TB Notes Newsletter

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No. 1, 2009

Special Events

Rifampin Turns 50

In 1957, a sample of soil from a pine wood on the French Riviera was brought for analysis to the Lepetit Pharmaceuticals research lab in Milan, Italy. There, a research group headed by Prof. Piero Sensi (1920– ) discovered a new bacteria, which was then named Nocardia mediterranei. This new species was immediately deemed to be of great scientific interest, since it produced a new class of molecules with antibiotic activity.

Prof. Sensi’s group had the humorous habit of choosing names for new compounds from popular culture. Since Prof. Sensi and some of his fellow researchers were particularly fond of a French crime story of that time whose title was Rififi (about a street fight between rival gangs), they decided to call these compounds rifamycins. After 2 years of research and testing to find more stable semi-synthetic products, in 1959 a new molecule with high efficacy and good tolerability was produced, and was named “rifampin.”

Since then, the derivatives of rifamycins have changed the face of TB in the world, shortening treatment regimens to the current 6- to 9-month short-course therapy, and thereby improving cure rates, relapse rates, and incidence of adverse reactions. In 2006, almost 2 million new TB cases were cured with the rifampin-based World Health Organization (WHO) regimens, and it is likely that many millions of lives have been saved since the introduction of rifampin in clinical practice in 1968.

On May 4, an official celebration of the discovery was held in Milan City Hall, with Prof. Sensi himself in attendance. Dr. Sensi provided a vivid flashback to the heroic times of this research. He was then awarded the Milan City Medal by the local authorities for his important and historic work.

—Reported by Dr. Luigi R. Codecasa
Head of the TB Reference Centre
Villa Marelli Inst.-Niguarda Hospital
Milan, Italy

2009 TB Awareness Walk

DTBE’s Third TB Awareness Walk took place on Saturday, March 21, 2009, in Atlanta’s Grant Park.  It was a chilly morning, but all the sunshine eventually made it a pleasant event.  Many activities were available this year for the participants, including a steel band and a rock duo providing entertainment, face painting for adults and kids, and a clown who provided balloons in various shapes and sizes for the kids.  In addition, we had three speakers: Dr. Richard Besser, the acting Director of CDC; Dr. Terry Chorba, Associate Director for Science from our center, NCHHSTP; and Ken Patterson from RESULTS International. This event is not a fundraiser, but it is an awareness raising effort.  Therefore, there is no registration fee, and free t-shirts are provided each year.  In fact, the t-shirts account for most of the expenses of the walk which are covered by donations from many businesses and individuals.  The names and logos of the donors/sponsors were displayed on the back of the t-shirts.

As with many events, partnerships are one of the essential ingredients to success. This idea builds upon the U.S. theme for World TB Day, “Partnerships for TB Elimination.”  The partnerships for the walk included the National Tuberculosis Controllers Association (NTCA), the lead organization for this event; CDC; the American Lung Association of the Southeast Region; the Georgia Division of Public Health; the Fulton County Health Department; the DeKalb County Board of Health; RESULTS International; the Watsonian Society (a CDC employee organization); Emory University; and Morehouse College.

We tried to reach out to the Atlanta community and beyond in a number of ways.  Our marketing efforts included word of mouth, e-mails, our website, www.tbwalk.org, Craig’s List, Facebook, Twitter, flyers and business cards, write-ups in community bulletins, the CDC parents’ network, and CDC announcements.

So, what were the results?  We had 1,170 online registrations this year, at least 200 more than the previous year.  The number of individuals who actually showed up reached 738 this year, which again is almost 200 more than the previous year’s estimate of 550 attendees.  Fox 5 News provided media coverage.

An after-action review was conducted on April 15, 2009, to obtain feedback on the walk.  We discussed what went well, what did not, and any improvements that are needed for next year. We hope to have an even better turn-out in 2010!

