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Newsletters > TB Notes Newsletter > TB Notes
3, 2008 > Directors Letter
TB Notes Newsletter
No. 3, 2008
Directors Letter
Dear Colleague:
The 57th annual Epidemic Intelligence Service (EIS) conference,
which is held in Atlanta, convened this year April 14–18. The
Division of Tuberculosis Elimination (DTBE) had a very successful
week of research presentations and recruitment. DTBE has recruited
three new EIS officers from the incoming class; we welcome them to
the division. Please see the summary of this conference provided by
Kevin Cain and Tim Holtz in this issue.
The 2008 National TB Controllers Workshop, sponsored by the
National Tuberculosis Controllers Association (NTCA), was held June
10–12 at the Crowne Plaza Hotel in Atlanta. My last TB Notes Dear
Colleague letter devoted only a paragraph to the workshop; in this
letter I will share some of the highlights of this important
meeting.
The theme of the meeting was the appropriate and timely message
of “Many Cultures, One Cause.” Several preworkshop activities were
held on June 9, including the Advanced Medical Practitioner's
Meeting. At that session, the National Society of TB Clinicians was
formed. The Society will function as a section within the NTCA; its
purpose will be to advance the elimination of TB in the United
States and its Territories. Members of the Society will work in
partnership with the TB control officials to provide the clinician’s
perspective on issues vital to the success of eliminating TB.
The main activities of the workshop began on June 10. The first
general session featured a number of welcomes and updates, including
a motivational keynote speech by Stephanie Bailey, Chief of Public
Health Practice at CDC. Asserting that health protection investments
produce health system value, she challenged us to harness the
incredible technology at our disposal to reduce health disparities
and improve the health equity of all U.S. residents. During breaks,
participants were able to view and discuss the posters on display,
which represented some of the excellent work being done by TB
control staff in this country. Please see the related article in
this issue about the winners of the poster contest.
We also heard about some of the challenges of quarantine and
global migration, with updates on the Electronic Disease
Notification (EDN) system and the new 2007 TB Technical Instructions
(TB TI) for Panel Physicians (physicians who examine foreign
citizens applying for entry into the United States as immigrants or
refugees). Gisela Schecter of the California Department of Public
Health described the site visit that was conducted in May–June 2008
to evaluate the screening program for U.S.-bound Philippine
immigrants using the new 2007 TB TI. The evaluation team reported
that the Philippines TB screening program has done an outstanding
job of developing thorough and effective procedures for implementing
the TB TI; more than 21,000 patients have been screened using the TB
TI since October 2007. The team found that implementation of
mycobacterial culture in the screening process has produced
improvements. Through March 2008, the program detected 244 TB cases
among screened applicants; among those, 142 were smear-negative and
culture-positive for M. tuberculosis and would not have been
detected using the old screening instructions. The Division of
Global Migration and Quarantine (DGMQ) has also updated the
Technical Instructions for Civil Surgeons (physicians who perform
the medical examinations of aliens within the United States). Please
see Mary Naughton’s related article in this issue.
The third general session was dedicated to challenges encountered
with specific social cultures. We heard sobering statistics that
reminded us of the serious health disparities between white,
non-Hispanic U.S. residents and racial/ethnic minority populations
in this country that make cultural competency so compelling and
important. Some of the presentations in this session reminded us
that the challenges we face in treating TB patients can arise not
only from the patient’s culture, but from that of the institution
housing the patient. For example, we heard descriptions of the
cultural divide between corrections and public health staff; two
presenters noted that corrections and public health do not speak the
same language, and that each culture must try to understand and
respect the other’s mission and purpose.
The last general session dealt with the changes in practice and
technology that TB controllers are experiencing. Patrick Moonan
introduced TB GIMS (the Tuberculosis Genotyping Information
Management System), which will advance genotyping information
management from local, ad hoc reports to national, standardized
reports. This will automate the process of submitting isolate
information, reporting genotyping results, and tracking and
analyzing data. Dolly Katz, Smita Chatterjee, and Margaret Oxtoby
presented results from an NTCA survey about the Translating Research
into Practice (TRiP) workgroup. The survey results indicated several
key points for successfully translating research into practice: 1)
it helps to start small, 2) it’s important to show how the change
can benefit stakeholders, 3) for change to be institutionalized, it
needs to be written down, and 4) remember that legislators and
administrators can be your friends. The final session topic dealt
with challenges with the patient. These presentations essentially
confirmed what we know: that it takes collaboration among TB
control, nursing, laboratory, and legal staff to manage challenges
with patients. Please mark your calendars: the 2009 NTCA Workshop
has been set for June 15–19, 2009. I hope to see you there!
On a final note, I am happy to report that on July 31, President
Bush signed H.R. 5501, the Lantos-Hyde U.S. Global Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of
2008. The bill provides a 5-year strategy for confronting AIDS, TB,
and malaria, authorizing $48 billion for these global health
programs. The legislation also addresses TB prevention and control,
incorporating language from the Stop TB Now Act. The measure allows
expansion of the U.S. Agency for International Development's (USAID)
global TB control activities, and commits $4 billion over the next 5
years to treat and prevent TB, the biggest killer of people with
HIV/AIDS. The authorization supports treatment for 4.5 million TB
cases, and diagnosis and treatment of 90,000 new MDR cases by 2013.
In addition, Congress recently passed the Comprehensive TB
Elimination bill, which reauthorizes domestic TB programs. As of
this writing, the measure is awaiting signature by the President.
Thanks to the many partners who make themselves available to answer
policymakers' questions about TB prevention and control.
Kenneth G. Castro, MD
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