CDC - Directors letter - TB Notes 2, 2012 - TB

CDC - Directors letter - TB Notes 2, 2012 - TB

TB Notes Newsletter

(PDF  - 1M)

No. 4, 2012

Dear Colleague:
This year-end issue of TB Notes provides an opportunity to reflect on some of the events of the past year and to remember the many accomplishments of TB control staff. This serves as a way to highlight the successes of the TB control community, and a reminder of the tremendous value of the important public health work you do. Please bear in mind that there are always more accomplishments than we have time and space to describe!
As you all know, at least 24 states from Florida to Maine and west to Michigan and Wisconsin were in the path of Hurricane Sandy, with New Jersey and New York experiencing particularly severe damage. DTBE program and laboratory consultants reached out to state and local TB programs affected by the storm to ascertain their status and needs. I am glad to report that our initial concerns about lost or displaced DOT patients have now dissipated. For those of you affected by this storm, please know that our thoughts and prayers are with you.
The World Health Organization’s Global Tuberculosis Report 2012 provides the latest data about the global TB epidemic and progress in TB care and control at global, regional, and country levels. Some of the report’s key findings are as follows: New cases of TB have been falling for several years and fell at a rate of 2.2% between 2010 and 2011. The TB mortality rate has decreased 41% since 1990 and the world is on track to achieve the global target of a 50% reduction by 2015. However, the global burden of TB remains enormous. In 2011, there were an estimated 8.7 million new TB cases (13% in persons co-infected with HIV) and 1.4 million deaths from TB, including almost 1 million deaths among HIV-negative individuals and 430,000 among people who were HIV positive. TB is one of the top killers of women, with 300,000 deaths among HIV-negative women and 200,000 deaths among HIV-positive women in 2011. I encourage you to review this very useful and informative report.
This year sees the departure of several long-time DTBE senior staff. Mr. Greg Andrews retired in June, and Dr. Elsa Villarino and Mr. Joe Scavotto are departing at year’s end. Elsa, who has served as the lead of the TB Trials Consortium (TBTC) for several years, is leaving DTBE in December for another position in CDC. Joe, Deputy Director of DTBE’s Field Services and Evaluation Branch, is retiring in January. We cannot quite imagine DTBE without them and we wish them much happiness and success in the future.
We note with sadness the passing away this year of several former DTBE staff members, and we remember with gratitude their lives and contributions. Mr. Don Brown, who died in March, and Ms. Sha Juan Colbert, who died in February, were remembered in earlier issues of TB Notes this year. Ms. Pat Griffin passed away in September; we provide an “In Memoriam” note on Pat in this issue.
A highlight of the year was the announcement of the 2012 Charles C. Shepard Science Awards. We were very pleased to congratulate staff members (names of DTBE staff highlighted in bold type) who served as coauthors in the publication “Three months of rifapentine and isoniazid for latent tuberculosis infection,” by TR Sterling, ME Villarino, AS Borisov, N Shang, F Gordin, E Bliven-Sizemore, J Hackman, CD Hamilton, D Menzies, A Kerrigan, SE Weis, M Weiner, D Wing, MB Conde, L Bozeman, CR Horsburgh Jr, RE Chaisson; TB Trials Consortium PREVENT TB Study Team. N Engl J Med. 2011 Dec 8; 365(23): 2155-66. This publication received one of the 2012 Charles C. Shepard Science Awards, in the Prevention and Control category. It was accepted by Andrey Borisov and Lorna Bozeman on behalf of their co-authors.
Dr. Peter Cegielski and colleagues published results of a study that used a geographic information system (GIS) to target high-risk neighborhoods for testing and treatment of LTBI. We include a summary of that interesting and important work in this issue.
Also this year, DTBE was pleased to announce the launch of the Spanish TB website, available at http://www.cdc.gov/tb/esp. The website provides a variety of basic TB information on exposure, testing, and treatment. It includes translated DTBE fact sheets, publications, and posters, as well as recorded video and audio podcasts in Spanish.
This issue includes two reports pertaining to the new 12-dose regimen for treatment of latent TB infection (LTBI). On Sept. 18, the first participant was successfully enrolled into TBTC Study 33. This study, called iAdhere, is evaluating self-administration of the 12-dose LTBI regimen; we provide a short report on that study.
As I review these and many other accomplishments of DTBE staff, which are too numerous to include here, I am again proud to be part of the impressive work that is routinely done by U.S. TB control workers. Thank you for your continued commitment and hard work, so much of which is done out of the public eye and without thanks. You are all public health heroes! Happy holidays, and please stay safe during the winter season.

