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Tuberculosis

Tuberculosis, MTB, or TB (short for tubercle bacillus) is a common, and in many cases lethal, infectious disease caused by various strains ofmycobacteria, usually Mycobacterium tuberculosis.[1] Tuberculosis typically attacks the lungs, but can also affect other parts of the body. It is spread through the air hen people ho have an active T! infection cough, snee"e, or other ise transmit their saliva through the air. #ost infections areasymptomatic and latent, but about one in ten latent infections eventually progresses to active disease hich, if left untreated, kills more than $%& of those so infected. 'ne third of the orld(s population is thought to have been infected ith M. tuberculosis,[)] ith ne infections occurring at a rate of about one per second. In *%%+, there ere an estimated 1).+ million chronic active cases globally, hile in *%1%, there ere an estimated ,., million ne cases and 1.$ million associated deaths, mostly occurring in developing countries. The absolute number of tuberculosis cases has been decreasing since *%%-, and ne cases have decreased since *%%*.[$] The distribution of tuberculosis is not uniform across the globe. about ,%& of the population in many /sian and /frican countries test positive in tuberculin tests, hile only $01%& of the 1nited 2tates population tests positive. [1] #ore people in the developing orld contract tuberculosis because of compromised immunity, largely due to high rates of 3I4 infection and the corresponding development of /I52.

Signs and symptoms
The main symptoms of variants and stages of tuberculosis are given, ith many symptoms overlapping ith other variants, hile others are more (but not entirely) specific for certain variants. #ultiple variants may be present simultaneously. /bout $01%& of those ithout 3I4, infected ith tuberculosis, develop active disease during their lifetimes. In contrast, )%& of those coinfected ith 3I4 develop active disease. Tuberculosis may infect any part of the body, but commonly occurs in the lungs(kno n as pulmonary tuberculosis).

'ccasionally. resulting in massive bleeding (. 2ymptoms may include chest painand a prolonged cough producing sputum. the infection may erode into the pulmonary artery. #iliary T! makes up about 1%& of e7trapulmonary cases. The upper lung lobes are more fre<uently affected by tuberculosis than the lo er ones.67trapulmonary T! occurs hen tuberculosis develops outside of the lungs. the central nervous system (in tuberculous meningitis).asmussen(s aneurysm). commonly kno n as miliary tuberculosis. and in very rare cases. Extrapulmonary In 1$0*%& of active cases. 67trapulmonary T! occurs more commonly in immunosuppressed persons and young children. chills. among others. The reason for this difference is not entirely clear.or to poor lymph drainage ithin the upper lungs. idespread form of T! is called :disseminated: T!. These are collectively denoted as :e7trapulmonary tuberculosis:. they remain :asymptomatic:).e. / potentially more serious. Pulmonary If a tuberculosis infection does become active.a form of osteomyelitis.and significant finger clubbing may also occur. causing other kinds of T!.8eneral signs and symptoms include fever. the lymphatic system (in scrofula of the neck). it is also kno n as :osseous tuberculosis:. the genitourinary system (in urogenital tuberculosis). and the bones and >oints (in ?ott(s disease of the spine). [1] It may be due either to better air flo . @hen it spreads to the bones. night s eats. it most commonly involves the lungs (in about 9%& of cases). Causes #ycobacteria . the infection spreads outside the respiratory organs. /bout *$& of people may not have any symptoms (i. and fatigue. loss of appetite. this occurs in more than $%& of cases. =otable e7trapulmonary infection sites include the pleura (in tuberculous pleurisy). Tuberculosis may become a chronic illness and cause e7tensive scarring in the upper lobes of the lungs. eight loss. In those ith 3I4. people may cough up blood in small amounts. 67trapulmonary T! may coe7ist ith pulmonary T! as ell.

