TB Notes Newsletter

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No. 4, 2009

PERSONNEL NOTES

Ije Agulefo, MPH, a Health Education Specialist with DTBE’s Communications, Education, and Behavioral Studies Branch, was a recipient of a 2009 Coordinating Center for Health Information and Service (CCHIS) Director’s Award for her contributions to CDC’s H1N1 response efforts. She served a first detail to the CDC Joint Information Center (JIC) in May on the Clinician Communication Team (CCT), and completed a second detail in November on the Community Health Outreach and Education Team (CHET). She received a CCHIS Director’s Award certificate and letter of commendation for these contributions. Gail Williams, MPH, CHES, Community Health Education Team (CHET) Leader, CCHIS Emergency Communication System, expressed her appreciation for Ije’s assistance as follows: “On behalf of all the Community Health Outreach and Education Team members, I want to express my sincere gratitude for allowing Ms. Ijeoma Agulefo to surge with us during the CDC 2009 H1N1 Influenza Pandemic Response in the Joint Information Center. We particularly requested Ms. Agulefo because of her experience in working within our team structure, her knowledge and working relationship she has developed with our partners, and her ability to join our efforts and hit the ground running. A lot has been accomplished and much needs to be maintained. We were fortunate to have Ms. Agulefo and look forward to her continued support, as time permits.”

Ije was specifically cited by Ms. Williams for drafting purchase requests to support the development of Public Service Announcements; collaborating and serving as the CHET liaison in the development of PSAs for the American Indian/Alaskan Native PSAs; contributing to the CHET 2009 H1N1 Strategic Planning Retreat; and serving in the Joint Information Center as an advanced surge member. Ije’s experience, qualifications, skills, and training were also cited in the letter of commendation. Congratulations, Ije!

Terry Avant, RN, BSN, has been selected by the Field Services and Evaluation Branch (FSEB) as the senior Public Health Advisor (PHA) for the Georgia TB control program. In his capacity as senior PHA, he will provide leadership and guidance to state program officials for TB control and prevention activities statewide. In his most recent assignment, he served as the Infection Control Coordinator for the Carl Vinson VA Medical Center, Dublin, Georgia. In that position he was responsible for all infection control and infectious disease issues, including the TB and immunization programs. Prior to that, Terry served as the Infectious Disease Coordinator for the Georgia Public Health South Central District, also in Dublin, Georgia, and was responsible for all infectious disease programs for the district.

Terry is a retired Lieutenant Colonel in the U.S. Army.  He graduated from the U.S. Army Preventive Medicine Program in 1986 and served as a Community Health Nurse (CHN) until he retired in 1997.  As a CHN, he was responsible for infectious disease programs including sexually transmitted diseases, HIV/AIDS, TB, and chronic hepatitis. His duties included maintaining the TB, HIV/AIDS, and hepatitis registries and providing treatment and/or follow-up for these programs. Terry officially joined FSEB and DTBE on November 8, 2009. Welcome, Terry!

Alexander (Alex) Bowler retired on December 1, 2009, after a distinguished career of more than 16 years as the Wyoming state TB program manager.  Alex was one of the founding members of the National TB Controllers Association, serving a total of 12 years on the Board of Directors. In 2001, Alex hosted the first meeting of the Northern Rocky Mountain TB Controllers Association in Jackson, and in 2002, he served as the President of the Wyoming Public Health Association.

Alex has been tireless in advocating for the support of TB prevention and control programs in low-incidence areas.  Wyoming was one of four states in the Rocky Mountain region that participated in CDC’s Tuberculosis Epidemiologic Studies Consortium Task Order #6.  This was a 5-year project whose primary purpose was to develop and implement regionally based interventions to strengthen the capacity of TB programs in low-incidence areas.    

Alex will be remembered for his wonderful sense of humor as well as for the leadership, knowledge, and expertise that he so skillfully demonstrated every day in his TB work at the local, state, and national level. Alex is looking forward to spending significantly more time in the great outdoors of Wyoming, improving his hunting and fishing skills.  (The elk and the rainbow trout had better beware!) He also intends to do consulting in the health-care field.  We wish Alex the very best in this new and exciting phase of his life!

