MDR-TB Treatment & Prevention
Fwd: [tb-update] Week of December 5 to December 11, 2010 by the CDC
Dear All,
Please find below all relevant news and updates from the CDC TB-Related News and Journal Items Weekly Update. In "Journal Articles": whenever possible I've included links to full text articles.
---------- Forwarded message ----------
From: <>
Date: Fri, Dec 10, 2010 at 12:31 PM
Subject: [tb-update] Week of December 5 to December 11, 2010
TB-Related News and Journal Items Weekly Update
Week of December 5 to December 11, 2010
To subscribe to the list, please visit:
http://www.cdcnpin.org/lyris/ui/listservs.aspx#journal.
CDC provides the TB-Related News and Journal Items Weekly Update as a public service only. This update is a compilation of TB-related articles published for the benefit and information of people interested in TB, and we do not confirm the accuracy of the data in the articles that are abstracted. Providing synopses of key scientific articles and lay media reports on TB does not constitute CDC endorsement. This update may also include information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases, and announcements. Reproduction of this text is encouraged; however, copies may not be sold. For those items reproduced from the first section of the TB weekly update, the CDC HIV/Hepatitis/STD/TB Prevention News Update should be cited. For any other items in the TB weekly update, you may cite the CDC TB-Related News and Journal Items Weekly Update.
> TB-Related Announcements
1. “Asking the Right Questions: A Visual Guide to Tuberculosis Case Management for Nurses” now available online
NEW
The Francis J. Curry National TB Center announces a new online educational toolkit: Asking the Right Questions: A Visual Guide to Tuberculosis Case Management for Nurses (http://www.nationaltbcenter.ucsf.edu/arq/index.cfm) .
The primary target audience is nurses in the public and private health sectors, but the toolkit materials are also useful for TB outreach workers, health care workers in facilities where TB cases are found, and community-based providers who may identify TB suspects or help to treat patients with TB.
Learners can use the Asking the Right Questions educational toolkit to:
Prompt critical thinking about TB case management
Find relevant basic national training materials and guidelines
Get an overview of the full TB case management timeline
Asking the Right Questions is an educational toolkit that can be used for self-paced learning or for mixed classroom and self-paced learning. It has three components:
(1)The Visual Guide (poster) presents a timeline of the full TB case management process and suggests critical questions to ask throughout the process to ensure full assessment of TB suspects and completion of safe, effective treatment for TB disease.
(2) The Reference Guide takes the critical questions another level deeper and offers short topics that briefly explain relevant concepts, and provides hyperlinks to training materials from the CDC and Regional Training and Medical Consultation Centers and to current national guidelines and selected
publications.
(3) The Web Guide offers several features for exploring questions and concepts. These features include: an interactive exploration of critical questions linking to Reference Guide topics and hyperlinks, a presentation about the TB case management timeline that is part of the Visual Guide, an online glossary, and downloadable learning guides with suggested curricula.
To put these materials to use, two learning guides suggest training curricula for self-paced learning and for a combination of self-paced and classroom-based learning, adaptable to the needs of your jurisdiction or agency. The Facilitator’s Guide offers suggestions for presenting a curriculum that combines self-paced study with classroom discussion and activities. The Self-Paced Learning Guide outlines a learning curriculum that can be completed by the learner at his or her own pace.
We would like to acknowledge two TB professionals who made important contributions to development of this product. Kim Field, BSN, PHN, RN, MSN, of the Washington State TB Control Program, developed the initial idea for the product and served as a subject matter expert throughout its development. Dr. Masae Kawamura, of the San Francisco TB Control Program, provided her expertise as the medical content reviewer.
2. Pilot Testing for Online TB Refresher Course for Physicians NEW
December 7, 2010
The NJMS Global Tuberculosis Institute is looking for physicians outside of the United States and Canada to pilot test an online training: "A Tuberculosis Refresher Course for Physicians."
The course is being developed for the World Medical Association and is geared to an international audience. Field testers will be asked to view the online course (about 2 hours) and complete an online questionnaire. If you are interested, please send an email to .
3. TB REACH Launches Call for Proposals for Wave 2 Funding
Stop TB Partnership, December 1, 2010
TB REACH is accepting proposals for the second wave of funding for projects that promote early and increased case detection of TB cases and ensure their timely treatment, while maintaining high cure rates within national TB programs.
TB REACH encourages the development and application of innovative, ground-breaking, and efficient approaches, interventions, and activities that result in increased TB case detection, reduced transmission, and prevention of the emergence of drug-resistant forms of TB. As suggested by its name, TB REACH focuses on reaching vulnerable people, people from poverty areas, and people who have limited or no access to TB services.
Eligibility criteria, examples of suitable interventions, technical guidance, the application form, and instructions for applicants are available on the TB REACH website: http://stoptb.org/global/awards/tbreach/
The deadline for submitting proposals for Wave 2 is February 28, 2011.
