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TB Notes 2, 2006
Highlights from State and Local Programs
  An Outbreak Response in a Rural, Southwest Missouri County Jail
  No Reported TB Cases in Wyoming in 2005
  Suffolk County (New York) Targeted TB Testing and Treatment Program Among the Foreign-born, 2000–2004
  The Changing Epidemiology of TB in Connecticut, 2000-2004
  Molecular Genotyping of Mycobacterium tuberculosis in Connecticut
  Third Annual Conference on TB in the U.S. Pacific Islands: Meeting Highlights, Challenges, and Solutions for Addressing the Disparities
  "Update: Tuberculosis Nursing" Workshop in Hawaii
  Lessons Learned in the Process of Evaluation – Illinois
  TB Education and Targeted Testing of Garfield County, Colorado, WIC Clients
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TB Notes Newsletter

No. 2, 2006

Dear Colleague:

The Advisory Council for the Elimination of Tuberculosis (ACET) met in Atlanta on February 15 to 16, 2006, with a full slate of topics to discuss. After being welcomed by Drs. Masae Kawamura and Ronald Valdiserri, we heard an update from our new Center Director, Dr. Kevin Fenton, who was selected for that position last November. He discussed CDC’s ongoing efforts to best organize its components by our common programs, services, and partners. To that end, our Center will retain its current divisions of HIV/AIDS Prevention, STD Prevention, and Tuberculosis Elimination, and is being joined by another division, the Division of Viral Hepatitis. Our Center will be officially renamed the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). We are pleased to be welcoming these new colleagues to our center, with whom we share a commitment to serve similar high-risk communities. Dr. Fenton informed us that Dr. Dale Hu, who had served as acting associate director for laboratory sciences, has left the Center and been replaced by Dr. Michele Owen in that position.

Dr. Julie Gerberding, CDC Director, joined us in our meeting to inform us of CDC budget issues, noting that there will be a reduction in funding for infectious disease activities for 2006 and 2007. Dr. Michael Fleenor then presented a follow-up regarding the NCID Board of Scientific Counselors (BSC) meeting that was held November 29–30, 2005. Attendees at that meeting discussed the advantages and disadvantages of consolidating the various advisory committees at CDC so as to reduce the number from 22 to eight. Some advisory committees are mandated by Congress, others are not; ACET is a mandated advisory group. Discussions continue on this matter.

I provided division updates in my DTBE Director’s report, beginning by mentioning progress in updating the ACET recommendations for preventing tuberculosis among foreign-born persons. We are working through the normal process of defining the process, reviewing evidence, engaging stakeholders, updating the guidelines, and disseminating and evaluating the findings; Dr. Dolly Katz of DTBE’s Surveillance, Epidemiology, and Outbreak Investigations Branch has been designated project lead for this activity. I also reported that DTBE staff members conducted eight epi-aids in 2005. Although cases of TB are going down overall, the outbreaks we now see involve very large numbers of contacts that need to be investigated, with the resultant expenditure of large amounts of TB control resources. I announced that USPHS TBTC Study 28, in which moxifloxacin will be substituted for INH to assess safety and feasibility in a 4-month regimen, had recruited its first two patients. (Note: As of mid-April, it had recruited 50.)

Dr. Drew Posey of the Division of Global Migration and Quarantine (DGMQ) provided an update on the recent efforts of CDC staff to fight TB and multidrug-resistant (MDR) TB in Hmong refugees still in Thailand. After the resettlement of almost 15,000 Hmong refugees in California, Minnesota, and several other states, MDR TB was reported in a number of these refugees and the resettlement was temporarily halted until improvements in screening could be implemented. Investigations ensued in California and Thailand. As a result of CDC’s collaborations in Thailand, changes were made in the refugee screening algorithm, with improvements in the laboratory capacity, the DOT procedures, and health communications such that the resettlement was restarted and the number of MDR TB cases in resettled persons subsequently dropped, from 44 cases before the changes to four cases afterwards. Dr. Jennifer Flood gave the perspective of California’s Department of Health Services on the Hmong refugee resettlement, describing case management problems that occurred and the impact the resettlement has had on California TB program resources.

