This chapter provides an empirical account of the evolutionary and epidemiological history of tuberculosis in populations around the world. Much has happened in the population biology of TB since 1960, and despite the development of highly efficacious drug therapy to prevent and cure TB, the disease remains the largest cause of death from a single, curable infectious agent. The challenge we face in the twenty-first century is to control—and ultimately eliminate—a pathogen that has inhabited human populations for tens of thousands and possibly millions of years. To begin to understand how TB control and elimination could be achieved, this chapter defines the problem. It describes the essential characteristics of Mycobacterium tuberculosis and the collection of diseases it causes, its origins and distribution in human populations, the dominant trends through time, and the burden of disease today.
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