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TB Notes Newsletter

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Return to Main Menu - TB Notes 1, 2008

Directors Letter

Dear Colleague:

The 38th Union World Conference on Lung Health was held in Cape Town, South Africa, November 8–12, 2007. Sponsored by the International Union Against Tuberculosis and Lung Disease (The Union), it was held at the Cape Town International Convention Centre (CTICC). The theme of the conference was "Confronting the Challenges of HIV and MDR in TB Prevention and Care." Other key international issues, such as tobacco control, child lung health, and asthma, were also addressed. Conference organizers believed it was appropriate for the World Conference to be held in Cape Town and to have a theme highly relevant for South African and other African colleagues. African health professionals daily confront the burden of HIV/AIDS and TB coinfection and its medical, health, social, and economic consequences, despite serious challenges and resource constraints. The conference addressed these constraints to effective prevention and care while taking into consideration broader issues.

The region of South Africa this year has attracted much medical attention from TB and lung health experts owing to the emergence of extensively drug-resistant strains of TB (XDR TB); the continuing epidemic of patients coinfected with TB and HIV; and the critical need for new drugs, diagnostic tools, and resources to address these problems. Speakers and delegates from more than 100 countries made presentations and led discussions. The conference included a special guest lecture and awards ceremony; three plenary sessions; 13 postgraduate courses; 11 full-day and two half-day courses; seven workshops; and 40 symposia. Topics ranged from rapid detection of drug resistance and transmission dynamics of MDR and XDR TB to ensuring integrated TB/HIV care and quality management for laboratory services. The Union/CDC latebreaker session was held again this year.

At the opening ceremony of the Union conference, plans for the 2008 World TB Day campaign were announced by Stop TB Ambassador Anna Cataldi. She announced that a campaign aimed at challenging people all over the world to do their part to fight TB will be launched in 2008 in the months before World TB Day, March 24. “The slogan, ‘I am stopping TB,’ says that everyone can take an active role in helping all people in need gain access to accurate TB diagnosis and effective treatment," Ms. Cataldi said. World TB Day is an opportunity for all of us in TB control to take stock of our progress and problems in overcoming TB worldwide and to renew our efforts.

The Advisory Council for the Elimination of Tuberculosis (ACET) convened November 27–28, 2007, in Atlanta. Dr. Hazel Dean, acting Deputy Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), provided updates on NCHHSTP activities and staff. She discussed NCHHSTP priorities, which include reducing health disparities; implementing program collaboration and service integration (PCSI) activities at the client level; and maximizing relationships among NCHHSTP divisions that are global in nature. I provided the DTBE Director’s update, including the announcement that the 2006 TB surveillance report is now available. Included in the report for the first time is a graph reflecting U.S. cases of extensively drug-resistant (XDR) TB during 1993–2006; there were 48 cases reported in 13 states and New York City. I reported that TBTC Study 28 has been completed; this trial assessed the impact on sputum conversion rates of substituting moxifloxacin for isoniazid in the standard intensive phase of TB treatment. The study found that the moxifloxacin arm had a slightly higher (although statistically nonsignificant) sputum conversion rate, and had excellent tolerability.

Ms. Fran DuMelle outlined several legislative proposals that could result in congressional funding for certain TB control activities such as the development of new tools for the elimination of TB, the expansion of DOTS coverage, and treatment of individuals with TB/HIV and those with MDR or XDR TB. We heard the latest update from Dr. Dolly Katz about the revision of the guidelines for controlling TB in foreign-born persons; first drafts have been completed for most sections. Dr. Drew Posey of the Division of Global Migration and Quarantine (DGMQ) reported that the CDC Technical Instructions for Panel Physicians were finalized and are posted on the CDC website. The instructions have been implemented in Mexico, the Philippines, and Thailand; Vietnam and other areas will begin soon. Dr. Francisco Averhoff of DGMQ discussed the use of homeland security tools for public health purposes, such as the “Do not board” order; since May 2007, CDC has requested 17 such orders for persons with known or suspected infectious TB. Dr. Diana Schneider gave a comprehensive presentation on case management and legal issues in the border region, and the progress being made by the Transnational TB Continuity of Care Workgroup.

Dan Ruggiero of DTBE and Donna Wegener of the Southeast Regional Training and Medical Consultation Center (RTMCC) gave updates about the activities and accomplishments of the four RTMCCs. In 2006, the RTMCCs provided over 100 courses that resulted in the training of 7,126 health care workers, disseminated 3,850 products online, and provided 1,720 medical consultations. Dr. Wanda Walton and Dr. Tony Catanzaro gave updates on the National Strategic Plan for TB Training and Education and the National Tuberculosis Curriculum Consortium (NTCC), respectively. Both are coming to the end of their coverage period and must review options for future development and activities. Dr. Rick Goodman reviewed the issues relevant to public health TB control laws in the setting of emerging drug-resistant TB and described options for conducting an updated review of TB control laws. Dr. John Ridderhof discussed the capacity of U.S. laboratories to do second-line drug-susceptibility testing (DST) and areas needing improvement, such as turn-around time. He also summarized a World Health Organization (WHO) Expert Meeting held July 2007 to discuss policy guidance on second-line DST; meeting participants concluded by recommending rapid rifampicin testing in high-risk settings for screening, but said that conventional DST is still the gold standard.

Dr. Ann Buff summarized the contact investigation around the traveler with suspected XDR TB; the extensive investigation found no evidence of M. tuberculosis transmission from the patient. Mr. Shannon Jones briefed us on action steps and recommendations developed by the TB in African Americans workgroup. Dr. Michael Leonard, representing the Infectious Diseases Society of America (IDSA), gave an update on the letter sent to the American Thoracic Society (ATS) and IDSA expressing concerns about use of fluoroquinolones in treating community-acquired pneumonia. Concerns are that the use of fluoroquinolones could delay a diagnosis of TB, and also that fluoroquinolone monotherapy could lead to resistance. ATS agreed with these concerns, but suggested CDC should address them in its guidelines. I suggested resubmitting the letter to other infectious and respiratory disease groups; this discussion will continue. Edward Nardell gave an update on the BCG workgroup, which is revisiting the use of BCG for the protection of health care workers, students, and others in foreign settings having a high prevalence of MDR or XDR TB. After discussing additional business, we adjourned and will reconvene in March 2008.

As I mentioned above, March 24 is observed as World TB Day around the globe. World TB Day provides an opportunity to communicate TB-related problems and solutions and to support worldwide TB-control efforts. Every year, DTBE posts data on U.S. trends in TB, reports of state and local World TB Day activities, and training and educational materials that can be ordered or downloaded. Please visit the DTBE website for information about the 2008 campaign and materials you can use to promote TB control efforts in your area.

Kenneth G. Castro, MD

 
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