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No. 1, 2009


Revised Self-Study Modules on Tuberculosis

Background. The Self-Study Modules on Tuberculosis, modules 1–5, were originally published by CDC/DTBE in 1995. These important TB education materials were developed in response to the 1985–1992 U.S. resurgence of TB. Large cities were hit hardest by the resurgence, so much so that the New York City Bureau of TB Control was compelled to hire new public health workers to help address this public health emergency. These new workers needed basic training about tuberculosis and TB control, and the Bureau turned to DTBE for help in 1992. Wanda Walton of DTBE facilitated the development of concise, easy-to-understand, scientifically accurate materials for these new staff. The materials were well received, leading Dr. Walton and colleagues in DTBE to revise and more fully develop these materials into training modules that could be used in any U.S. setting by any health worker new to TB control. Thus in 1995 the Self-Study Modules on Tuberculosis series was created for national distribution.

These booklets have served as an important resource in training scores of new TB control workers. Over the years, however, the body of knowledge and the literature about TB epidemiology, diagnosis, treatment, and other aspects of TB control has evolved. To ensure that new TB control workers have access to the best and most up-to-date information about TB control, the Self-Study Modules were revised and updated; they were published in fall 2008.

What’s New:
The Introduction has been expanded to include a description of all nine modules in the Self-Study Modules series; the 1995 version only described modules 1–5, the basic or “core” training modules. The new Introduction includes information on how to obtain the materials, online as well as in print; how to obtain continuing education credit for working through the modules; and where to find additional TB education and training materials.

Module 1, Transmission and Pathogenesis of Tuberculosis, has been expanded to include information on the various forms of drug-resistant TB; interferon gamma release assays, or IGRAs; latent TB infection, or LTBI; and additional species of mycobacteria. The history of TB has been updated with recent events.

Module 2, Epidemiology of Tuberculosis, has been updated to reflect current TB data, and the fact that TB trends have reversed since the first printing of the Self-Study Modules. In 1992, reported U.S. cases reached an all-time high of 26,673; in 2006, they had decreased to 13,779. Yet several concerns remain, including disproportionate rates in certain racial and ethnic minorities; an increasing proportion of TB cases in foreign-born persons; the continued incidence of MDR and XDR TB; and, despite overall decreases in TB, increases in some areas. HIV infection remains the strongest known risk factor for developing TB disease among people with latent TB infection.

Module 3, Targeted Testing and the Diagnosis of Latent Tuberculosis Infection and Tuberculosis Disease, changes its focus from the general diagnosis of TB infection and disease to targeted testing, to find those persons who are at high risk of developing TB disease and who would benefit from treatment. The discussion of diagnosing latent TB infection covers not only tuberculin skin tests (TSTs), but also IGRAs, describing how they are both performed and listing their advantages and disadvantages. The material on diagnosis of TB disease includes information on nucleic acid amplification (NAA) tests as part of the bacteriologic examination.

The 4th module, Treatment of Latent TB Infection and TB Disease, has been completely updated to reflect current recommendations for treatment of LTBI and TB disease. It includes recommendations for treating persons with HIV and other special treatment considerations.

Module 5, Infectiousness and Infection Control, also reflects the significant scientific advances that have occurred in the field of infection control, and summarizes CDC’s current official guidelines on the subject.

If you have questions about the updated Self-Study Modules on Tuberculosis, 1–5, please contact Amera Khan at To view or order them, please access the TB webpage.

—Reported by Amera Khan, MPH,
and Ann Lanner
Div of TB Elimination


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