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TB Notes 3, 2002
Greetings from Atlanta, where we are having a long, hot summer.
I believe the reason we get so much done is that we prefer to travel
to the field, away from Atlanta, or stay and work long hours in
our air-conditioned offices rather than venture out into the hot,
Senate Bill 1115 (S115), the proposed 5-year reauthorization of
CDC’s TB elimination program, has passed a critical first step in
the legislative process to authorize and fund TB elimination efforts
in the United States. The bill was first introduced by Senator Edward
M. Kennedy in June 2001. It was referred to the Senate Committee
on Health, Education, Labor, and Pensions, and on June 19, 2002,
the committee favorably passed the bill by a unanimous voice vote.
The bill amends the Public Health Service Act, Section 317E, to
entitle this program the "National Program for Tuberculosis
Elimination," and increases the authorized funding level to
$235 million for fiscal year 2003, and such sums as may be necessary
for fiscal year 2004 through 2007. (Please note that this bill is
an authorization to spend funds but does not provide for those funds.)
It emphasizes the recommendations of the Institute of Medicine (IOM)
report, and is specifically amended to prioritize funding for research,
demonstration projects to improve TB screening and treatment of
high-risk immigrants, and collaboration with foreign countries,
especially Mexico, to address TB elimination in the United States.
It also requires the Secretary to submit a biennial report to the
Senate Committee on Health, Education, Labor, and Pensions, and
to the House Committee on Energy and Commerce describing the extent
to which recommendations of the Advisory Council for the Elimination
of Tuberculosis (ACET) have been implemented. The bill must pass
a Senate vote before consideration and a vote by the House of Representatives.
There have been a number of important TB-related meetings this
summer; I would like to summarize some of them for those who were
unable to attend. The 98th International Conference of
the American Thoracic Society (ATS) was held in Atlanta from May
17 to 22, 2002. A number of DTBE staff attended this conference,
which always provides an important opportunity for the sharing of
vital information. Highlights included the traditional CDC TB poster
night, which was hosted this year by the American Lung Association
of Georgia; a major symposium on TB treatment; and an update from
our colleagues in the TB Trials Consortium.
The 4th World Congress on Tuberculosis was held June 3-5 in Washington,
DC. The meeting brought together TB control officials, public health
officials, and researchers to evaluate the state of the global TB
epidemic since the last world TB Congress, which was held in 1992;
review the status of TB research; and identify TB research gaps.
The meeting gave attendees the opportunity to share information,
through submitted abstracts, about the important TB research that
is being conducted globally and to reach a consensus on the future
direction for such research. Nearly 800 participants from 58 countries
attended the meeting, which was considered an outstanding success.
One notable high point was an evening banquet speech by Congressman
Sherrod Brown, who has been a leader in promoting increased U.S.
government support of both domestic and global TB control. Dr. Rick
O’Brien, chief of the Research and Evaluation Branch (REB), is coordinating
the publication of the abstracts that were presented at the Congress.
The members of ACET met on June 6; this meeting was also held in
Washington, DC, to allow travelers to attend both meetings. Following
are a few highlights from the meeting: Ms. Fran DuMelle of the American
Lung Association (ALA) discussed current domestic and international
legislative issues regarding TB, including Senate Bill 1115, which
I mentioned above. Dr. Scott McNabb of the Surveillance and Epidemiology
Branch (SEB) gave us a progress report on the TB genotyping manual
that is being developed as a hands-on guide that TB controllers
can use in applying genotyping in their TB control programs, and
Dr. Rick O’Brien provided interim guidance on the use of the new
Quantiferon test. There was a discussion about TB in the southeastern
United States; DTBE has received supplemental funding for a small
number of additional projects, and is using it in part for the intensification
of TB prevention efforts in the southeastern United States. We then
reviewed the U.S. TB morbidity data for 2001. As you know, the good
news is that TB cases were down again (although only by 2%) to 15,989;
the bad news is that 50% of the cases were among persons born outside
the United States. We also discussed CDC’s response to the IOM report,
which has now gone to the printer; distribution of the document
will be made to appropriate partners and colleagues. DTBE is forming
a workgroup to develop indicators and a process by which ACET will
be able to monitor CDC’s progress in implementing the action steps
in the report. The draft indicators and process will be presented
at the next ACET meeting in November.
This year’s National TB Controllers Association (NTCA) workshop
was also a huge success, owing to the hard work of the planning
committee. The meeting was held June 18-19 in Alexandria, northern
Virginia, rather than in Atlanta; preworkshop meetings on June 16
and 17 and postworkshop meetings on June 20 allowed attendees to
attend formal annual meetings as well as informal training and information-sharing
sessions. The theme of the workshop was "Program Evaluation:
the Key to Improving Your Program." Under this broad topic,
presenters from different backgrounds and perspectives gave participants
a number of ways to look at and use evaluation to improve their
TB control programs. The venue, with its proximity to Washington,
DC, allowed state and big city TB personnel to visit members of
Congress and provide them with information on TB. I want to thank
all of the planners and presenters who worked so hard to make the
meeting a success. I am also grateful to the attendees, whose energy,
enthusiasm, and dedication made all the effort worthwhile.
Two relatively new groups established by DTBE conducted their annual
meetings August 7-9. The TB Education and Training Network (TB ETN)
met in Atlanta for its second annual conference. Over 80 persons
attended, some from outside the United States. The meeting, organized
by staff of the Communications and Education Branch (CEB), exceeded
expectations. The ideas generated and collaborations initiated by
the meeting participants were beneficial for all involved as well
as a sign of good things to come from the network. The TB Epidemiologic
Studies Consortium (TBESC) met in Denver for its second biannual
meeting. Dr. Scott McNabb of SEB organized and co-moderated discussions
and plans for current and proposed research projects for the group.
Among the goals that were met, the participants proposed to focus
on four research activities: 1) TB in persons born outside the United
States; 2) prevalence of latent TB infection in high-risk groups;
3) the evaluation of current LTBI practices; and 4) the development
of novel approaches for conducting contact investigations.
Several publications will be coming out later this year: the updated
treatment statement for TB, which is being developed by CDC, ATS,
and the Infectious Diseases Society of America (IDSA), has undergone
formative evaluation and is scheduled for publication this fall.
Dr. Jerry Mazurek of REB is chairing the development of guidelines
for the use of Quantiferon; this document will be published in the
Morbidity and Mortality Weekly Report series. Reported Tuberculosis
in the United States, 2001, the annual surveillance report prepared
by SEB, has been cleared and is being prepared for printing. And
a special issue of CDC’s journal Emerging Infectious Diseases
dedicated to genotyping is scheduled for publication in November.
Please note that DTBE is still interested in collecting reports
of serious adverse events related to treatment of latent TB infection
(CDC. Fatal and severe hepatitis associated with rifampin and pyrazinamide
for the treatment of latent tuberculosis infection — New York and
Georgia, 2000. MMWR 2001; 50: 289-91; CDC. Update: Fatal
and severe liver injuries associated with rifampin and pyrazinamide
for latent tuberculosis infection, and revisions in American Thoracic
Society/CDC recommendations — United States, 2001. MMWR 2001;
50: 733-735). Please call Lauren Lambert at (404) 639-8442 with
Kenneth G. Castro, MD
NOTE: The use of trade names in this issue is for identification
only and does not imply endorsement by the Public Health Service
or the U.S. Department of Health and Human Services.