although a fe cases have been seen in /frican emigrants. 1sing histological stains on e7pectorated samples from phlegm (also called :sputum:). bovis. although the prevalence of this pathogen has possibly been significantly underestimated. #. The high lipid content of this pathogen accounts for many of its uni<ue clinical characteristics. #. If a 8ram stain is performed. but the introduction of pasteuri"ed milk has largely eliminated this as a public health problem in developed countries.2canning electron micrograph of #ycobacterium tuberculosis The main cause of T! is #ycobacterium tuberculosis. #. It divides every 1. aerobic. microti. leprae. Risk factors .to *% hours. =T# cause neither T! nor leprosy. #T! either stains very eakly :8ramApositive: or does not retain dye as a result of the high lipid and mycolic acid content of its cell all. but #. hich usually divide in less than an hour. #. africanum. avium. The latter t o species are classified as :nontuberculous mycobacteria: (=T#). and #. tuberculosis comple7 (#T!D) includes four other T!Acausing mycobacteriaE #. the bacterium can gro only ithin the cells of a host organism. hich dyes /B!s a bright red that stands out clearly against a blue background. canetti. #. bovis as once a common cause of tuberculosis. africanum is not idespread. it is classified as an acidAfast bacillus (/B!). microti is also rare and is mostly seen in immunodeficient people. #ycobacteria have an outer membrane lipid bilayer. #T! can ithstand eak disinfectants and survive in a dry state for eeks. a small. hich is an e7tremely slo rate compared ith other bacteria. but they do cause pulmonary diseases that resemble T!. 'ther kno n pathogenic mycobacteria include #. In nature. #.and the auramineArhodamine stain follo ed by fluorescence microscopy.The most common acidAfast staining techni<ues are the Ciehl0=eelsen stain. scientists can identify #T! under a regular (light) microscope. The #. canetti is rare and seems to be limited to the 3orn of /frica. kansasii. #. and #. 2ince #T! retains certain stains even after being treated ith acidic solution. nonmotile bacillus. but it is a significant cause of tuberculosis in parts of /frica. tuberculosis can be cultured in the laboratory.

inhabitants and employees of locales here vulnerable people gather (e. ?eople ith prolonged.'ther disease states can also increase the risk of developing tuberculosis. making it one of the principal diseases of poverty.6ach one of these droplets may transmit the disease.This is a particular problem in subA2aharan /frica. Those at high risk thus includeE people ho in>ect illicit drugs. speak. snee"e. and others. / single snee"e can release up to H%. /fter about t o eeks of effective treatment. Transmission should only occur from people ith active T! A those ith latent infection are not thought to be contagious.$ to $. / person ith active but untreated tuberculosis may infect 1%01$ (or more) other people per year. ith an estimated **& infection rate. tuberculosis strain. The cascade of personA toAperson spread can be circumvented by effectively segregating those ith active (:overt:) T! and putting them on antiAT! drug regimens. especially in the developed orld. sub>ects ith nonresistant active infections generally do not remain contagious to others. medically underprivileged and resourceApoor communities. including the number of infectious droplets e7pelled by the carrier.Dhronic lung disease is another significant risk factor A ith silicosis increasing the risk about )%Afold. they e7pel infectious aerosol droplets %. such as corticosteroids and infli7imab (an antiAFT=B monoclonal antibody) are becoming increasingly important risk factors.% Gm in diameter.%%% droplets. since the infectious dose of tuberculosis is very lo (the inhalation of fe er than 1% bacteria may cause an infection). the level of immunity in the uninfected person. sing. the effectiveness of ventilation. the virulence of the #.g. here rates of 3I4 are high. . Tuberculosis is closely linked to both overcro ding and malnutrition. prisons and homeless shelters). including alcoholism and diabetes mellitus (threefold increase)./ number of factors make people more susceptible to T! infections. The most important risk factor globally is 3I4. or spit. the duration of e7posure. Dertain medications. fre<uent.The probability of transmission from one person to another depends upon several factors. highArisk ethnic minorities. Those ho smoke cigarettes have nearly t ice the risk of T! than nonsmokers. 1)& of all T! cases are infected by the virus. it typically takes three to four eeks before the ne ly infected person becomes infectious enough to transmit the disease to others. If someone does become infected. children in close contact ith highArisk category patients and health care providers serving these clients. Transmission @hen people ith active pulmonary T! cough. or close contact ith people ith T! are at particularly high risk of becoming infected. There is also a genetic susceptibility for hich overall importance is still undefined.

