An age-old disease, tuberculosis continues to afflict men and women around the world in the 21^st Century. Internationally, 9.2 million new cases of TB and 1.7 million deaths from the disease occurred in 2006, according to World Health Organization (WHO) estimates. In the U.S. , it is an occupational health concern for people who have an increased, work-related risk of exposure to the TB bacteria, such as workers in health-care facilities and correctional institutions.

In the decades after World War II, thanks to strides in detection and control, significant inroads were made against the disease. However, in the 1980s, this progress stalled as a result of several factors, and TB resurged. The public health community redoubled efforts to control the disease.

As part of its research and outreach mission, NIOSH stepped up to help protect men and women who were at increased risk of work-related infection from TB’s resurgence. On one track, working with our colleagues elsewhere in the U.S. Centers for Disease Control and Prevention (CDC) and other health institutions, we were at the table in helping to craft broader national initiatives in the renewed campaign against the disease. Our scientific findings and our insights into the dynamics of the workplace were important for incorporating occupational health protection as a critical part of national TB control guidance. A recent example is CDC’s 2005 guidelines for controlling TB transmission in health-care settings, http://www.cdc.gov/mmwr/PDF/rr/rr5417.pdf.

At the same time, responding to our stakeholders with direct assistance, we also helped employers and employees to identify risk factors in their workplaces and to institute effective protective measures. We have provided extensive technical assistance and guidance in the form of published guidelines, training materials, health surveillance data, health hazard evaluation reports, presentations at professional conferences, chapters in textbooks, and other resources. These materials include valuable resources not only for occupational health programs in health-care facilities, but also for programs in other places where work-related risks exist, such as correctional facilities, nursing homes, and homeless shelters.

To a significant extent, the renewed efforts here in the U.S. and abroad have been successful. For example, WHO estimates that the number of new TB cases per capita globally has fallen since 2003. In the U.S. , the incidence rate of TB among health-care workers declined during the period from 1994 to 2000.
http://www2l.cdc.gov/NIOSH-Chartbook/ch2/ch2-10-6.asp. However, as long as the disease exists, the potential for infection remains. In 2006, according to CDC statistics, 408 healthcare workers and 17 correctional workers were diagnosed as having TB. This is 425 cases too many. Two recent reports also highlight trends that further demonstrate the need to stay vigilant.

WHO reported on March 17 that progress in controlling TB world-wide slowed in 2006, the most recent year for which the international data were available. One important factor is the continued growth of multidrug-resistant TB, which poses ongoing challenges for diagnosis and treatment. The WHO report is essential reading for health professionals. http://www.who.int/tb/publications/global_report/2008/en/index.html.

An article in the March 21, 2008, issue of the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report found a similar slowdown in progress against TB in the United States . Recommendations in the article for vigorous actions to address this problem, and to push for the eradication of TB once and for all, involve roles for NIOSH and its partners. Among the recommendations: “improved case management and contact investigation, intensified outreach and testing of populations at high risk, better treatments and diagnostic tools, improved understanding of TB transmission, and continued collaboration with other nations to reduce TB globally.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm

Clearly, our ongoing NIOSH resources for employers and workers continue to meet a critical need. They include:

• “Protect Yourself Against Tuberculosis,” an easy-to-read guide that answers questions frequently raised by health-care workers about respiratory protection against TB, and provides key information about selecting, using, and maintaining respirators. Respiratory protection is a key measure in health-care facilities because engineering controls, such as the use of isolation rooms, may not completely contain the risk of exposure. http://www.cdc.gov/niosh/tb.html

• “TB Respiratory Protection Program in Health Care Facilities: Administrators’ Guide,” a practical guide for administrators and managers who are responsible for instituting and maintaining respiratory protection programs for health-care workers who may be exposed to patients infected with TB. http://www.cdc.gov/niosh/99-143.html.

• “Respirators: Your TB Defense” and “TB Respiratory Protection: Administrators’ Review,” two video programs that fulfill a need for interactive, visual training resources. The programs are available on DVD or as downloads from the Web. http://www.cdc.gov/niosh/docs/video/tb.html.

NIOSH has also contributed to the development, assessment, and guidance for use of environmental control measures such as ventilation and filtration, airborne infection isolation rooms (AIIR), portable air cleaners, and ultraviolet germicidal irradiation (UVGI), to the advancement of knowledge about personal protective equipment, and to improvements in methods for assessing TB exposure. These advances add to the base of knowledge that will be needed for protecting workers – and indeed, the public as a whole – as efforts against TB proceed in the 21st Century. NIOSH’s work is described in an evidence package presented to the National Academies last year for independent scientific review of the quality, relevance, and impact of our strategic research program for preventing occupational respiratory diseases. http://mtn.niosh.cdc.gov/drds/about/RDRP/ch6.1.htm

For health professionals, the ultimate goal is not simply the containment or control of TB. The ultimate goal is eradication. NIOSH is honored to be a partner in this historic enterprise. For more information about our resources for occupational health professionals, employers, and workers, please visit our topic page at http://www.cdc.gov/niosh/topics/tb. http://www.cdc.gov/niosh/topics/tb.