TB Notes 1, 2005
No. 1, 2005
Updates from the SEOIB
Heard of any outbreaks?
DTBE’s Outbreak Evaluation Unit (OEU) in Action
At one time or another, public health personnel at the local, state,
and national levels investigate TB outbreaks. These outbreaks are
natural opportunities for studying a classic “epidemiologic triad”:
the interaction of the environment, the host, and the pathogen Mycobacterium
tuberculosis. This article briefly describes how DTBE gathers
information about outbreaks and how DTBE can be of assistance in
responding to them.
The Outbreak Evaluation Unit (OEU): The OEU is comprised
of members from the Outbreak Investigations Team from the Surveillance,
Epidemiology, and Outbreak Investigations Branch (SEOIB), the Field
Services and Evaluation Branch (FSEB), the Communications, Education,
and Behavioral Studies Branch (CEBSB), the Mycobacteriology Laboratory
Branch (MLB), and the DTBE Office of the Director (OD). This group
combines the functions and expertise of the various branches, which
enables DTBE to evaluate reports of recent transmission of M.
tuberculosis thoroughly. These reports are assembled and shared
by the program consultants from FSEB. The OEU meets each Tuesday
to receive new reports, to monitor progress on pending reports,
and to recommend how DTBE can participate with state and local program
officials in the investigation and control of possible outbreaks.
As guided by the OEU, DTBE offers various types of responses that
are described below.
Types of Responses: One or a combination of these responses
can be offered to the local and state TB control officials:
- Telephone consultation. During a telephone consultation, a
team consisting of members from SEOIB, FSEB, CEBSB, and MLB (if
needed) consult with the state or local personnel about the investigation
and control of an outbreak. The consultation is interactive and
often requires a series of conference calls as results from the
investigation become available. The FSEB program consultant for
the jurisdiction coordinates the scheduling on behalf of DTBE.
- Technical on-site assistance. Aside from the standard epi-aid
response, DTBE can designate a team that is specially composed
to meet a request from jurisdictional authorities. This approach
suits situations that do not require the intensive response that
is characteristic of epi-aids.
- On-site outbreak investigation (epi-aid). An epi-aid is the
traditional CDC response to a request for on-site assistance.
For an epi-aid related to TB, an Epidemic Intelligence Service
(EIS) officer is invited by state and local officials to join
an outbreak investigation team. The epi-aid provides a prompt,
standard CDC response to state and local needs for epidemiologic
assistance, and it affords a unique training opportunity for the
assigned officer to develop epidemiologic skills.
An epi-aid for TB begins when the state epidemiologist invites
CDC participation by sending a request to OD, DTBE. Epi-aids are
collaborative by design---the CDC personnel work closely with the
state and the local health officials during the outbreak investigation.
A typical epi-aid for a TB outbreak investigation offers the following:
- On-site assistance from DTBE for 2-3 weeks, during which a DTBE
epi-aid team comprised of the EIS officer, a DTBE staff epidemiologist,
frequently a TB public health advisor, and on some occasions an
epidemiology elective student from a health-professions college
to work collaboratively with the state or the local outbreak-response
- An entrance meeting with the jurisdictional public health officials.
The purpose is to review the objectives of the investigation,
to determine the person in charge in the jurisdiction for potential
coverage from news media, to create a preliminary plan for the
investigation, and to schedule periodic update meetings.
- An exit interview with the jurisdictional public health officials.
The EIS officer, along with the epi-aid team and the collaborating
state or local outbreak-response team, present the preliminary
findings and provide preliminary recommendations for control of
the outbreak and any further investigations that might be needed.
- Temporary duty assignments for program assistance. If the investigation
team determines that a DTBE public health advisor would facilitate
the programmatic response to an outbreak, the FSEB program consultant
for the jurisdiction arranges this.
- Outbreak response emergency supplemental funds. Limited emergency
supplemental funds are allocated by Congress through DTBE for
tuberculosis outbreak abatement. If an outbreak response requires
new resources (e.g., extra personnel to be hired by contract),
the FSEB program consultant for the jurisdiction reviews the proposal
for how additional funds could be used.
- A final report (the trip report). This describes the methods
and results of the investigation and the final recommendations
from CDC. The report is sent to the jurisdictional public health
officials approximately 2 months after an investigation. Sometimes
they take longer because of ongoing data collection and new findings.
The detection of tuberculosis outbreaks plays a crucial role in
the elimination of this disease. Suspected episodes of transmission
of M. tuberculosis should be discussed with your program
—Reported by Kashef Ijaz, MD
and John A. Jereb, MD
Div of TB Elimination
Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333