Jesse Bradley, Maria Fraire, and Sharon McAleer, who comprise the DTBE Web Team, were the recipients of the DTBE Director's Recognition Award for the third quarter in 2009 for their outstanding contributions in migrating the DTBE website into the new CDC Web template. The DTBE website is a vital communication tool that receives over 5 million page views each year. The nomination for this award states, "Migrating the DTBE website into the new template was a monumental undertaking. At the time of the migration, the DTBE website was the largest division site to move into the new template. DTBE was also the first division in NCHHSTP to move into the new template. The team prepared for this transition early and systematically. First, they implemented a content inventory system, which consisted of the Team members helping content owners review Web pages, and updating or removing out-of-date pages. Second, the Web Team reviewed communication data for 2 years of website statistics and CDC INFO inquiries to identify the nature of TB information searched by users of the DTBE website. This information was used to inform the development of the new site structure. Third, with virtually no budget, the Web Team creatively identified ways to conduct a baseline usability study and card-sorting activities to gather information about how the DTBE website was searched by users. The team conducted in-person testing with the NPIN usability lab, as well as remote testing using online software. Fourth, results of the usability testing were analyzed to inform the development, navigation, and content labeling of the new DTBE website. The team held a Brown Bag to update division and center staff on the results of the usability testing, website statistics, content inventory, and plan to migrate to the new template. Fifth, the new CDC web template and navigation structure was re-designed by major adjustments to the layout and content structure (now drastically different from the previous DTBE Website).

"The Team, along with other CEBSB staff, reviewed thousands of web pages to ensure content was moved into the new templates correctly, the navigation structure worked, and that the most accessed information was easy for users to find. The Team reviewed the CDC template package prior to the migration to work out technical problems and to work with the CDC technical web teams to make modifications to the template to ensure that the template would be appropriate for the DTBE website. The Team worked around the limitations of the CDC template to ensure the site met the needs of DTBE and its partners. In all, the Web Team migrated over 4000 web pages, including PDF files and images. The Team anticipated potential problems and worked to resolve the problems prior to migration. They worked with the Mid-tier Data Center to develop a detailed error message to assist users with finding information on the new site.” The careful attention to detail, rigor, and service-oriented approach used by the Team Members during the successful migration of the DTBE webpage was recognized with this award.

Ann M. Buff, MD, MPH, will be leaving DTBE’s Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB) at the end of the year. Effective January 1, 2010, she will transfer to a new CDC position as a medical officer with the Vaccine Preventable Disease Eradication & Elimination Branch, Global Immunization Division, National Center for Immunization and Respiratory Diseases.  Ann will be seconded to the Polio Unit, Eastern Mediterranean Region Office, World Health Organization (WHO), located in Cairo, Egypt.  Her family will relocate from Atlanta to Cairo during the summer of 2010.

Ann started in DTBE in July 2006 as an Epidemic Intelligence Service (EIS) Officer assigned to SEOIB’s Outbreak Investigations Team.  The hallmark of her EIS assignment consisted of large, federally coordinated transportation TB investigations, which led to the completion of her eight EIS core learning activities in record time.  In 2006, she led a large TB case-control study aboard the U.S.S. Ronald Reagan, a U.S. Navy aircraft carrier.  The team earned a U.S. Public Health Service Outstanding Unit Citation for preventing the unnecessary screening of over 1,200 people, and Ann was awarded the Captain Gregory Gray Award for Military Operational Research from the U.S. Navy.  In 2007, she coordinated the investigation of an international traveler with suspected extensively drug-resistant (XDR) TB.  The investigation led to her appointment to WHO’s TB and Air Travel Working Group, which published the updated Tuberculosis and Air Travel: Guidelines for Prevention and Control in 2008.  Her work during her EIS fellowship led to numerous invitations to present at national and international conferences and to the publication of several articles, including “Investigation of Mycobacterium tuberculosis transmission aboard the U.S.S. Ronald Reagan, 2006” in Military Medicine, “Reporting Patterns and Characteristics of Tuberculosis among Travelers, United States, June 2006–May 2008” in Clinical Infectious Diseases, and “Two Tuberculosis Genotyping Clusters, One Preventable Outbreak” in Public Health Reports.

