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TB Notes 3, 2007
Director's Letter
Highlights from State and Local Programs
  Georgia Statewide TB Training
NTCA Workshop Poster Contest
2007 EIS Conference a Success for DTBE
National Tuberculosis Indicators Project (NTIP): An Update
Evaluation Team Visits TB Isolation Village in Thailand
TB Education and Training Network Updates
  Member Highlight
  Cultural Competency Subcommittee Update
Communications, Education, and Behavioral Studies Branch Update
  A Review of DTBE’s First Year Using the CDC INFO Call Center
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  TB/HIV Surveillance in Ethiopia
TB Epidemiologic Studies Consortium Updates
  2007 World TB Day: TBESC Sites Across the U.S. Get Involved
  “The First Global Symposium on Interferon-Gamma Assays” 2007
New CDC Publications
Personnel Notes
Calendar of Events
 
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TB Notes Newsletter

No. 3, 2007

TB EPIDEMIOLOGIC STUDIES CONSORTIUM UPDATES

2007 World TB Day: TBESC Sites Across the U.S. Get Involved

Each year, World TB Day (March 24) offers a terrific opportunity to raise awareness about TB in our communities. Several Tuberculosis Epidemiologic Studies Consortium (TBESC) members took advantage of this opportunity and hosted or participated in the events below.

  • Texas: On March 16, the Texas Department of State Health Services held two of its many organized World TB Day events. At the Houston World TB Day event, TBESC members Drs. Charles Wallace and Ed Graviss gave presentations on “Tuberculosis in Texas” and “New Laboratory Tools,” respectively. There was also a media conference with US Congressman Gene Green on March 16. Congressman Green has sponsored the Comprehensive TB Elimination Act, HR 1532, which calls for increased funding to support various mechanisms that aid TB elimination, such as projects that prevent, detect, and control TB in both US-born and foreign-born persons in the United States.
  • Denver: On March 21, Denver Public Health and Hospitals Authority hosted a TB informational session, where HHS Regional Health Administrator Dr. Zach Taylor and TBESC member Dr. Bob Belknap presented on “Confronting the TB Pandemic,” “Multidrug-Resistant TB Case Presentations,” and “Role of Newer Blood Tests in the Diagnosis of TB.” Other presenters included Annette Choszczyk from RESULTS, who spoke about her parents, who met in a TB sanitarium. Joanie, a 2-year-old girl, who was infected with TB but was treated owing to early testing, and her mother were also part of a presentation. About 55 people attended; many were area health department staff and/or infection control practitioners. The presentations were well received; many of the attendees were particularly interested in Interferon gamma release assays (IGRAs) and asked Dr. Belknap to speak about TB diagnostics at the local infection controllers meeting in April.
  • North Carolina: On March 22, the North Carolina TB Control program held a media call with the North Carolina RESULTS group, and included one of their TB patients on the call. On March 23, Duke University and the North Carolina TB Control Program held their 7th Annual Tuberculosis Symposium to commemorate World TB Day 2007. This year the theme was Tuberculosis: What Doesn’t Kill it, Makes it Stronger. The target audience for the symposium was physicians and other providers interested in TB control, prevention, treatment, and research. The TB symposium was very well-received and had its largest turnout, about 200 individuals at the "live" Duke site and another 70 at the four broadcast sites around the state. Enrollment for the symposium has grown every year since inception. Participants included physicians in the community who work with local TB clinics, as well as infection control practitioners, advance practice nurses, and TB nursing staff throughout the state. TBESC member Dr. Carol Dukes Hamilton presented on the “State of the State in North Carolina Tuberculosis Control.”
  • Curry National TB Center: On March 22, the Francis J. Curry National TB Center participated in San Francisco's World TB Day event, at which Dr. Masae Kawamura, TB Control Director, San Francisco Department of Public Health, presented information to the public about the recent transmission of TB within single-resident occupancy (SRO) hotels. The Center also prepared a World TB Day press release for four low-incidence states. On March 23, one of the Center’s state partners, the Utah TB control program, co-sponsored a World TB Day conference with the Utah Chapter of the American Lung Association. There were about 150 participants. Dr. Charlie Nolan from Seattle and King County Public Health, who is involved in TBESC’s Task Order 6, “Regional Capacity-Building in Low-Incidence Areas,” was invited to speak at the event about TB and global health issues to a gathering of mostly public health nurses.
  • Massachusetts: On March 22, TBESC member Sue Etkind participated in a media call, “World TB Day 2007: Tuberculosis Experts Give Massachusetts Update on Drug-Resistant TB Emergency,” which was sponsored by RESULTS. The media call gave an update on what the drug-resistant TB emergency means for Massachusetts and also gave recommendations to prevent an MDR outbreak like the outbreak that occurred in New York in the 1990s.
  • Minnesota: On March 22 and March 28, the Minnesota Department of Health participated in two educational sessions about TB. The educational session in Dakota County was about latent TB infection (LTBI) and the epidemiology of TB in Dakota County, and the educational session in Ramsey County was about the epidemiology of TB, treatment for LTBI and TB, and TB-related educational materials. The Minnesota Department of Health also submitted an article entitled "Tuberculosis: Answers to Your Questions" to several local newspapers. The article covered the basics about transmission, active TB disease, and latent TB infection. The newspapers target African, Hmong, and Hispanic populations in and around the Twin Cities (Minneapolis and St. Paul).
  • ALA Chicago: On March 23, the American Lung Association of Metropolitan Chicago (ALAMC), which is part of TBESC, had an all-day event under the theme TB Anywhere Is TB Everywhere. There were presentations on extensively drug-resistant (XDR) TB, local use of QuantiFERON, TB funding concerns and issues, global and local TB statistics, and a CDC “Quarantine Update.” Approximately 200 people attended. The ALAMC also had a satellite and webcast program, “Liver Toxicity and Latent TB Infection,” which was viewed by over 200 people. On the day before the World TB Day events, ALAMC staff also distributed information about TB at various public transportation stops in the metro Chicago area and asked individuals to join them in support of increased funding; 2,500 pieces of TB education materials were disseminated in 1.5 hours!
  • Atlanta: On March 24, the First Annual TB Awareness Walk sponsored by the National TB Controllers Association (NTCA) took place at Grant Park in Atlanta. The walk was very successful; over 600 people registered for the walk and about 500 people actually participated, including several TBESC members. Representatives from NTCA and from the group RESULTS, as well as CDC Director Dr. Julie Gerberding, NCHHSTP Director Dr. Kevin Fenton, and DTBE Director Dr. Kenneth Castro, were all speakers and participants in the event. The event was such a success that there is talk about doing this nationwide next year!
  • Maryland: On March 28, the Maryland Department of Health and Mental Hygiene, also a part of TBESC, hosted a well-received World TB Day presentation by Dr. Thomas Walsh entitled “TB: the Good, the Bad, and the Ugly.” The presentation gave a brief overview of TB, which included a description of TB, consequences of late and missed TB diagnoses, and the success of treatment, once patients are in care, even for those with drug-resistant TB disease.

