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TB Notes 3, 2004

Dear Colleague:

The United States lost one of its most productive and influential figures in TB control this summer: Dr. William Stead, former TB controller of Arkansas, died in July. Dr. Stead was a very creative and thoughtful contributor to the science of TB. Over a 30-year period, he helped pioneer the use of intermittent short-course regimens, made notable contributions to our understanding of TB epidemiology (such as the role of progression to TB disease vs. reinfection in late life, transmission from prison to community, transmission within nursing homes, and the protective effect of prior infection following re-exposure), guided one of the premier U.S. TB control programs for many years, and advocated effectively for the role of medical informatics in medical and public health research and practice. An inquisitive but polite colleague, he encouraged young investigators and contributed to many successful careers. His personal influence, creativity, and thoughtfulness will be missed. His obituary is included in the Personnel Notes section of this issue; I hope you will take a moment to read about his inspiring life and career.

The Advisory Council for the Elimination of Tuberculosis (ACET) convened in Atlanta June 23-24 in Corporate Square. Among those giving updates was Dr. Janet Collins, the Acting Director of the National Center for HIV, STD, and TB Prevention (NCHSTP). Dr. Collins, a behavioral scientist, comes to NCHSTP from the position of Deputy Director of CDC’s National Center for Chronic Disease Prevention and Health Promotion. She gave an update on NCHSTP activities and news, including Dr. Andy Vernon’s returning to DTBE to take the position of Chief of the Clinical and Health Systems Research Branch and Ann Cronin’s joining DTBE as Associate Director for Management and Operations. She spoke as well on CDC’s Futures Initiative, reminding us that to achieve the greatest health impact and reduce health disparities for our customers, CDC needs to focus on four key elements: alignment of our strategies with our goals and actions; performance measurement and improvement; integration across organizational units; and marketing. Under the Futures Initiative, NCHSTP is being combined with two other CDC centers, the National Center for Infectious Diseases (NCID) and the National Immunization Program (NIP), under a proposed new Coordinating Center for Infectious Diseases. Following Dr. Collins’ remarks, Dr. Michael Tapper and I discussed the revised infection control guidelines; Dr. Tapper explained that the new guidelines give much attention to the choice of respirators. After OSHA withdrew its proposed TB standard in December 2003, it set July 1, 2004, as the deadline for implementing the General Industry Respiratory Protection standard. After the meeting, ACET drafted and sent a letter to OSHA indicating its concerns.

We then heard from Ms. Eva Moya of the Border Health Commission, who discussed the binational card and the fact that health officials are seeing evidence of its success: patients are adhering to therapy. Dr. Sue Maloney talked about the continuing and serious challenges of overseas TB screening and stateside notification of immigrating TB patients. Dr. Michael Kurilla of the National Institutes of Health (NIH) gave an overview of the extensive portfolio of TB research projects his agency supports and conducts to find new TB drugs, vaccines, and diagnostics. From DTBE, Dr. Jerry Mazurek gave an update on the next generation of the QuantiFERON® test; Dr. Elsa Villarino provided updates on the TB Trials Consortium; and Dr. John Jereb discussed tumor necrosis factor blockers (TNF) and TB. These TNF blockers are given to patients with rheumatoid arthritis and other autoimmune conditions. They block the body’s natural macrophage-mediated immune response, thus preventing the inflammation caused by the immune response but also leaving the body vulnerable to infectious agents such as M. tuberculosis. DTBE and partners recently published guidance on TNF blockers: Tuberculosis associated with blocking agents against tumor necrosis factor-alpha---California, 2002--2003. MMWR 2004; 53(30): 683-686.

The next morning was taken up with a discussion of budget and funding issues. Dr. Geralyn Johnson of the Division of Immigration Health Services (DIHS), Health Resources and Services Administration (HRSA) followed, announcing that in May 2004, Immigration and Customs Enforcement (ICE) had approved the institution of a medical hold procedure for TB patients being deported from the country. The medical hold allows DIHS to notify local public health departments, enroll patients in treatment programs, and coordinate their removal with the public health authorities in the receiving country. Diana Schneider of DIHS and Mark Lobato of DTBE were acknowledged as having been instrumental in getting this change made, and Dr. Johnson requested formal ACET recognition of their contributions. Dr. Bess Miller of the Global AIDS Program provided updates on the President’s Emergency Plan for AIDS Relief (PEPFAR). This initiative was announced in January 2003, and has expanded to 15 countries now. Eight of those 15 are among the 22 countries with the highest TB burden, and 13 of the 15 have had large annual increases in TB since 1997. Dr. Miller suggested that TB DOTS programs can contribute to meeting the goals of PEPFAR, and that possibly PEPFAR funds could be used to support TB control. Dr. Michael Fleenor then gave an update on the activities of the ACET Workgroup on TB in the Foreign-born. The workgroup had been charged with determining if the 1998 guidelines on TB control in foreign-born populations are still adequate; their well-researched finding was no, they are not. The next step will be to obtain ACET input into how the guidelines need to be revised. Finally, Dr. Marisa Moore provided an update on Healthy People (HP) 2010 objective 14-11, Reduce tuberculosis. DTBE has proposed a revision of the HP 2010 target, from 1.0 new case per 100,000 population to 3.0 new cases per 100,000 population. This change will bring our HP 2010 target into alignment with the DTBE goal described in the Government Performance Results Act document.

On July 19, we were officially joined by our new coworkers from the former Division of AIDS, STD, and Tuberculosis Laboratory Research (DASTLR), now the DTBE Tuberculosis / Mycobacteriology Branch; Dr. Tom Shinnick is the branch chief. Staff of this important unit conduct laboratory studies on the microbiology, molecular biology, and biochemistry of mycobacteria, as well as on the pathogenesis and immunology of mycobacterial infections. Program areas focus on understanding M. tuberculosis and the pathogenesis of tuberculosis, but also incorporate studies with several other important pathogenic mycobacteria such as M. avium and M. leprae. The branch consists of two teams or sections: the Diagnostic Mycobacteriology Team, which is lead by Dr. Beverly Metchock, and the Immunology and Molecular Pathogenesis Team, which is lead by Dr. Jack Crawford.

Please mark your calendars: the 2005 TB Controllers Workshop has been scheduled for June 28-30, 2005, at the J.W. Marriott - Lenox in Atlanta. Pre-conference meetings will be scheduled for Monday, June 27.

Our work is becoming more interesting and challenging as CDC experiences a major reorganization and U.S. TB cases are increasingly found among complex social networks and foreign-born populations. Thanks to all of you for your willingness to weather these changes and your steady devotion to our common goal of TB prevention, control, and elimination.

Kenneth G. Castro, MD

NOTE: The use of trade names in this issue is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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