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TB Notes 3, 2001

Dear Colleague:

On October 4 in Seattle, I participated in a review of the TB projects funded by the Bill & Melinda Gates Foundation. It was most gratifying to see the progress to date in the development and implementation of these projects. While there, I had the opportunity to visit with Dr. Helene Gayle, the recently-departed Director of the National Center for HIV, STD, and TB Prevention (NCHSTP), who moved to Seattle at the end of August to become the Senior Medical Advisor on HIV, STD, and TB for the Gates Foundation. On August 27 Dr. Gayle was replaced at CDC by Dr. Harold Jaffe, Director, Division of AIDS, STD, and TB Research Laboratory, (DASTLR), National Center for Infectious Diseases (NCID), who was designated Acting Director, NCHSTP. CDC will conduct a national search for a permanent Director of NCHSTP. This process will likely take several months.

The Advisory Council for the Elimination of Tuberculosis (ACET) met on October 10 and 11 in Atlanta, Georgia. After the welcome and introductions, Dr. Harold Jaffe and I gave the NCHSTP and DTBE Directors’ Reports. Staff of the Office of the Inspector General of the General Accounting Office will visit CDC in spring 2002 as part of their review of the process and systems involved in TB control among INS detainees. This visit had originally been scheduled for September 18 and 19 but was postponed after the events of September 11. We heard a report on CDC’s role in response to those events from Kathy Cahill, CDC’s Associate Director for Policy, Planning, and Evaluation. CDC and the New York City (NYC) health department were quick to respond; 7 hours after the attacks, the first CDC team was en route. Over the next few days, more CDC epidemiologists were sent to conduct surveillance in hospitals. Four of DTBE’s Epidemic Intelligence Service (EIS) officers were among 71 CDC staff who assisted in NYC in response to the terrorist attacks. They were assigned to NYC hospitals, where they worked long, hard hours. We are glad to have them safely back in Atlanta. Several DTBE staff attended the US/Mexico binational health meeting that was held October 14-16 in El Paso, Texas. One goal of the meeting was to develop a binational health card, to help improve TB treatment in persons who frequently cross the US/Mexico border. On October 22 and 23, Dr. David Fleming, CDC’s Deputy Director for Public Health and Science, represented CDC at a meeting of the “Stop TB” initiative in Washington, DC. This meeting was in follow-up to the meeting that was held in March 2000 in Amsterdam and attended by officials from the 22 countries with the world’s highest TB incidence. After the Directors’ Reports, Dr. Jack Crawford of DASTLR, NCID, gave an explanation of a new technology for TB subtyping called mycobacterial interspersed repeated unit, or MIRU. This technology is based on detecting a series of repeated elements that exist throughout the TB genome; it has an intermediate specificity between IS6110 fingerprinting and spoligotyping. Dr. Tom Shinnick, also of DASTLR, suggested improving TB laboratory services by enhancing national and regional laboratory systems. Dr. Elsa Villarino of our Research and Evaluation Branch gave an update on tuberculin skin testing, and led a discussion on the relative merits of the two commercially available reagents. Mr. John Seggerson, DTBE’s Associate Director for External Relations, reviewed the history of the Strategic Plan for TB Training and Education. This initiative is at an important juncture in that it needs funding in order to continue its activities. He announced that the committee will not disband; it will continue its important work while looking for additional sources of funding. Members of ACET expressed their support for the Strategic Plan and its continuation. Next we heard a report on the epidemiology of TB in the Southeast United States from Lilia Manangan of the Surveillance and Epidemiology Branch (SEB), which was followed by a discussion of health disparities among different US population groups. Michael Iademarco, DTBE Associate Director for Science, reported on the continuing investigation into adverse events associated with taking 2 months of rifampin and pyrazinamide (2RZ) for latent TB infection (LTBI). As of October 10, CDC had received 83 reports of adverse events associated with treatment for LTBI. Of these, 27 met the case definition for this investigation (hospitalization or death associated with 2RZ for LTBI); six of these case-patients died. The investigations will continue; most likely a retrospective analysis will be conducted in order to capture more information about this public health challenge. Dr. Masae Kawamura, San Francisco TB controller, presented a draft MMWR on treating TB in persons detained by the Immigration and Naturalization Service (INS) and requested comments from ACET members on the document. Dr. Renee Ridzon of SEB gave an update on the draft revised infection control guidelines for health care workers; the group hopes to have a final draft at least by January 2002. Dr. Scott McNabb, also of SEB, discussed the status of the new TB Epidemiology Studies Consortium (TBES); 22 applicants were approved and 14 of these received funding. We heard expressions of disappointment from applicants who were approved but not funded; I requested that they submit their comments formally, in writing, to CDC’s Procurement and Grants Office to preclude future misunderstandings.

The 4th World Congress on Tuberculosis will be held in Washington, DC, on June 3-5, 2002. Details will be published shortly. This meeting will evaluate the state of the global TB epidemic since the last Tuberculosis World Congress in 1992, review the status of TB research, and identify research gaps. Topics covered will include fundamental, translational, and operational research. Attendance should be of interest to global TB control officials, TB researchers, health systems services researchers, policymakers, and funders, as well as infectious disease and pulmonary physicians. Meeting organizers include the National Institute of Allergy and Infectious Diseases and the Fogarty International Center of the US National Institutes of Health, the World Health Organization’s Special Programme for Research and Training in Tropical Diseases (TDR) and “Stop TB” initiative, the CDC, the US Agency for International Development, and the KNCV (the Royal Netherlands Tuberculosis Association). In addition, please note that the 2002 TB Controllers Workshop is tentatively scheduled for the week of June 17, 2002. Walt Page, president of the National TB Controllers Association (NTCA), is arranging meeting space in the Washington, DC, area.

DTBE and its partners have a number of documents in varying stages of preparation and completion. CDC’s plan in response to the Institute of Medicine (IOM) report, Ending Neglect: The Elimination of Tuberculosis in the United States, has been finalized and will go through clearance after editing. The Federal TB Task Force response to the IOM report has been finalized and is being formatted and edited; after clearance, it will be submitted for publication in CDC’s Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports series. The final draft of the CDC/ American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) statement on the treatment of TB is undergoing final review and will receive formative evaluation prior to publication. The document will be published in the American Journal of Respiratory and Critical Care Medicine, and will be reprinted as an MMWR with no changes. The ACET document on TB in low-incidence areas is moving through clearance. DTBE’s Dr. Jerry Mazurek had an article published in the October 10 issue of the Journal of the American Medical Association, titled “Comparison of a whole blood interferon-gamma assay with tuberculin skin testing for detecting latent Mycobacterium tuberculosis infection” (JAMA 2001;286:1740-1747). The US TB surveillance and morbidity report for the year 2000 has been sent to the MMWR office for publication. And the DTBE publication Core Curriculum: What the Clinician Should Know has been translated into Spanish. This document, which has been revised and updated several times since its initial publication, presents basic information about TB to health care professionals. Following my final review of the translated document, it will be printed and available for ordering.

Thank you for your continued hard work and dedication to the challenges of TB control. Please know that whatever your specific duties entail and wherever you do them, your contributions matter. Together, we are making a difference.

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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