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TB Notes Newsletter
No. 4, 2007
SURVEILLANCE, EPIDEMIOLOGY,
AND OUTBREAK INVESTIGATIONS
BRANCH UPDATE
11th Semiannual Meeting
of the Tuberculosis Epidemiologic Studies Consortium
The 11th
Semiannual Meeting of the Tuberculosis Epidemiologic Studies
Consortium (TBESC) was held on July 12–13 in Atlanta. The primary
purpose of the TBESC is to conduct epidemiologic, behavioral,
economic, laboratory, and operational research in TB prevention and
control.
Over 75 persons
participated in the meeting. Attendees included CDC staff, TBESC
principal investigators, project coordinators, and project specific
personnel.
TBESC members
and CDC staff gave updates on the status of ongoing TBESC research
projects and activities. Administrative and fiscal issues were also
discussed.
Topics
included-
- Tuberculosis in the foreign-born
- Acceptance
and completion of latent TB infection (LTBI) treatment in the US
and Canada in 2002
- New
developments in the diagnosis of TB and LTBI
- Administrative and fiscal updates on consortium-related
activities
- Update on
the Semiannual Tuberculosis Advisory Review (STAR) process
- Updates
from the Process Evaluation and Research Committees
- Update
from the Translating Research into Practice (TRiP) Workgroup
It is a very
exciting time for the consortium with a number of its studies in the
data analysis phase and others reporting results and describing
implications for TB programs. Manuscripts from TBESC studies on
pediatric TB and use of network analysis to characterize TB
transmission patterns were recently accepted for publication in
journals.
For more
information
please visit the
TBESC
website
.
—Reported by
Indhira Gnanasekaran, MPA
TBESC Project
Manager
CDC Team Teaches
TB/HIV Operational Research Course in
Kiev, Ukraine
A team of CDC
epidemiologists and technical experts recently collaborated with two
international partners, the World Health Organization (WHO) and the
KNCV Tuberculosis Foundation, to conduct a TB/HIV Planning &
Operational Research Workshop in Kiev, Ukraine, May 7–12, 2007. CDC
team members were Julia Ershova, Senior Service Fellow, Division of
Epidemiology and Surveillance Capacity Development, Coordinating
Office of Global Health; Ann Buff, EIS Officer, DTBE, NCHHSTP;
Kashef Ijaz, Chief, Field Services and Evaluation Branch, DTBE,
NCHHSTP; and Timothy Holtz, Medical Epidemiologist, DTBE, NCHHSTP.
Nineteen epidemiologists and physicians from Russia, Belarus,
Moldova, and Ukraine participated in the workshop. The goals of the
course were to promote TB/HIV collaborative activities at the
national and regional levels and for each country team to develop a
TB/HIV operational research proposal focused on improving operations
between TB and HIV programs. The CDC team taught applied
epidemiology and provided mentoring to country teams.
The first day of the workshop, Monday, was filled with
introductions, country presentations, and discussion of possible WHO
collaborative activities for national TB and HIV programs. Each
country team presented an overview of the epidemiology of TB/HIV,
challenges of TB/HIV control, and potential TB/HIV collaborative
efforts in their respective countries. The second day consisted of
presentations by Drs. Buff, Ijaz, and Holtz to lay the groundwork of
basic epidemiologic analysis, research design, and study proposal
development. The class particularly enjoyed an interactive sampling
techniques exercise in which CDC pens and travel mugs were awarded
for “sampled” participants. Julia Ershova spent Wednesday and
Thursday teaching CDC’s statistical software program, Epi-Info. The
class used the Russian version of Epi-Info for practical exercises
with data from a real epidemiologic investigation. Participants were
eager to show off their data analysis and graphing skills at the end
of each exercise. After two and a half days of intense epidemiology
training, the class was ready for a break from the classroom. On
Thursday afternoon, participants visited one of two field sites in
Kiev. Half the class visited a harm reduction center funded by a
coalition of non-governmental organizations working in HIV/AIDS
where all clients receive HIV testing, counseling, and educational
support services. The other half visited a TB control program
dispensary where TB patients receive medical care, counseling, and
support services.
