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TB Notes Newsletter

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No. 4, 2013

Dear Colleague:

This year-end issue typically serves as an opportunity to reflect on the year’s notable events and accomplishments in TB control and elimination. It’s a time to celebrate the hard work of all in the TB community and to look ahead to opportunities for the next year.

In a number of respects, this has been a challenging year. We started 2013 with news of a shortage of isoniazid, one of the first-line drugs used to fight TB. The nation also experienced shortages of Tubersol and Aplisol, the only two tuberculin products commercially available for use in the diagnosis of infection with Mycobacterium tuberculosis.

In March, CDC’s grantees received a letter announcing a series of spending cuts that significantly reduced federal resources. These cuts necessitated some difficult decisions about staffing and program activities.

In August, DTBE’s Director, Dr. Castro, left DTBE to serve in a temporary capacity as Acting Director of the Division of HIV/AIDS Prevention when its director, Jonathan Mermin, was selected as the new Director of NCHHSTP. I have been honored to serve as Acting Director of DBTE in Dr. Castro’s absence. In the same month, DTBE staff packed up files, papers, books, and documents, and moved (to the building next door) as part of series of moves to consolidate CDC staff, as much as possible, and to use government-owned rather than leased property.

In October, most of the staff members of our Division were furloughed for 17 days. During this time, DTBE could only address urgent issues, and many important activities experienced interruptions and delays.

However, there were also positive events and substantial accomplishments this past year. We welcomed a new Regional Training and Medical Consultation Center (RTMCC), the Mayo Center for Tuberculosis, located in Rochester, Minnesota. With the addition of the Mayo TB Center, the RTMCCs saw a reconfiguration of their coverage areas. We appreciate the efforts and cooperation of all involved in making this transition.

In March, CDC’s World TB Day observance was held. Dr. Kenneth Castro, Director, DTBE, led the proceedings. Dr. Terrence Lo, EIS officer in DTBE, gave the TB trends update, and Dr. Susan Ray, Emory University professor and medical consultant for the Georgia Department of Public Health, gave an inspiring and notable keynote address. Dr. Wanda Walton, Chief, Communications, Education, and Behavioral Studies Branch (CEBSB), DTBE, reported on DBTE’s TB Personal Story project. In this initiative, TB and LTBI patients describe their TB experience, in print or on camera; these stories are then posted online. Three patients from Atlanta, Georgia, told their stories on camera, and Dr. Walton shared their stories at the observance. DTBE is seeking additional participants for this project. If you know of a person who successfully completed treatment for TB or LTBI, with help from the local TB program, whose TB story is compelling, and who is willing to share the story in person or in print, please let us know. Please contact Nicole Richardson-Smith or Ann Lanner to learn more.

On October 25, CDC released new guidelines on the use of bedaquiline fumarate, a new drug available to treat multidrug-resistant tuberculosis (MDR TB) — Provisional CDC Guidelines for the Use and Safety Monitoring of Bedaquiline Fumarate (Sirturo) for the Treatment of Multidrug-Resistant Tuberculosis. Bedaquiline, which received accelerated approval from the Food and Drug Administration (FDA) in December 2012, is the first new type of TB drug to be approved in over 40 years to treat this deadly disease. Please see a report on it in this issue.

In July, Dr. Castro took part in a successful Healthy People 2020 Progress Review webinar, featuring the Immunization and Infectious Diseases and Global Health topic areas. The webinar examined the burden of infectious diseases nationally and internationally, with a special emphasis on TB. Participants also learned about one community-based organization’s work on TB prevention and treatment in the U.S.-Mexico border region. You can read a summary of the event in this issue.

This fall, DTBE released its annual surveillance report, Reported Tuberculosis in the United States, 2012, as well as the accompanying slide set. The report presents summary data for TB cases verified and counted in 2012. This edition contains a number of new tables, including genotyping data. In 2012, the reported number of TB cases (9,945) and case rate (3.2 cases per 100,000) both decreased; these represent declines of 5.4% and 6.1%, respectively, compared to 2011.

In July, the FDA gave authorization for the marketing of the Xpert MTB/RIF, the first FDA-reviewed test that, in less than 2 hours, can simultaneously detect M. tuberculosis-complex and determine if the bacteria contain genetic mutations that indicate resistance to rifampin, an important antibiotic for the treatment of TB. In October, CDC published an MMWR report providing guidance on use of the Xpert assay.

On a lighter note, staff of DTBE’s CEBSB had fun this summer and fall with their award-winning TB educational product, Edgar Allan Crow. He/it won first prize at the Atlanta Botanical Garden’s event, Scarecrows in the Garden. Read about it here.

As for 2014, we already know the year ahead will bring significant change. On December 16, Dr. Castro announced his decision to vacate the position of Director, DTBE, effective December 31, 2013, and his plans to seek voluntary retirement from the Commissioned Corps near the end of FY 2014. He indicated that this was a very difficult decision because of his passion for our shared mission and the great friends and colleagues that he had enjoyed working with in DTBE over the past 20 years. His tremendous achievements and impact on TB control and elimination efforts were recently recognized when he was selected to receive the International Union Against Tuberculosis and Lung Disease North American Region Lifetime Achievement Award. The announcement for the recruitment of a new permanent Director, DTBE, will be made in early 2014.

As the year draws to a close, I want to thank all of you for your hard work, resilience, and commitment to the important mission of TB control and elimination. It’s a privilege to work with such outstanding staff and partners, here and around the globe. Have a peaceful and safe time with family and friends, and safe travels wherever your plans take you this season.

Philip LoBue, MD, FACP, FCCP
Acting Director
Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

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