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

Tuberculosis (TB)

TB Notes Home

• TB Notes 4, 2012
  • Director's Letter
    
  • Highlights from State and Local Programs
    • TB screening practices of Civil Surgeons evaluating status adjustors seeking permanent residence in the United States -- New England, 2011
  
  
  • TB Education and Training Network and TB Program Evaluation Network Updates
    • 2012 TB ETN & TB PEN Conference
  
  
  • Communications, Education, and Behavioral Studies Branch Updates
    • CDC Patient Education Brochure Available: 12-Dose Regimen for Latent TB Infection
    • DTBE Team Builds the Best Scarecrow Ever … and Provides TB Education
  
  
  • Clinical Research Branch Updates
    • First Study Participant Is Successfully Enrolled into TBTC Study 33!
  
  
  • International Research and Programs Branch Updates
    • Eliminating TB, One Neighborhood at a Time
  
  
  • Laboratory Branch Updates
    • LB Expands Molecular Detection of Drug Resistance Service
    • A Revitalized Focus on Pyrazinamide Is Essential for Tuberculosis Elimination
  
  
  • Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
    • DTBE ' s Annual Surveillance Report – What ' s New?
    • Predicting U.S. Tuberculosis Case Counts by Foreign-born Country of Origin
  
  
  • New CDC Publications
  
  
  • Personnel Notes
  
  
  • Calendar of Events
  
  

TB Notes Newsletter

(PDF  - 1MB)

No. 4, 2012

HIGHLIGHTS FROM STATE AND LOCAL PROGRAMS

TB Screening Practices of Civil Surgeons Evaluating Status Adjustors Seeking Permanent Residence in the United States -- New England, 2011

The authors presented this report as a poster at the 2012 National TB Controllers Workshop in Atlanta, Georgia. The poster was the second place winner in the NTCA poster competition. From July 1, 2010, to June 30, 2011, a total of 32,734 foreign-born individuals in New England applied to adjust their status to permanent residents (status adjustors or SAs). Screening SAs is one strategy for detecting infection with Mycobacterium tuberculosis in this high-risk group. SAs must undergo medical examinations, including TB screening, performed by licensed physicians designated by the US Citizenship and Immigration Services (USCIS). These physicians are called civil surgeons. CDC provides civil surgeons with technical instructions (TIs) for SA medical examinations. However, little is known about the characteristics and practices of these physicians. In July 2011, surveys were mailed to all civil surgeons with viable addresses currently practicing in Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont. Respondents were asked about the characteristics of their practice, as well as their TB screening and follow-up procedures. Responses were analyzed using descriptive statistics; chi square or t-tests were used to test associations. Of 143 civil surgeons to whom the survey was sent, 119 (83%) responded. The majority were in private practice (59%). The median number of years as a civil surgeon was 9. While their residency training was diverse, most (71%) attended medical school in the U.S; 34% received additional training beyond a primary residency. All respondents used appropriate TB screening tests: 98% used tuberculin skin tests (TSTs) and 2% used interferon-gamma release assays (IGRAs). All respondents would obtain chest radiographs (CXR) for SAs with positive screening tests. The TIs also recommend a CXR for all SAs who are immunocompromised or have symptoms suggestive of TB. However, 57% and 29% of civil surgeons would not obtain a CXR for SAs who had a negative TST or IGRA and who were immunocompromised or symptomatic, respectively. If TB disease was suspected, 80% report or refer to the health department; 16% refer to a specialist only. If LTBI was diagnosed, the majority of civil surgeons (70%) referred to specialists, other providers, or the health department, while 15% started treatment. Of 119 respondents, 71 (60%) CS estimated the number of SA they evaluated in the past 12 months. The mean number of SA evaluated per year is higher among private providers than providers based at community health centers (CHC) (248 versus 46; p=0.001). Private providers were also more likely to have read the TIs (93% versus 67%, p<0 .001=".001" 100="100" 65="65" a="a" about="about" and="and" case="case" chc="chc" correctly="correctly" for="for" however="however" interpretation="interpretation" less="less" likely="likely" ltbi="ltbi" of="of" or="or" p="0.028)." providers="providers" refer="refer" respond="respond" scenario="scenario" start="start" than="than" the="the" they="they" to="to" treatment="treatment" tsts="tsts" versus="versus" were="were">In conclusion, our results indicate that New England civil surgeons are largely adherent to the CDC TIs. Civil surgeons’ characteristics vary by practice location. All used appropriate screening tests. However, many did not obtain CXR as recommended by the TIs for immunosuppressed or symptomatic SAs.  Most civil surgeons refer SAs to other providers (e.g., a specialist, primary care provider, or health department) for TB disease and LTBI. Potential areas for future training include appropriate use of CXR in screening and follow-up of TB suspects.
—Reported by Kelley Bemis (CSTE/CT Department of Public Health), Lynn Sosa and Alison Stratton, CT Dept of Public Health, Andy Tibbs and Jennifer Cochran, MA Dept of Public Health, and Mark Lobato and Alfonso Rodriguez Lainz, CDC