Eligible applications will be reviewed by the Proposal Review Committee, an independent group of experts, during March 2011. All proposals recommended for funding will be presented for approval to the Stop TB Partnership Coordinating Board at its next meeting. The final results of the review are likely to be made available to all applicants by May 2011.
TB REACH was launched officially on January 25, 2010. Thirty projects in 19 eligible countries, which aimed to detect and treat an additional 40,000 new smear-positive TB cases, received funding under Wave 1. The TB REACH initiative receives support from the Canadian International Development
Agency (CIDA).
4. Craig David on World AIDS Day: Let's Make a Prevention Revolution!
Stop TB Partnership, December 1, 2010
Goodwill Ambassador Craig David is sending the world this message:
People living with HIV are particularly vulnerable to TB. Not only are they much more likely to get it, they are also much more likely to die of the disease.
One out of every four AIDS-related deaths is caused by TB. Last year, 400 000 people living with HIV died from TB.
But these deaths are preventable: If people living with HIV test for TB, they can get access to care and be cured.
Preventing HIV will help prevent TB.
Join the Prevention Revolution http://on.fb.me/95aBoI.
> News Item(s) From the CDC HIV/Hepatitis/STD/TB Prevention News Update
1. TB Mortality in Russia Goes Down by Over 8 Percent
ITAR-TASS News Agency, November 24, 2010
Deaths from TB in Russia this year are down by 8.4 percent compared to last year, according to a recent statement by Tatiana Golikova, the minister of health and social development. The largest decreases were observed in the Murmansk, Chelyabinsk and Novosibirsk regions, and the Khabarovsk territory. Diagnosis of the condition earlier, when it is more treatable, is helping lower the mortality rate for TB in Russia, she said.
> Headlines
1. WHO Endorses New Rapid TB Test (Switzerland)
Stop TB Partnership, www.stoptb.org, December 8, 2010
The World Health Organization (WHO) has endorsed a new rapid test for TB, which can give an accurate diagnosis in about 100 minutes compared to current tests that can take up to three months. The new test is a fully automated nucleic acid amplification test (NAAT), which has been rigorously assessed for 28 months for its field effectiveness in the early diagnosis of TB and of multidrug-resistant TB (MDR TB), as well as TB complicated by HIV infection, which can be more difficult to diagnose. This easy and safe test uses DNA technology that can be used apart from conventional laboratories.
WHO is calling for fully automated NAAT to begin under clearly defined conditions, as part of national plans for TB and MDR TB treatment and control, and is providing recommendations and guidance for countries to incorporate the test in their programs. Policy and operational guidance are being issued, based on findings from expert reviews, and a global consultation attended by representatives from national programs, development aid agencies, and international partners. One of the major concerns in the assessment of the test was affordability. The Foundation for Innovative New Diagnostics (FIND), co-developer of the test, has negotiated with Cepheid, the manufacturer, for a 75 percent price reduction for countries most affected by TB. The preferential pricing will be granted to 116 low-and
middle-income countries where TB is endemic, with additional reduction as the demand increases. Dr. Giorgio Roscigno, FIND’s Chief Executive Officer, commented on the desire to remove obstacles and financial barriers that may prevent successful implementation of the new technology. He observed that
for the first time in TB control, there will be access to state-of-the-art technology simultaneously in low, middle, and high-income countries.
2. Inmate Says Jail Time Led to TB Infection (United States)
Star Advertiser, www.staradvertiser.com, December 6, 2010
A former inmate of the Halawa Correctional Facility in Honolulu, Hawaii, has filed a federal lawsuit claiming that Hawaii’s Department of Public Safety did not adequately safeguard him and other inmates from TB while incarcerated. In October, J. Michael Seabright, US District Judge, denied a motion by the state attorney general’s office to dismiss the suit. The plaintiff, who served a five-year sentence and was released from the prison infirmary in November with a supply of TB medications, is representing
himself in a million dollar claim against prison authorities. He said that the diagnosis affected him mentally and was responsible for ending his relationship with his girlfriend. Tommy Johnson, Deputy Director for Corrections for the Department of Public Safety, stated that Hawaii’s inmates are tested for various diseases when they enter the prison system, and are retested for TB every year. The plaintiff said that he always tested negative except for this year, when he tested positive one month after
fainting. He believes that he contracted the disease from other inmates who should have been isolated and properly treated. The attorney general’s office argued in court that it is possible that the plaintiff contracted TB from a visitor rather than from another inmate. The lawsuit is scheduled for trial next year. According to the health department, Hawaii led the nation in TB cases in 2009, with a rate of 9.1 cases per 100,000 people.
