{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T07:58:40Z","timestamp":1788249520510,"version":"build-2803163510"},"reference-count":77,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2003,2,28]],"date-time":"2003-02-28T00:00:00Z","timestamp":1046390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Science Foundation"},{"name":"Avina Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Phys Anthropol"],"published-print":{"date-parts":[[2003,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study documents the course of a tuberculosis epidemic in an immunologically naive group of South American Indians within fewer than 20 years after first sustained contact with outsiders. Groups of Northern Ach\u00e9 (ah\u2010CHAY) of eastern Paraguay were contacted and settled on reservations between 1971\u20131979. Not surprisingly, the Ach\u00e9 are very susceptible to tuberculosis, and the epidemiological characteristics of the disease are quite different from those of populations that have had tuberculosis for centuries. Within 6 years of the first detected case of tuberculosis among the Ach\u00e9, the prevalence rate of active tuberculosis cases reached 18.2%, and of infected cases among adults, 64.6%, some of the highest rates ever reported for any human group. Remarkably, males and females are equally likely to have been diagnosed with active tuberculosis, Ach\u00e9 children between birth and 5 years of age are least vulnerable to tuberculosis, high nutritional and socioeconomic status do not decrease the risk of disease or infection, and children immunized with BCG are less responsive to tuberculin challenge than are other children. Moreover, similar to the Yanomam\u00f6, but unlike populations of European or African descent, a high percentage of Ach\u00e9 with active disease test negative on tuberculin challenge tests (purified protein derivative; PPD). These differences may be due to a high prevalence of diminished cell\u2010mediated immunity, and T\u2010helper 2 dominance. We also hypothesize that these immunological characteristics, low genetic diversity, hostile intergroup interactions, and behavioral noncompliance to treatment protocols together contribute to the high rates of active disease observed. Existing tuberculosis control programs are poorly equipped to handle the impact of these causal complexities on the course of recent tuberculosis epidemics that have quickly spread throughout native communities of Latin America during the last decade. Am J Phys Anthropol 121:000\u2013000, 2003. \u00a9 2003 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ajpa.10228","type":"journal-article","created":{"date-parts":[[2003,5,6]],"date-time":"2003-05-06T10:01:39Z","timestamp":1052215299000},"page":"134-150","source":"Crossref","is-referenced-by-count":37,"title":["Longitudinal study of tuberculosis outcomes among immunologically naive Ach\u00e9 natives of Paraguay"],"prefix":"10.1002","volume":"121","author":[{"given":"A. 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