—Submitted by Vic Tomlinson
Div of TB Elimination
On behalf of the TB Walk Committee

World TB Day Observance and Luncheon

On March 24, 2009, Atlanta DTBE staff organized two events in commemoration of World TB Day 2009: an observance that featured several presenters, and a luncheon. The World TB Day observance began with opening remarks and a welcome from Dr. Terry Chorba, Associate Director for Science, NCHHSTP, and Mr. Phil Talboy, Deputy Director of DTBE. They highlighted the sobering current status of the global TB problem, setting the stage for the talks that followed.

Dr. Val Robison, team lead for the surveillance team in the Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB), presented 2008 provisional TB data and trends. She reported that the 12,898 new TB cases (rate: 4.2/100,000) represent the lowest U.S. number and rate ever recorded. Yet despite this good news, progress has slowed, and we are seeing a plateau in the rate of decline. Persons of foreign origin and racial/ethnic minorities still bear a disproportionate burden of TB disease, and intensified efforts are needed to address these persistently high rates.

Dr. Mitesh Desai, an Epidemic Intelligence Service (EIS) Officer in DTBE, reported on two simultaneous outbreaks of multidrug-resistant (MDR) TB in Chuuk state, Federated States of Micronesia (FSM), during 2007–2009. The investigation revealed extensive transmission among household contacts; 16/205 (8%) of the contacts had confirmed or suspected MDR TB disease, and 124 (60%) had latent TB infection. As of March 13, 2009, about half of the confirmed and suspected cases of MDR TB (10 of 21) have been in persons under 15 years of age. But because second-line drugs for MDR TB were not available in FSM, five persons died, including two children. These outbreaks have underscored how a lack of basic TB control activities can allow the emergence and spread of drug-resistant TB. Please see the two articles in the MMWR for March 20, 2009.

Mr. John Seggerson provided an update on the development of the new TB elimination plan from Stop TB USA. For context, he outlined previous U.S. TB control or elimination plans, the most recent being the 2000 Institute of Medicine (IOM) report, Ending Neglect, and gave a brief assessment of U.S. progress towards achieving the five major goals of the IOM report. With this background, John then outlined Stop TB USA’s recommendations for all entities involved in TB control. These include recommendations for CDC to continue its basic control activities, while at the same time accelerating the research that will yield better tools for the diagnosis and treatment of TB and LTBI. CDC’s partners in public health should ensure that they have effective and just TB control laws and regulations, and that patients have timely access to high-quality TB diagnosis, treatment, and prevention services. We will hear more about this important document in coming months.

Mr. Vic Tomlinson reported on the Third Annual TB Awareness Walk, held on Saturday, March 21, 2009, in Atlanta’s Grant Park. This has become a much-anticipated event among DTBE staff, owing to hard work, planning, and a little luck in the weather department. Vic has inspired a small army of volunteers to pool their time and talents into planning, organizing, and carrying out this event each year. The organizers have thoughtfully added entertainment to the event so that family members and friends of DTBE staff have as much fun as we do!

Dr. Besser, at back, with the TB Walk organizers

Following the World TB Day observance presentations, we proceeded to the World TB Day luncheon. The staff members of the Field Services and Evaluation Branch traditionally organize this luncheon for the benefit of the division, and they once again came through with a memorable event. At the luncheon, we heard a spirited performance of three musical selections from the Atlanta affiliate of the U.S. Public Health Service Wind Ensemble, consisting of Drs. John Jereb, Tim Holtz, and Mary Reichler. This was followed by the amazing work of Mr. Joe M. Turner, a magician who stumped us all with his feats of illusion. We enjoyed an abundance of good food, as long as we all remembered to bring the tickets we had purchased! And as if this were not enough, there were door prizes galore. Hats off to the hard-working and well-organized members of the luncheon committee for another great World TB Day luncheon, especially to Mr. Bruce Heath, who as the newest member of FSEB was “volunteered” to head the committee!

We hope other TB control programs enjoyed their World TB Day events and activities as much as we did!

—Reported by Ann Lanner
Div of TB Elimination