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No. 2, 2009

Director's Letter

Dear Colleague:

We in the CDC Division of Tuberculosis Elimination (DTBE) were very pleased to learn of the appointment of Tom Frieden, MD, MPH, to the position of CDC Director, and we proudly welcome him back!  A physician with training in internal medicine, infectious diseases, public health, and epidemiology, Dr. Frieden worked for CDC from 1990 until 2002 and is especially known for his expertise in TB control.

Dr. Frieden began his career at CDC in 1990 as an Epidemiologic Intelligence Service (EIS) Officer at the New York City (NYC) Health Department. As a CDC assignee, he then served as Director of the Bureau of Tuberculosis Control and Assistant Commissioner for the NYC Health Department from 1992 to 1996. In that role, he led a program that rapidly reduced TB, including reducing cases of multidrug-resistant (MDR) TB, by 80 percent.

Dr. Frieden was then “loaned” for 5 years to the World Health Organization office in India, where he assisted with national TB control efforts. The program he helped put in placed in India has now treated more than 10 million patients and has saved more than one million lives.

In 2002, after his tremendous success in India, Dr. Frieden was appointed NYC Health Commissioner. During his tenure in that position, the number of smokers in New York City declined by 350,000, and teen smoking decreased by half. New York City became the first place in the United States to eliminate transfats from restaurants, to rigorously monitor the diabetes epidemic, and to require certain restaurants to post calorie information prominently. Also under his leadership, the department established the largest community electronic health records project in the country.

Dr. Frieden has received numerous awards and honors and has published approximately 200 scientific articles. A recent publication of note is “Lessons from tuberculosis control for public health,” which appeared in the April 2009 issue of the International Journal of Tuberculosis and Lung Disease. He received both his medical degree and master’s of public health degree from Columbia University, and completed infectious disease training at Yale University. Dr. Frieden arrived at CDC headquarters in June.

Of note, one of Dr. Frieden’s first official duties as Director of CDC was to serve as the keynote speaker at the 2009 National TB Conference, held in Atlanta June 16–18.  In his remarks, Dr. Frieden spoke of being TB Controller for New York City at the time of the alarming spike in TB cases, and in particular the outbreaks of multidrug-resistant TB that were occurring. He recalled the words of Dr. Karel Styblo, who was scientific director of the International Union Against TB and Lung Disease (IUATLD) at the time, and had pioneered the development of the directly observed treatment, short-course (DOTS) strategy. While visiting in the early 1990s, he reviewed Dr. Frieden’s annual report on the NYC TB control program, then said, "You diagnosed 3,811 patients with tuberculosis. How many of them did you cure?”  This spurred Dr. Frieden to initiate a program of cohort analysis, which assured that every TB patient was accounted for and followed to cure, and which resulted in “turning the tide” of TB in New York City. Dr. Frieden reminded us that there can be no cheating -- accountability for each patient’s outcome is key.

Please note, DTBE educational materials on cohort review are available on our website; the DVD includes a video segment with Dr. Frieden discussing the benefit of cohort review (www.cdc.gov/tb/education/cohort.htm). Below are brief descriptions, with links to ordering information:

  • Understanding the TB Cohort Review Process: Instruction Guide
    This document explains what the cohort review method is, how to use it to enhance your current TB control activities, and how to adapt it to your own program area.
  • Understanding the TB Cohort Review Process: DVD
    This 22-minute DVD brings the cohort review process to life, illustrates the benefits of adopting cohort review, and highlights the roles of the cohort review team members. 
    Ordering Information

With the theme, “TB Elimination – It Takes a Village,” the conference was a very successful gathering of TB control staff coming together to discuss their insights and experiences and learn from each other. A regular highlight of these conferences is the poster competition, owing to the wide array of topics addressed and information shared. Please see the articles in this issue about the poster competition awards and about two other special awards that were given.

Other TB-related conferences in which DTBE staff have recently participated included the 2009 APHL Annual Meeting, held May 5–8 in Anchorage, Alaska. Sponsored by the Association of Public Health Laboratories, this meeting brought together laboratory scientists, governmental officials, corporate representatives, and others for 4 days of intensive sessions on public health laboratory science, practice, and policy.

A small number of DTBE staff attended the 2009 American Thoracic Society (ATS) International Conference, May 15–20, in San Diego, California. In addition to the planned activities, the ATS organizing staff also monitored the public health issues raised by the outbreak of swine flu, and added a special session with experts in influenza and public health.  With thousands of experts in respiratory health in attendance from around the world, ATS recognized the opportunity and obligation to provide the latest information about this public health challenge.

Upcoming conferences and meetings for this summer include the 15th semi-annual meeting of the TB Epidemiologic Studies Consortium (TBESC), being held July 22–23 at the Hyatt Regency Cambridge in Boston, Massachusetts, as well as the TB Education and Training Network (TB ETN) annual conference, which meets in Atlanta July 28–30, at the Westin Atlanta North at Perimeter. This year's TB ETN meeting will serve as a joint conference for the TB Education and Training Network (TB ETN) and the TB Program Evaluation Network (TB PEN). I hope you will find time during this busy summer to attend these important meetings!

Kenneth G. Castro, MD

 

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