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TB Notes 4, 2007
Director's Letter
Highlights from State and Local Programs
  Delaware’s Lang TB Clinic Team Selected as Finalist for 2006 Team Excellence Award
New Tools Available to Help With Program Evaluation
TB Education and Training Network Updates
  Member Highlight
  Seventh Annual Conference Highlights
  TB ETN Cultural Competency Workgroup Update
  Second Annual Focal Points Meeting
Data Management and Statistics Branch Update
  Public Health Information Network (PHIN) Conference Held in August 2007
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  11th Semiannual Meeting of the TB Epidemiologic Studies Consortium
  CDC Team Teaches TB/HIV Operational Research Course in Kiev, Ukraine
  2006 Annual Surveillance Report
New CDC Publications
Personnel Notes
Calendar of Events
 
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TB Notes Newsletter

No. 4, 2007

SURVEILLANCE, EPIDEMIOLOGY, AND OUTBREAK INVESTIGATIONS BRANCH UPDATE

11th Semiannual Meeting of the Tuberculosis Epidemiologic Studies Consortium

The 11th Semiannual Meeting of the Tuberculosis Epidemiologic Studies Consortium (TBESC) was held on July 12–13 in Atlanta. The primary purpose of the TBESC is to conduct epidemiologic, behavioral, economic, laboratory, and operational research in TB prevention and control.

Over 75 persons participated in the meeting. Attendees included CDC staff, TBESC principal investigators, project coordinators, and project specific personnel.

TBESC members and CDC staff gave updates on the status of ongoing TBESC research projects and activities. Administrative and fiscal issues were also discussed.

Topics included-

  • Tuberculosis in the foreign-born
  • Acceptance and completion of latent TB infection (LTBI) treatment in the US and Canada in 2002
  • New developments in the diagnosis of TB and LTBI
  • Administrative and fiscal updates on consortium-related activities
  • Update on the Semiannual Tuberculosis Advisory Review (STAR) process
  • Updates from the Process Evaluation and  Research Committees
  • Update from the Translating Research into Practice (TRiP) Workgroup

It is a very exciting time for the consortium with a number of its studies in the data analysis phase and others reporting results and describing implications for TB programs. Manuscripts from TBESC studies on pediatric TB and use of network analysis to characterize TB transmission patterns were recently accepted for publication in journals.

For more information on the TBESC, please visit our website at www.cdc.gov/tb/TBESC/default.htm.

—Reported by Indhira Gnanasekaran, MPA
TBESC Project Manager

CDC Team Teaches TB/HIV Operational Research Course in Kiev, Ukraine

A team of CDC epidemiologists and technical experts recently collaborated with two international partners, the World Health Organization (WHO) and the KNCV Tuberculosis Foundation, to conduct a TB/HIV Planning & Operational Research Workshop in Kiev, Ukraine, May 7–12, 2007. CDC team members were Julia Ershova, Senior Service Fellow, Division of Epidemiology and Surveillance Capacity Development, Coordinating Office of Global Health; Ann Buff, EIS Officer, DTBE, NCHHSTP; Kashef Ijaz, Chief, Field Services and Evaluation Branch, DTBE, NCHHSTP; and Timothy Holtz, Medical Epidemiologist, DTBE, NCHHSTP.  Nineteen epidemiologists and physicians from Russia, Belarus, Moldova, and Ukraine participated in the workshop. The goals of the course were to promote TB/HIV collaborative activities at the national and regional levels and for each country team to develop a TB/HIV operational research proposal focused on improving operations between TB and HIV programs.  The CDC team taught applied epidemiology and provided mentoring to country teams.

Participants in the TB/HIV Planning & Operational Research WorkshopThe first day of the workshop, Monday, was filled with introductions, country presentations, and discussion of possible WHO collaborative activities for national TB and HIV programs.  Each country team presented an overview of the epidemiology of TB/HIV, challenges of TB/HIV control, and potential TB/HIV collaborative efforts in their respective countries. The second day consisted of presentations by Drs. Buff, Ijaz, and Holtz to lay the groundwork of basic epidemiologic analysis, research design, and study proposal development. The class particularly enjoyed an interactive sampling techniques exercise in which CDC pens and travel mugs were awarded for “sampled” participants. Julia Ershova spent Wednesday and Thursday teaching CDC’s statistical software program, Epi-Info. The class used the Russian version of Epi-Info for practical exercises with data from a real epidemiologic investigation. Participants were eager to show off their data analysis and graphing skills at the end of each exercise.  After two and a half days of intense epidemiology training, the class was ready for a break from the classroom. On Thursday afternoon, participants visited one of two field sites in Kiev. Half the class visited a harm reduction center funded by a coalition of non-governmental organizations working in HIV/AIDS where all clients receive HIV testing, counseling, and educational support services. The other half visited a TB control program dispensary where TB patients receive medical care, counseling, and support services. 