the infection a7es and anes. this has the te7ture of soft. In those ith 3I4. Tuberculosis of the lungs may also occur via infection from the blood stream. Tissue destruction and necrosis are often balanced by healing and fibrosis. affected areas are eventually replaced by scar tissue.Pathogenesis /bout 9%& of those infected ith #.[H. is generally located in either the upper part of the lo er lobe. /ffected tissue is replaced by scarring and cavities filled ith caseous necrotic material. If T! bacteria gain entry to the bloodstream from an area of damaged tissue. !acteria inside the granuloma can become dormant. is called miliary tuberculosis. kno n as the :8hon focus:. they can spread throughout the body and set up many foci of infection. This is kno n as a 2imon focus and is typically found in the top of the lung. some of these cavities are >oined to the air passages bronchi and this material can be coughed up. #acrophages. hite tubercles in the tissues. hite cheese and is termed caseous necrosis. and the bones. ?eople ith this disseminated T! have a high fatality rate even ith treatment (about )%&). or the lo er part of the upper lobe. and so can spread the infection. To the naked eye. latent T! infections (sometimes called IT!I). This severe form of T! disease.This hematogenous transmission can also spread infection to more distant sites. 1pon cure. active tuberculous disease. though for unkno n reasons it rarely affects the heart. and fibroblasts are among the cells that aggregate to form granulomas. /nother feature of the granulomas is the development of abnormal cell death (necrosis) in the center of tubercles. such as peripheral lymph nodes. the brain. Treatment ith appropriate antibiotics kills bacteria and allo s healing to take place. skeletal muscles. ith lymphocytes surrounding the infected macrophages. /ll parts of the body can be affected by the disease. or thyroid. here they invade and replicate ithin endosomes of alveolar macrophages. all appearing as tiny. tuberculosis have asymptomatic. the kidneys. resulting in latent infection. pancreas.] . The primary site of infection in the lungs. ! lymphocytes. the risk of developing active T! increases to nearly 1%& a year. If effective treatment is not given. ith only a 1%& lifetime chance that the latent infection ill progress to overt. 5uring active disease. It contains living bacteria. T lymphocytes. most common in young children and those ith 3I4. T! infection begins hen the mycobacteria reach the pulmonary alveoli. Tuberculosis is classified as one of the granulomatous inflammatory diseases. In many people. The granuloma prevents dissemination of the mycobacteria and provides a local environment for interaction of cells of the immune system. the death rate for active T! cases is up to --&.

/s may increase sensitivity hen used in addition to the skin test but may be less sensitive than the skin test hen used alone. marinum and #. hile it is effective against disseminated disease in childhood. be considered in those ith signs of lung disease or constitutional symptoms lasting longer than t o eeks./ have similar limitations in those ith 3I4. s"ulgai. ho ever./s). Prevention Tuberculosis prevention and control efforts primarily rely on the vaccination of infants and the detection and appropriate treatment of active cases. . 3o ever. tuberculosis in a clinical sample (e.Diagnosis 5iagnosing active tuberculosis based merely on signs and symptoms is difficult. 3odgkin(s lymphoma. 3o ever they are affected by #. are recommended in those ho are positive to the #antou7 test.as is diagnosing the disease in those ho are immunosuppressed. and a small decrease in case numbers. malnutrition. or a tissue biopsy). as they rarely alter ho a person is treated. #.g. or most notably. The @orld 3ealth 'rgani"ation has achieved some success ith improved treatment regimens. ho ever.Thus.I8. InterferonAK release assays and tuberculin skin tests are of little use in the developing orld.!lood tests to detect antibodies are not specific or sensitive. The #antou7 tuberculin skin test is often used to screen people at high risk for T!. so they are not recommended. The test may be falsely negative in those ith sarcoidosis. / diagnosis of T! should. / chest JAray and multiple sputum cultures for acidAfast bacilli are typically part of the initial evaluation. in those ho truly do have active tuberculosis. / definitive diagnosis of T! is made by identifying #. the difficult culture process for this slo Agro ing organism can take t o to si7 eeks for blood or sputum culture. are not routinely recommended. I8. sputum. These are not affected by immuni"ation or most environmental mycobacteria. Vaccines The only currently available vaccine as of *%11 is bacillus Dalmette08uLrin (!D8) hich. on a blood sample.These tests. pus. so they generate fe er falseApositive results. treatment is often begun before cultures are confirmed. Those ho have been previously immuni"ed may have a falseApositive test result. kansasii. =ucleic acid amplification tests and adenosine deaminase testing may allo rapid diagnosis of T!.Interferon gamma release assays (I8.

