[Problems posed by tuberculosis in the world in 1982].

Abstract

One hundred years after the discovery of the tubercle bacillus the struggle against tuberculosis still poses numerous problems on a world scale. Each year, 10 million new cases appear: nearly five million are highly contagious; 95% of these cases come from developing countries. The official notification system currently in force is imperfect but a reckoning of the annual infection risk, from a methodical enquiry into tuberculous disease gives exact information on the size of the problem and its evolutionary time scale in each country. This is the best epidemiological index currently available. The technical problems of the struggle against tubercle are resolved in theory: the selective detection of groups at risk, centered on a network of bacteriology laboratories enables identification of all the sources of infection; chemotherapy, becoming safer and safer, with a duration reduced to 6 or 9 months at the maximum and curing practically 100% of the patients; properly performed BCG vaccination reduces the risk of infantile tuberculosis. Operational problems remain the most serious. The greatest difficulties are seen in countries with the highest prevalence: they are linked to a global shortage of resources but also at times a poor utilisation of the resources available. A concerted international action could render antituberculous drugs and the appropriate sanitary technology to all countries. With a judicious use of available information and means each country could today achieve an effective national antituberculous programme.