A histone H3K36 chromatin switch coordinates DNA

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It has, however, been argued with great vehemence that, even with high mortality rates, the elimination of susceptibles cannot possibly account for the tuberculosis resistance emerging in certain populations, and it has been pointed out that `epidemic' tuberculosis can again develop should these groups experience adverse socioeconomic conditions (Youmans 1979). In this view the decline in the tuberculosis wave in developed countries should be ascribed to `suburbanization' and the `immunizing' e¡ect of an active infection successfully survived.

This suggests that social and biological factors can be overcome by a decent tuberculosis control programme, and that once they are overcome they can be maintained without the same intensity of e¡ort. I realize that the magnitude is much greater in the areas you have studied, but have you considered that they can be used as demonstration areas to test this approach? Donald: The areas in question have now been identi¢ed by the local government as being demonstration areas, and the World Health Organization DOTS (directly observed therapy short-course) approach is being implemented there precisely as a demonstration.

Am Rev Respir Dis 90:524^541 Nel JCWK, de Villiers PJT 1993 Pulmonary tuberculosis amongst the San in Bushmanland, Namibia. S Afr J Epidemiol Infect 8:18^21 Parkin DP, Vandenplas S, Botha FJH et al 1997 Trimodality of isoniazid elimination. Phenotype and genotype in patients with tuberculosis. Am J Respir Crit Care Med 155:1717^1722 Roelsgaard E, Iversen E, Bicher C 1964 Tuberculosis in tropical Africa. Bull WHO 30:459^518 Schaaf HS, Botha P, Beyers N et al 1996 The 5-year outcome of multidrug-resistant tuberculosis patients in the Cape Province of South Africa.

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