—Reported by Indhira Gnanasekaran, MPA
Div of TB Elimination

“The First Global Symposium on Interferon-Gamma Assays” 2007

Note: At the First Global Symposium on Interferon-Gamma Assays held in February 2007 in Vancouver, Canada, Naasha Talati, MD, from the Division of Infectious Diseases at Emory University gave a talk entitled, “Poor Concordance between Interferon-Gamma Release Assays and Tuberculin Skin Test in the Diagnosis of Latent Tuberculosis Infection Among HIV-Infected Individuals.” This study was funded through the CDC Tuberculosis Epidemiologic Studies Consortium (TBESC) Task Order #5 and through a grant from the CDC Foundation to Emory University. Coauthors on the study include Ulrich Seybold, Bianca Humphrey, Abiola Aina, Jane Tapia, Paul Weinfurter, Rachel Albalak, and Henry M. Blumberg.  A synopsis of the study and preliminary results are presented below. 

The interferon-gamma release assays (IGRAs) represent a new generation of diagnostic tools for detecting latent TB infection (LTBI). One IGRA is currently FDA-approved for use in the United States. CDC has published recommendations on the use of the FDA-approved IGRA (QuantiFERON-TB Gold) [MMWR 2005;54(No. RR-15):49-55] but there are few data on the use of IGRAs in immunocompromised patients. CDC has recommended additional research in this area.

Published studies on the use of IGRAs in immunocompromised persons (including those with HIV infection) are limited by small sample size and lack of CD4 T-cell data. The specific aims of this study focused on determining the prevalence of LTBI using three diagnostic tests—the tuberculin skin test (TST), QuantiFERON-TB Gold in Tube (QFT-G) and TSPOT.TB (TSPOT)—and assessing concordance between these diagnostic tests for LTBI. HIV-infected individuals were enrolled at two urban HIV clinics in Atlanta, Georgia, between June 2004 and June 2006. Blood was drawn for the IGRAs, QFT-G, and TSPOT, and a TST was then placed.

The study enrolled 692 HIV-infected persons. Mean age was 42 years, 478 (69%) were male, 547 (79%) were African American, and 62 (9%) were foreign-born. The mean CD4 count was 351/ ml, and median viral load was <400 copies/ml. All patients had a TST and QFT-G performed. Nineteen patients (2.8%) had a positive TST result and 32 (4.6%) of 692 persons had a positive QFT-G result.  A subset of patients (n=338) had the TSPOT test performed; 14 (4.2%) had a positive TSPOT. Only one patient had a positive result for all three diagnostic tests and only one patient had both TSPOT and QFT-G positive results. Concordance between the three tests was poor: TST and QFT-G, k= 0.12 (95% CI -0.01 - 0. 26); TST and TSPOT, k= 0.2 (95% CI -0.06-0.46); TSPOT and QFT-G, k= 0.05 (95% CI -0.10-0.20).  An indeterminate QFT-G was seen in 32 (4.6%) patients, and an indeterminate TSPOT was seen in 47 (14%) patients. In multivariate analysis, a CD4 count < 200/ ml was associated with indeterminate QFT-G and TSPOT results (OR=3.4, 95% CI 1.5-7.7 and OR=3.9, 95% CI 1.8-8.1, respectively.)

Overall there was a low prevalence of LTBI in this urban HIV-infected patient population. Among the two IGRAs, indeterminate results were more likely to occur in those persons with CD4 ≤ 200 / ml.  Poor concordance between diagnostic tests for LTBI was documented. This raises concerns about the utility of IGRAs among HIV-infected individuals. Further studies are needed to assess the utility of IGRAs in HIV-infected individuals, particularly in high TB prevalence areas.

—Reported by Naasha Talati, MD
and Henry M. Blumberg, MD
Division of Infectious Diseases
Emory University School of Medicine

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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