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TB Notes 3, 2000

International Updates

TB Control Activities in India

India has more cases of TB than any other country in the world. It accounts for nearly 30% of the global TB burden, and has an estimated 2 million new cases every year. Although many aspects of modern TB control were established in India, until recently program performance had been poor. The new Indian program now covers more than 250 million people and is placing more than 20,000 patients on treatment every month. The quality of diagnosis has been good, and treatment success rates have been 80%. More than 400,000 patients have been treated in the new program, saving more than 60,000 lives. The (recently retired) Director of the DTBE International Activity, Nancy J. Binkin, MD, MPH, participated in a comprehensive joint program review that identified further areas for improvement and established a framework for expansion of the program to cover the entire country. Training is provided to all levels of staff, and more than 100,000 health workers have been trained thus far. A small group of carefully selected local supervisors has been recruited, trained, and supervised. They provide high quality, ongoing monitoring and supervision to support the program and build capacity at district and state levels. Important research on the epidemiologic, social, and economic burden of TB has been conducted and disseminated, as has research on health care delivery and involvement of private practitioners in TB control. For example, recent studies indicate that in India more than 300,000 children leave school every year owing to TB in the family, and more than 100,000 women are rejected by their families every year because of having TB. Ambitious studies on the annual risk of TB infection, drug resistance surveillance, and the epidemiologic impact of effective TB control are underway. A book, Research for Action, was published to disseminate key lessons from research and the implications of this research for action.

—Reported by Thomas R. Frieden, MD, MPH

DTBE epidemiologist Thomas Frieden, MD, MPH, is assigned to the South East Asia Regional Office of the World Health Organization, with the focus of assisting in the improvement of TB control in India.

Immigrant and Refugee Screening

Below is a copy of a letter that was sent in October from Mr. Tony Perez, Director, Division of Quarantine, CDC, to epidemiologists, TB controllers, refugee health program coordinators, and AIDS Directors at the state level. This letter, which provides important updated recommendations for the screening of immigrants and refugees from certain African countries, was deemed appropriate and important for inclusion in TB Notes. If you know of any public officials or organizations that have a need to know this information and may not have received it, please share it with them.

State EPI

CDC Hosts Philippines Visitor

In summer 2000, CDC hosted Dr. Eric A. Tayag of the Republic of the Philippines for a week of meetings. Dr. Tayag was recently promoted to the position of Director of the newly formed National Infectious Disease Cluster (NIDC) within the Philippines Department of Health (DOH) from his previous position as lead Epidemiologist at San Lazarus Hospital in Manila. Owing to recent efforts in the Philippines to decentralize government, the functions of the TB Control Service now are part of NIDC. Dr. Tayag is a graduate of two CDC programs: the Field Epidemiology Program, offered by the Epidemiology Program Office (EPO), and the Management for International Public Health Program, offered by the Public Health Practice Program Office (PHPPO). While at CDC in Atlanta, Dr. Tayag met with experts in EPO, PHPPO, the National Immunization Program (NIP), the National Center for Infectious Diseases (NCID), and DTBE about the control of TB and other infectious diseases, surveillance, and vaccine-preventable diseases.

TB is a major public health problem in the Philippines. The Philippines ranks third worldwide in TB rates. A recent prevalence survey conducted by the DOH showed the prevalence of AFB smear–positive persons to be about 300 per 100,000 and AFB culture–positive persons to be about 800 per 100,000 among the general population. Prevalence among the urban poor was significantly greater. The private sector treats an estimated 50% of the TB cases. Sponsored by WHO, the DOH began directly observed treatment, short-course (DOTS) in 1996, and after relatively rapid expansion, currently covers about 45% of the population. The DOH strategy for TB control includes achieving 100% DOTS expansion by 2001. In cooperation with USAID, the DOH is partnering with EPO, DTBE, and PHPPO on a 3-year project to reduce the threat of HIV/AIDS and other selected infectious diseases (including TB). In the United States, immigrants from the Philippines are the second largest group contributing to TB among the foreign-born.

—Reported by Michael Iademarco, MD, MPH
Division of TB Elimination


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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