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TB Notes Newsletter

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No. 3, 2011

LABORATORY BRANCH UPDATE

Highlights from the APHL 7th National Conference on Laboratory Aspects of Tuberculosis

More than 140 participants attended the 7th National Conference on Laboratory Aspects of Tuberculosis which was held in Atlanta, Georgia, June 13–15, 2011. The 2.5 day event featured speakers who addressed a variety of topics. Conference attendees included clinicians, TB controllers, and representatives from clinical, academic, and public health laboratories.

The conference began with a keynote address given by Dr. William Burman, University of Colorado. Dr. Burman spoke about insights into drug resistance and drug-susceptibility testing from a clinician’s viewpoint, as an example, reviewing in detail the inter-related clinical and laboratory challenges with the use of ethambutol.  Additional topics of discussion during the conference included practical considerations for implementation of new technologies such as assays for the molecular detection of mutations associated with drug resistance and interferon gamma release assays in the laboratory; updated recommendations for mycobacteriology drug-susceptibility testing; approaches for assuring quality; and strategies for validating non-FDA approved assays. New basic research discoveries and TB as a global disease were also featured.

Ken Jost, right, receives Laboratorian Award from Ed Desmond. Photo by Wanda Walton.

Ken Jost, right, receives Laboratorian Award from Ed Desmond. Photo by Wanda Walton.

The 2-day conference was colocated with the National TB Conference for the second year in a row. A Laboratory Late Breaker Session was included as part of the conference. This session included short oral presentations selected from abstracts submitted for the laboratory conference, and other late breaking topics. Participants had an opportunity to learn about significant findings and model practices impacting laboratory testing for TB. Another breakout session, moderated by Dr. Beverly Metchock, DTBE, Dr. Ed Desmond, CA Department of Public Health, and Dr. Susan Ray, Emory University, covered drug-resistant TB and featured audience-interactive case studies involving collaboration between the laboratory and control program.

On June 15th, NTCA presented awards for Exemplary Performance and Service in TB Prevention and Control. A highlight of the event was the presentation of the Ed Desmond Laboratorian of the Year Award to Ken Jost of the Texas Public Health Laboratory. Ken was nominated by Dr. Barbara Seaworth, Dr. Charles Wallace, Denise Dunbar, and others. Among the many accolades given to Ken, the nominators stated  “…(Ken) works diligently to ensure that as providers we have the most rapid access to laboratory services possible. He takes a sincere interest in patients and their outcomes. He has a tremendous understanding of the importance of each laboratory test used in management of those at risk for tuberculosis. He is able to educate providers on the value and biases of particular tests, as well as to explain test results and to provide references to those interested.”  Ken is known both nationally and internationally as a recognized expert consultant, educator, and technical advisor for CDC, the International Union Against Tuberculosis and Lung Disease (IUATLD), and the Association of Public Health Laboratories (APHL). He has shown leadership through his participation on numerous APHL workgroups. CDC/DTBE/LB wishes to congratulate Mr. Ken Jost on this well-deserved honor.

Through sponsorship from APHL and CDC, representatives from public health laboratories that are partially funded through CDC cooperative agreements attended the conference this year. The authorized PowerPoint presentations from the 7th National Conference on Laboratory Aspects of Tuberculosis are now posted online.

—Submitted by Frances Tyrrell
Div of TB Elimination/LB

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Tuberculosis Laboratory Aggregate Report Released

Image of Tuberculosis Laboratory Aggregate ReportThe Tuberculosis Laboratory Aggregate Report was distributed to attendees of the 7th National Conference on Laboratory Aspects of TB on June 13, 2011, in Atlanta.  It was developed by the Laboratory Capacity Team (LCT) within the Laboratory Branch (LB) and contains data provided by 58 U.S. Public Health Laboratories (PHL) that receive cooperative agreement funds from CDC’s Division of Tuberculosis Elimination.  This is the second report of its kind; the first was released in 2010 and contained PHL workload and turnaround time (TAT) data from 2008. In this latest edition, LCT reports similar data for calendar year 2009 and provides a comparison to 2008 indicators to identify changes in testing volumes and TAT. The analyses presented, which in many cases are stratified by volume, are meant to serve as a guide for PHL to develop benchmarks and make peer comparisons.  The data can be used as an educational tool to aid in the exploration of successful testing practices, as well as those that may need examination. This report is to be used only as a guide and is not intended for other purposes that may be disciplinary in nature.

Some of the principal changes in PHL workload shown in this year’s aggregate report include a significant decrease in the number of clinical specimens received for TB testing, as well as a decrease in the number of patients with culture-positive results for Mycobacterium tuberculosis complex between 2008 and 2009.  However, there was a significant increase in the number of nucleic acid amplification tests (NAAT) performed by PHL in 2009 as compared to 2008. Additionally, TAT indicators for 2009 were analyzed and compared to 2008. With the exception of time to specimen receipt in the laboratory, TATs increased for all indicators (i.e., smear result, identification of Mycobacterium tuberculosis complex, and drug susceptibility testing). The reasons for the slower TATs are unknown, but might be due to reductions in staff and batching of tests resulting from changes in resources.

In addition to the workload and TAT data, the report provides information on testing methods and algorithms. The current report graphically depicts the criteria for NAAT used by the PHL to determine which specimens will receive testing.  The most used criterion observed was testing a diagnostic specimen from all patients with a smear-positive result and on request, from patients with a smear-negative result.  Also, first-line and second-line drug susceptibility testing (DST) methodologies and the specific anti-tuberculosis drugs tested are presented. Currently, 37 PHL perform first-line DST using the MGIT 960 system and 10 of the 18 PHL that perform second-line DST in-house reported using the indirect agar proportion method.  The document concludes with relevant references and resources. Future reports will monitor and identify potential trends in workload, TAT, and methodologies.

Members of LCT have learned a great deal through collaboration and communication with our PHL partners. We would like to thank them for taking the time to provide the data utilized in the Tuberculosis Laboratory Aggregate Report as well as for their participation in LCT site visits.

To review the report online, please visit the CDC website.

—Submitted by Tracy Dalton, PhD
Laboratory Consultant
DTBE/LB/LCT

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