmid: 18038063
references.citation: PLoS Med. 2007 Jan;4(1):e20
references.pmid: 17227135
references.citation: Int J Tuberc Lung Dis. 2004 Mar;8(3):286-98
references.pmid: 15139466
references.citation: Lancet. 2007 Oct 27;370(9597):1500-7
references.pmid: 17964351
references.citation: Tubercle. 1991 Dec;72(4):284-90
references.pmid: 1811360
references.citation: Lancet Infect Dis. 2006 Aug;6(8):483-95
references.pmid: 16870527
references.citation: MMWR Recomm Rep. 2005 Nov 4;54(RR-12):1-81
references.pmid: 16267499
references.citation: Int J Tuberc Lung Dis. 2007 Sep;11(9):1042-5
references.pmid: 17705985
references.citation: Semin Respir Crit Care Med. 2008 Oct;29(5):481-91
references.pmid: 18810682