title: Controversies and unresolved issues in tuberculosis prevention and control: a low-burden-country perspective.
abstract: Despite declining incidence in most high-income countries, tuberculosis shows no signs of disappearing in the near future. Although surveillance data from most Western European countries show relatively stable declines in the rate of tuberculosis over the past several decades, some have reported either an increasing rate or a decelerating pace of reduction in recent years. The burden of disease now disproportionately affects high-risk groups such as migrants, homeless persons, and prisoners. In view of the concentration of cases in urban areas and high-risk deprived groups, interventions that may not be efficient when applied to the general population may be highly cost effective when targeted at high-risk groups. In this article, we examine some controversial elements of tuberculosis prevention and control in low-burden countries and recommend issues for further research. In particular, we assess current evidence on the duration of protection by BCG vaccine, the screening of migrants and hard-to-reach groups, and the use of preventive therapy for contacts of cases of infectious multidrug-resistant tuberculosis. This analysis is presented from the perspective of low-tuberculosis-burden, high-income countries attempting to eliminate tuberculosis.
authors.affiliation: Respiratory Diseases Department, Health Protection Services Colindale, Health Protection Agency, London, UK. ibrahim.abubakar@hpa.org.uk
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
authors.forename: Helen R
authors.initials: HR
authors.lastname: Stagg
authors.forename: Ted
authors.initials: T
authors.lastname: Cohen
authors.forename: Punam
authors.initials: P
authors.lastname: Mangtani
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rodrigues
authors.forename: Laura
authors.initials: L
authors.lastname: Pimpin
authors.forename: John M
authors.initials: JM
authors.lastname: Watson
authors.forename: S Bertel
authors.initials: SB
authors.lastname: Squire
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000276:immunology; D003140:Communicable Disease Control / Q000379:methods; D019049:Developed Countries / Q000191:economics / Q000706:statistics & numerical data; D006703:Ill-Housed Persons; D006801:Humans; D015994:Incidence; D011159:Population Surveillance; D011329:Prisoners; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D014171:Transients and Migrants; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control*; D014505:Urban Population
chemical_list: D000995:Antitubercular Agents; D001500:BCG Vaccine