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TB Notes Newsletter
No.
3, 2007
TB EPIDEMIOLOGIC STUDIES CONSORTIUM UPDATES
2007 World TB Day: TBESC Sites Across the
U.S.
Get Involved
Each year, World TB Day (March 24) offers a terrific opportunity
to raise awareness about TB in our communities. Several Tuberculosis
Epidemiologic Studies Consortium (TBESC) members took advantage of
this opportunity and hosted or participated in the events below.
-
Texas: On March 16, the Texas
Department of State Health Services held two of its many
organized World TB Day events. At the Houston World TB Day
event, TBESC members Drs. Charles Wallace and Ed Graviss gave
presentations on “Tuberculosis in Texas” and “New Laboratory Tools,”
respectively. There was also a media conference with US
Congressman Gene Green on March 16. Congressman Green has
sponsored the Comprehensive TB Elimination Act, HR 1532, which
calls for increased funding to support various mechanisms that
aid TB elimination, such as projects that prevent, detect, and
control TB in both US-born and foreign-born persons in the
United States.
- Denver: On March 21, Denver Public Health and
Hospitals Authority hosted a TB informational session, where
HHS Regional Health Administrator
Dr. Zach Taylor and TBESC member Dr. Bob Belknap presented on
“Confronting the TB Pandemic,” “Multidrug-Resistant TB Case
Presentations,” and “Role of Newer Blood Tests in the Diagnosis
of TB.” Other presenters included Annette Choszczyk from
RESULTS, who spoke about her parents, who met in a TB
sanitarium. Joanie, a 2-year-old girl, who was infected with TB
but was treated owing to early testing, and her mother were also
part of a presentation. About 55 people attended; many were area
health department staff and/or infection control practitioners.
The presentations were well received; many of the attendees were
particularly interested in Interferon gamma release assays (IGRAs)
and asked Dr. Belknap to speak about TB diagnostics at the local
infection controllers meeting in April.
-
North Carolina: On March 22, the
North Carolina TB Control program held a media call with the
North Carolina RESULTS group, and included one of their TB
patients on the call. On March 23,
Duke
University and the North Carolina TB
Control Program held their 7th Annual Tuberculosis Symposium to
commemorate World TB Day 2007. This year the theme was
Tuberculosis: What Doesn’t Kill it, Makes it Stronger. The
target audience for the symposium was physicians and other
providers interested in TB control, prevention, treatment, and
research. The TB symposium was very well-received and had its
largest turnout, about 200 individuals at the "live" Duke site
and another 70 at the four broadcast sites around the
state. Enrollment for the symposium has grown every year since
inception. Participants included physicians in the community who
work with local TB clinics, as well as infection control
practitioners, advance practice nurses, and TB nursing staff
throughout the state. TBESC member Dr. Carol Dukes Hamilton
presented on the “State of the State in North Carolina
Tuberculosis Control.”
- Curry National TB Center: On March 22, the Francis J.
Curry National TB Center participated in
San Francisco's World TB Day event, at
which Dr. Masae Kawamura, TB Control Director, San Francisco
Department of Public Health, presented information to the public
about the recent transmission of TB within single-resident
occupancy (SRO) hotels. The Center also prepared a World TB Day
press release for four low-incidence states. On March 23, one of
the Center’s state partners, the Utah TB control program,
co-sponsored a World TB Day conference with the Utah Chapter of
the American Lung Association. There were about 150
participants. Dr. Charlie Nolan from Seattle and King County
Public Health, who is involved in TBESC’s Task Order 6,
“Regional Capacity-Building in Low-Incidence Areas,” was invited
to speak at the event about TB and global health issues to a
gathering of mostly public health nurses.
-
Massachusetts: On March 22, TBESC
member Sue Etkind participated in a media call, “World TB Day
2007: Tuberculosis Experts Give Massachusetts Update on
Drug-Resistant TB Emergency,” which was sponsored by RESULTS.
The media call gave an update on what the drug-resistant TB
emergency means for
Massachusetts and also gave
recommendations to prevent an
MDR outbreak like the outbreak that
occurred in
New York in the 1990s.
-
Minnesota: On March 22 and March
28, the Minnesota Department of Health participated in two
educational sessions about TB. The educational session in
Dakota
County was about latent TB infection (LTBI)
and the epidemiology of TB in
Dakota
County, and the educational session in
Ramsey
County was about the epidemiology of
TB, treatment for LTBI and TB, and TB-related educational
materials. The Minnesota Department of Health also submitted an
article entitled "Tuberculosis: Answers to Your Questions" to
several local newspapers. The article covered the basics about
transmission, active TB disease, and latent TB infection. The
newspapers target African, Hmong, and Hispanic populations in
and around the Twin Cities (Minneapolis and
St. Paul).
-
ALA
Chicago: On March 23, the American Lung
Association of Metropolitan Chicago (ALAMC), which is part of
TBESC, had an all-day event under the theme TB Anywhere Is TB
Everywhere. There were presentations on extensively
drug-resistant (XDR) TB, local use of QuantiFERON, TB funding
concerns and issues, global and local TB statistics, and a CDC
“Quarantine Update.” Approximately 200 people attended. The
ALAMC also had a satellite and webcast program, “Liver Toxicity
and Latent TB Infection,” which was viewed by over 200 people.