The @orld 3ealth 'rgani"ation declared T! a :global health emergency: in 199). and therefore. hich hinders the entry of drugs and makes many antibiotics ineffective. The t o antibiotics most commonly used are isonia"id and rifampicin. 3o ever.AT!). pyra"inamide and ethambutol for the first t o months.e. ?art of the reasoning arguing against the use of the vaccine is that it makes the tuberculin skin test falsely positive.confers inconsistent protection against contracting pulmonary T!. Management Treatment of T! uses antibiotics to kill the bacteria. having a health care provider atch the person take their medications. ith more than 9%& of all children being vaccinated. and the 1nited 2tates. isonia"id. @here resistance to isonia"id is high. and treatments can be prolonged. taking several months. of no use in screening. . testing to determine to hich antibiotics it is sensitive is important before determining treatment. Iatent T! treatment usually employs a single antibiotic.ecurrent disease If tuberculosis recurs./ number of targets they have set are not likely to be achieved by *%1$. it is the most idely used vaccine orld ide. i. If multiple drugAresistant T! (#5. hile active T! disease is best treated ith combinations of several antibiotics to reduce the risk of the bacteria developing antibiotic resistance.and in *%%-. !D8 is only administered to people at high risk.#ethods to remind people of the importance of treatment do ho ever appear effective. the 1nited Mingdom.A . =evertheless. / tuberculosis classification system developed by the /merican Thoracic 2ociety is used primarily in public health programs. mostly due to the increase in 3I4Aassociated tuberculosis and the emergence of multiple drugA resistant tuberculosis (#5. the immunity it induces decreases after about ten years. The evidence to support this practice over people simply taking their medications independently is poor. is si7 months of a combination of antibiotics containing rifampicin. The recommended treatment of ne Aonset pulmonary tuberculosis. 5irectly observed therapy. / number of ne vaccines are currently in development. 6ffective T! treatment is difficult. is recommended by the @3' in an effort to reduce the number of people not appropriately taking antibiotics. due to the unusual structure and chemical composition of the mycobacterial cell all. ethambutol may be added for the last four months as an alternative.?eople ith latent infections are also treated to prevent them from progressing to active T! disease later in life. as of *%1%./s tuberculosis is uncommon in most of Danada. the 2top T! ?artnership developed a 8lobal ?lan to 2top Tuberculosis that aims to save 1H million lives bet een its launch and *%1$. and only rifampicin and isonia"id for the last four months.

In primary T! disease (some 10$& of cases). These dormant bacilli produce active tuberculosis in $01%& of these latent cases.oughly oneAthird of the orld(s population has been infected ith #. 67tensively drugAresistant T! is also resistant to three or more of the si7 classes of secondAline drugs. Epidemiology In *%%+. Prognosis ?rogression from T! infection to overt T! disease occurs hen the bacilli overcome the immune system defenses and begin to multiply. ith estimates that it might account for more than $%& of reactivated cases in areas here T! is common.& in 199$. do n from . 3o ever. not taking the prescribed regimen appropriately (lack of compliance). The chance of death from a case of tuberculosis is about H& as of *%%. The risk of reactivation increases ith immunosuppression. a latent infection occurs ith no obvious symptoms. Medication resistance ?rimary resistance occurs hen a person becomes infected ith a resistant strain of T!. #5.. tuberculosis and 3I4. the prevalence of T! per 1%%. and as also relatively high in /sia. hich as first observed in *%%) in Italy. or using lo A<uality medication. and ne infections occur at a rate of one per second on a global scale. most infections ith #. tuberculosis do not cause T! disease. this occurs soon after the initial infection.and 9%0 . . often many years after infection. Totally drugAresistant T!. in the ma>ority of cases. In people coinfected ith #.%%% people as highest in subA 2aharan /frica. treatment ith at least four effective antibiotics for 1. such as that caused by infection ith 3I4. the risk of reactivation increases to 1%& per year.AT! is defined as resistance to the t o most effective firstAline T! drugsE rifampicin and isonia"id. 5rugAresistant T! is a serious public health issue in many developing countries. as its treatment is longer and re<uires more e7pensive drugs.3o ever. / person ith fully susceptible T! may develop secondary (ac<uired) resistance during therapy because of inade<uate treatment. 2tudies using 5=/ fingerprinting of #. tuberculosis.T!) is detected. tuberculosis strains have sho n reinfection contributes more substantially to recurrent T! than previously thought. to *H months is recommended. is resistant to all currently used drugs. but not idely reported until *%1*.

