National Surveillance for Severe Adverse
Events (Hospitalization or Death) Associated with Treatment
of Latent Tuberculosis Infection
Between October 2000 and December 2003, DTBE received reports
of 49 patients with severe adverse events associated with the
use of the 2-month regimen of rifampin and pyrazinamide (RZ)
for the treatment of latent tuberculosis infection (LTBI); 12
(24%) of the 49 patients died. In addition, since January 1,
2004, DTBE has received two reports of serious adverse events
for patients started on therapy (RZ=1 and isoniazid=1).
A severe adverse event is defined as hospitalization or death
of a person receiving treatment for LTBI.1-4 On the
basis of these data, the American Thoracic Society and CDC recommended
that RZ should generally not be offered for treatment of persons
with LTBI, regardless of HIV status.4 Rifampin
and pyrazinamide should continue to be administered in multidrug
regimens for the treatment of persons with active TB disease.5
To better estimate the incidence of severe adverse events (hospitalization
or death) associated with any treatment for LTBI in the United
States, DTBE is developing a national surveillance system. Surveillance
of such events will provide data to support further revisions
of guidelines, if deemed necessary, for treatment of persons
with LTBI. To facilitate this surveillance system, DTBE requests
that health care providers and health departments report any
hospitalization or death related to any treatment for LTBI to
Lilia Manangan in the Surveillance Team; Surveillance, Epidemiology,
and Outbreak Investigations Branch; DTBE, CDC; telephone number:
404-639-8401 or email: firstname.lastname@example.org.
—Reported by Lilia Manangan, RN, MPH
Div of TB Elimination
*For latent tuberculosis infection (LTBI).
LTBI guidelines: see reference 6 below.
1. CDC. Fatal and severe hepatitis associated with rifampin
and pyrazinamide for the treatment of latent tuberculosis infection
— New York and Georgia, 2000. MMWR 2001;50(15):289-91.
2. Update: Fatal and severe liver injuries associated with
rifampin and pyrazinamide for latent tuberculosis infection,
and revisions in American Thoracic Society/CDC recommendations
— United States, 2001. MMWR 2001;50(34).
3. CDC. Update: Fatal and severe liver injuries associated
with rifampin and pyrazinamide treatment for latent tuberculosis
infection. MMWR 2002; 51(44):998-9.
4. American Thoracic Society/CDC. Update: Adverse event data
and revised American Thoracic Society/CDC recommendations against
the use of rifampin and pyrazinamide for treatment of latent
tuberculosis infection — United States, 2003. MMWR 2003;52(31):735-9.
5. American Thoracic Society, CDC, Infectious Diseases Society
of America. Treatment of tuberculosis. Am J Respir Crit Care
6. American Thoracic Society, CDC. Targeted tuberculin testing
and treatment of latent tuberculosis infection. Am J Respir
Crit Care Med 2000;161:S221-S247).