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TB Notes NewsletterReturn to Main Menu - TB Notes 4, 2007No. 4, 2007Dear Colleagues: The Advisory Council for the Elimination of Tuberculosis (ACET) met on July 10–11 in Atlanta. After introductions and welcoming remarks, I gave the DTBE Director’s update. I noted senior staff changes that have occurred this year: Dr. Kashef Ijaz became Chief, Field Services and Evaluation Branch, and Dr. Eugene McCray returned to DTBE as Chief, International Research and Programs Branch, replacing Dr. Charles Wells, who left CDC to take a position with Otsuka pharmaceuticals. Also, Dr. Jack Crawford retired from the Mycobacteriology Laboratory Branch. Ms. Susan DeLisle, Associate Director for Program Integration, gave an update on center activities on behalf of Dr. Kevin Fenton, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). She also described the NCHHSTP program collaboration and service integration (PCSI) activities. These activities will be focused at the field or client level to provide holistic services for the client. She reported that a PCSI consultation would be held August 21–22 at the Roybal campus. The purpose of the consultation was to “engage key stakeholders of NCHHSTP programs in advising on direction-setting for PCSI activities over the next 5 years.” Please see my remarks on this meeting below. Drs. Denise Koo and Tony Catanzaro discussed training and education initiatives for professionals in TB control, with Dr. Koo describing competencies for epidemiologists and Dr. Catanzaro discussing the National Tuberculosis Curriculum Consortium (NTCC). The charge of the NTCC is to increase instruction about TB control in medical schools by enhancing the curriculums that professors are teaching and making relevant, useful material available for free. Drs. Drew Posey and Charles Nolan provided updates on activities related to TB screening U.S.-bound Burmese refugees. An evaluation team felt that the International Organization for Migration is doing an excellent job of screening these refugees, and believe that performing cultures and drug-susceptibility testing adds much value to a refugee screening program. Dr. Phil LoBue reported on the Federal TB Task Force’s progress in developing a U.S. government action plan for extensively drug-resistant (XDR) TB. The group is working on the second draft, with the goal of publication in the MMWR in December. We heard a brief report on the TB in African Americans Workgroup from Shannon Jones, who is the Workgroup chair. The group will work to address the TB disparity among African Americans. Several speakers presented updates related to XDR TB . Drs. Kashef Ijaz and John Jereb summarized DTBE’s outbreak response plan and recent outbreak investigations, and outlined the plan for responding to XDR TB. Dr. Elsa Villarino reviewed CDC recommendations for the use of BCG vaccine in the United States to prevent TB, particularly in health care workers. She concluded that, in theory, the interferon-gamma release assay (IGRA) should be more useful than the tuberculin skin test (TST) for post-BCG follow-up testing. Dr. Rick Goodman reviewed public health laws related to TB control, and presented several options for building on ACET’s 1993 recommendations on state TB laws. We also heard several presentations on XDR TB preparedness planning. Dr. Ann Buff provided an interim status report on the investigation of the U.S. traveler originally identified with XDR TB who flew to Europe against medical advice. She indicated that the next steps were to complete the contact investigations for close contacts, health care workers, and passengers by the end of July; analyze the data; and disseminate the results. Mr. Bruce Burney of CDC’s Division of Emergency Operations provided an informative overview of the CDC Director’s Emergency Operations Center and how it functions during public health emergencies. Dr. Peter Cegielski gave a very useful presentation on drug resistance, indicating that TB drug resistance is being created in countries where a standard regimen is used rather than regimens that are based on drug susceptibility testing. We then heard several presentations about the Regional Training and Medical Consultation Centers (RTMCCs). Dr. Phil LoBue described the vision of the RTMCCs: to make expert medical consultation on TB available to all U.S. health care providers using a regional framework. The scope of coverage has changed; the San Francisco and New Jersey centers will scale down from