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No. 4, 2009

SURVEILLANCE, EPIDEMIOLOGY, AND OUTBREAK INVESTIGATIONS BRANCH UPDATE

 

15th Semiannual Meeting of the Tuberculosis Epidemiologic Studies Consortium (TBESC)

Tuberculin skin tests (TSTs) can cause a boosting effect in TB blood tests, according to preliminary results of a new study reported at the 15th Semiannual Meeting of the Tuberculosis Epidemiologic Studies Consortium (TBESC).

Charles Daley, MD, the study’s principal investigator, reported that a previous TST can cause previously negative interferon gamma release assays (IGRAs) to become positive in health care workers enrolled in the study. The effect was noted in QuantiFERON®-TB Gold In-Tube (QFT) as well as in T-SPOT®.TB (T-spot), Daley reported.

Enrolled participants for the longitudinal study were healthcare workers undergoing routine latent TB infection (LTBI) screening at one of four TBESC study sites. Participants were screened with TST, T-spot, and QFT; the purpose of the study was to determine the tests’ stability, repeatability, and reproducibility, and the impact of TST testing on subsequent IGRA testing. Healthcare workers enrolled in the study are tested with QFT, T-spot, and TST at 0, 6, 12, and 18 months.

Dr. Daley reported that the effect of TST on subsequent IGRAs occurred within 2 weeks, and occurred in persons who initially had a definitive negative IGRA result.

Approximately 100 principal investigators, project coordinators, and other TBESC personnel attended the meeting July 22–23 at the Hyatt Regency Cambridge Hotel in Cambridge, MA, to discuss recent TB research and to plan next steps needed for current research in breakout sessions. Attendees were welcomed by Ann Cronin from CDC’s DTBE and Dr. Bob Horsburgh of the University of Massachusetts, the host site of the meeting. Following the first day of meetings, participants enjoyed a welcome reception in the hotel’s courtyard.

Other presentations on the first day of the meeting included a preliminary analysis of molecular epidemiology of multidrug-resistant TB in the United States, and modeling and cost-effectiveness of potential strategies for reducing the burden of TB in the United States.

On the second day of the meeting, Dr. Mary Reichler presented data on her study, “Prospective evaluation of immunogenetic and immunologic markers for susceptibility to M. tuberculosis infection and progression from M. tuberculosis infection to active TB.” Dr. David Holland discussed the costs and cost effectiveness of four potential LTBI treatment regimens, finding that 3 months of INH and rifapentine given by DOT is a cost-effective intervention in certain high-risk groups, when compared to 9 months of INH or 4 months of rifampin.

Other meeting highlights included:

  • Publications and Presentations Committee update
  • External Relations Committee update
  • TRiP Workgroup update
  • TBESC Recompetition update
  • PGO question and answer session

The 16th Semiannual TBESC meeting will be held at the Crowne Plaza Ravinia in Atlanta, GA, January 19–22, 2010.

—Reported by Suzanne Beavers, MD
Div of TB Elimination

Tuberculosis Epidemiologic Studies Consortium Newly Funded Research

In September 2009, the Tuberculosis Epidemiologic Studies Consortium (TBESC) announced the funding of four new research studies aimed at increasing understanding of TB and latent tuberculosis infection (LTBI). The studies were initially nominated as research proposals; the TBESC Semi-annual TBESC Advisory Review (STAR) committee and the DTBE branch chiefs then met to discuss each study’s merits and feasibility.

The first study, “Improving Testing for Tuberculosis (TB) and Latent Tuberculosis Infection (LTBI) for Persons with Human Immunodeficiency Virus (HIV) at Health Resources and Services Administration (HRSA) Title III-Funded HIV Clinics” will evaluate methods of providing TB services to HIV-infected persons treated at HRSA clinics. HRSA Title III-funded clinics treat approximately one fourth of all persons in the United States with HIV; a majority of the clinics’ clients are members of racial and ethnic minorities. Therefore, studying methods of TB screening and treatment in HRSA clinics, as well as means to improve these methods, may lead to better TB and HIV outcomes in minority populations.

The second research project, “Quantifying the Risk of Premature Death in TB Survivors,” was designed to determine the number of years of life lost after TB treatment is completed. The study will perform a survival analysis comparing the 10-year mortality of persons with active TB to persons with LTBI and the general population. The goal of this study is to determine whether, despite successful TB treatment, TB patients are at risk for premature death because of lung injury or other similar causes and whether that results in a net loss of years of life. This information could then be used to convince patients and their physicians of the importance of LTBI treatment and TB prevention.

A study entitled “Evaluation of Interferon Gamma-Release Assays (IGRAs) in Overseas Immigration Examination of Children in Moderate- and High-burden Countries” is designed to evaluate the feasibility of IGRA testing to predict progression from B2 latent TB to active disease in children immigrating to the United States. Children undergoing overseas immigration evaluation in Mexico, the Philippines, and Vietnam will be screened with TST and IGRA prior to entering the United States; their results will then be compared with risk factors for previous TB exposure. The IGRA and TST results will also be compared to clinical evaluation and sputum culture.

The final approved research study, “Estimating the Cost of TB in the United States,” will evaluate the total cost of TB treatment for medium and large TB programs. Data will be gathered on the costs to the TB program per TB case, as well as the societal costs of TB. Results will be used to inform TB program planning on expenses of caring for TB patients; they will also be used to educate persons not familiar with TB care on the costs of caring for TB patients.

The four studies described above are both scientifically sound and can feasibly be completed in the final 2 years of the consortium. We are excited about both starting the newly funded studies and completing current TBESC studies. We look forward to the results of these studies adding to the current knowledge of TB prevention, diagnosis, and treatment.

—Reported by Suzanne Beavers, MD
Div of TB Elimination

 

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