Progressing toward tuberculosis elimination in low-incidence areas of the United States. Recommendations of the Advisory Council for the Elimination of Tuberculosis.

In 2000, 22 states had tuberculosis (TB) incidence rates less than or equal to the Advisory Council for the Elimination of Tuberculosis (ACET) year-2000 interim objective of 3.5 cases/100,000 population, which is defined as low incidence. These states reported 1,949 TB cases, 11.9% of the national total of 16,377 cases in 2000. Health departments in low-incidence states, and in low-incidence regions within states with higher rates, need distinctive strategies, based on their specific epidemiologic characteristics, for maintaining skills and resources for finding increasingly rare TB cases, containing outbreaks, and ending transmission. Capacity for all the essential components of a TB prevention and control program must be retained at local, state, and national levels; failure to do so increases the risk of a new TB resurgence. In low-incidence areas, especially important are an adequate public health infrastructure and creative integration of resources, some of which until now have not played a role in TB control. Operational research is needed for determining the most efficient control measures. Eventually, with continued success in eliminating TB, low incidence will be attainable in all states, and the nation will profit from the lessons learned in the current low-incidence states.