3. Myanmar: Funding, Access Challenges to TB Treatment (Myanmar)
IRIN, www.irinnews.org, December 3, 2010
According to Eva Nathanson, technical officer for the World Health
Organization (WHO), there is a need for improved case finding in Myanmar, as
some areas are difficult to access. More patients need to be found and
treated. Myanmar is number 19 on the WHO list of tuberculosis high-burden
nations in the world. The government figures indicate that 1.5 percent of
the country’s 53 million inhabitants contract TB annually. Although the
country ranks TB as a priority, diagnosis and treatment are difficult, as
there is only one microscopy center per 150,000 people, compared with the
international standard of one per 100,000. Also, there are two laboratories
performing culture and drug susceptibility testing, compared with the
international standard of one laboratory per 5 million people. In many
communities, people do not complete treatment and are unaware of the
consequences of this behavior. There were an estimated 4,800 MDR TB patients
in 2009. Myanmar’s National TB Program (NTP) and Médecins Sans Frontières
(Doctors Without Borders), with technical assistance from WHO, began a
two-year DOTS-Plus pilot project in July 2009, to treat 275 MDR TB patients
in Yangon and Mandalay. The NTP has plans to expand treatment in 2011. The
country’s five-year national strategic plan for TB control (2011-2015) has
calculated the total cost for TB control to be US $160 million.
4. 43 Special Labs Coming to Test for Drug-Resistant TB (India)
The Times of India, http://timesofindia.indiatimes.com, December 2, 2010, by
Kounteya Sinha
India’s nationwide TB control program is setting up 43 specialized
laboratories to diagnose MDR TB. About 19 laboratories are already in place,
and the others should be functioning in the next few months. According to
Dr. L. S. Chauhan, director general of the TB control program, it takes
about four to six months to confirm one case of drug resistance, compared to
the line probe assay test used in the new labs, which can detect MDR TB in
two days. Dr. Chauhan stated that India has 600,000 MDR TB cases in 10
states, and by March 2011, the country would be able to detect all cases in
all states. India estimates that about three percent of all new cases are
MDR TB, while 12 to 17 percent of retreatment cases are MDR. The county is
also increasing its laboratories to better diagnose TB among HIV/AIDS
patients. At Christian Medical College, Vellore, researchers are evaluating
a new technology called Xpert, a rapid molecular test for detection of TB
and rifampin resistance.
5. Global Fund Suspends Malaria, TB Grants in Mali (Mali)
Washington Post, www.washingtonpost.com, December 7, 2010, by the Associated
Press
The Global Fund to Fight AIDS, TB, and Malaria announced that $4 million to
fight disease in Mali has been misappropriated. As a result, the Fund has
temporarily suspended two malaria grants and terminated a TB grant. The
malaria grants were meant to provide anti-malarial bed nets and malaria
drugs. The TB grant was meant to provide TB treatment for incarcerated
persons, people in mining communities, and patients with multidrug-resistant
TB. According to the Fund, authorities in Mali have arrested 15 individuals
suspected of fraud.
6. Former Patients at Morriston Hospital ‘May Have Been Exposed to
Tuberculosis’ (United Kingdom)
This is South Wales, www.thisissouthwales.co.uk, December 4, 2010, by Nino
Williams,
Abertawe Bro Morgannywg (ABM) University Health Board and Public Health
Wales notified about 92 former patients of Morriston Hospital, Swansea,
Wales, that they may have been exposed to TB, after a patient on the same
ward was diagnosed with the disease. ABM University Health Board did not
believe that any other patient came into close contact with the TB patient
and felt that the risk of exposure to TB was low. The former patients also
received information leaflets about TB, including its symptoms. Data from
the Health Protection Industry show that TB cases have risen by one third in
Wales in almost a year. There were 167 cases in 2008 and 220 in 2009. Data
also show that the increase in TB cases across the United Kingdom was the
largest since 2005.
7. Quezon City Expands Anti-TB Campaign (The Philippines)
Manila Bulletin, www.mb.com.ph, December 7, 2010, by Chito Chavez
Quezon City government has expanded its efforts to eliminate TB by involving
public and private groups in the campaign to fight TB. About 150 individuals
and representatives from the mayor’s office, Quezon City Council,
organizations, hospitals, agencies, and groups attended an anti-TB campaign
event. Mayor Herbert Bautista stated that he hoped that the information on
how to fight TB will assist the city to reach the Millennium Development
Goals target of 70 percent case detection rate, 85 percent cure rate, and 50
percent reduction in TB incidence by 2015. Felisa Tang of the Quezon City
Health Department listed some of the anti-TB initiatives the city government
had adopted, including programmatic management of multidrug-resistant TB,
the provision of 43 health centers to serve as treatment sites, and two new
treatment centers. She noted that city residents who have TB symptoms should
take advantage of the services at the 43 health centers. Other ways in which
Quezon City Council members are fighting TB include integrating plans of all
the participating agencies and organizations, monitoring the implementation
of TB control plans in the city, conducting regular meetings and updates
from TB control implementers, and assisting members to ensure a smooth
implementation of the program and of the TB referral network system. Tang
also listed what individuals can do to help prevent TB. The Philippines
ranks ninth of 22 countries on the WHO list of tuberculosis high-burden
nations. The disease is sixth among the 10 leading causes of death in the
country, with an average of 75 fatalities a day, and is ranked eighth among
the 10 leading causes of illness in Quezon City.
