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TB Notes 1, 2003

Dear Colleague:

Please be reminded that World TB Day is approaching. World TB Day is held each year on March 24th to commemorate the date when Robert Koch announced his discovery of the bacillus that causes TB. Around the world, TB control programs, nongovernmental organizations, and others take advantage of the increased interest in TB generated by World TB Day to describe their own TB-related problems and solutions, and to support worldwide TB control efforts. CDC strongly encourages state and big city TB controllers to develop specific state or local activities or special messages to take advantage of the press interest that World TB Day will stimulate. As we announced in an e-mail to TB controllers and CDC field staff, we are currently aware of several planning activities in preparation for World TB Day, in addition to a number of events that have occurred or that are already scheduled. These include the following:

  • November 19, 2002 - The National Coalition for the Elimination of Tuberculosis (NCET) established a World TB Day planning committee that is currently drafting tailored messages for use with opinion leaders.
  • March 21, 2003 - A Notice to Readers about World TB Day and TB-related material will appear in the Morbidity and Mortality Weekly Report (MMWR).
  • March 24, 2003 - The U.S. Agency for International Development will sponsor a press conference at the National Press Club.
  • March 27, 2003 - The U.S.-Mexico binational TB card pilot project will be launched in El Paso, Texas.
  • The National Center for HIV, STD, and TB Prevention (NCHSTP) Office of Communications is developing a media advisory relating to TB elimination in connection with the MMWR articles.
  • The World Health Organization and the American Lung Association will issue press releases.

If your TB control program is planning an event around World TB Day, we would like to hear about it. As soon as your event is planned, please send an e-mail summarizing the event to Scott McCoy at We will post these activities on the 2003 World TB Day section of the CDC Division of TB Elimination Web site.

DTBE continues to investigate cases of severe liver injury associated with the use of the regimen of 2 months of rifampin and pyrazinamide (RZ) for the treatment of latent TB infection (LTBI). Revised recommendations for the use of RZ were published in the August 31, 2001, issue of the MMWR. On October 24, 2002, an Epi-X announcement providing an update on severe liver injury associated with RZ treatment for LTBI was posted. A summary of the cases reported to date was published on November 8, 2002, in the MMWR. On September 24, 2002, we sent out a letter to TB control practitioners who prescribe RZ and asked them to complete an important survey, a Patient Cohort Enumeration, that reports the number of persons taking this regimen. Less than 50% of the surveys have been returned to DTBE. Because of the extreme importance of determining the rate of adverse events associated with the RZ regimen, it is imperative that we receive all of these surveys. If you received one of these surveys and have not yet completed and returned it, please do so now. For a more detailed update on the RZ investigation, please see the article by Lauren Lambert in this issue.

Please mark your calendars: the National TB Controllers Workshop is being held this year at the Capitol Hilton in Washington, DC, the week of June 9 - 13, 2003. As you know, this annual meeting and workshop is a chance for all of us in TB control to learn something new, make new contacts, renew old acquaintances, and share our knowledge and experiences with others. The theme of the workshop is "Maintaining Momentum" and will focus on priority program activities or initiatives in the areas of case management, contact investigations, and targeted testing and treatment of latent TB infection. We will send you more information about the meeting as it becomes available.

The Advisory Council for the Elimination of Tuberculosis (ACET) met on November 7 and 8, and again on February 4 and 5, at Corporate Square in Atlanta. In the first meeting, we heard that Dr. Harold Jaffe had been selected as the Director of NCHSTP and Dr. Andy Vernon, formerly project officer for the TB Trials Consortium, had been hired as the NCHSTP Associate Director for Science. I reported that the binational TB card was being tested in several pilot areas. Dr. Charles Nolan described the September 27 visit by ACET members to Washington, DC, to provide information on TB to Dr. Eve Slater, Assistant Secretary for Health, Department of Health and Human Services (DHHS). Dr. Slater was receptive to the presentation, but implied that bioterrorism-related activities would probably have a higher priority for funding than TB programs. Dr. Elsa Villarino of DTBE’s Research and Evaluation Branch (REB) then discussed adverse events involving tuberculin reagents; the group recommended completion of analyses and consideration of publication. In the afternoon, Dr. Ron Valdiserri reported on the November meeting of the DHHS/Department of Justice Workgroup on post-INS detention completion of TB therapy. The INS was clearly receptive to working with DHHS but may have their hands tied in regards to making changes in the law. We heard Dr. Diane Bennett, previously with DTBE and now with the NCHSTP Division of HIV/AIDS Prevention, report on the 1999-2000 US National Health and Nutrition Examination Survey (NHANES) of tuberculin skin test data. The preliminary estimate of the U.S. prevalence of TB infection between 1999 and 2000 was 4.1%, and was substantially higher in foreign-born persons. Dr. John Jereb of the Field Services Branch (FSB) gave an update on INH-associated liver injury; he stated that the surveillance system is imperfect, but that during site visits, health care providers can be educated on the subject and reminded of its importance. Reconvening the next day, we were addressed by Dr. David Fleming, CDC Deputy Director, who expressed his appreciation to ACET members for their service and discussed the need for TB controllers to work closely with bioterrorism programs in building up the nation’s public health infrastructure. Efforts to prepare our nation for bioterrorism attacks will likely increase our readiness for TB outbreaks as well. Drs. Paul Halverson and Michael Hatcher of CDC’s Public Health Practice Program Office, and Ms. Sue Etkind, TB Controller for Massachusetts, gave presentations on public health infrastructure issues. There was general agreement about the need to strengthen the capacity of state and local health departments in the area of TB control, particularly if federal funds are shifted towards other priorities such as bioterrorism. Dr. Zach Taylor of FSB gave an overview of the TB cooperative agreement recompetition process; a major point of discussion was how funds should be distributed among recipients. Members of ACET agreed to send a letter to the Director of CDC requesting that any discussion about or funding for bioterrorism activities should also address the public health infrastructure in general. Another important subject discussed was TB elimination in the southeastern United States; Dr. Stephanie Bailey, Director of Health of the Nashville, Tennessee, health department, discussed a proposal to hold a conference to address TB disparities.