Following EIS, Ann joined the Outbreak Investigations Team as a staff medical officer and epidemiologist.  She supervised EIS officers and staff during Epi-Aids and technical assistance visits, taught both domestic and international epidemiology courses in Ukraine, South Africa, and Afghanistan, and co-authored the tuberculosis chapter in the Control of Communicable Diseases Manual, 19th edition (2008).  As a Commissioned Corps officer, she volunteered for a 30-day deployment aboard the U.S.S. Kearsarge to Haiti and the Dominican Republic for “Continuing Promise 2008,” a humanitarian assistance mission.  In July 2009, she was promoted to Commander, U.S. Public Health Service.  We wish Ann and her family all the best as she transitions to her new position in Cairo, Egypt! 

Jennifer Carter is a CDC/Emory federal work study student with the Surveillance Team of the Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB). She is in her second year at Rollins School of Public Health, Emory University working towards her masters degree in public health in Epidemiology. She graduated from the University of California, Berkeley, in May 2006 with a B.A. in Integrative Biology. She worked during the summer of 2009 at the Infectious Diseases Division at the Contra Costa County public health department in Martinez, CA. She also interned with CDC’s Morbidity and Mortality Weekly Report office during the spring of 2009. Jennifer grew up in Orange County, CA, where her parents and most of her family live. Besides infectious diseases, her passions include playing guitar and hiking with her dog.

Pei-Jean Feng, MPH, joined the Clinical and Health Systems Research Branch (CHSRB) of DTBE effective October 12, 2009, and is working as an epidemiologist and analyst primarily with the TB Trials Consortium (TBTC) Data & Coordinating Center. Prior to joining DTBE, Pei-Jean worked as an epidemiologist in the Prevention and Response Branch of CDC’s Division of Healthcare Quality and Promotion (DHQP). While in DHQP, she worked on a team conducting epidemiology and surveillance activities around hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA). Pei-Jean holds a masters degree in public health (with a concentration in Epidemiology) from the Rollins School of Public Health at Emory, and a bachelors degree in Human Biology from the University of Texas at Austin. She joins CHSRB as the perfect follow-up to a honeymoon in the Caribbean and Taiwan.

CAPT Timothy Holtz, MD, MPH, FACP, has left DTBE to serve in CDC’s Division of HIV/AIDS Program (DHAP) as the Country Program Director, Thailand-U.S. (CDC) Collaboration (TUC) in Bangkok. His last day in DTBE was Oct. 31, 2009. In his new role, Tim will oversee large clinical trials of pre-exposure prophylaxis of antiretrovirals among intravenous drug users, as well as upcoming microbicide HIV prevention trials.

Tim had served as a medical epidemiologist in DTBE’s International Research and Programs Branch (IRPB) since September 2002 and as the team lead for the TB Program Strengthening and Epidemiology Unit since July 2008. Tim entered CDC as an Epidemic Intelligence Service (EIS) Officer in 1999, serving as a medical officer in the malaria epidemiology branch. He also completed his preventive medicine residency through CDC, during which time he was intensely involved with the CDC response to the World Trade Center disaster and the anthrax attacks in 2001.

After joining DTBE in 2002, Tim worked in southern Africa, Eastern Europe, and South America on multidrug-resistant (MDR) TB control and TB/HIV program capacity building. He participated in and led several operational research training courses in the former Soviet Union and sub-Saharan Africa. Tim was part of a team of scientists who recognized the emerging threat of resistance to second-line anti-TB drugs, and his analysis established the evidence base for the working definition and acronym for extensively drug-resistant (XDR) TB. For the past several years, Tim has been working with several governments in sub-Saharan Africa and Central Asia to evaluate the extent of anti-TB drug resistance in the continent, and formulate policies to address XDR TB and HIV/AIDS. Since 2006, he served as CDC’s representative on the STOP TB Partnership's Green Light Committee, which aims to increase access to life-saving second-line anti-tuberculosis drugs and provide technical assistance and regular programmatic review of national MDR TB treatment programs. Tim has been cited several times by CDC for his achievements in scientific writing, and has published widely in the public health literature during his time with DTBE. He has also served as mentor and supervisor to five EIS officers in the Division since 2005, and has been committed to bringing high-quality EIS talent to DTBE.