> Journal Articles
1. Annals of Internal Medicine. 2010 Oct 19; Volume 153, Number 8: 516-522.
High Incidence of Hospital Admissions with Multidrug-Resistant and
Extensively Drug-Resistant Tuberculosis Among South African Health Care
Workers; O'Donnell, M.R., Jarand, J., Loveday, M., Padayatchi, N., et al.
Abstract in PubMed:
http://www.ncbi.nlm.nih.gov/pubmed/20956708?dopt=Abstract
<http://www.ncbi.nlm.nih.gov/pubmed/20956708?dopt=Abstract>
Nosocomial transmission has been described in extensively drug-resistant TB
(XDR TB) and HIV coinfected patients in South Africa. However, little is
known about the rates of drug-resistant TB among health care workers in
countries with high TB and HIV burden. This study estimated rates of
multidrug-resistant TB (MDR TB) and XDR TB hospitalizations among health
care workers in KwaZulu-Natal, South Africa. A retrospective study was
conducted of patients with drug-resistant TB who were admitted to a public
TB referral hospital in KwaZulu-Natal, South Africa from 2003 to 2008 for
the initiation of drug-resistant TB therapy. The patients were 231 health
care workers and 4,151 non-health care workers admitted for initiation of
MDR TB or XDR TB treatment. Hospital admission rates and hospital admission
incidence rate ratios were measured. Estimated incidence of MDR TB
hospitalization was 64.8 per 100,000 health care workers versus 11.9 per
100,000 non-health care workers (incidence rate ratio, 5.46 [95% CI, 4.75 to
6.28]). Estimated incidence of XDR TB hospitalizations was 7.2 per 100,000
health care workers versus 1.1 per 100,000 non-health care workers
(incidence rate ratio, 6.69 [CI, 4.38 to 10.20]). A higher percentage of
health care workers than non-health care workers with MDR TB or XDR TB were
women (78% vs. 47%; P < 0.001), and health care workers were less likely to
report previous TB treatment (41% vs. 92%; P < 0.001). HIV infection did not
differ between health care workers and non-health care workers (55% vs.
57%); however, among HIV-infected patients, a higher percentage of health
care workers were receiving antiretroviral medications (63% vs. 47%; P <
0.001). The study had an observational retrospective design, is subject to
referral bias, and had no information on type of health care work or
duration of occupational exposure to tuberculosis. Health care workers in
this HIV-endemic area were substantially more likely to be hospitalized with
either MDR TB or XDR TB than were non-health care workers. The increased
risk may be explained by occupational exposure, underlining the urgent need
for TB infection-control programs.
2. Cardiopulmonary Physical Therapy Journal. 2010 Sep; Volume 21, Number 3:
5-10. Six Minute Walk Test in People with Tuberculosis Sequelae;
Sivaranjini, S., Vanamail, P., Eason, J.
Free full text:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941351/?tool=pubmed
TB is an infectious disease that affects the lungs and results in poor lung
compliance secondary to diffuse fibrotic changes to lung tissue.
Consequently, people with pulmonary TB experience impaired gas exchange
resulting in a decline in functional capacity. This study evaluated the
physical functional capacity (VO(2)max) in a group of older (50 - 65 years)
people with pulmonary TB and compared them to an age-matched healthy group.
A secondary purpose was to develop reference equations that could be used to
predict 6 minute walk test (6MWT) distance in older, healthy people in
India. Sixty healthy subjects (30 male and 30 female) and 60 subjects with a
diagnosis of pulmonary TB (30 male and 30 female) participated in the study.
All subjects underwent a 6MWT. Walk-work was calculated and used for
evaluating functional capacity. Group comparison for functional capacity was
done using 2-tailed t-tests. Pearson product correlation was used to examine
for significant relationships and regression analysis was used to derive
reference equations. There was a significant difference between groups in
regard to functional capacity and 6MWT distance (p < 0.001). Reference
equations were developed that use age, height, and weight as predictors for
6MWT distance in the healthy group. The sequelae from pulmonary TB have
considerable impact on functional capacity in older people in India.
3. European Respiratory Review. 2009 Dec 1; Volume 18, Number 114: 295-9.
Paradoxical Reactions in Non-HIV Tuberculosis Presenting as Endobronchial
Obstruction; Bloch, S., Wickremasinghe, M., Wright, A., Rice, A., et al.
Free full text in PDF:
http://err.ersjournals.com/content/18/114/295.full.pdf
Paradoxical reaction (PR) in TB is common and may affect up to 25% of
patients. PR has the potential to cause significant morbidity and, on
occasion, death. Although PR has been recognized for some time, the
pathophysiology, especially in HIV-negative patients, is not well
understood. The researchers present two cases of PR in HIV-negative patients
with TB presenting as significant airway obstruction secondary to a florid
endobronchial component. These cases demonstrate that PR should be
considered in all patients presenting with airway symptoms who have started
TB treatment. The outcomes of the cases illustrate the need for wider
recognition of this condition and more research to characterize patients who
may be at risk, in order to gain a greater understanding of the mechanisms
involved and to make or predict this diagnosis earlier.
