Latent Tuberculosis Infection: the final frontier of tuberculosis elimination in the USA

Dear Colleague,

May 11, 2017

The United States has made substantial progress toward the goal of tuberculosis (TB) elimination by prioritizing the early diagnosis, isolation, and treatment of those with infectious TB disease.  However, epidemiological and modeling data suggest that TB cannot be eliminated in the United States without addressing latent TB infection. Up to 13 million people in the United States have latent tuberculosis infection, and live with the potential of developing TB disease at some point in their lives. More than 85% of U.S. TB cases are estimated to be associated with reactivation of longstanding, untreated latent TB infection.

Major new efforts are required to incorporate latent TB infection testing and treatment in public and private health systems. We outlined steps towards TB elimination in “Latent tuberculosis infection: the final frontier of tuberculosis elimination in the USA,” published in The Lancet Infectious Diseases.

• Establish a surveillance system or registry for latent TB infection to monitor progress. While TB disease is a nationally notifiable disease, latent TB infection is not reported to most health departments or the Centers for Disease Control and Prevention (CDC).
• Expand targeted testing for latent TB infection in at-risk populations. CDC and the U.S. Preventive Services Task Force (USPSTF) recommend testing populations that are at increased risk for TB infection.
• Increase the use of new short-course treatment regimens for latent TB infection. Shorter treatment regimens help patients to complete treatment faster, with fewer side effects and better adherence.
• Engage affected communities and medical providers who serve at-risk communities.  Many of those at high risk for latent TB infection or TB disease do not traditionally receive care in health departments—but are seen by private health care providers and community health centers.
• Increase public health staffing for implementation and oversight. Public health departments provide TB-related technical assistance, education, and outreach to clinicians, health care agencies, and community organizations.

Better diagnostic tools and treatment regimens for latent TB infection are also needed. Tests that indicate higher reactivation risk would help identify people more likely to develop TB disease once infected. Developing even shorter latent TB infection treatment regimens than those that are currently available would help more patients complete treatment.

We encourage public health professionals in local and state TB programs to partner with clinicians, health care agencies, and community organizations to expand efforts to diagnose and treat people with latent TB infection. CDC has latent TB infection resources that partners can use as part of outreach and education with affected communities and the health care providers serving these communities.

Thank you for your work and commitment to eliminate TB.

Sincerely,

/Jonathan Mermin/
Jonathan H. Mermin, M.D., MPH
RADM and Assistant Surgeon General, USPHS
Director
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/nchhstp

/Philip LoBue/
Philip LoBue, MD, FACP, FCCP
Director
Division of Viral Hepatitis
Director, Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/tb