TB Notes Newsletter
No. 2, 2013
As I related in recent e-mails to staff, I have been asked to serve as Acting Director, Division of HIV/AIDS Prevention (DHAP), until they identify a permanent Director. With some reluctance, I have agreed to work in this capacity on a time-limited basis, starting August 19. I have recommended to Center leadership that Dr. Phil LoBue serve as interim DTBE Director while I am on TDY.
It is with profound sadness that I report the passing of two former TB public health advisors, Louis Salinas and Bertrand W. Russell. Although they both left DTBE some time ago, many of you may remember them, especially those of you in the field. Please see the In Memoriam section of this issue to read about their important contributions and accomplishments.
As many of you know, CDC grantees received a letter in March from CDC’s Procurement and Grants Office, stating that a series of spending cuts will cancel approximately $85 billion in budgetary resources across the federal government for the remainder of the federal fiscal year. Because of these cuts, very difficult decisions are being made regarding staffing and program activities. Shortages of TB drugs and diagnostics have also hindered TB program work. Yet in the face of these challenges, the U.S. TB case count is under 10,000 for the first time ever. I appreciate that you are maintaining your resilience and remaining focused on the work that needs to be done.
The Federal TB Task Force (TBTF) met in Bethesda, Maryland, on April 8. The TBTF is a coalition of federal agencies involved in U.S. TB research and control efforts. It facilitates coordination of activities among these agencies. Dr. Christine Sizemore of the National Institutes of Health (NIH) and I currently serve as co-chairs. At this meeting, a major topic of discussion was the shortage of TB drugs and diagnostic products. We shared updates regarding our efforts, in collaboration with the Food and Drug Administration (FDA), to find ways to address these shortages.
There is now some good news: isoniazid is available again. The shortage of PPD tuberculin solutions is being resolved as well. The supply of Aplisol (JPH Pharmaceuticals) is normal and stable, and the supply of Tubersol (Sanofi) is back to normal, although the distribution chains have not been restored fully. A link to the FDA website on shortages of biological agents including tuberculin PPD solutions is at http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/Shortages/default.htm
The 62nd conference of the Epidemic Intelligence Service (EIS) was held April 22–26, 2013, in Atlanta. This conference is an annual scientific meeting for the national and international public health community. At the conference, EIS officers present investigation findings, epidemiologists discuss current topics, presentations highlight CDC’s epidemiologic activities, public health professionals network and share ideas, and CDC programs recruit new EIS officers. Please see the summary in this issue about the TB-related presentations given this year.
The Advisory Council for the Elimination of Tuberculosis (ACET) met in Atlanta June 4 and 5. I shared DTBE’s proposed strategic vision, which has three components: retain our optimistic goal of eventual TB elimination in the U.S.; bridge the current gaps in implementation, knowledge, and ambition; and focus our activities so as to address challenges and opportunities. Dr. Jon Warkentin suggested that it is time to update the joint CDC/ACET document, Essential Components of a Tuberculosis Prevention and Control Program, http://www.cdc.gov/MMWR/preview/MMWRhtml/00038823.htm. Dr. Christine Ho gave an update on the Affordable Care Act (ACA), reminding us that guarantees for inherently governmental public health services were not the goal of the ACA, and that expansion of the ACA will not really decrease the need for CDC and health department partners to provide these critical services. We also discussed drug and diagnostics shortages. Presenting the field perspective, Dr. Jennifer Flood suggested that DTBE consider forming a team dedicated to addressing drug supply issues as one way to prevent shortages in the future. Providing the CDC perspective, Dr. Sundari Mase noted that shortages are most often caused by manufacturing issues. Possible proactive solutions include creating a TB drug repository, as well as working with the HHS repository to stockpile TB drugs. We also heard updates on TB in correctional settings, in homeless populations, and in persons residing along the US/Mexico border. These populations have multiple and complex risk factors, contributing to increased rates of TB in these groups. We need to continue to look for opportunities to partner with others to reduce TB in these hard-hit groups. The next ACET meeting is planned for December 3-4, 2013.
The 2013 National TB Conference was held in Atlanta from June 11 to 13, 2013. In this issue, we have included information on the winners of the annual poster competition as well as the recipients of the NTCA special awards.
Kenneth G. Castro, MD
Assistant Surgeon General, USPHS, & Commanding Flag Officer
CDC/ATSDR Commissioned Corps
Director, Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention