First the good news: Tuberculosis in the United States is at an all-time low, and active cases are dropping at the rate of almost 7 percent each year. Those facts certainly are reassuring. But good news often invites complacency. And if recent history is any indication, the nation cannot afford to be complacent about tuberculosis.

After medical advances led to a declining number of cases, Congress eliminated all funding dedicated to fighting tuberculosis in the 1970s. The subsequent collapse of tuberculosis public health systems led to a new surge of the disease - including multi-drug-resistant strains - during the 1980s. Fighting the resurgence cost the United States billions of dollars, with at least $1 billion extra spent in New York City alone. Neglecting tuberculosis prevention and treatment now could have even more disastrous consequences, considering the potential for new infections. Millions of people in the United States are believed to be carrying the bacteria that can trigger active tuberculosis infections.

It's time for the United States to end this pattern of neglect and intensify the fight against tuberculosis. By strengthening public health services, improving methods for finding and treating people with latent infections, and targeting high-risk communities, the nation could realistically eliminate this disease as a public health threat by 2035. In the United States, tuberculosis deaths are rare, and even drug-resistant strains can be cured by a very strict regimen of antibiotics. Infection with tuberculosis requires prolonged contact - usually spending several hours in a confined area with a person who has an active case of the disease. But treating active cases is not enough to eradicate the disease. People can unknowingly carry the bacteria that cause tuberculosis for years without getting sick. The disease can suddenly turn active and infectious when the immune system is compromised by changes in health, such as being infected with HIV or developing diabetes.

Identifying and treating latent cases of tuberculosis before they become infectious is key to eliminating the disease. More than 40 percent of all new cases in the United States are among the foreign-born coming from nations with high rates of the disease. Risk of developing active tuberculosis is highest during their first five years in this country. Without aggressive interventions, these individuals soon could account for the majority of new tuberculosis cases in the United States.

For these reasons, it is imperative to require more stringent testing of immigrants from high-risk countries before they are allowed to enter the United States. Current procedures require that prospective immigrants get chest X-rays to screen for active cases. But skin testing for latent infections also should be a part of the visa application process. Immigrants with suspected disease or infection could enter the United States, and should then be required to undergo evaluation and therapy before becoming permanent residents.

In total, approximately 250,000 potential immigrants per year would be included in this enhanced screening program, which could prevent an estimated 2,100 cases of tuberculosis. But mandatory screening and treatment is not needed for the approximately 7 million foreign-born individuals with latent tuberculosis cases who already reside in the United States. Instead, culturally sensitive and foreign-language outreach programs should be designed to encourage these people to receive treatment.

Targeted screening programs also should be implemented for other high-risk groups. Mandatory testing should be required for inmates at correctional facilities, as new infections can more easily be transmitted in the close setting of a prison. For substance abusers, the homeless, and others at risk who are hard to reach, community-based organizations, neighborhood health centers, and private providers should be enlisted to help identify undetected cases and encourage treatment.

Although expanding screening and treatment efforts will go a long way to eradicating tuberculosis, the United States will never be able to eliminate this disease until the global tuberculosis epidemic is brought under control. Tuberculosis is a leading cause of death from infectious diseases globally, killing 2 million to 3 million people annually. Because this disease is preventable, treatable, and curable, these deaths are particularly tragic. Financial and technical assistance should be increased for those countries that are suffering from epidemics of tuberculosis.

Without a doubt, it is comforting to realize that tuberculosis is on the downswing in the United States. But although we may be winning the battle, the war against tuberculosis must continue until the disease is eliminated completely.