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TB Notes Newsletter

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No. 3, 2012

Dear Colleague:

Summer has been busy as usual for the Division of Tuberculosis Elimination (DTBE). The Advisory Council for the Elimination of Tuberculosis (ACET) met on June 6 here in Atlanta. It was a short meeting, one day rather than the usual day and a half, and was conducted by webinar for field staff as well as in person for Atlanta staff. Dr. Andrew Hill of DTBE’s Data Management and Statistics Branch gave an update on modeling TB trends in the United States, as summarized in a report published in January 2012 in the journal Epidemiology and Infection. The report concludes that given current TB control efforts are maintained, TB elimination in the U.S.-born population is possible before the end of this century. However, TB elimination in the foreign-born population is not likely in this same time frame, even if we increase rates of targeted testing and treatment of TB infection in in U.S. residents and immigrants.

Dr. Tom Navin, Chief, Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB), gave a talk about the importance of TB in special populations. Dr. Navin’s branch used the software SaTScan™ to analyze a cohort of TB cases. SaTScan™ is a free software that analyzes spatial, temporal, and space-time data. In this case, zip codes of TB patients comprised the input data. Using this methodology, SEOIB was able to detect high-risk clusters, i.e., those likely to become outbreaks. This could provide a way to prioritize clusters for early intervention.

I provided a talk on future directions and challenges for TB elimination in the United States. For new ACET members, I restated DTBE’s priorities: 1) prevent new cases of TB and LTBI by finding and curing all persons with TB, 2) reduce TB in foreign-born persons in the U.S., 3) reduce TB in racial and ethnic minorities in the U.S., 4) reduce the impact of MDR and XDR TB in the U.S. and the world, and 5) reduce HIV-associated TB in the U.S. and the world. To address the challenge of managing and dealing with the huge reduction in purchasing power from 1994 to 2012, DTBE has been revising the formula for distribution of TB prevention and control funding, in effect since 2005. We are moving towards the goal of distributing funds on the basis of each TB program’s epidemiologic needs and performance.

Mr. Shannon Jones III, current chair of ACET, led a discussion of the need to develop a 3–5 year strategic plan for ACET. He asked ACET members to assess where ACET stands and to determine how the committee can best support DTBE. This topic will be revisited again after input is received from ACET members.

On June 6–7, 2012, the TB Epidemiologic Studies Consortium-II (TBESC) held its second semiannual meeting here in Atlanta. Please read the summary of that meeting provided by Dr. Suzanne Beavers. Dr. Beavers has since left DTBE for another position in CDC’s National Center for Environmental Health. We wish her good luck in her new position.

During June 11–14, DTBE and our TB control colleagues gathered in Atlanta for the 2012 National TB Workshop. In this issue we have the winners of the National TB Controllers Association (NTCA) poster competition, as well as winners of the second annual special awards for Exemplary Performance and Service in TB Prevention and Control. In addition, we share in this issue several of the presentations from the meeting.

On June 27, I was very pleased to announce that several DTBE staff and their colleagues in the TB Trials Consortium had received the prestigious Charles C. Shepard Science Award in the Prevention and Control category. The CDC Shepard Science Awards were established in 1986 in honor of Charles C. Shepard, MD. Dr. Shepard was the chief of the CDC Leprosy and Rickettsia Branch for over 30 years until his death in 1985. The prestigious awards began as a way to recognize the best manuscript on original research, and have now expanded to include four categories, as well as the Charles C. Shepard Lifetime Achievement Award. The four categories include Assessment, Prevention and Control, Laboratory Science, and Data Methods and Study Design. This year the competition included 69 nominated articles, with 630 authors in all, and four nominees for the Lifetime Achievement Award.

The winning Prevention and Control paper was “Three months of rifapentine and isoniazid for latent tuberculosis infection,” published in December 2011 in the New England Journal of Medicine (NEJM 2011; 365 [23]: 2155–2166). The authors were Timothy R. Sterling, M. Elsa Villarino, Andrey S. Borisov, Nong Shang, Fred Gordin, Erin Bliven-Sizemore, Judith Hackman, Carol Dukes Hamilton, Dick Menzies, Amy Kerrigan, Stephen E. Weis, Marc Weiner, Diane Wing, Marcus B. Conde, Lorna Bozeman, C. Robert Horsburgh, and Richard E. Chaisson for the TB Trials Consortium PREVENT TB Study Team. Andrey and Lorna were on hand to accept the award on behalf of their coauthors. Congratulations again to the TB Trials Consortium for this honor!

The Division had another strong contender nominated for the Shepard Award, the paper “6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: a randomised, double-blind, placebo-controlled trial,” published in The Lancet in 2011 (Lancet 2011; 377: 1588-98). The authors were Taraz Samandari, Tefera B. Agizew, Samba Nyirenda, Zegabriel Tedla, Thabisa Sibanda, Nong Shang, Barudi Mosimaneotsile, Oaitse I. Motsamai, Lorna Bozeman, Margarett K. Davis, Elizabeth A. Talbot, Themba L. Moeti, Howard J. Moffat, Peter H. Kilmarx, Kenneth G. Castro, and Charles D. Wells, and received a certificate of recognition for demonstrating excellence in science.

Greg Andrews, Team Lead of the Field Operations Team II, FSEB, retired on June 29, 2012, after more than 38 years of exemplary service to CDC.  He will be greatly missed by all of us in TB control! Please read about his myriad accomplishments in the Personnel Notes section.

From July 22 to 27, 2012, CDC staff from DTBE and other programs attended or participated in the XIX International AIDS Conference, held in Washington, DC. This was the first time in 22 years that the International AIDS Conference has been held in the United States; it was last held in the U.S. in 1990 in San Francisco. Subsequently, U.S restrictions on the entry of people living with HIV prohibited the conference’s return for two decades. Following years of advocacy and under a process initiated by President George W. Bush and completed by President Barack Obama, the U.S. restrictions were lifted in 2010, paving the way for the conference’s return. In light of the serious consequences of TB/HIV comorbidity, TB control programs should be constantly looking for ways to collaborate with colleagues in HIV/AIDS programs, such as implementing routine opt-out HIV testing of all TB patients. Collaboration is essential as we in TB deal with increasingly shrinking budgets and increasingly hard-to-reach patient populations. 

I’m pleased to report that Dr. Tom Shinnick was unanimously elected to the position of Chair, Global Laboratory Initiative (GLI) Core Group, for the period 2012–2014. Tom took on this role effective August 1, 2012. The Global Laboratory Initiative (GLI), one of seven main working groups of the Stop TB Partnership (STP), is a network of international technical experts dedicated to accelerating and expanding access to laboratory services in response to HIV-associated and drug-resistant TB. It serves as an independent advisory group to the World Health Organization (WHO), the STP, development agencies, and countries. Congratulations to Tom for his appointment to this position!

I hope you survived the heat of the season, perhaps staying indoors to watch some of the Olympic events. In my humble opinion, all of you working in TB control are deserving of your own medals! Thanks for the important work you do.

Kenneth G. Castro, MD
Assistant Surgeon General, USPHS, & Commanding Flag Officer
CDC/ATSDR Commissioned Corps
Director, Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

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