We heard from DTBE’s Dr. Philip LoBue as well as Dr. Farah Parvez of New York City and Dr. Michael Puisis of Chicago with presentations on preventing TB transmission in correctional facilities. Dr. LoBue gave a report on the guidelines for preventing TB in correctional facilities, which are being revised and will be submitted soon for MMWR publication. Dr. Parvez discussed NYC’s proposal to change from universal tuberculin skin testing to giving targeted TSTs upon intake in NYC jails. Dr. Puisis gave an alternative view, proposing that persons in correctional settings are inherently high risk, particularly in NYC, and suggested the increased use of chest radiographs in TB screening programs in correctional facilities. The guidelines will likely encourage programs to implement evidence-based measures to prevent TB in correctional facilities.

We heard a series of presentations on border health issues. Dr. Gary Simpson of New Mexico gave a talk on the complexities of providing TB treatment to binational, interstate, and international patients, particularly those with comorbid medical or psychiatric conditions and those in legal custody. Questions frequently arise regarding responsibility and authority of state and federal entities in these cases. Dr. Ram Koppaka of DGMQ discussed federal public health law and how it applies to patients crossing the border and within states. Dr. Zach Taylor of DTBE provided further data on the burden of TB in binational border areas, and I gave an update on the evaluation of the Binational Card in lieu of Dr. Kayla Laserson. (Kayla has departed DBTE for a position as director of CDC’s field station in Kenya.) Ms. Mary Lou Valdez of the HHS Office of the Secretary, and also on the Border Health Commission, spoke to us of efforts of the Commission to improve TB control on the border.

Drs. Nick DeLuca and Zach Taylor gave presentations on our ongoing efforts to address TB among African Americans. Zach gave an update on the three 3-year demonstration projects which were awarded funding by CDC to intensify efforts to reduce TB rates in African-American communities. They were tasked with developing, implementing, and evaluating interventions for these communities; these projects were developed and implemented, and evaluation is now ongoing, with results to be available soon. Nick discussed progress and next steps on the project to identify and overcome barriers to TB treatment adherence for LTBI and TB disease among African Americans in the Southeast; formative research is in progress. Nick mentioned the 2003 consultation that was convened by DTBE and ACET to raise awareness about and solicit support for efforts to reduce TB in African Americans; DTBE plans to readdress these issues at a follow-up meeting in mid-May 2006. Finally, Dr. David Weissman of NIOSH talked about the National Occupational Research Agenda (NORA), which is an initiative to develop an occupational diseases research agenda for the nation. A discussion of fit testing and respirator issues followed his talk. After discussing some follow-up items, we were adjourned. The council will reconvene July 26–27, 2006.

A limited number of DTBE staff traveled to Chicago March 2–4, 2006, for the 10th Annual Conference of the International Union Against Tuberculosis and Lung Disease (IUATLD) North American Region. The theme of this year’s special anniversary meeting was “A Past Decade of Accomplishment, A Future Decade of Ambition.” The meeting gave special recognition to Dr. George Comstock, considered by many one of the leading experts on TB worldwide, whose significant contributions paved the way for considerable improvement in TB prevention and control activities. Speakers shared their expertise in a variety of educational sessions, including “50 Years of TB: Lessons from the Past, Prospects for the Future,” “Beyond TB: Limiting the Risks from Infectious Disease Outbreaks,” “Epidemiology: Mapping the Route to Control,” “TB/HIV: Intertwining Epidemics,” “The Future of Tuberculosis Treatment,” “Clinical Issues: Real Problems, Real Solutions,” and a Nursing Assembly program.

As you know, World TB Day is observed each year on March 24. Around the world, TB programs, nongovernmental organizations, and others take advantage of the increased interest generated by World TB Day to discuss their own TB-related problems and solutions, and to support worldwide TB control efforts. This year, a large number of U.S. TB control programs planned activities and press conferences for this day to highlight the need to stay focused on TB control efforts. DTBE maintains a World TB Day website with information on the activities that each site planned, as well as tools that are available for future events: Activities were also planned for CDC staff in Atlanta so that those of us here could join with our field staff and health department colleagues in observing this day.

Kenneth G. Castro, MD


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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