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TB Notes 2, 2002
As many of you know by now, preliminary TB data for 2001 are available.
On March 12, Dr. Marisa Moore of the Surveillance and Epidemiology
Branch (SEB) of the Division of TB Elimination (DTBE) forwarded
to TB Control Officers and DTBE field staff an e-mail containing
provisional 2001 data from the national TB surveillance system.
As she reported, these data indicate that, in 2001, a total of 15,991
TB cases were reported from the 50 states and the District of Columbia,
representing a decrease of 2% from 2000 and 40% from 1992. The case
rate in 2001 was 5.6 per 100,000, and the proportion of cases among
foreign-born persons was 50%. The 2001 provisional TB case total
was included in the March 22, 2002, Morbidity and Mortality Weekly
Report (MMWR) “Notice to the Readers” about World TB Day. With
this provisional total, the number of U.S. TB cases has now decreased
for the ninth straight year. However, the percentage decline in
the number of TB cases is less than it has been. Although data from
one year do not constitute a trend, this may be the first sign of
stagnation in U.S. TB decreases. As we continue to focus on the
goal of eliminating TB in the United States, we must keep in mind
that achieving that goal will require not only the ability to rapidly
increase resources for local TB control efforts when outbreaks occur,
but also the will and resources to combat the devastating impact
of the global TB epidemic.
For some time DTBE had operated under a continuing resolution.
I am pleased to report that Congress has approved a modest increase
in funding for TB control activities. After consultation with the
National TB Controllers Association (NTCA), NCHSTP leadership, and
DTBE senior staff, we decided to use the $5 million increase in
the following ways: to fund all successful competitors in the TB
Epidemiologic Studies Consortium; to evaluate the efficacy of once
weekly isoniazid and rifapentine for treatment of latent TB infection;
to intensify TB prevention and control activities in African-American
communities in the Southeast; to provide regional capacity-building
in low-incidence areas; to enhance the electronic notification system
for state TB control and refugee health; and to support the development
of a binational U.S.-Mexico information exchange system. As you
will appreciate, these activities are consistent with recommendations
in the Institute of Medicine report Ending Neglect.
The Data Safety Monitoring Board for the TB Trials Consortium (TBTC)
has recommended the termination of Study 23, which had enrolled
approximately 180 HIV-positive persons into a single-arm treatment
trial for TB disease using intermittent rifibutin. Five participants
relapsed; all had rifamycin-resistant TB. A "Notice to the
Readers" on the subject appeared in the MMWR that was
published on March 15. We have recommended against the use of highly
intermittent (i.e., twice weekly) therapy in HIV-infected persons
with CD4+ counts less than 100 per microliter.
The 7th Annual Conference of the North American Region of the International
Union Against Tuberculosis and Lung Disease convened in Vancouver,
British Columbia, Canada, from February 28 until March 2, 2002.
This year’s theme was “TB Cure for All -- North American Challenges
and Contributions.” I had the honor of serving as a speaker at the
conference, and thus was able to contribute to as well as gain from
this outstanding learning and networking opportunity. Several staff
members of DTBE had poster presentations at this meeting; as usual,
I was proud of the collaborative work reflected in these presentations.
Staff of the DTBE Communications and Education Branch featured a
display of DTBE educational materials, including the newly-developed
tuberculin skin test ruler (please see the article about the ruler
in this issue).
From May 17 to 22, 2002, a number of DTBE staff will be attending
the 98th International Conference of the American Thoracic
Society (ATS). This year’s meeting is being held in Atlanta, Georgia.
For information, please contact the ATS by mail at 1740 Broadway,
New York, NY 10019, by telephone at (212) 315-8780, by e-mail at
firstname.lastname@example.org, or at the Web site www.thoracic.org/ic/ic2002.
I hope that many of you are planning to attend the 2002 National
TB Controllers Workshop, which is being held this year from June
18 to 19, 2002, in Alexandria, Virginia. This annual workshop is
a crucial opportunity to bring together Division of TB Elimination
and state and local TB control staff. It is organized and sponsored
by the National TB Controllers Association (NTCA) and DTBE. The
theme for this year's workshop is “TB Program Evaluation: Keys to
Improving Performance.” Presentations will focus on gaining a better
understanding of different evaluation methods and planning for program
adjustments indicated by such evaluations. There will also be two
concurrent brown bag sessions on Tuesday, June 18: one session on
TB cooperative agreements and the 2003 applications, and one session
on revisions to the Report of Verified Case of Tuberculosis (RVCT)
form. As you know, the workshop committee has also invited poster
abstracts for this 2002 National TB Controllers Workshop. The 2002
workshop will be based on a format similar to that used in the previous
workshops. Breakout sessions have been scheduled to allow for more
in-depth consideration of the key issues. I would like to remind
you that hotel reservations should be made no later than Friday,
May 16, 2002. Questions should be directed to Walter Page at NTCA
(770-455-0801), or to Sherry Hussain (404-639-8989) or Paul Poppe
(404-639-8120) at CDC. We look forward to an outstanding and successful
meeting and encourage you to obtain information and register online
at the following secure Web site: http://sec.cdcmeetings.com/tb/.
Although I mentioned this in the previous issue of TB Notes,
it bears repeating. The 4th World Congress on Tuberculosis will
be held June 3-5 in Washington, DC. This important meeting will
be cosponsored by CDC, the National Institutes of Health, and the
World Health Organization/Special Programme for Research and Training
in Tropical Diseases. The stated purpose of the Congress is to evaluate
the state of the global TB epidemic since the last TB World Congress,
which was held in 1992; review the status of TB research; and identify
research gaps. The meeting will address fundamental, translational,
and operational research topics, and should be of interest to global
TB control officials, TB researchers, health systems services researchers,
policymakers and funders, as well as infectious disease and pulmonary
physicians. The abstracts were due by March 1, and notification
of acceptance was to be sent out on or about April 1. For international
travelers only, a limited amount of travel support may be available
for those presenting posters or "late-breaker" talks.
Detailed information regarding the meeting program can be found
at the Web site www.niaid.nih.gov/dmid/tuberculosis/tbcongress/.
Following are updates on upcoming publications of interest: the
revised ATS/IDSA/CDC TB Treatment Statement will be reviewed in
final form in June and published in the fall. In addition, on March
29, Scott McNabb of DTBE’s SEB met with editorial staff from the
CDC journal Emerging Infectious Diseases regarding a September
or October special issue that will feature more than 20 manuscripts
on TB genotyping.
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.