The nation's number of new tuberculosis cases dropped for the fourth straight year in 1996, reaching the lowest level since the government started counting in the 1950s.
"We're on the right track toward the elimination of tuberculosis in this country," said Ken Castro, M.D., of the national Centers for Disease Control and Prevention.
But he and others at a news conference last week cautioned against complacency, saying TB surged in the mid-1980s because the nation let down its guard.
Castro noted that 20 states and the District of Columbia showed no reduction or even had increases from 1995 to 1996, and that sporadic outbreaks of drug-resistant TB continue to be reported.
In Ohio, there were 301 cases reported in 1996, up 7.5% from 1995. There were 2.7 cases per 100,000 Ohioans, placing them 40th in reported cases among the states.
Last year's nationwide count of new TB cases was 21,327, down nearly 7% from 1995. That's the fewest cases recorded by the CDC, which started national surveillance in 1953.
Officials credited programs that seek out people with infectious tuberculosis, diagnose them and make sure the patients take their full course of therapy. To be cured, a TB patient must take drugs for six months or longer, even after symptoms are gone.
The TB case total in 1996 was about where it would have been a decade earlier if the TB resurgence hadn't interrupted years of decline, Castro said.
From 1985 to 1992, TB cases rose almost 20%, said Charles Felton, M.D., speaking on behalf of the American Lung Association. The reason, Felton said, is that federal funding aimed specifically at TB control had been replaced with general public health block grants to states, which led many states to cut back their anti-TB efforts.
Congress restored much of the anti-TB money by 1992, he said. "If we do not continue to support TB control efforts, we will face an inevitable rise in tuberculosis cases once again," Felton said. "And the next time, the fight against TB will be much more costly."
Among the areas reporting TB increases in 1996 were the District of Columbia, up 36%, and Oregon, up 22%, Castro said.
He said it would take further study to determine why they and 19 other states bucked the nationwide trend. Many are probably still rebuilding their anti-TB programs, he said.
Castro also noted that an increasing proportion of the nation's cases are being found in people born outside the country. They accounted for 37% of cases in 1996, up from 22% a decade before. Two-thirds of the foreign-born people with TB were natives of Mexico, the Philippines or Vietnam, he said.
Part of the rise is because of an influx of immigrants, he said. Many people diagnosed with TB probably entered the country with harmless, latent infections of TB germs, Castro said. These infections can turn active after years of dormancy.
The best response to the rise is to support anti-TB efforts in other countries, he said.
The worldwide spread of TB has leveled off for the first time in decades, the World Health Organization announced last month.