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No. 4, 2009

Dear Colleague:

As the year ended, we in CDC’s Division of Tuberculosis Elimination (DTBE) remained busy with meetings and events of importance to TB control.

The 2008 TB surveillance annual report, Reported Tuberculosis in the United States, 2008, was posted online on September 24, 2009. The full report and slide set are available on the website. In addition, an updated Trends fact sheet is also available.

The Advisory Council for the Elimination of TB met in Atlanta on October 27 and 28. I will summarize a few of the presentations. Dr. Hazel Dean, Deputy Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), reported on the proposed reorganization of CDC, which is expected to be implemented by January 2010. One result is that NCHHSTP’s Global AIDS Program will be reorganized into a new Center for Global Health.

Rachel Stricof, representing the Healthcare Infection Control Practices Advisory Committee (HICPAC), summarized infection control guidance regarding 2009 influenza A (H1N1). CDC guidance emphasizes a hierarchy of controls, with vaccination as the most effective prevention strategy. Where personal protective equipment is needed, N95 respirators should be used. Facilities where N95 respirators are in short supply should prioritize respirator use for highest-risk situations such as aerosol-generating procedures and infections requiring airborne precautions (such as M. tuberculosis).

We received an update from Dr. Dolly Katz on the revised guidelines for preventing TB in foreign-born persons in the United States. Major changes from the previous guidelines include the recommendation to provide latent TB infection (LTBI) testing at least once to every foreign-born person from a high-risk country. The guidelines will also state that interferon gamma release assays (IGRAs) are preferable to tuberculin skin tests in these populations. The document will include specific guidance for follow-up and evaluation of immigrants with class B notifications.

We heard an interesting report on health care reform from Mr. Michael Craig and Mr. Donald Shriber of the CDC Washington office. Indicating that some kind of health reform bill is expected to pass this year, they described how CDC might be affected by health reform. It is anticipated that CDC might gain new, higher-priority authority to address health issues. Also, public health institutions could be strengthened within and across government, and reforms could give more individuals access to preventive services such as vaccines and screenings.

Drs. Andrew Vernon and Elsa Villarino described the results of the recompetition of the TB Trials Consortium (TBTC), a collaborative team of investigators conducting clinical research to find new TB drugs and drug regimens. From its origin in 1993 with strong CDC oversight and only North American sites, it has matured into a truly collaborative and global entity with 10 U.S. sites and 10 international sites. The TBTC has conducted nine major studies enrolling over 10,000 patients. This is truly a success story, and we anticipate additional important work from this group.

I provided an update on the Federal TB Task Force (TBTF), on which I serve as co-chair with Dr. Christine Sizemore (NIH). The TBTF met in Bethesda in August 2009 to continue progress on the Plan to Combat Extensively Drug-Resistant Tuberculosis; this was published in February 2009 (MMWR 2009;58 [RR-3]) and is available online. The TBTF also identified a few critical unmet needs on which we could collaborate, and subsequently chose four topics and established working groups. The aim is to develop inter-agency demonstration projects that can be implemented within existing resources. These topics include advancing the development of molecular diagnostic tests for TB and drug resistance, with special attention to pediatric patients; implementing diagnosis and treatment with quality-assured drugs for MDR/XDR TB and again, special needs of pediatric patients will be addressed; preventing TB transmission through infection control, with special attention to settings in which HIV-coinfected persons receive care; and developing TB clinical trial data standards, expanding a process already initiated by the Food and Drug Administration (FDA). All topics will include approaches for training, education, and capacity-building, and optimally will span the continuum of early development to implementation. We will provide updates on our progress with these activities.

We next heard several presentations on TB control in the U.S.-affiliated Pacific Islands (API), with an overview provided by Mr. Andy Heetderks. Populations in this region deal with many health disparities, compounded by serious challenges related to geography, politics, and infrastructure. In 2008, the API’s TB case rate was 86.6, compared to 4.2 for the U.S. overall. To address the region’s TB-related problems, DTBE has been working with other organizations serving the area such as the Secretariat of the Pacific Community (SPC), the World Health Organization (WHO), the Pacific Island Health Officers Association, the U.S. Dept. of the Interior, and others. These collaborations have resulted in much-needed improvements such as standardized patient registries; development of a flexible new surveillance tool, TBanywhere.net; greatly improved laboratory and medical consultation services; and the development of regional training. The region will continue to experience challenges, but with the recent changes, is now in a better position to deal with them.

After additional discussion and business, the meeting was adjourned. The next ACET meeting will be held March 2–3, 2010.

DTBE staff and colleagues conducted the annual training for new TB program managers, the TB Program Managers Course, November 2–6, 2009. This is a comprehensive course that covers a broad range of areas that program managers will deal with. Please see the article about the course in this issue.

The 40th Union World Conference on Lung Health, which is organized by the International Union Against Tuberculosis and Lung Disease, was held in Cancún, Mexico, December 3–7, 2009. The theme of this year’s conference was Poverty and lung health. This theme was highly relevant for any participant working to reduce the burden of HIV/AIDS, tuberculosis, asthma, pneumonia, tobacco-related and other lung diseases, and the consequences of air pollution. The important medical, social, and economic consequences of lung health in high-burden countries were also discussed.

Kenneth G. Castro, MD

 

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