Tim trained in primary care medicine at Harvard University/Cambridge Hospital, Cambridge MA, after which he worked with the Tibetan Government-in-exile in the Indian Himalaya while on a Health and Human Rights fellowship from the Columbia University College of Physicians and Surgeons. He is board certified in internal medicine as well as preventive medicine. Tim is an assistant professor of global health at the Rollins School of Public Health at Emory University, where he teaches courses in TB and health and human rights. He is also an Assistant Clinical Professor of Family and Preventive Medicine at the Emory University School of Medicine, where he leads an elective in human rights and social medicine for medical students. Tim is a founding member of Doctors for Global Health (DGH), a non-governmental organization that runs health and human rights programs in Central America, South America, and Africa, and served on its board from 1997 to 2003. He was also one of the founding members of the Health and Human Rights Workgroup at CDC in 2003. His medical memoir of working in India with Tibetan refugees, entitled A Doctor in Little Lhasa: One Year in Dharamsala with the Tibetans in Exile was published in 2009. He is also the co-author of the Oxford University Press' Textbook of International Health, published in 2009 with Drs. Anne-Emanuelle Birn and Yogan Pillay.

Alan Locke, a DTBE Public Health Advisor assigned to Nashville, Tennessee, is serving in a temporary duty assignment (TDY) with DTBE’s Data Management and Statistics Branch to support national coordination activities for the TIMS transition. In this position, Alan is communicating with state TB control programs and with DTBE staff involved with the TIMS transition regarding resource needs and electronic data management problems; monitoring and tracking progress towards the TIMS transition by providing regular feedback to DTBE stakeholders and the state TB community; assessing TIMS, eRVCT, and TB program area module (PAM) training needs and coordinating training offers to meet these needs; and assisting in planning efforts for the next phase of the eRVCT and TB PAM.

Alan’s assignment with the Tennessee TB control program began in 2007. He has been carrying out a variety of roles in that assignment, working mostly with special projects assigned by the Medical Director/TB Control Officer. One of his projects included collaborating with the state laboratory to produce an ongoing report based on reviewing the quality of sputum collection and turn-around times. The report, which was distributed at the 2008 annual state-wide meeting, highlighted the need for greater attention to detail in regards to the labeling, collection, and timely transportation of sputum specimens. In fall 2008, in conjunction with the state's TB epidemiologist, Alan gave a presentation to TB staff across the state on RVCT changes, specifically on Tennessee’s transition from TIMS to the new TB PAM, which went “live” in January 2009. Alan has also worked on the TB cooperative agreement, conducted program reviews, and participated in a project that looked into the feasibility of using Ora-Quick HIV rapid testing for high-risk TB contacts to infectious cases (currently deemed not feasible for Tennessee). Most recently, Alan has worked on developing a protocol for using videophones and web cameras to perform directly observed therapy. Tennessee is adopting this technology owing to the cost savings and client incentives this program offers; the state is in the early phases of this project and hopes to pilot this in early 2010. Alan joined CDC in 1988 as a Public Health Advisor/Disease Intervention Specialist (DIS) in CDC’s STD program in Miami, and subsequently served in a number of STD assignments with increasing responsibilities. He joined DTBE in 2006 with an assignment to Fort Wayne-Allen County, Indiana, and in 2007 he was assigned to the TB control program in Nashville, TN.

Lee Ann Ramsey is the recipient of the DTBE Director's quarterly recognition award for the Fourth Quarter in 2009. Lee Ann was nominated "for her exemplary work to improve the business practices of not only the Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB), but of the entire Division of Tuberculosis Elimination. At a time of unprecedented increases in the complexity of administrative procedures and at a time when SEOIB’s other Public Health Analyst has been detailed to another job, Ms. Ramsey has tackled and resolved such difficult problems as bringing order to contract procedures, understanding and responding to new hiring procedures, ensuring that all staff members have adequate office space and computers support, and getting travelers to their destination and home. Specifically, Ms. Ramsey has worked tirelessly to establish efficient budgeting procedures for our CITS contract; kept abreast of new AHRC procedures and requirements and established standardized position descriptions for our most common positions; responded to the challenges of housing new staff members and led the Division in establishing office sharing procedures; and mastered GovTrip complexities that have resulted in reducing last-minute travel crises from being commonplace to being rare.”

Current staff members of SEOIB are unanimous in their gratefulness for being able to count on Ms. Ramsey to understand the labyrinth of the federal bureaucracy, foresee problems before they occur, and implement effective procedures that minimize repetitive and inefficient work.

