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TB Notes 2, 2000

Highlights from State and Local Programs

A Report of the 5th Annual Four Corners Region TB Conference

"Tuberculosis, Past and Present - A Millennial Challenge" was the theme for the 5th Annual Four Corners Region TB Conference. Presented and hosted by the Arizona Department of Health Services and sponsored by the Navajo Area Indian Health Service, the 2-day conference was held on the scenic campus of the San Juan College in Farmington, New Mexico, on October 20-22, 1999. The conference averaged a daily attendance of 71 persons, most of whom were representatives of the states of the Four Corners region (Arizona, Colorado, Utah, and New Mexico) and of the Navajo Nation. The first session opened Wednesday afternoon and was attended by 80 persons who included public health, Indian Health Service (IHS), and private physicians; TB technicians; community and public health nurses; infection control practitioners; state program managers; health educators; TB nurse consultants; and a wide spectrum of associated health professionals. The IHS Clinical Support Center designated up to 14.25 hours of Category 1 credit of continuing education for physicians and 17.1 contact hours for nurses.

The goal of the conference was to improve collaboration between the various entities involved in prevention and control of TB in the Four Corners region with a focus on Native Americans and the Navajo Nation.

Dr. John Sbarbaro, Professor, University of Colorado School of Medicine and well- known expert in the field of TB, opened the conference with information on historical facts and fallacies related to TB and then described various conventional and unconventional anti-TB drug regimens, explaining when and why they might be used. Dr. Sbarbaro was followed by representatives from each of the region's states, who provided a historical look at TB from each state. Dr. Zachary Taylor, Division of TB Elimination, CDC, opened the session on Thursday with a presentation on new recommendations for the treatment of latent TB infection, and Suzanne Banda and Kathleen Tully from the Francis J. Curry National TB Center conducted a mini-workshop on contact investigations. Dr. Mark Saddler from Farmington, New Mexico, gave the group a clinical perspective on TB, diabetes, and renal failure in the area's population, and Ms. Ursula Knoki-Wilson, CNM, shared with us some spiritual and cultural insights into the Navajo Nation. Susan Good, RN, public health advisor (Arizona) presented Navajo Nation TB case surveillance data, and Bob Ferguson (New Mexico) and Kristina Hustad (Arizona) presented laboratory testing updates to wrap up the final morning session of the conference.

Donated gifts were used as "participant incentives" throughout the conference and a group dinner offered entertainment and an opportunity to get to know each other better.

—Submitted By Susan E. Good, RN, Manager
Public Health Advisor
Arizona TB Control Program

Chicago Program Evaluates TB Reporting in the City

Like others, the Chicago TB Control Program relies upon the information provided by cooperating providers and infection control personnel to detect new TB cases occurring in the community. Reinforced by the results of contact investigations, regular monitoring of mycobacteriology laboratories, and somewhat less regular reviews of death certificates, program managers have been confident that most new TB cases are being reported in a timely manner.

Traditional difficulties experienced in reporting TB cases from high-risk groups such as recent immigrants and the homeless populations have not diminished in Chicago. Confidence in TB reporting systems tends to be eroded by recent reports suggesting that the mandated use of DOT might actually cause some providers to conceal TB patients by such means as treating them empirically or using out-of-state laboratories to hide positive lab reports. Thus, it is recognized that regular evaluations of surveillance systems are necessary, especially when substantial changes in morbidity occur, such as the recent declines seen in Chicago.

Beginning in September 1999, the Chicago TB Control Program began conducting a two-part evaluation of its TB reporting system. The first part was a detailed review of data collection and surveillance procedures performed by an EIS officer; the second part was an attempt to survey selected pharmacy records for prescriptions of anti-TB drugs as a method to determine possible underreporting of cases.

The review performed by the EIS officer followed a traditional method of visits to sites, interviews with staff, observation of procedures, and analysis of data from selected cohorts of patients. A comprehensive report of this review was presented at the EIS Surveillance Course at CDC in October 1999. The report gives a detailed view of TB case reporting in Chicago by describing its usefulness, acceptability, and sensitivity. The timeliness of reporting to an official agency and of public health action were also evaluated. For 195 smear-positive pulmonary TB cases reported in 1998, 49% were reported to the health department within 3 days of diagnosis, and 73% were reported within 7 days of diagnosis. For timeliness of public health action, it showed that for cases reported to the program in the first half of 1999, an average of 4.2 days elapsed between the date of a report a TB case and the assignment of that case for contact interview; with 37% assigned within one day, but 14% assigned after 7 days. Such data are useful for making meaningful recommendations to TB program managers.

The survey of pharmacy records, which is an attempt to formally assess the sensitivity of TB reporting systems, had not been done previously in Chicago. This method attempts to identify patients who have received specific combinations of major anti-TB drugs during a specific time period and then match their names to surveillance records.

Initially, the program sought to include the three major private pharmacies in Chicago in the survey but could not secure agreements with them. It was successful, however, in conducting the survey at Cook County Hospital, where infection control staff routinely use a pharmacy survey to monitor drug prescriptions to pediatric patients. The hospital agreed to search its pharmacy records for patients who had been prescribed any combination of two or more of the drugs isoniazid, rifampin, pyrazinimide, and ethambutol during June 1999.

The hospital was able to provide TB staff with the names of 78 patients who had been prescribed such regimens. Mindful that the list could include previously reported cases, patients started on treatment but later having TB ruled out, as well as patients being treated for atypical mycobacterium infections, staff were not alarmed to initially discover that 35 (45%) of the 78 names were unknown to the TB program. Medical records of the 35 patients are currently being reviewed, and the results will be provided in a future report. The TB program plans to include at least four additional hospitals in the survey.

—Reported by John Kuharik
Chicago Department of Public Health
TB Control Program

Texas Project Wins Award

The Association of State and Territorial Health Officials (ASTHO) gave first place to "Grupo Sin Fronteras" in the competition for the 1999 ASTHO Vision Award. This award recognizes projects that achieve excellence in public health through innovation, in a unique and outstanding way. The Vision Award includes a monetary prize of $5,000, which was received in February by the nominator for this national competition, Domingo J. Navarro, M.B.A., TB Program Manager for Public Health Region (PHR) 11.

"Grupo Sin Fronteras" began in April 1995 with the signing of the first Memorandum of Understanding (M.O.U.) between the state of Texas and the Mexican state of Tamaulipas. The project coordinates binational TB control and prevention efforts in the border area of the lower Rio Grande Valley, encompassing the Texas counties of Cameron, Hidalgo, Starr, and Zapata and the municipalities of Reynosa and Matamoros in Tamaulipas. The binational TB project manager position of "Grupo Sin Fronteras" was vacant from March 1999 until June 1999, when Mr. Abel Cepeda began his new responsibilities. Mr. Cepeda works in the PHR 11 Office in Harlingen, Texas.

The project provides culture and sensitivity testing for all sputum specimens submitted by Tamaulipas health departments through the South Texas Hospital laboratory. Outreach workers offer directly observed therapy to binational patients as well as TB education to communities. In addition, the project gives ongoing assistance to the Tamaulipas state health department with TB training.

It is gratifying to see innovative work recognized and rewarded; this honor is well-deserved. The PHR 11 TB elimination staff are to be congratulated also for their dedication and efforts. Special thanks go to Cindy Tafolla, Public Health Technician IV, Clara Fraga, Administrative Technician III, and Alicia Trejo, Administrative Technician II in Medical Records. For more information about this project, please contact the Texas Department of Health at (512) 458-7447.

—Reported by Ann Tyree
Texas Department of Health


Released October 2008
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