Tuberculosis control in the Americas: current approaches.

Tuberculosi remains a serious public health problem in the Americas, and it has not declined as rapidly or as much as experts projected it would in the 1940's. Scientific advances in control of the disease over the last three decades have produced effective chemotherapeutic agents, established the immunizing capacity of BCG vaccine, and demonstrated the superior value of bacteriologic diagnosis in symptomatic individuals over mass community x-ray surveys, which are both inefficient and costly. They have also shown that most cases can be treated on an ambulatory basis, obviating the need for the lengthy hospital stays which have heretofore weighed so heavily on budgets. By standardization of control methods, both for diagnosis and for chemotherapy, these tasks can be taken on by polyvalent staff in the general health services, whose wide coverage places them in a position to reach a much larger segment of the population than that attended by the traditional vertical system. To a greater or lesser degree, all the countries in the Americas are beginning to orient their strategies in this direction, and some of them already have considerable progress to report.