Davies and Squire say it’s too soon to conclude on the efficacy of directly observed treatment short courses (DOTS) for treating tuberculosis.1
Norway and Sweden are sociodemographically, politically, and culturally comparable. However, the Norwegian tuberculosis control programme fully complies with the DOTS strategy promoted by the World Health Organization and the International Union Against Tuberculosis and Lung Diseases, but that in Sweden does not. Most strategies for preventing tuberculosis in the two countries are otherwise comparable to the US and most European countries, so these “twin countries” provide an excellent “case-control model” to study the effect of DOTS nationally.
Transmission of tuberculosis is stable in Norway, despite its import from immigration and increasing incidence.2 Immigrants from regions with high rates of tuberculosis bring in different strains of Mycobacterium tuberculosis, but they do not significantly contribute to the spread of disease in the resident population.
Serious shortcomings have been revealed in Sweden, however.3 The National Board of Health and Welfare has criticised the Swedish Institute for Infectious Disease Control for not stopping the spread of drug resistant M tuberculosis in Stockholm.3 4
The epidemiology of tuberculosis is completely different in the two countries. By introducing obligatory DOTS to all patients, Norwegian health personnel accomplish prompt diagnosis and treatment in a diverse population.2 5 In Sweden, however, control is complicated by the lack of DOTS.3 This situation is a strong argument for introducing DOTS in all countries where it has not yet been implemented.
Competing interests: None declared.
References
- 1.Davies GR, Squire SB. Doubts about DOTS. BMJ 2008;336:457-8. (1 March.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dahle UR, Eldholm V, Winje BA, Mannsåker T, Heldal E. Impact of immigration on the molecular epidemiology of Mycobacterium tuberculosis in a low-incidence country. Am J Respir Crit Care Med 2007;176:930-5. [DOI] [PubMed] [Google Scholar]
- 3.Kan B, Berggren I, Ghebremichael S, Bennet R, Bruchfeld J, Chryssanthou E, et al. Extensive transmission of an isoniazid-resistant strain of Mycobacterium tuberculosis in Sweden. Int J Tuberc Lung Dis 2008;12:199-204. [PubMed] [Google Scholar]
- 4.Dahle UR. Public health programmes: you don’t know what you’ve got till it’s gone BMJ 2004;328:1568. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Schwartzman K. “Them” and “us”: the two worlds of tuberculosis? Am J Respir Crit Care Med 2007;176:840-2. [DOI] [PubMed] [Google Scholar]