THE NEED FOR EPIDEMIC INTELLIGENCE

THE PAST DECADE has witnessed an unprecedented upturn in tuberculosis morbidity and outbreaks of difficult-to-treat and highly lethal multid rug-resistant tuberculosis. In the early 1990s, a national consensus d eveloped among public health officials to define more comprehensively the problem, and in January 1993, expanded tuberculosis surveillance w as implemented nationwide. Carefully selected epidemiologic and case m anagement variables were added to the Report of Verified Case of Tuber culosis form. information is collected on the health status and treatm ent of patients, including human immunodeficiency virus status, drug s usceptibility test results, and the initial drug regimen. Completion o f therapy and use of directly observed therapy are also monitored. The new surveillance system allows a comparison of the quality of care of patients in the public and private sectors. Additional epidemiologic variables include membership in high-risk groups (the homeless, reside nts of correctional or long-term care facilities, migrant worker;, hea lth care workers, and correctional employees) and substance abuse (inj ecting drug use, non-injecting drug use, and excess alcohol use). The additional information derived from expanded tuberculosis surveillance is crucial to optimal patient management, policy development resource allocation, as well as program planning, implementation, and evaluati on at Federal, State, and local levels.