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TB Notes NewsletterReturn to Main Menu - TB Notes 1, 2008
No. 1, 2008
Directors Letter
Dear Colleague:
The 38th Union World Conference on Lung Health was held in Cape
Town, South Africa, November 8–12, 2007. Sponsored by the
International Union Against Tuberculosis and Lung Disease (The
Union), it was held at the Cape Town International Convention Centre
(CTICC). The theme of the conference was "Confronting the Challenges
of HIV and MDR in TB Prevention and Care." Other key international
issues, such as tobacco control, child lung health, and asthma, were
also addressed. Conference organizers believed it was appropriate
for the World Conference to be held in Cape Town and to have a theme
highly relevant for South African and other African colleagues.
African health professionals daily confront the burden of HIV/AIDS
and TB coinfection and its medical, health, social, and economic
consequences, despite serious challenges and resource constraints.
The conference addressed these constraints to effective prevention
and care while taking into consideration broader issues.
The region of South Africa this year has attracted much medical
attention from TB and lung health experts owing to the emergence of
extensively drug-resistant strains of TB (XDR TB); the continuing
epidemic of patients coinfected with TB and HIV; and the critical
need for new drugs, diagnostic tools, and resources to address these
problems. Speakers and delegates from more than 100 countries made
presentations and led discussions. The conference included a special
guest lecture and awards ceremony; three plenary sessions; 13
postgraduate courses; 11 full-day and two half-day courses; seven
workshops; and 40 symposia. Topics ranged from rapid detection of
drug resistance and transmission dynamics of MDR and XDR TB to
ensuring integrated TB/HIV care and quality management for
laboratory services. The Union/CDC latebreaker session was held
again this year.
At the opening ceremony of the Union conference, plans for the 2008
World TB Day campaign were announced by Stop TB Ambassador Anna
Cataldi. She announced that a campaign aimed at challenging people
all over the world to do their part to fight TB will be launched in
2008 in the months before World TB Day, March 24. “The slogan, ‘I am
stopping TB,’ says that everyone can take an active role in helping
all people in need gain access to accurate TB diagnosis and
effective treatment," Ms. Cataldi said. World TB Day is an
opportunity for all of us in TB control to take stock of our
progress and problems in overcoming TB worldwide and to renew our
efforts.
The Advisory Council for the Elimination of Tuberculosis (ACET)
convened November 27–28, 2007, in Atlanta. Dr. Hazel Dean, acting
Deputy Director, National Center for HIV/AIDS, Viral Hepatitis, STD,
and TB Prevention (NCHHSTP), provided updates on NCHHSTP activities
and staff. She discussed NCHHSTP priorities, which include reducing
health disparities; implementing program collaboration and service
integration (PCSI) activities at the client level; and maximizing
relationships among NCHHSTP divisions that are global in nature. I
provided the DTBE Director’s update, including the announcement that
the 2006 TB surveillance report is now available. Included in the
report for the first time is a graph reflecting U.S. cases of
extensively drug-resistant (XDR) TB during 1993–2006; there were 48
cases reported in 13 states and New York City. I reported that TBTC
Study 28 has been completed; this trial assessed the impact on
sputum conversion rates of substituting moxifloxacin for isoniazid
in the standard intensive phase of TB treatment. The study found
that the moxifloxacin arm had a slightly higher (although
statistically nonsignificant) sputum conversion rate, and had
excellent tolerability.
Ms. Fran DuMelle outlined several legislative proposals that could
result in congressional funding for certain TB control activities
such as the development of new tools for the elimination of TB, the
expansion of DOTS coverage, and treatment of individuals with TB/HIV
and those with MDR or XDR TB. We heard the latest update from Dr.
Dolly Katz about the revision of the guidelines for controlling TB
in foreign-born persons; first drafts have been completed for most
sections. Dr. Drew Posey of the Division of Global Migration and
Quarantine (DGMQ) reported that the CDC Technical Instructions for
Panel Physicians were finalized and are posted on the CDC website.
The instructions have been implemented in Mexico, the Philippines,
and Thailand; Vietnam and other areas will begin soon. Dr. Francisco
Averhoff of DGMQ discussed the use of homeland security tools for
public health purposes, such as the “Do not board” order; since May
2007, CDC has requested 17 such orders for persons with known or
suspected infectious TB. Dr. Diana Schneider gave a comprehensive
presentation on case management and legal issues in the border
region, and the progress being made by the Transnational TB
Continuity of Care Workgroup.
Dan Ruggiero of DTBE and Donna Wegener of the Southeast Regional
Training and Medical Consultation Center (RTMCC) gave updates about
the activities and accomplishments of the four RTMCCs. In 2006, the
RTMCCs provided over 100 courses that resulted in the training of
7,126 health care workers, disseminated 3,850 products online, and
provided 1,720 medical consultations. Dr. Wanda Walton and Dr. Tony
Catanzaro gave updates on the National Strategic Plan for TB
Training and Education and the National Tuberculosis Curriculum
Consortium (NTCC), respectively. Both are coming to the end of their
coverage period and must review options for future development and
activities. Dr. Rick Goodman reviewed the issues relevant to public
health TB control laws in the setting of emerging drug-resistant TB
and described options for conducting an updated review of TB control
laws. Dr. John Ridderhof discussed the capacity of U.S. laboratories
to do second-line drug-susceptibility testing (DST) and areas
needing improvement, such as turn-around time. He also summarized a
World Health Organization (WHO) Expert Meeting held July 2007 to
discuss policy guidance on second-line DST; meeting participants
concluded by recommending rapid rifampicin testing in high-risk
settings for screening, but said that conventional DST is still the
gold standard.
Dr. Ann Buff summarized the contact investigation around the
traveler with suspected XDR TB; the extensive investigation found no
evidence of M. tuberculosis transmission from the patient. Mr.
Shannon Jones briefed us on action steps and recommendations
developed by the TB in African Americans workgroup. Dr. Michael
Leonard, representing the Infectious Diseases Society of America
(IDSA), gave an update on the letter sent to the American Thoracic
Society (ATS) and IDSA expressing concerns about use of
fluoroquinolones in treating community-acquired pneumonia. Concerns
are that the use of fluoroquinolones could delay a diagnosis of TB,
and also that fluoroquinolone monotherapy could lead to resistance.
ATS agreed with these concerns, but suggested CDC should address
them in its guidelines. I suggested resubmitting the letter to other
infectious and respiratory disease groups; this discussion will
continue. Edward Nardell gave an update on the BCG workgroup, which
is revisiting the use of BCG for the protection of health care
workers, students, and others in foreign settings having a high
prevalence of MDR or XDR TB. After discussing additional business,
we adjourned and will reconvene in March 2008.
As I mentioned above, March 24 is observed as World TB Day around
the globe. World TB Day provides an opportunity to communicate
TB-related problems and solutions and to support worldwide
TB-control efforts. Every year, DTBE posts data on U.S. trends in
TB, reports of state and local World TB Day activities, and training
and educational materials that can be ordered or downloaded. Please
visit the DTBE website for information about the 2008 campaign and
materials you can use to promote TB control efforts in your area.
Kenneth G. Castro, MD
Last Updated:
07/01/2008
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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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