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Lessons from New York's tuberculosis epidemic

In the late 1980s New York city witnessed a dramatic epidemic of tuberculosis. By 1990, with 3% of the US population, the city had 15% of the country's cases. From 1984 to 1991 incidence increased from 23 to 50/100 000, and in some poor areas rates were much higher. In central Harlem, for example, incidence rose from 90 to 220/100 000. Among black men aged 35-44 the incidence in 1991 was 469/100 000, almost 45 times the national average.1 Now, however, the number of cases and the incidence have both declined dramatically. How has this been achieved and what are the lessons for other places facing a tuberculosis epidemic?

Two aspects of the New York epidemic suggested that it was home grown rather than associated with immigration.2 Firstly, childhood tuberculosis rates (suggesting recent acquisition) were rising, particularly among black Americans. Between 1987 and 1990 cases in children under 15 rose by 97%, from 74 cases to 146; 92% of these cases occurred in children aged 4 …