Volume 25, Number 3—March 2019
Tuberculosis Surveillance and Control, Puerto Rico, 1898–2015
|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.
1These authors were co–principal investigators.