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TB Notes 4, 2006
Director's Letter
Highlights from State and Local Programs
  Los Angeles Presents "The Opera and Perspectives on TB"
  Arizona's and Sonora's Meet and Greet Program for Deportees with TB
  The Flex Power of Memoranda of Agreements (MOAs)
  HIV Status Not Routinely Determined for TB Cases: an Evaluation of Four California Local TB Programs
CDC/ATSDR Group Award for Minority Health Mentor/Champion of Excellence
Laboratory Update
  New Technologies Unveiled at the 2006 National TB Controllers' Workshop
Nursing Updates
  The Red Snappers of National Tuberculosis Nurses Coalition (NTNC)
  Pacific Island TB Controllers Association (PITCA) -  Workshop for Nurses
TB Education and Training Network Updates
  Member Highlight
  Sixth Annual Conference Highlights
  Cultural Competency Subcommittee Update
Communication, Education, and Behavioral Studies Branch Update
  New Communication Efforts to Stop TB in the African-American Community
Clinical and Health Systems Research Branch Update
  Using a Private Claims Database for TB Health Services Research, Evaluation, and Analysis
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  9th Semiannual Meeting of the Tuberculosis Epidemiologic Studies Consortium
  TBESC Task Order #10: Monitoring Performance and Measuring Cost of TB Public Health Practice at County and State Health Departments: Are We Making a Health Impact?
New CDC Publications
Personnel Notes
Calendar of Events
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TB Notes Newsletter

No. 4, 2006

Director's Letter - December 2006

Dear Colleagues:

For 2005 we reported the good news of another decrease in the overall number of new tuberculosis (TB) cases, with 14,097 confirmed cases and a case rate of 4.8/100,000. This compares with 14,515 cases and a 4.9/100,000 case rate for 2004. Our hard-working state and big city TB control staff accomplished this despite the many fiscal and programmatic challenges facing them. The state of Wyoming reported zero TB cases for 2005 (and in fact did this in 1989 as well!). Please accept my congratulations for the outstanding work all of you are doing. However, we cannot be complacent. National figures mask some worrisome underlying trends: there has been a slowing in the rate of decline for the past 3 years, and 20 states reported an increase in the incidence of TB.

The Advisory Council for the Elimination of Tuberculosis (ACET) met July 26–27 and December 5–6 in Atlanta. In the July meeting, Dr. Ron Valdiserri announced he would be leaving CDC to join the Veterans Health Administration in Washington, DC, and Dr. Masae Kawamura finished her 2-year commitment as Chair of ACET; Dr. Michael Fleenor of Alabama will serve as ACET’s new Chair. I announced the release of DTBE’s newest TB control guidelines, “Prevention and control of tuberculosis in correctional and detention facilities: recommendations from CDC,” (MMWR 2006; 55 [No. RR-9]). I also reported that on May 16 and 17 in Atlanta, CDC and RTI International hosted a successful summit, “Stop TB in the African-American Community.” DTBE staff were planning the annual TB Education and Training Network conference (please see Scott McCoy’s summary of that conference in this issue) as well as the TB Managers’ Course. I reported that US Public Health Service/TB Trials Consortium (TBTC) Study 26 underwent review in May 2006 by the Data Safety Monitoring Board, which recommended continuation of the study. This trial of short-course treatment of latent TB infection uses a 3-month once-weekly regimen of isoniazid and rifapentine, compared to standard 9-month therapy with isoniazid. Enrollment continues for Study 28, a trial substituting moxifloxacin for isoniazid in standard intensive-phase TB treatment and assessing the effect on 2-month sputum conversion rates. This could be a defining study for fluoroquinolones in TB treatment regimens. I mentioned that as of June 30, 2006, states had submitted 18,386 isolates to the contract laboratories for genotyping. I also related news of the upcoming departures of several valued DTBE staff: Dr. Lisa Nelson was leaving to head up CDC’s TB/HIV office in Mozambique, Subroto Banerji was taking a position as a public health advisor assigned to South Africa for CDC’s Global AIDS Program, and Dr. Michael Iademarco had accepted the position of Health and Human Services (HHS) Health Attache for Vietnam.

Dr. Mary Naughton of the Division of Global Migration and Quarantine (DGMQ) and I discussed issues around civil surgeons, who examine patients here in the United States applying for a change of their immigration status. The US Citizenship and Immigration Services (USCIS) will be revising the civil surgeon rule to strengthen civil surgeon qualifications and will transfer funds to CDC for its continued technical assistance with the program. Dr. Drew Posey of DGMQ discussed the revised Technical Instructions for overseas TB screening of immigrants: diagnostic testing will be more comprehensive, children will be required to be medically evaluated, the medical exam will be valid for only 3 months, and treatment for TB must be given overseas as directly observed therapy. Dr. Posey and Kai Young of DTBE gave updates on TB in the Hmong refugees being resettled in the United States. After the treatment algorithm was revised in early 2005, case rates of TB, including MDR TB, declined from 508/100,000 in refugees who were resettled June 2004–January 2005 to 69/100,000 in those resettled February 2005–July 2006. Also, Dr. Tom Navin reported on the TB Evaluation Workgroup’s process to readdress and better define high-priority national TB program objectives.

