Eliminating tuberculosis one neighborhood at a time.
OBJECTIVE
We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it.


METHODS
In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project.


RESULTS
Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County.


CONCLUSIONS
Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States.
Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. pcegielski@cdc.gov
J Peter
JP
Cegielski
David E
DE
Griffith
Paul K
PK
McGaha
Melanie
M
Wolfgang
Celia B
CB
Robinson
Patricia A
PA
Clark
Willis L
WL
Hassell
Valerie A
VA
Robison
Kerfoot P
KP
Walker
Charles
C
Wallace
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D060740:Disease Eradication / Q000379:methods*; D005260:Female; D062305:Geographic Mapping; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D044465:White People; D055815:Young Adult
D000995:Antitubercular Agents; D007538:Isoniazid