there ere .%& reduction in its T! mortality rate bet een 199% and *%1%. including the difficulty of developing an effective vaccine. the e7pensive and timeA consuming diagnostic process. The absolute number of tuberculosis cases (:prevalence:) has been decreasing since *%%$.%s. million ne cases of T! diagnosed. . ith 1. 3opes of totally controlling the disease have been dramatically dampened because of a number of factors. The earliest unambiguous detection of #. 6astern #editerranean 1+). In *%1%.+ million chronic active cases. T! is mainly a disease of older people and the immunocompromised.ates per 1%%. especially in remote areas. the increase in 3I4Aassociated tuberculosis. Main article: istory of tuberculosis 6gyptian mummy in the !ritish #useum A tubercular decay has been found in the spines of 6gyptian mummies. in countries here incidence rates have declined dramatically (such as the 1nited 2tates).[$] Dhina has achieved particularly dramatic progress.. about %. and the emergence of drugAresistant cases in the 19. Tuberculosis is more common in developing countries. 2outheast /sia *+. In /frica. ith an estimated *. tuberculosis involves evidence of the disease . Tuberculosis is the second most common cause of death from infectious disease (after those due to 3I4N/I52).'f these 1. the /mericas )-. In *%%+. most of these occurring in developing countries. /frica ))*.H$ million deaths.. and @estern ?acific 1)9 in *%1%. tuberculosis is many times more common among the aboriginal peoples. In *%%+. there ere an estimated 1). In developed countries..*%% cases per 1%%. and 1.%%% people.% million ne cases. India had the largest total incidence. about .9$& of infections remain asymptomatic. tuberculosis is less common and is found mainly in urban areas. 3o ever. hile only $01%& of the 12 population test positive. In the 1nited 2tates the /borigines have a fivefold greater mortality from T!. The incidence of T! varies ith age. 6urope -).In Danada and /ustralia. it primarily affects adolescents and young adults. ith an appro7imate . hile ne cases (:incidence:) have decreased since *%%*.%& of the population in many /sian and /frican countries test positive in tuberculin tests.. the necessity of many months of treatment. the country ith the highest estimated incidence rate of T! as 2 a"iland.%%% people in different areas of the orld hereE globally 1+.H$ million deaths. Tuberculosis has been present in humans since anti<uity at the latest.)$ million occur in those coinfected ith 3I4.

hich delayed the recognition of infected milk as a source of infection. /lthough the pulmonary form associated ith tubercles as established as a pathology by 5r . 2keletal remains sho prehistoric humans (H%%% !D) had T!.9. ?eople believed this as caused by the original person ith T! draining the life from the other family members.H$. then as transferred to humans. the o ner of #ammoth Dave. as as previously believed.obert Moch.). Oohn Droghan. !oth strains of the tuberculosis bacteria share a common ancestor. or hether it diverged from a common ancestor. hich could have infected humans as early as the =eolithic . I.evolution. 2chPnlein. @hile it as not . and as not named tuberculosis until 1. and researchers have found tubercular decay in the spines of 6gyptian mummies dating from )%%%0*H%% !D. 3e received the =obel ?ri"e in physiology or medicine in 19%$ for this discovery. @hen one member of a family died from it. brought a number of people ith tuberculosis into the cave in the hope of curing the disease ith the constant temperature and purity of the cave air. hich as almost al ays fatal. the risk of transmission from this source as dramatically reduced by the invention of the pasteuri"ation process. due to the variety of its symptoms. Dr! Robert "och discovered the tuberculosis bacillus! The bacillus causing tuberculosis. the other infected members ould lose their health slo ly..?hthisis is a 8reek ord for consumption. / comparison of the genes of #. folklore often associated tuberculosis ith vampires. T! as not identified as a single disease until the 1. calling it (tuberculin(. !efore the Industrial .%%% years ago. 5r.)9 by O. 3ermann !rehmer opened the first T! sanatorium in 1. an old term for pulmonary tuberculosis. hether tuberculosis originated in bovines.in the remains of bison dated to appro7imately 1+. ?oland. is currently unclear. Moch did not believe the bovine (cattle) and human tuberculosis diseases ere similar. as identified and described on *H #arch 1. tuberculosis comple7 (#T!D) in humans to #T!D in animals suggests humans did not ac<uire #T!D from animals during animal domestication.ichard #orton in 1-.8enetic studies suggest T! as present in the /mericas from about the year 1%% /5.evolution. around H-% !D.*%s. 5uring the years 1. 3ippocrates identified phthisis as the most idespread disease of the times. Iater. they died ithin a year.01.$9 in 2okoQo sko. Moch announced a glycerine e7tract of the tubercle bacilli as a :remedy: for tuberculosis in 1. #ycobacterium tuberculosis. It as said to involve fever and the coughing up of blood.* by .9%. 3o ever.

