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TB Notes Newsletter

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No. 2, 2010

Dear Colleague:

Happy spring to all! Staff of the Division of Tuberculosis Elimination (DTBE) have kept up their usual busy pace; I will mention a few activities. On March 2-3, 2010, the Advisory Council for the Elimination of Tuberculosis (ACET) met in Atlanta. Dr. Hazel Dean, Deputy Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), reported that a new Office of Infectious Diseases has been created at CDC. This office will support infectious disease activities, and will house NCHHSTP plus two other national centers. Also, within NCHHSTP, the Global AIDS Program is transitioning into another new CDC entity, the Center for Global Health.

In my ACET report, I gave an update on DTBE staff deployed to H1N1 duties (please see the related item in this issue), and there were several reports on CDC’s response to the earthquake in Haiti. I also discussed a recently developed mathematical model of TB trends, which shows that the most important determinant for TB elimination will be preventing the progression of LTBI to TB disease, especially in foreign-born persons. In an important study in Botswana, a trial of 6-month vs 36-month isoniazid preventive therapy (IPT) for HIV patients demonstrated that TB/HIV-coinfected persons receiving 36 months of IPT had a 92% reduction in progression to TB compared to those receiving only 6 months of IPT.

Other updates reflected the Division’s focus on prevention and control of TB in high-risk populations such as immigrants and other foreign-born persons from high-burden areas, health care workers who work in high-risk settings, and TB patients with comorbidities such as HIV or diabetes. We also heard an update on a new DTBE laboratory service for rapid detection of drug-resistant TB.

Dr. Tom Navin and I both shared data on the unexpected decline in reported TB cases for 2009. The number of reported TB cases in the United States is at an all-time low, with 17 consecutive years of decline. However, racial/ethnic minority populations and foreign-born persons continue to account for a disproportionate percentage of TB cases. A number of explanations have been put forward to explain the decline, among them the recent economic recession. DTBE and the National TB Controllers Association are conducting surveys and studies regarding the decline and will report their findings later this year.

The 14th Annual Conference of the International Union Against Tuberculosis and Lung Disease (IUATLD), North American Region (NAR), convened March 11-13 in Orlando, Florida. The conference presented research on the diagnosis, treatment, and management of TB and HIV coinfection; provided a forum where attendees, which included participants from Latin America, the Caribbean, and Haiti, could network with others; and provided participants an opportunity to exchange knowledge and expertise among those working in the HIV/TB field. I was honored to give the George W. Comstock lecture this year. This NAR meeting had a series of outstanding presentations covering a wide variety of topics, ranging from basic and laboratory sciences to practical challenges being addressed by TB control programs. 

DTBE observed World TB Day through a number of activities and publications. DTBE’s World TB Day website is updated each year with tools, graphics, and other resources for TB programs planning their World TB day activities. The Morbidity and Mortality Weekly Report (MMWR) of March 19 included several items developed by DTBE staff. These included a front-page message box about World TB Day, plus several articles: Decrease in Reported Tuberculosis Cases, United States, 2009; Monitoring Tuberculosis Programs --- National Tuberculosis Indicator Project, United States, 2002–2008; and Launch of TB Genotyping Information Management System (TB GIMS).

On March 24, DTBE hosted an observance at CDC’s Global Communications Center at the main Roybal campus. This event was preceded by a well-attended tour and open house conducted by the Mycobacteriology Laboratory Branch (please see the related article in this issue) and was followed by a reception that was sponsored by the American Lung Association in Georgia.

Dr. Tom Frieden, CDC Director, gave a great keynote presentation, and we were also honored to have Dr. Margaret Chan, Director General of the World Health Organization (WHO), as a speaker. Other outstanding remarks were provided by Dr. Janet Collins, CDC Associate Director for Program, and Dr. Kevin Fenton, Director, NCHHSTP.

On Saturday, March 27, DTBE and partners held the fourth annual TB Awareness Walk. In addition to increasing awareness about TB, this popular event allows us to gather in a more informal setting with family and friends to enjoy music and entertainment and take a 2-mile walk around Grant Park in Atlanta.

I was most appreciative of all the efforts contributing to this very successful series of events around World TB Day. I hope all of you were also able to gain support and visibility for your ongoing efforts through your World TB Day activities.

I hope to see all of you who are working so successfully to prevent and control TB in the United States at the 2010 National TB Conference in June here in Atlanta.

Kenneth G. Castro, MD

 

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