4. Hemodialysis International. 2010 Oct; Volume 14, Number 4: 505-509. doi:
10.1111/j.1542-4758.2010.00470.x. Tuberculosis in Patients on Hemodialysis
in an Endemic Region; Kazancioglu, R., Ozturk, S., Gursu, M., Avsar, U., et
al.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/20955284
Clinical presentation of TB is different in hemodialysis patients than in
the general population. This study analyzed hemodialysis patients with TB in
Istanbul. Patients who were on a chronic hemodialysis program in Istanbul
for more than 3 months and diagnosed to have TB at least 3 months after the
start of hemodialysis were included. To discard the effect of immigration
from other cities, the researchers included only patients who had started
their dialysis program in Istanbul. Their demographic and clinical data were
analyzed using Statistical Package for Social Sciences for Windows ver.
13.0. Of the 925 patients screened from 7 different centers, 31 (3.35%) were
found to have TB. The mean age was 52.3±13.5 years. The male/female ratio
was 18/13. The mean duration of dialysis therapy and the duration of
dialysis till the diagnosis of TB were 62.6±54.3 and 21.7±25.7 months,
respectively. Extrapulmonary TB constituted 48.39%. Treatment ended with a
cure in 18 (58.05%); was still ongoing in 12 (38.70%) patients; and one
(3.25%) died of pulmonary TB. The lower incidence of TB compared with
previous reports may be related to the differences in the diagnostic
criteria and the decrease in the rate of TB during recent years. The
demographic and clinical parameters of the patients were quite similar to
the average dialysis population in Turkey. Hence, the researchers cannot
address a subpopulation with additional risk. It is important to prevent TB
in hemodialysis patients due to difficulties in the diagnosis and treatment.
Thus the researchers recommend routine screening of hemodialysis patients
and effective isolation and treatment of infected patients.
5. The Indian Journal of Chest Diseases and Allied Sciences. 2010 Jul-Sep;
Volume 52, Number 3: 153-8. Role of Corticosteroids in the Treatment of
Tuberculosis: An Evidence-Based Update; Kadhiravan, T., Deepanjali, S.
Free full text PDF: http://medind.nic.in/iae/t10/i3/iaet10i3p153.pdf
Corticosteroids are often used as an adjunct in the treatment of various
forms of TB and for the prevention of complications, such as constrictive
pericarditis, hydrocephalus, focal neurological deficits, pleural adhesions,
and intestinal strictures. Notwithstanding, they have been proven in
clinical trials to improve the following outcomes only--death or disability
in HIV-seronegative patients with tubercular meningitis and tubercular
pericarditis. Despite a lack of specific evidence for efficacy in
HIV-coinfected patients with tubercular meningitis or pericarditis,
corticosteroids are generally recommended in them as well. Corticosteroids
significantly decrease the risk of pleural thickening in patients with
tubercular pleural effusion; the clinical significance of this finding,
however, is unclear. Recently, it has been demonstrated that the use of
corticosteroids improves the morbidity in HIV-coinfected patients with
paradoxical TB immune reconstitution inflammatory syndrome (IRIS). However,
evidence favoring the use of corticosteroids in other clinical situations is
sparse or lacking. Likewise, the biological mechanisms underlying their
beneficial effect in TB meningitis and pericarditis remain poorly
understood.
6. The Indian Journal of Chest Diseases & Allied Sciences. 2010 Jul-Sep;
Volume 52, Number 3: 139-43. Domestic Cooking Fuel Exposure and Tuberculosis
in Indian Women; Behera D, Aggarwal G.
Free full text in PDF: http://medind.nic.in/iae/t10/i3/iaet10i3p139.pdf
A case-controlled study was undertaken to find out the possible relationship
of biomass fuel and pulmonary TB. Ninety-five non-smoking females with
sputum positive TB and 109 healthy controls were interviewed using a
questionnaire to obtain detailed information on type of fuel used in homes,
duration of cooking, passive smoking, location of kitchen, socioeconomic
status, adequacy of ventilation, number of people per room, and respiratory
symptoms occurring during cooking. Odds ratio (OR) was ascertained by
logistic regression analysis. The cases were from a low socioeconomic status
and the kitchens used by them were inadequately ventilated. Controls had
less smoke accumulation in the rooms while cooking and cases had associated
respiratory symptoms more often. Logistic regression analysis revealed that
TB was significantly influenced by the location of the kitchen (OR 0.201,
95% confidence interval [CI] 0.08-0.51) and the presence of respiratory
symptoms while cooking (OR 10.70, 95% CI 2.90-39.56). The odds of having TB
did not differ significantly among various fuel types either on univariate
(OR 0.99, 95% CI 0.45- 2.22) or multivariate analysis (OR 0.60, 95% CI
0.22-1.63). No association was found between type of fuel used and TB.
