Low-incidence guide issued by ACET

Proficiency, resources often pinched

Guidelines tailored to the special needs of low-incidence states — defined as states with a TB caseload of less than or equal to 3.5 per 100,000 — were published last month by the Advisory Council to Eliminate Tuberculosis (ACET). The new guide appeared in the May 3 issue of the Morbidity & Mortality Weekly Report.

ACET offered almost a dozen recommendations for the states. Problems in such areas often include lack of expertise, money, and resources, the advisory body says. Yet such areas must continue to shoulder high fixed costs and be ready to cope with not only the occasional case but also outbreaks and even shifting migration patterns that bring populations with a higher incidence of TB or TB latency.

Form partnerships for contact investigations

Among ACET’s recommendations are the following:

  • Update TB statutes and TB control policy manuals at least every 2 years.
  • Maintain an elimination plan designed for local circumstances.
  • Form partnerships to ease the burden of labor-intensive contact investigations and targeted testing; likewise, consider adopting case-management techniques for treatment of contacts.
  • Consider collaborative arrangements for laboratory services.
  • Don’t ask local programs for more information than is really needed.
  • Consider regionalized approaches to the top-priority function of education and training.
  • Let policy-makers know the importance of elimination programs.

More research is needed into several areas of low-incidence policy, ACET adds. For example, more information is needed on regionalized approaches to resource-sharing, whether "face time" can be replaced by distance-based learning and "virtual classrooms," whether costly targeted testing can be cost-effective in low-incidence areas, and what the optimal size is for low-incidence programs.

North Dakota child infected 50 others

Four brief case studies in the document showed several ways outbreaks happen in low-incidence areas. In Maine, a diagnosis delayed for eight months spawned 21 cases; in North Dakota, a child with pulmonary TB infected 50 others (though children are often presumed not to be infectious); in Indiana, drug use and other illicit activities hindered contact investigation; and in Kansas, traditional investigation techniques failed to link cases among exotic dancers and their associates.