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Volume 25, Number 3—March 2019
Historical Review

Tuberculosis Surveillance and Control, Puerto Rico, 1898–2015

Emilio Dirlikov1Comments to Author , Dana Thomas1Comments to Author , David Yost, Betzaida Tejada-Vera, Maria Bermudez, Olga Joglar, and Terence Chorba
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Dirlikov, D. Thomas, D. Yost, O. Joglar, T. Chorba); United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA (D. Thomas, D. Yost); National Center for Health Statistics, Hyattsville, Maryland, USA (B. Tejada-Vera); Puerto Rico Department of Health, San Juan, Puerto Rico (M. Bermudez, O. Joglar)

Main Article

Table 1

Summary of the evolution of TB surveillance, diagnosis, and treatment in Puerto Rico over 3 periods*

Period Surveillance Diagnosis Treatment
1898–1946 Passive, relying on voluntary reporting; Bureau of TB established in 1924; TB becomes a part of vital statistics centrally compiled by PRDH in 1931 Primarily clinical diagnosis; TST progressively routinized after 1929; chest radiography and limited sputum examination in TB dispensaries since 1935 Pneumothorax procedures, bed rest in sanatorium, and isolation of patients with active TB
1947–1992 TB recording and reporting through PRDH TB centers and centralized at PRDH; private physicians, hospitals, and VA report to PRDH; case-level data collection and reporting to NTSS uses RVCT TST and chest radiography routine for screening (e.g., medical cards); limited sputum AFB examination and ability to culture Three-drug regimen of streptomycin, PAS, and isoniazid; free treatment in 3-mo courses for total treatment of >2 y; introduction of short-course regimens using rifampin in the 1970s
1993–2015 RVCT revised and expanded;
CDC NTSS electronic registry launched; molecular testing for DST at PRDH laboratory and genotyping and molecular testing through CDC introduced Diagnosis relies on sputum AFB examination and culture; screening with TST and chest radiography; few cases diagnosed clinically DOT, 4-drug regimen of isoniazid, rifampin, pyrazinamide, and ethambutol; intensive and continuation phase for 6–8 mo; regimens individualized according to DST results

*AFB, acid-fast bacillus; CDC, Centers for Disease Control and Prevention; DOT, directly observed therapy; DST, drug-sensitivity testing; NTSS, National TB Surveillance System; PAS, para-aminosalicylic acid; PRDH, Puerto Rico Department of Health; RVCT, Report of Verified Case of Tuberculosis; TB, tuberculosis; TST, tuberculin skin testing; VA, Veterans Administration.

Main Article

1These authors were co–principal investigators.

Page created: February 19, 2019
Page updated: February 19, 2019
Page reviewed: February 19, 2019
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