However, low socioeconomic status, smoky rooms, location of the kitchen,
ventilation, and associated respiratory symptoms during cooking are likely
to be important contributors.
7. The International Journal of Tuberculosis and Lung Disease. 2010 Nov;
Volume 14, Number 11: 1430-5. Latent Tuberculosis Infection among Close
Contacts of Multidrug-Resistant Tuberculosis Patients in Central Taiwan;
Huang, Y.W., Shen, G.H., Lee, J.J., Yang, W.T.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/20937183
Both the tuberculin skin test (TST) and the QuantiFERON®-TB Gold In-Tube
test (QFT-GIT) may be used to detect Mycobacterium tuberculosis infection. A
positive reaction to either test can indicate latent TB infection (LTBI).
These tests can be used to study the rate of infection in contacts of
multidrug-resistant TB (MDR TB) patients. This study evaluated the
transmission status of MDR TB patients in Taiwan by examining their close
contacts and compared the efficiency of TST and QFT-GIT. Chest radiographs,
TST, and QFT-GIT were performed in household contacts of confirmed MDR TB
patients to determine their infection status. A total of 78 close contacts
of confirmed MDR TB patients were included in the study. The majority of the
MDR TB patients were parents of the close contacts and lived in the same
building; 46% of the subjects were TST-positive and 19% were
QFT-GIT-positive, indicating LTBI that was likely to develop into active MDR
TB. There was a lack of consistency between TST and QFT-GIT results in
subjects with previous bacille Calmette-Guérin vaccination. It is concluded
that household contacts of MDR TB patients are likely to develop LTBI; thus,
follow-up and monitoring are mandatory to provide treatment and reduce the
occurrence of active infection.
8. The International Journal of Tuberculosis and Lung Disease. 2010 Nov;
Volume 14, Number 11: 1447-53. Low BMI and Falling BMI Predict
HIV-Associated Tuberculosis: A Prospective Study in Tanzania; Maro, I.,
Lahey, T., Mackenzie, T., Mtei, L., et al.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/20937186
Low body mass index (BMI) is a known risk factor for TB in people without
HIV, but there are no prospective studies linking BMI to the risk of
HIV-associated TB. In HIV-infected adults with CD4 counts ≥ 200 cells/μl
receiving placebo in a TB booster vaccine trial in Dar es Salaam, Tanzania,
the researchers measured BMI at baseline and Year 1, and related baseline
BMI and change in BMI to the risk of developing TB. The researchers
documented 92 cases of TB among 979 subjects followed for a mean of 3.2
years. Compared to subjects who did not develop TB, subjects who developed
TB had a lower baseline BMI (23.2 vs. 24.6 kg/m(2), P = 0.006), and a
greater BMI decline from baseline to Year 1 (-0.4 vs. 0.6 kg/m(2), P <
0.001). In multivariate analyses, baseline BMI was associated with the risk
of developing TB (hazard ratio [HR] per kg/m(2) 0.94, 95%CI 0.90-0.99, P =
0.028), as was the change in BMI from baseline to Year 1 (HR per kg/m(2)
0.79, 95%CI 0.71-0.87, P < 0.001). Subjects with a baseline BMI < 17 kg/m(2)
were more likely to develop TB (HR 3.72, 95%CI 1.16-12.0, P = 0.028). It is
concluded that low and falling BMI predict HIV-associated TB.
9. The International Journal of Tuberculosis and Lung Disease. 2010 Nov;
Volume 14, Number 11: 1475-80. MODS Accreditation Process for Regional
reference Laboratories in Peru: Validation by GenoType® MTBDRplus; Coronel,
J., Roper, M., Mitchell, S., Castillo, E., et al.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/20937190
Although considerable effort has been put into the development and
evaluation of new diagnostics for TB and multidrug-resistant TB (MDR TB),
little attention has thus far been paid to the technical aspects of
initiating quality-assured routine service use. For implementation of the
microscopic-observation drug susceptibility (MODS) methodology in the
Peruvian reference laboratory network, a laboratory accreditation process
was devised; MODS results from an expert reference laboratory (Universidad
Peruana Cayetano Heredia [UPCH]) were used as the standard against which
implementing laboratory MODS results were judged to ensure that, prior to
use for patient care, implementing laboratories achieved the same high
performance with MODS as previously demonstrated in the research laboratory.
This study evaluated the validity of MODS-based accreditation and the
concordance of MODS drug susceptibility testing (DST) with molecular
testing. Head-to-head comparison of MODS DST results from implementing
Peruvian regional reference laboratories and the accrediting expert MODS
laboratory (UPCH) with GenoType® MTBDRplus DST. The concordance of
phenotypic MODS rifampicin (RMP) DST with GenoType MTBDRplus was
respectively 97.4%, 97.9%, and 97.1% for the two implementing regional
laboratories and UPCH, and respectively 94.7%, 95.7%, and 94.6% for
isoniazid (INH) DST. High and consistent levels of MODS/MTBDRplus
concordance for INH and RMP DST confirm the validity of the use of rapid
methods as reference standards for accreditation.