national to regional consultations, while the Florida and Texas centers are being asked to expand from state to regional coverage. For most states, the state or local TB program will continue to provide primary medical consultation; in states with low capacity, the RTMCC will provide this. The legal aspects of regional consultation, however, may require additional inquiry. We also heard remarks from Drs. Rey McDonald, Dave Ashkin, Barbara Seaworth, and Charles Daley, representing the RTMCCs in New Jersey, Florida, Texas, and California, respectively. Dr. Tom Shinnick shared the laboratory plan for responding to XDR TB. The Federal TB Task Force is developing an action plan for XDR TB patterned after the MDR TB action plan, and a key part of the plan is improving laboratory capacity. U.S. labs currently have limited capability to respond to XDR TB. Dr. Patrick Moonan then reported on DTBE’s genotyping activities in response to XDR TB. These activities include developing the National MDR/XDR TB Registry; creating the TB Genotyping Information Management System (TB GiMS); and undertaking TBESC task order 8, an analysis of the molecular epidemiology of MDR TB in the United States. The meeting was then adjourned; the next meeting will be held in November. Members of the National Coalition for the Elimination of Tuberculosis (NCET) met August 2–3, 2007, in Atlanta for a strategic planning retreat, with the support of DTBE. NCET members attending the retreat were Jeff Caballero, Fran DuMelle, Sue Etkind, Dr. Phil Hopewell, Dr. Randall Reves, and John Seggerson. I attended, joined by several CDC staff members who included Phil Talboy, Dr. Kashef Ijaz, Dr. Wanda Walton, and Ann Cronin. Representatives of several other national and international organizations also participated. The meeting concluded with specific recommendations: 1) Change identity from NCET to Stop TB USA to provide a more distinctive name and a clear link to the global Stop TB Partnership; 2) Appoint workgroups to develop Stop TB USA launch activities and to develop an updated TB elimination plan; 3) Present Stop TB USA and its planned initiatives at the November 27–28, 2007, ACET meeting; 4) Launch Stop TB USA at the IUATLD-North America Region Meeting in San Diego in February 2008; 5) Follow up the initial launch with activities for World TB Day in March 2008; and 6) Present a new plan for U.S. TB elimination based on input from national and global partners by May 31, 2008. We hope to see renewed commitment and action in the U.S. TB elimination arena as a result of this reinvigoration of the coalition. The seventh annual TB Education and Training Network (TB ETN) conference was convened August 7–9, 2007, in Atlanta with 143 TB educators in attendance. This annual conference is an opportunity for TB educators to meet, exchange ideas and success stories, learn about new or different products and strategies, and network with peers. Please see the related article in this issue by Holly Wilson. As I mentioned above, on August 21–22, NCHHSTP hosted its first consultation on Program Collaboration and Service Integration (PCSI). More than 50 CDC staff and 70 external partners gathered at the Roybal campus to help guide our PCSI efforts and chart PCSI activities over the next 5 years. In the 2 days, attendees shared their views about what PCSI could do for those populations most affected by HIV, STDs, TB, and viral hepatitis, and developed solutions to potential barriers to PCSI. Participants agreed that the next steps would include developing a policy document to help facilitate dialogue on what works and what needs strengthening; exploring funding opportunities for PCSI efforts; and focusing our effort in the areas of integrated surveillance, integrated funding (i.e., program announcements), and integrated staff training and skills development. DTBE staff members helping with this effort were Kashef Ijaz, Val Robison, Andy Heetderks, Heather Duncan, and Joe Scavotto. Our external partners included representatives of the National TB Controllers Association, the Council of State and Territorial Epidemiologists, and the RTMCCs. Dr. Fenton was most impressed by this historic collaboration, and has promised to provide a report on the consultation. Thanks to all of you for your commitment, and for another great year of progress in our battle against tuberculosis. I hope you have a safe and peaceful remainder of 2007. Kenneth G. Castro, MD
Last Reviewed: 05/18/2008 |
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