On Friday, the country team members spent several
hours fine-tuning their proposals, and the CDC epidemiologists
presented the final lectures. Dr. Holtz presented a discussion of
the ethics of medical research, a new topic for many of the class
participants. On Saturday morning, teams pitched their preliminary
proposals with formal 15-minute PowerPoint presentations. Each
country team developed a solid operational research proposal,
incorporating many of the principles and techniques presented during
the workshop. Going forward, DTBE epidemiologists will continue to
provide mentoring as teams finalize and submit their proposals for
ethical review. WHO and KNCV Tuberculosis Foundation will provide
seed funding for each finalized proposal and oversight during the
research phase.
Workshop
participants had the opportunity to evaluate the workshop and all
participants rated the quality of presentations as “very good” or
“excellent.” Participants particularly valued the interactive
nature of the course and rated the skills taught as very useful.
This workshop was also a valuable opportunity for DTBE to enhance
epidemiologic capacity in Eastern Europe and to strengthen
relationships by collaborating with our international partners, the
WHO and KNCV Tuberculosis Foundation.
—Reported by Ann
Buff, MD
Div of TB
Elimination
2006 Annual Surveillance Report
This year’s
annual surveillance report, Reported Tuberculosis in the United
States, 2006, was released in October 2007, and is posted on the
Internet at www.cdc.gov/tb/surv/default.htm. Hardcopy versions will
be available in November 2007.
Statistical
highlights of Reported Tuberculosis in the United States, 2006,
include the following:
- Case
counts: 13,779 TB cases were reported to CDC from the 50 states
and the District of Columbia, representing a 2.1% decrease from
2005
- 20
states reported increases in case counts
- California, New York, Texas, and Florida accounted for 48%
of the overall 2006 national case total
- For
the third consecutive year, Hispanics (30%) exceeded
non-Hispanic blacks (27%) as the racial/ethnic group with
the largest percentage of total cases
- Blacks
or African-Americans represented 44% of TB cases in
U.S.-born persons and accounted for approximately 19% of the
overall national case total
- Hispanics and Asians together represented almost 80% of TB
cases in foreign-born persons and together accounted for
almost 45% of the overall national case total
- Case
rates: The TB case rate declined from 4.7 to 4.6 per 100,000
population, representing a 3.1% decrease from 2005
- 12
states and DC reported rates above the national average
- 26
states met the definition for low incidence (<3.5
cases per 100,000 population)
- The TB
case rate was 2.3 per 100,000 for U.S.-born persons and 22.0
for foreign-born persons
- Asians
and Native Hawaiians or Other Pacific Islanders continue to
have the highest case rate among all racial and ethnic
groups
- Burden in
the foreign-born: The proportion of all cases occurring in
foreign-born persons was 57%
- 27
states had >50% of total cases among foreign-born
persons
- 11
states had >70% of total cases among foreign-born
persons
- The
top five countries of origin of foreign-born persons with TB
were Mexico, the Philippines, Vietnam, India, and China
- Drug
resistance: The proportion of cases with primary multidrug-resistant
TB was less than 1.0%.
- Updated
case counts are given for each year from 1993 through 2005
- The
calculation of completion of therapy was changed to present data
only for cases where therapy of 1 year or less was indicated
- A new
slide depicting the case counts for XDR TB cases since 1993 was
added to the standard slide set
Following are
suggested citations for hard copy and online versions:
Hard copy: CDC.
Reported Tuberculosis in the United States, 2006. Atlanta,
GA: U.S. Department of Health and Human Services, CDC; October 2007.
Online:
CDC.
Reported Tuberculosis in the United States, 2006. Atlanta, GA:
U.S. Department of Health and Human Services, CDC; 2006.
—Reported by Sandy
Althomsons
Div of TB
Elimination
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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