Tuberculosis in the Healthcare Setting in the 1990s: From Bird Island to the Bronx

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Abstract
Our nation's attention has recently been focused on the resurgence of tuberculosis as a significant public health problem. The human immunodeficiency virus (HIV) epidemic has played a seminal role in this development. In addition, the concurrent increase in poverty and homelessness, particularly in our inner cities, and the changes in patterns of immigration into the United States have also played a contributing role. Finally, the deterioration of our public health infrastructure, together with decreasing access to medical care, served as the perfect breeding environment for Mycobacterium tuberculosis infection to gain new and dangerous ground. The abrupt change in 1985 in the persistently downward trend in the incidence of tuberculosis cases in the U.S. signaled the first “shot across the bow” in what is now a full-scale war against this old enemy. In the 1990s, tuberculosis has now resumed its historical position of importance and danger in our inner cities. Tuberculosis control strategies -- once thought to be destined solely for the history books -- have regained public health and institutional attention, especially in settings serving inner-city, impoverished, or immunosuppressed populations.