Valerie Anne Robison, DDS, MPH, PhD, who has served as Surveillance Team Leader in DTBE’s Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB) for over 5 years, left DTBE on December 18 to become the Lead Dental Officer in the Division of Oral Health in the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).  She will lead the Surveillance, Investigation and Research Team, which is charged with surveillance of national oral disease and behavioral (using NHANES, BRFSS, and cancer registries), guidelines development, and evaluation of preventive interventions. She will collaborate with international partners in oral health policy in less-developed countries, which has been a long-time passion. Val received her D.D.S. (Doctorate in Dental Surgery) in 1979 from the University of North Carolina in Chapel Hill. She worked in Kathmandu, Nepal, from 1980 to 1982 in Hospital Dentistry. She returned to the United States in 1982 and received her MPH (in International Health) from Johns Hopkins University. Preferring tropical climes, she lived in Tanzania 1983–1990, working at the Ministry of Health as National Coordinator of Community Oral Health Programs.  She again returned to the United States to enroll in the doctoral program of the University of North Carolina, where she received her Ph.D. in Epidemiology in 1995. She moved to Tyler, Texas, in 1995 and worked for the University of Texas Health Science Center at Tyler, where she was responsible for TB surveillance, epidemiologic, and health services research in a state-wide program.  In 1996, Val took a faculty position at the Johns Hopkins School of Hygiene and Public Health. This involved living in northern Thailand for 3 years as director of field activities for the HIV/AIDS collaborative research program between Johns Hopkins University and Chiang Mai University, Thailand.

Val began her CDC career in 1999 when she came to Atlanta and joined the Division of Reproductive Health in HIV/AIDS research.  From 2002 to 2005, she worked in the Division of Oral Health and was responsible for national surveillance and integration of oral health into other Divisions’ activities at NCCDPHP.  She was recently cited at her 30-year dental school reunion as having the most interesting and unusual career path in her class. 

Val moved to DTBE in 2005 where she became the Team Lead for the Surveillance Team in SEOIB. In that position, Val has been responsible for maintaining and improving our excellent surveillance data quality and disseminating summaries of our surveillance data, most prominently through the World TB Day MMWR surveillance summary in March of each year and through the annual Reported Tuberculosis in the United States, published in the fall of each year. We know of no other program at CDC that publishes surveillance summaries in a more timely fashion. Her team has won kudos for the 2009 revision of the RVCT data collection form, the TB surveillance data training program, the enhanced MDR/XDR registry project, National Surveillance for Severe Adverse Events (Hospitalization or Death) Associated with Treatment of Latent Tuberculosis Infection, the Online TB Information System (OTIS), National TB Surveillance Data Analysis Steering Committee (ASC), web-based training on assurance of confidentiality to protect NTSS data, and the online TB data request system.

We have grown to cherish Val’s even temper, her dedication to encouraging team cohesion, and her willingness to help anyone who wants to understand TB surveillance. We wish Val the best in her new job and her return to her roots in oral health.

James Shepherd, MD, PhD, joined the International Research and Programs Branch (IRPB) of DTBE effective October 25, 2009.  He has assumed the position of Associate Director for TB at CDC Botswana (aka the Botswana USA or BOTUSA collaboration) in Gaborone.  He is leading a very talented group of locally employed staff in the conduct of clinical trials, operations research, epidemiological studies, and public health evaluations to address the TB and TB/HIV situation in Botswana.  These activities will be done in close collaboration with the Global AIDS Program at CDC Botswana, the Ministry of Health, and other in-country partners. 

Dr. Shepherd, who is a dual citizen of the US and the UK, completed his scientific training at the University of London before beginning a career as a molecular biologist/immunologist in the US. His interest in infectious diseases and Tropical Medicine led him towards a clinical career, and he left bench science to return to medical school at the Columbia University College of Physicians and Surgeons in 1995. After completing his internship and residency in Internal Medicine at Beth Israel Deaconess Medical Center in Boston and fellowship training in Infectious Diseases at Johns Hopkins Hospital in Baltimore, he took a position as an Assistant Professor of Medicine at University of Maryland School of Medicine, where he acted as clinical advisor to a large PEPFAR-supported antiretroviral therapy (ART) program in Nigeria.  He lived and worked in Nigeria for two and a half years prior to joining CDC-Botswana from Nigeria in January 2008 as the Care and Treatment Team Leader within the Global AIDS Program Team and left this position to join DTBE.  His research interests over the recent years have focused on HIV subtype differences in pathogenesis, the natural history of HIV co-receptor tropism, the emergence of antiretroviral drug-resistance in Africa, and operational research in HIV and TB treatment programs in Africa.