Tuberculosis in West Virginia: an island in an encroaching sea.

West Virginia, for the past one hundred fifty years has adapted to the changing character of tuberculosis. The historical factors that influenced the changes from isolation of infected patients to mainstream treatment of tuberculosis are chronicled in this report. West Virginia, with its organized public health system and favorable demographics has, since 1970, seen a steady decline of tuberculosis. This decline in incidence exceeded national projection goals for TB elimination. New tuberculosis threats from increased third world immigration and global epidemic pressures are challenges for tuberculous management in both the United States and West Virginia. This report concludes with organizational guides designed to meet the new potential tuberculosis threats.