On the day before the World TB Day events, ALAMC staff also
distributed information about TB at various public
transportation stops in the metro
Chicago area and asked individuals to join
them in support of increased funding; 2,500 pieces of TB
education materials were disseminated in 1.5 hours!
-
Atlanta: On March 24, the First
Annual TB Awareness Walk sponsored by the National TB
Controllers Association (NTCA) took place at Grant Park in
Atlanta. The walk was very successful; over
600 people registered for the walk and about 500 people actually
participated, including several TBESC members. Representatives
from NTCA and from the group RESULTS, as well as CDC Director
Dr. Julie Gerberding, NCHHSTP Director Dr. Kevin Fenton, and
DTBE Director Dr. Kenneth Castro, were all speakers and
participants in the event. The event was such a success that
there is talk about doing this nationwide next year!
- Maryland: On March 28, the Maryland Department of
Health and Mental Hygiene, also a part of TBESC, hosted a
well-received World TB Day presentation by Dr. Thomas Walsh
entitled “TB: the Good, the Bad, and the Ugly.” The presentation
gave a brief overview of TB, which included a description of TB,
consequences of late and missed TB diagnoses, and the success of
treatment, once patients are in care, even for those with
drug-resistant TB disease.
—Reported by Indhira
Gnanasekaran, MPA
Div of TB Elimination
“The First Global Symposium on Interferon-Gamma Assays” 2007
Note: At the First Global Symposium on Interferon-Gamma Assays
held in February 2007 in Vancouver,
Canada, Naasha Talati, MD, from the Division of
Infectious Diseases at
Emory
University gave a talk entitled, “Poor Concordance
between Interferon-Gamma Release Assays and Tuberculin Skin Test in
the Diagnosis of Latent Tuberculosis Infection Among HIV-Infected
Individuals.” This study was funded through the CDC Tuberculosis
Epidemiologic Studies Consortium (TBESC) Task Order #5 and through a
grant from the CDC Foundation to
Emory
University. Coauthors on the study include
Ulrich Seybold, Bianca Humphrey, Abiola Aina, Jane Tapia, Paul
Weinfurter, Rachel Albalak, and Henry M. Blumberg. A
synopsis of the study and preliminary results are presented below.
The interferon-gamma release assays (IGRAs) represent a new
generation of diagnostic tools for detecting latent TB infection (LTBI).
One IGRA is currently FDA-approved for use in the
United States. CDC has published
recommendations on the use of the FDA-approved IGRA (QuantiFERON-TB
Gold) [MMWR 2005;54(No. RR-15):49-55]
but there are few data on the use of IGRAs in immunocompromised
patients. CDC has recommended additional research in this area.
Published studies on the use of IGRAs in immunocompromised
persons (including those with HIV infection) are limited by small
sample size and lack of CD4 T-cell data. The specific aims of this
study focused on determining the prevalence of LTBI using three
diagnostic tests—the tuberculin skin test (TST), QuantiFERON-TB Gold
in Tube (QFT-G) and TSPOT.TB (TSPOT)—and assessing concordance
between these diagnostic tests for LTBI. HIV-infected individuals
were enrolled at two urban HIV clinics in
Atlanta,
Georgia, between June 2004
and June 2006. Blood was drawn for the IGRAs, QFT-G, and TSPOT, and
a TST was then placed.
The study enrolled 692 HIV-infected persons. Mean age was 42
years, 478 (69%) were male, 547 (79%) were African American, and 62
(9%) were foreign-born. The mean CD4 count was 351/ ml, and median
viral load was <400 copies/ml. All patients had a TST and QFT-G
performed. Nineteen patients (2.8%) had a positive TST result and 32
(4.6%) of 692 persons had a positive QFT-G result. A subset of
patients (n=338) had the TSPOT test performed; 14 (4.2%) had a
positive TSPOT. Only one patient had a positive result for all three
diagnostic tests and only one patient had both TSPOT and QFT-G
positive results. Concordance between the three tests was poor: TST
and QFT-G, k= 0.12 (95% CI -0.01 - 0. 26); TST and TSPOT, k= 0.2
(95% CI -0.06-0.46); TSPOT and QFT-G, k= 0.05 (95% CI -0.10-0.20).
An indeterminate QFT-G was seen in 32 (4.6%) patients, and an
indeterminate TSPOT was seen in 47 (14%) patients. In multivariate
analysis, a CD4 count < 200/ ml was associated with indeterminate QFT-G and TSPOT results (OR=3.4, 95% CI 1.5-7.7 and OR=3.9, 95% CI
1.8-8.1, respectively.)
Overall there was a low prevalence of LTBI in this urban
HIV-infected patient population. Among the two IGRAs, indeterminate
results were more likely to occur in those persons with CD4 ≤ 200 /
ml. Poor concordance between diagnostic tests for LTBI was
documented. This raises concerns about the utility of IGRAs among
HIV-infected individuals. Further studies are needed to assess the
utility of IGRAs in HIV-infected individuals, particularly in high
TB prevalence areas.
—Reported by Naasha
Talati, MD
and Henry M. Blumberg, MD
Division of Infectious Diseases
Emory
University
School of Medicine
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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