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TB Notes 2, 2000

Dear Colleagues:

Earlier this year I shared the following preliminary news: a total of 17,528 TB cases were reported from the 50 states and the District of Columbia in 1999, a decrease of 5% from 1998 and 34% from 1992, the height of the TB resurgence in the United States. The 1999 rate was 6.4 per 100,000 population, the lowest recorded since national surveillance for TB began in 1953. Keep up the great work!

The Advisory Council for the Elimination of Tuberculosis (ACET) met on February 9 and 10 in Atlanta. Paul Poppe discussed TB Controllers' concerns about the FY2000 TB cooperative agreement process. Dr. Eugene McCray discussed the Leadership and Investment to Fight an Epidemic (LIFE) initiative, which is providing $35 million to combat HIV/AIDS in Africa and other areas of the world hard-hit by AIDS. A new CDC office has been created, the Global AIDS Activity (GAA), through which CDC will carry out its LIFE initiative activities. Dr. McCray has accepted a full-time position as Director of the GAA. Dr. Renee Ridzon summarized a TB infection control meeting held in Arlington, Virginia, in December 1999. The group concluded that the risk of occupationally-acquired TB and TB infection is decreasing in the United States, but that continued vigilance is needed to keep the problem under control. I then gave an update on division-wide issues. DTBE will continue to directly support some states on outbreak investigations, but CDC and the states need to develop a long-term response plan. DTBE continues to focus on trials of treatment for latent infection, since this activity is the most relevant research component for the United States. DTBE has approved a recommendation to develop a consortium with state and local health departments in an effort to build capacity for these institutions to conduct epidemiologic studies. The group then discussed the epidemiology of TB in low-incidence areas and the possible need for an ACET statement on TB control in such areas. Dr. Philip Spradling reported on a TB outbreak in a dormitory for HIV-infected inmates in a South Carolina prison. ACET also discussed a suggested review and update of the 1994 occupational health policies, which do not emphasize the significance of skin testing, the fit testing issue, or the administration and completion of preventive therapy among workers who convert.

On June 7 and 8, 2000, ACET met again in Atlanta with the following agenda items and proceedings: Dr. Helene Gayle and I provided the Directors' reports and updates. These included a briefing on the important Ministerial Conference on Tuberculosis and Sustainable Development that was held March 22-24 in Amsterdam, and an update on the IOM report on TB elimination in the United States. Dr. Bess Miller spoke about LIFE initiative country assessments and the role of tuberculosis. After the lunch break, we focused on the topic of TB control in low-incidence states. Dr. Kathleen Gensheimer gave a state epidemiologist's perspective on TB control in a low-incidence state; Dr. John Tillinghast discussed the role of the private medical sector in TB control for such areas; and Ms. Carol Pozsik described the impact of an outbreak on a state TB control program. Dr. John Jereb talked of the internal assessment of TB control in low-incidence areas. Dr. Nolan then lead a discussion of the draft outline of a proposed ACET document on the subject. When the meeting resumed next day, Dr. Nolan and I reviewed and lead a discussion about the recommendation to review and update the 1994 occupational health guidelines. Dr. Andy Vernon described findings from the TB Trials Consortium (TBTC) Study 22. Dr. Charles Nolan discussed the next steps in working with Immigration and Naturalization Services (INS) staff regarding the problem of detaining immigrants with TB. The next meeting will be held October 18-19, 2000.

The 5th Regional Conference of the North America Region (NAR) of the International Union Against TB and Lung Disease (IUATLD) was held in Vancouver, BC, Canada, on February 24-26. The calibre of the presentations was outstanding; undoubtedly the NAR/IUATLD meeting has become an important forum for the exchange of scientific and programmatic information.

World TB Day was March 24th. This annual event commemorates the date on which Robert Koch announced his discovery of the TB bacillus. Events for this year's World TB Day included a significant world TB conference entitled "Tuberculosis and Sustainable Development," held in Amsterdam, The Netherlands, beginning on March 22 and ending on World TB Day, March 24. In addition, the new WHO report on drug-resistant TB was released at that time. High-level representatives of governments from 20 high-prevalence countries attended the ministerial conference in order to better understand the social and economic impacts of TB, to assess how effective TB programs can contain the epidemic and contribute to overall development, and to identify priority actions for the new millennium. Dr. Donna Shalala, the Secretary of DHHS, Dr. Margaret Hamburg, the Assistanty Secretary of DHHS, Dr. Helene Gayle, Director of NCHSTP, and other CDC staff attended this important conference.

In early May the Institute of Medicine (IOM) released its report on the status of TB elimination in the United States. It is available on the Internet on the IOM website at This report, entitled Ending Neglect: The Elimination of Tuberculosis in the United States, addresses the questions, Is TB elimination in this country a feasible goal? And if so, how do we proceed? The experts who prepared the report concluded that TB can be eliminated, but it will not be possible with the current tools we have. Such an effort will require additional financial resources and a strong commitment by policymakers. This, of course, is what CDC and the ALA have been promoting since the resurgence of TB in the 1980s and 1990s. Very importantly, the report identified areas for accelerated progress and made several recommendations for specific activities to be undertaken by CDC. On July 26 and 27, DTBE staff met to discuss these recommendations and develop strategies for their implementation. This process reinforced and validated our existing priorities for TB control and elimination, while presenting new challenges for our Division. DTBE senior staff have identified cross-branch workgroups that will be responsible for follow-up activities toward implementing the strategies.

The "ATS 2000 Toronto" conference and the "ALA/CLA 2000" conference were held in Toronto, Ontario, Canada, on May 5-10, 2000. The sessions offered the latest information in clinical science, basic science, and behavioral aspects of respiratory disease and public health education. As part of the ATS 2000 Conference, there was a program of special interest to TB control workers entitled "Tuberculosis Control Strategies." This year's TB poster session was cosponsored by the DTBE and the Division of Tuberculosis Prevention and Control (DTBPC), Bureau of HIV/AIDS, STD and TB (BHST), Laboratory Centre for Disease Control (LCDC), Health Canada.

The American Thoracic Society and CDC have published two new statements, the first being "Diagnostic standards and classification of tuberculosis in adults and children," Am J Respir Crit Care Med 2000;161:1376-95. The second, "Targeted tuberculin testing and treatment of latent tuberculosis infection," was published as a journal article, Am J Respir Crit Care Med 2000;161(Part 2):S221-S247, and was also published in the Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports series. If you wish to access the statements on your computer or obtain copies, please visit the DTBE Web site at

A reminder that the National TB Controller's Workshop is scheduled for August 30 through September 1, 2000, in Atlanta at the Omni Hotel, located at the CNN Center. The workshops will concentrate on the very important theme of orchestrating better contact investigations. I hope to see you there!

Kenneth G. Castro, MD


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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