Presentation on the ethics of medical researchOn Friday, the country team members spent several hours fine-tuning their proposals, and the CDC epidemiologists presented the final lectures. Dr. Holtz presented a discussion of the ethics of medical research, a new topic for many of the class participants. On Saturday morning, teams pitched their preliminary proposals with formal 15-minute PowerPoint presentations. Each country team developed a solid operational research proposal, incorporating many of the principles and techniques presented during the workshop. Going forward, DTBE epidemiologists will continue to provide mentoring as teams finalize and submit their proposals for ethical review. WHO and KNCV Tuberculosis Foundation will provide seed funding for each finalized proposal and oversight during the research phase. 

Workshop participants had the opportunity to evaluate the workshop and all participants rated the quality of presentations as “very good” or “excellent.”  Participants particularly valued the interactive nature of the course and rated the skills taught as very useful.  This workshop was also a valuable opportunity for DTBE to enhance epidemiologic capacity in Eastern Europe and to strengthen relationships by collaborating with our international partners, the WHO and KNCV Tuberculosis Foundation.

—Reported by Ann Buff, MD
Div of TB Elimination

2006 Annual Surveillance Report

This year’s annual surveillance report, Reported Tuberculosis in the United States, 2006, was released in October 2007, and is posted on the Internet at www.cdc.gov/tb/surv/default.htm. Hardcopy versions will be available in November 2007.

Statistical highlights of Reported Tuberculosis in the United States, 2006, include the following:

  • Case counts: 13,779 TB cases were reported to CDC from the 50 states and the District of Columbia, representing a 2.1% decrease from 2005
    • 20 states reported increases in case counts
    • California, New York, Texas, and Florida accounted for 48% of the overall 2006 national case total
    • For the third consecutive year, Hispanics (30%) exceeded non-Hispanic blacks (27%) as the racial/ethnic group with the largest percentage of total cases
    • Blacks or African-Americans represented 44% of TB cases in U.S.-born persons and accounted for approximately 19% of the overall national case total
    • Hispanics and Asians together represented almost 80% of TB cases in foreign-born persons and together accounted for almost 45% of the overall national case total
  • Case rates: The TB case rate declined from 4.7 to 4.6 per 100,000 population, representing a 3.1% decrease from 2005
    • 12 states and DC reported rates above the national average
    • 26 states met the definition for low incidence (<3.5 cases per 100,000 population)
    • The TB case rate was 2.3 per 100,000 for U.S.-born persons and 22.0 for foreign-born persons
    • Asians and Native Hawaiians or Other Pacific Islanders continue to have the highest case rate among all racial and ethnic groups
  • Burden in the foreign-born: The proportion of all cases occurring in foreign-born persons was 57%
    • 27 states had >50% of total cases among foreign-born persons
    • 11 states had >70% of total cases among foreign-born persons
    • The top five countries of origin of foreign-born persons with TB were Mexico, the Philippines, Vietnam, India, and China
  • Drug resistance: The proportion of cases with primary multidrug-resistant TB was less than 1.0%.
  • Updated case counts are given for each year from 1993 through 2005
  • The calculation of completion of therapy was changed to present data only for cases where therapy of 1 year or less was indicated
  • A new slide depicting the case counts for XDR TB cases since 1993 was added to the standard slide set

Following are suggested citations for hard copy and online versions:

Hard copy: CDC. Reported Tuberculosis in the United States, 2006. Atlanta, GA: U.S. Department of Health and Human Services, CDC; October 2007.

Online: CDC. Reported Tuberculosis in the United States, 2006 [online]. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2006. Available at www.cdc.gov/tb/surv/surv2006/default.htm.

—Reported by Sandy Althomsons
Div of TB Elimination

 


Released October 2008
Centers for Disease Control and Prevention
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