Despite the decline in mortality in the past two decades that has resulted from public-health programs for treatment, prevention, and surveillance, tuberculosis continues to be a problem in at least half our states and a drain on the scarce public-health dollar. Approximately 30,000 new cases of tuberculosis have been reported annually over the past several years, 1 with the city of Washington having the dubious distinction of a case rate higher than that of any state in the continental United States. Moreover, the transmission of new infection in urban areas and among the young indicates that, without prompt new strategies, the . . .