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Lancet. 2015 Dec 5;386(10010):2344-53. doi: 10.1016/S0140-6736(15)00323-2. Epub 2015 Oct 26.

Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection.

Author information

Institute of Epidemiology and Health, University College London, London, UK; Department of Medicine, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil.
Children's Hospital at Westmead and the Centre for Research Excellence in Tuberculosis, University of Sydney, Australia.
Cambodian Health Committee, Phnom Penh, Cambodia.
Perinatal HIV Research Unit, University of Witwatersrand, Soweto, South Africa.
National Institute for Research on Tuberculosis, Chennai, India.
Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address:

Erratum in

  • Lancet. 2015 Dec 5;386(10010):2256.


The billions of people with latent tuberculosis infection serve as the seedbeds for future cases of active tuberculosis. Virtually all episodes of tuberculosis disease are preceded by a period of asymptomatic Mycobacterium tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a crucial opportunity to interrupt tuberculosis transmission and reduce the global burden of tuberculosis disease. Programmes focusing on single strategies rather than comprehensive programmes that deliver an integrated arsenal for tuberculosis control might continue to struggle. Tuberculosis preventive therapy is a poorly used method that is essential for controlling the reservoirs of disease that drive the epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-finding and treatment, control of transmission, and health systems strengthening could ultimately lead to worldwide tuberculosis elimination. In this Series paper we outline challenges to implementation of preventive therapy and provide pragmatic suggestions for overcoming them. We further advocate for tuberculosis preventive therapy as the core of a renewed worldwide focus to implement a comprehensive epidemic control strategy that would reduce new tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical tuberculosis infections, develop novel diagnostics and drug regimens specifically for subclinical tuberculosis infection, strengthen health systems and community engagement, and enhance sustainable large scale implementation of preventive therapy programmes.

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