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TB Notes Newsletter

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No. 4, 2011

Dear Colleague:

This end-of-year letter provides an opportunity to reflect on the remarkable advances made in TB control this year. In Global Tuberculosis Control 2011, the World Health Organization (WHO) reports that the number of people with TB dropped to 8.8 million in 2010, after peaking at 9 million in 2005; TB deaths fell to 1.4 million in 2010, after reaching 1.8 million in 2003. Here in the United States, our state and local TB control partners reported a continued reduction in TB cases: 11,182 new cases in 2010, a reduction of 3.1% from 2009 (see Reported Tuberculosis in the United States, 2010). This steady achievement, despite insufficient resources, is evidence of their expertise and dedication—they are true public health heroes!

CDC’s Division of Tuberculosis Elimination (DTBE) and its academic and public health partners had several noteworthy achievements, as well. The TB Trials Consortium (TBTC) concluded Study 26, which showed the efficacy of a new regimen of isoniazid and rifapentine for latent TB infection (LTBI) that is completed in 12 doses, rather than 270 doses of isoniazid. The findings were published in the December 8, 2011, issue of the New England Journal of Medicine.  Also this year, DTBE began its laboratory service to state health departments for the molecular detection of drug resistance, shortening time to results from 42 to 2 days. Collaborative teams provided outbreak investigation assistance and program support in Arizona; Puerto Rico; Kane County, Illinois; and the Republic of the Marshall Islands. Other collaboration resulted in the development and implementation of the Quality Assurance for TB Surveillance Data Training. DTBE staff and colleagues published clinical trial results demonstrating that 36 months of isoniazid is superior to 6 months of therapy for LTBI in HIV-infected persons. This study, together with a previously published study that successfully evaluated a screening algorithm in Southeast Asia to detect TB in HIV-infected persons, informed and led to updated WHO policy recommendations. The Core Curriculum on Tuberculosis: What the Clinician Should Know was rigorously reviewed, updated, and published. We also celebrated the conclusion of the first 10 years of the TB Epidemiologic Studies Consortium (TBESC), and the selection of the sites for the new TBESC. These are remarkable accomplishments!

As we wrap up this year, it’s not too soon to begin thinking about World TB Day—March 24, 2012. CDC has adopted the WHO 2012 World TB slogan, Stop TB in my lifetime. In the next few months, DTBE will be developing posters and other communication products to assist you in your own World TB Day efforts. We will keep you updated on planned activities and links that may be helpful.

We note with sadness the unexpected death in July of Phyllis Cunningham. Phyllis had served as the supervisor of the Mycobacteriology Laboratory at the Wadsworth Center, New York State Department of Health, and was a valued member of the Division of Infectious Diseases. Please see the Personnel Notes section of this issue to read more.

As I mentioned above, the TBTC has completed Study 26, a 10-year, 8,000-patient trial of ultra short-course treatment of LTBI, using a once-weekly 12-dose regimen of isoniazid and rifapentine, compared to standard 9-month daily therapy with isoniazid. We are pleased to report that on December 9, CDC published guidelines in the Morbidity and Mortality Weekly Report (MMWR) on the use of the new LTBI treatment regimen, based on the published results of Study 26 and two other recent studies. This issue includes an article summarizing the new MMWR guidance. Please read it, but be sure to refer to the guidelines themselves for specific regimen details.

In July 2011, the Tuberculosis Epidemiologic Studies Consortium (TBESC) held its 19th and last semi-annual meeting of its first 10-year cycle; that meeting is described in this issue. In September, I announced the results of the re-competition for the TBESC. This was a highly competitive process, and we received many strong applications; unfortunately, resources were insufficient to fund all proposals. After a thorough evaluation process, 10 sites were selected to be part of the new TBESC: the California Department of Public Health, the Denver Health and Hospitals Authority, Duke University, Emory University, Hawaii Department of Health, Maricopa County Department of Public Health, Maryland Department of Public Health, Public Health Seattle-King County, University of Florida Board of Trustees, and the University of North Texas Health Science Center.  On December 8, 2011, the newly constituted TBESC met in Atlanta to discuss protocol development for the long-term follow-up of contacts with latent TB infection.

CDC staff successfully planned and carried out the 11th annual conference of the TB Education and Training Network and the 3rd annual conference of the TB Program Evaluation Network, held jointly in Atlanta September 20–22, 2011. This year’s theme was Waves of Change, Oceans of Opportunity. Plenary topics included health literacy, partnerships with federally qualified health centers (FQHC), cohort review, and new technology tools for TB health education, training, and evaluation.  Please read more about these conferences in this issue. 

The 42nd Union World Conference on Lung Health was held in Lille, France, October 26–30. The conference theme this year was “Partnerships for Scaling-up and Care,” which highlighted the importance of collaboration in our common efforts to address the conditions affecting lung health. A small contingent of CDC staff attended to share the results of their important work.

The final 2011 meeting of the Advisory Council for the Elimination of Tuberculosis (ACET) was held December 6–7, 2011. After Center and division reports, we heard other CDC updates on Division of Global Migration and Quarantine (DGMQ) overseas screening activities and on program collaboration and service integration (PCSI), followed by ACET reports on TB elimination and on the drug shortage situation. ACET workgroups then reported on the feasibility of TB elimination and on proposals for revising the structure of the National TB Program, in light of current reduced funding. These were followed by discussions about the future direction for TB control and elimination in the United States, with perspectives and options offered by severa lpresenters. Resolutions were not finalized by the end of the meeting. We will provide more information on this critical issue as it becomes available.

As I review this year’s accomplishments by DTBE staff and partners, I am once again proud and deeply impressed by the depth and breadth of our work. You have all worked hard this year. Here and globally, people affected by TB will likely be touched in some way by the work you have done. I hope you will take time to rest this holiday season, to reconnect with the persons and traditions that bring meaning to your lives, and to recharge for the challenges of next year!

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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