ACET met again on December 5 and 6. Dr. Michael Fleenor and CDC committee management staff gave new members an orientation in which ACET’s role as a public health advisory council was described. Dr. Fleenor provided an overview of some of ACET’s major initiatives between 2003 and 2006. These have included meetings and communications focused on improving U.S. TB control efforts in African Americans and foreign-born populations and increasing the funding for TB drug research. I reported that in 2006, CDC/DTBE was invited by local/state health departments to assist with five outbreak investigations; the affected populations included two foreign-born communities, two groups of drug users, and a large group consisting of sailors and civilians traveling together aboard a U.S. Navy ship. I also provided an update on the ongoing process and timetable for revising the TB case report form (Report of Verified Case of TB). The revision team is currently requesting comments from TB partners and will ask ACET to review the proposed revision in early 2007; CDC and OMB clearances are expected in another year, and availability of the new RVCT is estimated for 2009. I cited the achievements of the Regional Training and Medical Consultation Centers: combined, they have completed over 200 hours of training and have trained over 500 participants annually. They have developed a number of new education and training products and have established medical consultation services. I also provided an update on the “Projects to Intensify Efforts for Reducing TB Rates in African-American Communities.” In 2002, ACET called for CDC to address high rates of TB in African-American communities; as a result, DTBE competitively awarded supplemental funds to Georgia, South Carolina, and Chicago for the development, implementation, and evaluation of TB-reduction interventions in these communities. We learned a number of lessons from these projects: partnerships with community organizations serving African Americans are crucial; care providers must be culturally acceptable and physically accessible to patients; and patient mistrust, misconceptions, and fear of stigma must be overcome. I reported on the TB Epidemiologic Studies Consortium’s Task Order 18, which will evaluate new Interferon-gamma release assays for the diagnosis of LTBI in health care workers, and compare these assays to the tuberculin skin test (TST). This will be a longitudinal study of about 2500 health care workers who will be retested every 6 months until they have been retested at least three times. Participating sites include the health departments of Texas, Maryland, and Denver, and Columbia University.

I then shared DTBE’s budget plans. We anticipate that for fiscal year (FY) 2007, the division will experience an overall 5% budget cut. DTBE branches are currently reviewing areas where reductions can occur. Hiring actions will be postponed, and funding will be reduced for cooperative agreements and research projects. Funding for travel, printing, and information technology infrastructure will be reduced. Our budget planning will include consultations with our national TB control partners and with ACET.

Dr. Charles Wells gave an overview of extensively drug-resistant (XDR) TB and its implications for TB control. Some of the countries of origin of U.S. foreign-born TB patients also have a high burden of multidrug-resistant (MDR) TB and a high risk of XDR TB, such as Mexico, the Philippines, and Vietnam. Increases in MDR TB and XDR TB would create increasing demands on the capacity of U.S. laboratories. In addition, XDR TB would likely have a negative impact on U.S. initiatives for HIV treatment and care, as well as U.S. capacity to respond to outbreaks and provide treatment. He cited a need for updated policies and guidelines as well as a comprehensive U.S. government response. In updates on the resettlement of Hmong and Burmese refugees, we learned that the prevalence of TB is similar among the two groups, but that the prevalence of MDR TB is much lower among the Burmese. Dr. Drew Posey, DGMQ, gave an update on the Technical Instructions for Overseas Screening and Treatment of Tuberculosis. DGMQ is developing a manual that will provide information on implementing the new Technical Instructions; it will be used by DGMQ and panel physicians. A draft is expected in June 2007 and will be provided to NTCA and ACET. Members of NTCA and ACET are reviewing the current draft of the Technical Instructions. We learned from Dr. Bill Mac Kenzie that in 2005, persons from Mexico made up 14% of the total U.S. cases. Drug-susceptibility testing is limited in Mexico; to address this, a national survey for TB drug resistance is planned for that country. Ms. Molly Lindner of USAID Mexico provided an update on TB projects in Mexico supported by USAID. Joe Scavotto gave a progress report on DTBE efforts to develop a redistribution formula for the TB cooperative agreement funding; discussions on this topic will continue. Dr. Phil LoBue indicated that the Federal TB Task Force will be refocusing on the global threat of XDR TB; members are discussing potential areas of coordinated U.S. government response. Mr. Scott Danos reported that the current electronic TB surveillance system, TIMS, will definitely still be in place for calendar years 2007 and 2008. After that, it will be replaced by the National Electronic Disease Surveillance System (NEDSS) TB program area module, a web-based system with instant messaging of RVCT data to CDC.

Two new slide sets are available on the DTBE Internet, the 2005 Surveillance slide set and the slide set that accompanies the MMWR publication “Guidelines for preventing the transmission of M. tuberculosis in health-care settings, 2005.”

My heartfelt thanks to all for your outstanding work and accomplishments this year, and best wishes for a safe and peaceful holiday season!

Kenneth G. Castro, MD


Released October 2008
Centers for Disease Control and Prevention
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