10. The International Journal of Tuberculosis and Lung Disease. 2010 Nov;
Volume 14, Number 11: 1411-7. Predictors of Failure to Complete Tuberculosis
Treatment in London, 2003-2006; Cegolon, L., Maguire, H., Mastrangelo, G.,
Carless, J., et al.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/20937180
This study investigated TB treatment completion failure in London and
associated risk factors during 2003-2006. A cross-sectional analysis of
treatment outcome and other explanatory variables was conducted in a cohort
of TB patients reported to the London TB Register from 2003 to 2006. An
innovative definition of TB treatment outcome more suitable for
low-incidence industrialized countries, such as the United Kingdom, was
adopted. A multivariable logistic approach was used to assess predictors of
unsuccessful outcome. A total of 12,929 TB cases were notified from 2003 to
2006, of which 12% (n = 1536) failed to complete TB treatment. The
proportion of cases failing to complete treatment showed a significant
decrease from 2003 to 2006 (13% in 2003 vs. 10% in 2006). Males, the
elderly, hospitalized patients, short- and long-term immigrants, Whites, and
the least deprived, were more likely to fail to complete treatment. The
proportion of TB treatment success in London exceeded the World Health
Organization recommended threshold of 85%. Some specific categories of
patients that are more likely to fail to complete treatment should be
targeted by health services to enhance their engagement and adherence to the
treatment regimen.
11. The International Journal of Tuberculosis and Lung Disease. 2010 Nov;
Volume 14, Number 11: 1418-23. Risk of Relapse and Failure after Retreatment
with the Category II Regimen in Nepal; Yoshiyama T, Shrestha B, Maharjan B.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/20937181
This study investigated the probabilities of failure and relapse and of
amplifying drug resistance to isoniazid (INH) and rifampicin (RMP) after the
Category II retreatment regimen in a cohort study of smear-positive TB
retreatment cases. Of 250 cases started on Category II retreatment, 209 were
relapse cases; of these, 18 were INH-resistant RMP-susceptible, 18 were
INH+RMP-resistant and nine were culture-negative. Of 19 return after
interruption cases, two were INH-resistant RMP-susceptible and one was
INH+RMP-resistant. Among 22 failures, no case was INH-resistant
RMP-susceptible, six were INH+RMP-resistant and 14 were culture-negative. No
INH-susceptible RMP-resistant cases were observed. Among 182
INH+RMP-susceptible cases, one failed and four relapsed during follow-up.
Two of the five cases became INH+RMP-resistant and the remaining three
remained susceptible. Among 20 INH-resistant RMP-susceptible cases, two
failed and none relapsed. One of the two became INH+RMP-resistant and the
other case remained INH-resistant RMP-susceptible. The proportion of
resistance among retreatment cases in Kathmandu Valley was not high. The
risk of relapse with amplification of RMP resistance among INH-resistant
RMP-susceptible cases on the Category II retreatment regimen was 5% (1/20),
and that among INH+RMP-susceptible cases was 1% (2/182).
12. Journal of Acquired Immune Deficiency Syndrome. 2010 Dec 1; Volume 55,
Number 4: 446-50. Causes of Early Mortality in HIV-Infected TB Suspects in
an East African Referral Hospital; Kyeyune, R., den Boon, S., Cattamanchi,
A., Davis, J.L., et al.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/21105258
Respiratory infections are a leading cause of death in Africa, especially
among HIV-infected patients. Data on the etiology of fatal respiratory
diseases are largely based on autopsy studies. The researchers evaluated
causes of pneumonia associated with early mortality among hospitalized
HIV-infected patients in Kampala, Uganda. A prospective cohort study was
conducted of HIV-infected patients admitted to Mulago Hospital, Kampala,
with at least two weeks of cough. Consecutively enrolled patients with
negative Ziehl Neelsen sputum smears for acid-fast bacilli underwent
bronchoscopy with bronchoalveolar lavage and examination for mycobacteria
(smear, solid culture), Pneumocystis jirovecii (Giemsa stain), and fungi
(KOH mount, India ink stain, Sabouraud culture). Early mortality was defined
as death before the two-month follow-up visit. Follow-up data were available
for 353 (87%) of 407 patients enrolled. Of participants with follow-up data,
112 (32%) died within two months. Among patients with early mortality, a
diagnosis was confirmed in 74 (66%), including TB (56%), cryptococcal
pneumonia (1%), Pneumocystis pneumonia (3%), pulmonary Kaposi sarcoma (4%),
and pneumonia caused by two or more disease processes (3%). It is concluded
that mortality in HIV-infected TB suspects is high, with TB associated with
the largest proportion of deaths. A significant proportion of patients die
without a confirmed diagnosis.
13. Molecular Systems Biology. 2010 Oct 19; Volume 6:422. Insight into Human
Alveolar Macrophage and M. tuberculosis Interactions via Metabolic
Reconstructions; Bordbar, A., Lewis, N.E., Schellenberger, J., Palsson,
B.Ø., et al.