?rior to the introduction of this drug.. 2ociety and culture . even under the best conditions. and the infected poor ere :encouraged: to enter sanatoria that resembled prisons (the sanatoria for the middle and upper classes offered e7cellent care and constant medical attention). Improvements in public health began significantly reducing rates of tuberculosis even before the arrival of streptomycin and other antibiotics.3opes of completely eliminating T! (cf.The emergence of #5.1$. It as called bacillus of Dalmette and 8uLrin (!D8). its initial focus as tuberculosis research. smallpo7) ere dashed after the rise of drugAresistant strains in the 19.effective. including the :pneumothora7 techni<ue:. The subse<uent resurgence of tuberculosis resulted in the declaration of a global health emergency by the @orld 3ealth 'rgani"ation in 199). In 1. rates of tuberculosis began to rise in the early 1-%%s to a peak level in the 1.. 8reat !ritain. In 6urope. thereby simultaneously reducing the total bacterial load and increasing the effectiveness of systemic antibiotic therapy. !y 191.AT! has again introduced surgery as an option ithin the generally accepted standard of care in treating T! infections. one in four deaths in 6ngland as due to :consumption:. $%& of those ho entered died ithin five years (circa 191-). the only treatment (e7cept sanatoria) as surgical intervention.esearch Douncil as formed in !ritain in 191). Tuberculosis caused the most idespread public concern in the 19th and early *%th centuries as an endemic disease of the urban poor.%s. T! as put on a notifiable disease list in !ritain. using attenuated bovineAstrain tuberculosis. #ortality then decreased nearly 9%& by the 19$%s. The !D8 vaccine as first used on humans in 19*1 in Brance. @hatever the (purported) benefits of the :fresh air: and labor in the sanatoria. although the disease remained a significant threat to public health such that hen the #edical . one in si7 deaths in Brance as still caused by T!. hich involved collapsing an infected lung to :rest: it and allo tuberculous lesions to heal. In 19H-. /fter determining the disease as contagious in the 1. but only received idespread acceptance in the 12/. the development of the antibiotic streptomycin made effective treatment and cure of T! a reality. hen it caused nearly *$& of all deaths. and 8ermany after @orld @ar II. campaigns ere started to stop people from spitting in public places. Durrent surgical interventions involve removal of pathological chest cavities (:bullae:) in the lungs to reduce the number of bacteria and to increase the e7posure of the remaining bacteria to drugs in the bloodstream. /lbert Dalmette and Damille 8uLrin achieved the first genuine success in immuni"ation against tuberculosis in 19%-.%s.%%s. it as later successfully adapted as a screening test for the presence of presymptomatic tuberculosis.

'ne approach involves adding a subunit vaccine to !D8.#4/. is based on a genetically modified vaccinia virus. and advance market commitments. an e7ample of a subunit vaccine. the /eras 8lobal T! 4accine Boundation received a gift of more than R*. and the /eras 8lobal T! 4accine Boundation. in part due to poor disease management ithin the private health care sector. ?rograms such as the .$/. researchers and policymakers are promoting ne economic models of vaccine development. #any resourceApoor places as of *%11 still only have access to sputum microscopy. . T o main approaches are being used to attempt to improve the efficacy of available vaccines. are involved ith research. To encourage further discovery. / number of potential candidates are currently in phase I and II clinical trials. including the 2top T! ?artnership. hile the other strategy is attempting to create ne and better live vaccines. ta7 incentives. India had the highest total number of T! cases orld ide in *%1%.esearch The !D8 vaccine has limitations. .evised =ational Tuberculosis Dontrol ?rogram are helping to reduce T! levels amongst people receiving public health care. 4accines are hoped to play a significant role in treatment of both latent and active disease. / number of groups. including pri"es.The @orld 3ealth 'rgani"ation and the !ill and #elinda 8ates Boundation are subsidi"ing a ne fastAacting diagnostic test for use in lo A and middleAincome countries. and research to develop ne T! vaccines is ongoing. the 2outh /frican Tuberculosis 4accine Initiative. /mong these.% million (12) from the !ill and #elinda 8ates Boundation to develop and license an improved vaccine against tuberculosis for use in high burden countries. currently in trials in 2outh /frica.