In the February meeting, the following topics were discussed: After the directors’ remarks, I gave an update on the use of the commercial tuberculin skin tests in routine skin testing programs. Some users of the available tuberculin reagents have experienced problems with adverse reactions, false positive reactions, and other events related to product quality. Dr. Michael Iademarco, Associate Director for Science in DTBE, provided an update on the revision of the infection control guidelines. This has been a tremendous undertaking and will produce a detailed, comprehensive document that reflects CDC’s current recommendations for preventing M. tuberculosis transmission in health care settings. The afternoon was devoted to several discussions related to TB among persons not born in the United States. Ms. Fran DuMelle of the American Lung Association (ALA) reported on current legislation affecting domestic TB activities, and Dr. Joanne Carter of the nonprofit group Results gave an update on the current legislation pertaining to international TB issues. We have learned that there will be a modest increase in fiscal year 2003 funding for TB control ($3.8 million). Dr. Sarah Royce shared with us the State of California’s experiences in tracking and following Class B immigrants and refugees. Dr. Susan Maloney of CDC’s Division of Global Migration and Quarantine (DGMQ) reported on CDC’s progress in improving the process of conducting overseas TB screening and stateside notification of TB cases. The staff of DGMQ have made great strides in updating and streamlining this process, including the development and implementation of several new forms, but much remains to be done. Mr. Michael Qualls of the International Activities office in DTBE gave a report on the TB Coalition for Technical Assistance, which was followed by a report from Dr. Anne Fanning, representing the International Union Against TB and Lung Disease (IUATLD), on its current activities. The next day Dr. Eric Blank, representing the Association of Public Health Laboratories (APHL), gave a report on the Fourth National Conference on Laboratory Aspects of TB, which was held in December in San Francisco. The conference provided attendees with information on current technical and programmatic issues including quality assurance, delivery of optimal TB laboratory services in response to the changing epidemiology of TB in the United States, and the applications and impact of new technologies and recommendations for drug susceptibility testing. In addition, he gave an update on a national task force to improve TB laboratory services. Dr. Stephanie Bailey reported on the progress of the workgroup on TB in the southeastern United States and in U.S.-born African Americans. Funding has been awarded to the sites conducting research and the studies are scheduled to begin soon. I then gave an update, along with Dr. Gene Migliaccio of the Immigration and Naturalization Service (INS), about the ongoing discussions between CDC and INS on ways to improve completion of therapy in persons with TB being held in INS custody. And finally, Mr. Scott McCoy of DTBE’s Communications and Education Branch shared with us the plans for World TB Day, which include the official kick-off of the binational TB card pilot project in Texas on March 27.

As usual, DTBE staff have been involved in the development of several publications and training products. A Mantoux Tuberculin Skin Test Training Materials Kit is now available for ordering; please see the related article in this issue. DTBE recently worked with staff of the MMWR to develop and distribute an MMWR Dispatch - initially distributed in electronic format only - that provides guidance on the use of the QuantiFERON®-TB test, a new skin test for latent TB infection that uses serum instead of tuberculin. The recommendations were also published on January 31, 2003, in the MMWR Recommendations and Reports series; you can access the report at In addition, the TB treatment statement was published February 15 in the American Journal of Respiratory and Critical Care Medicine (Am J Respir Crit Care Med 2003; 167: 603-662). This document puts forth TB treatment guidelines developed by the American Thoracic Society, the Infectious Diseases Society of American, and CDC. The statement can be accessed electronically at Later this year, CDC will publish the same document in the MMWR Recommendations and Reports series.

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.


Released October 2008
Centers for Disease Control and Prevention
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