Dear Colleague Letters
A Letter from Dr. Rochelle Walensky, CDC Director on World TB Day
March 24, 2021
Although preventable and treatable, tuberculosis (TB) remains one of the world’s top infectious disease killers, taking the lives of approximately 4,000 persons every day. One fourth of the world’s population – nearly 2 billion people – are infected with the TB bacteria and approximately 10 million become ill with the disease each year. Public health leaders have set ambitious goals to end TB by 2035; however, the Coronavirus Disease 2019 (COVID-19) pandemic could have devastating effects on global TB programs including a reversal of progress made in the last decade.
The United States is currently reporting record low TB cases, however, too many people still suffer from the disease. Up to 13 million people in the United States have latent TB infection, and without treatment, are at risk for developing TB disease in the future. A July 2020 report found that as personnel from U.S. state, local, and territorial TB programs were deployed to support their jurisdictions’ COVID-19 response, most TB programs experienced partial or high impact on staff capacity and TB control services.
On March 24th each year, we observe World TB Day to commemorate Dr. Robert Koch’s announcement of his discovery of Mycobacterium tuberculosis, the bacillus that causes TB. This year, we commemorate World TB Day as the COVID-19 pandemic has created unprecedented challenges for our communities, public health departments, and healthcare facilities. As the response to COVID-19 continues, it is important to maintain essential TB diagnosis, treatment, and prevention services. I know from my own experience as an infectious disease physician how critical it is for healthcare providers to “Think TB,” especially for patients in groups at higher risk of the disease.
Timely diagnoses of TB disease save lives and prevent spread in our communities.
Healthcare workers in the United States and around the world are working tirelessly to mitigate the effects of COVID-19 on TB services while demonstrating resiliency and commitment to saving lives, reaching global TB targets, and achieving our goal of ending TB. In addition to working to maintain services, TB professionals are providing critical skills and expertise needed for the COVID-19 response, including case investigation, contact tracing, infection control, and clinical care and treatment.
CDC remains your partner and a resource in the fight against TB. Domestically, CDC leads a state-of-the-art national TB program and conducts clinical trials and epidemiologic research that
contribute to new diagnostics, treatments, and approaches for eliminating TB. CDC’s TB Trials Consortium and collaborators from the National Institute of Health’s AIDS Clinical Trials Group recently announced the results of Study 31/A5349, the first clinical trial to identify a shorter 4-month daily treatment regimen that is as effective as (non- inferior to) the existing 6-month daily regimen in curing drug-susceptible TB disease. This is the first new short treatment regimen for drug-susceptible TB disease in almost 40 years.
CDC continues to broaden coordination with national, state, and local partners to strengthen TB programs in the United States and reach communities disproportionately affected by TB. This includes engaging private and public primary healthcare providers to expand latent TB infection testing and treatment. To prevent the development of TB disease, CDC is working to make testing for latent TB infection a routine part of primary care for patients at higher risk of TB disease, encouraging healthcare providers to use newer TB blood tests to screen for latent TB infection, and prescribe shorter treatments for latent TB infection.
Globally, CDC is on the frontlines working alongside partners in countries with the highest TB burden to end the disease. Between 2000 and 2018, 58 million lives were saved, and deaths fell by 38 percent. With CDC support, the number of people receiving TB preventive treatment doubled from 2018 to 2019. In 2020, CDC supported TB screening for 8.1 million people living with HIV – nearly 60 percent of all people living with HIV screened for TB through PEPFAR. Of the 4.1 million people who received TB preventive treatment in 2019, 3.5 million were persons living with HIV. Despite this progress, the global community is not on track to achieve the World Health Organization’s End TB targets. Ambitious actions and resources are needed to reach United Nations TB targets for 2022, particularly in the context of the COVID-19 pandemic.
As we observe World TB Day, I encourage you to visit CDC’s Division of Tuberculosis Elimination and Division of Global HIV and TB for additional resources, testimonies from TB survivors, and success stories from domestic and global TB elimination champions.
We are in a time of unprecedented challenge and opportunity. We must regain the momentum lost because of COVID-19, accelerate progress, and endeavor to use the pandemic as an opportunity for transformative change. Thank you for your continued commitment as we work together to eliminate TB in the United States and around the world.
Rochelle P. Walensky, MD, MPH
Director, CDC, and