TB Notes Newsletter
No. 2, 2006
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director for laboratory sciences, has left the Center and been replaced
by Dr.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
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: http://www.cdc.gov/nchstp/tb/WorldTBDay/2006/default.htm.
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