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TB Notes 2, 1999

Dear Colleague:

The 1999 International American Lung Association (ALA)/American Thoracic Society (ATS) conference was held April 23-28 in San Diego, California. While I had to miss this meeting because of my daughter’s illness, it featured a great deal of new clinical, basic-science, and public health practice information on TB, including updates on global activities. There were several symposia, minisymposia, and poster-discussion sessions, as well as our annual public health poster session. I am told that the TB sessions, as always, were well-attended, with much enthusiastic discussion. I continue to be impressed by the intense interest in TB which has continued at the ALA/ATS meetings. If you have not been able to do so in the past, please consider attending these annual meetings in the future, as they are an inspiration, in addition to being a good place to network. As an added incentive to attend, please note that CDC and Canada's Centre for Disease Control will hold a joint public health poster session at next year’s annual ALA/ATS meeting, to be held in Toronto.

The Advisory Council for the Elimination of Tuberculosis (ACET) met on June 9 and 10 at Corporate Square in Atlanta. The meeting consisted of a day and a half of updates and follow-up discussions on a variety of current topics. Dr. Ron Valdiserri and I gave some updates on selected division and center activities. I briefly reviewed the 1998 TB data: 18,361 new cases were reported, which represents a case rate of 6.8/100,000 population and a 7% decline from 1997; 42% of these cases were in foreign-born persons. We expect to publish these data in late summer or fall, both in a Morbidity and Mortality Weekly Report (MMWR) and in the annual surveillance summary. I also discussed the recent planning retreat attended by DTBE senior staff. At the retreat, we reaffirmed our dedication to the mission of TB elimination, and established DTBE priorities for improvement: case finding and completion of therapy; contact investigations and treatment of latent infection; targeted testing and adherence, specifically in HIV-infected persons and in class B1 and B2 immigrants; outbreak response and capacity building; conducting evaluation and economic analysis activities; and providing technical assistance and capacity building to global partners. Dr. Valdiserri talked about National HIV Testing Day, June 24; CDC is developing a short-term campaign in connection with this date as well as a long-term campaign called "Know Your HIV Status." Dr. Frank Collins of the Food and Drug Administration then gave an excellent update on the development of TB vaccines. The conclusion of his informative talk is that, while there have been promising results from some mouse trials, it will be some time before we have a TB vaccine that is better than BCG. On the positive side, the recent research and technologic advances make TB vaccine development a realistic undertaking. Wanda Walton, who is our new Chief of the Communications and Education Branch, provided a comprehensive update on TB training and education activities as well as on the TB Training Summit. Dr. Charles Nolan and I presented information on DTBE’s June 8 meeting with the Institute of Medicine (IOM) committee, which is reviewing DTBE’s progress toward elimination. We also heard an update on the revision of A Strategic Plan for the Elimination of Tuberculosis in the United States. In the afternoon, the meeting presentations focused on international TB-related activities. Dr. Amy Bloom of the U.S. Agency for International Development (USAID) discussed recent TB-related activities at her agency. Dr. Bess Miller provided information about the international "Stop TB" initiative, and Dr. Nancy Binkin gave an overview of the current activities of her staff in the International Activities branch. For the remainder of the afternoon, Mr. Jack Spencer of the Division of Sexually Transmitted Diseases of NCHSTP discussed his division’s development of a U.S. syphilis elimination strategy. The next day, the meeting attendees were welcomed by CDC’s new director, Dr. Jeffrey Koplan. Drs. Patricia Simone and Ida Onorato then provided information on recent TB outbreaks and related follow-up issues, such as the importance of RFLP and of implementing adequate contact investigations to effectively improve adherence with treatment of latent TB infection. Mr. Scott McCoy, recently of the NCHSTP Office of Communications but now with the DTBE Communications and Education Branch, gave a well-received update on the National TB Communication Initiative; the late morning was given over to a presentation by Dr. Meade Morgan of the Epidemiology Program Office (EPO) on the complex and long-term project of integrating all CDC-wide surveillance activities.

As I mentioned above, CDC and ACET have developed an important document that will be published in the MMWR this August, A Strategic Plan for the Elimination of Tuberculosis in the United States: A Renewed Commitment. ACET decided to reassess the original plan in terms of current conditions and circumstances, and concluded that it is appropriate to make updated recommendations for achieving TB elimination. The group determined that, although there are challenges for TB elimination — for example, the need for new and additional tools and technology to fight TB, and serious TB problems in other countries that clearly affect TB control in the United States — there have been successes, and there are opportunities for future success as well. Moreover, if there is an opportunity to eliminate this disease from our country and from the world, there is a moral and societal obligation to do so. The plan makes the following recommendations: 1) tailor TB prevention, control, and elimination strategies to local epidemiology; 2) establish new strategic partnerships and reach new stakeholders; 3) sharpen and expand the use of current tools for TB prevention and control; 4) develop new tools for TB elimination; 5) recommit to the global battle against TB; and 6) mobilize advocacy and political will at national, state, and local levels.

Another important statement on which CDC and ATS are collaborating is a statement on targeted testing and treatment of latent TB infection; this is expected to come out later this year. This document will review the current data on the drugs and regimens that have been found to be effective in treating latent TB infection.

DTBE and the International Union Against Tuberculosis and Lung Disease (IUATLD) will cosponsor a TB late-breaker session Sept. 15-18 at the 30th World Conference on Lung Health, which is being held in Madrid, Spain. This late-breaker session is intended as a forum for the dissemination of information about developments and findings that are new and significant, and that occurred since the April 15, 1999, deadline for abstracts, or for which information has just become available. The session will consist of eight oral presentations of 10 minutes each. This is the first year that such a session is being presented. Drs. Ida Onorato and Pattie Simone are organizing the effort. It should be an interesting meeting; I encourage those of you attending the IUATLD conference to stop by this session.

The importance of contact investigations in the control and eventual elimination of TB in this country is becoming increasingly clear. Several DTBE staff are conducting studies, and other related activities are planned. It seemed an appropriate time to present reports on the spectrum of current DTBE contact investigation activities, so we have done just that in this issue of TB Notes. Please see the articles by Robin Shrestha-Kuwahara and by Suzanne Marks of the Research and Evaluation Branch; by Mary Reichler of the Surveillance and Epidemiology Branch; and by Maria Fraire of the Communications and Education Branch.

I know that many of you will be busy in the upcoming weeks and months preparing your FY 2000 recompeted cooperative agreement applications, which are due at the end of August. I hope that in spite of your busy schedules you will take a little time of well-deserved vacation to be with your families and to "recharge your batteries." Many thanks for all your hard work and for all your contributions, recognized and unrecognized; you are helping the United States control TB and move closer to the reality of TB elimination.

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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