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TB Notes Newsletter
No. 4, 2007
Dear Colleagues:
The 2006 TB Surveillance Slide Set and
accompanying text were posted on the DTBE web site at
on September 25. This slide set was developed to
accompany the annual surveillance report, Reported
Tuberculosis in the United States, 2006. The annual
report was posted on the DTBE web site October 15, 2007,
and the hard copy reports will be mailed in November. In
this slide set, we report that 13,779 cases of TB were
diagnosed and documented in 2006, a 2.1% decrease from
14,080 in 2005.
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 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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