Full free text: http://www.nature.com/msb/journal/v6/n1/full/msb201068.html
Metabolic coupling of Mycobacterium tuberculosis to its host is foundational
to its pathogenesis. Computational genome-scale metabolic models have shown
utility in integrating -omic as well as physiologic data for systemic,
mechanistic analysis of metabolism. To date, integrative analysis of
host-pathogen interactions using in silico mass-balanced, genome-scale
models has not been performed. The researchers, therefore, constructed a
cell-specific alveolar macrophage model, iAB-AMØ-1410, from the global human
metabolic reconstruction, Recon 1. The model successfully predicted
experimentally verified ATP and nitric oxide production rates in
macrophages. This model was then integrated with an M. tuberculosis H37Rv
model, iNJ661, to build an integrated host-pathogen genome-scale
reconstruction, iAB-AMØ-1410-Mt-661. The integrated host-pathogen network
enables simulation of the metabolic changes during infection. The resulting
reaction activity and gene essentiality targets of the integrated model
represent an altered infectious state. High-throughput data from infected
macrophages were mapped onto the host-pathogen network and were able to
describe three distinct pathological states. Integrated host-pathogen
reconstructions thus form a foundation upon which understanding the biology
and pathophysiology of infections can be developed.
14. PLoS One. 2010 Oct 11; Volume 5, Number 10: e13339. Knowledge, Health
Seeking Behavior and Perceived Stigma towards Tuberculosis among
Tuberculosis Suspects in a Rural Community in Southwest Ethiopia; Abebe, G.,
Deribew, A., Apers, L., Woldemichael, K., et al.
Full free text:
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0013339
Perceived stigma and lack of awareness could contribute to the late
presentation and low detection rate of TB. The researchers conducted a study
in rural southwest Ethiopia among TB suspects to assess knowledge about and
stigma toward TB and their health seeking behavior. A community-based
cross-sectional survey was conducted from February to March 2009 in the
Gilgel Gibe field research area. Any person 15 years and above with cough
for at least 2 weeks was considered a TB suspect and included in the study.
Data were collected by trained personnel using a pretested structured
questionnaire. Logistic regression analysis was done using SPSS 15.0
statistical software. Of the 476 pulmonary TB suspects, 395 (83.0%) had ever
heard of TB; "evil eye" (50.4%) was the commonly mentioned cause of TB.
Individuals who could read and write were more likely to be aware of TB
[(crude OR = 2.98, (95%CI: 1.25, 7.08)] and more likely to know that TB is
caused by a microorganism [(adjusted OR = 3.16, (95%CI: 1.77, 5.65)] than
non-educated individuals. Males were more likely to know the cause of TB
[(adjusted OR = 1.92, (95%CI: 1.22, 3.03)] than females. 51.3% of TB
suspects perceived that other people would consider them inferior if they
had TB. High stigma toward TB was reported by 199(51.2%). 220 (46.2%) did
not seek help for their illness. Individuals who had previous anti-TB
treatment were more likely to have appropriate health seeking behavior
[(adjusted OR = 3.65, (95%CI: 1.89, 7.06)] than those who had not. There was
little knowledge about TB in the Gilgel Gibe field research area. The
researchers observed inappropriate health seeking behavior and stigma toward
TB. TB control programs in Ethiopia should educate rural communities,
particularly females and non-educated individuals, about the cause and the
importance of early diagnosis and treatment of TB.
15. Structure. 2010 Oct 13; Volume 18, Number 10: 1353-63. Structural
Insight into Serine Protease Rv3671c that Protects M. tuberculosis from
Oxidative and Acidic Stress; Biswas, T., Small, J., Vandal, O., Odaira, T.,
et al.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/20947023
Rv3671c, a putative serine protease, is crucial for persistence of
Mycobacterium tuberculosis in the hostile environment of the phagosome. The
researchers show that Rv3671c is required for M. tuberculosis resistance to
oxidative stress in addition to its role in protection from acidification.
Structural and biochemical analyses demonstrate that the periplasmic domain
of Rv3671c is a functional serine protease of the chymotrypsin family and,
remarkably, that its activity increases on oxidation. High-resolution
crystal structures of this protease in an active strained state and in an
inactive relaxed state reveal that a solvent-exposed disulfide bond controls
the protease activity by constraining two distant regions of Rv3671c and
stabilizing it in the catalytically active conformation. In vitro
biochemical studies confirm that activation of the protease in an oxidative
environment is dependent on this reversible disulfide bond. These results
suggest that the disulfide bond modulates activity of Rv3671c depending on
the oxidative environment in vivo.
16. Tropical Medicine & International Health. 2010 Nov; Volume 15, Number
11: 1289-1299. doi: 10.1111/j.1365-3156.2010.02625.x. Implications of the
Global Increase of Diabetes for Tuberculosis Control and Patient Care;
Ruslami, R., Aarnoutse, R.E., Alisjahbana, B., Van Der Ven, A.J., et al.
PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/20955495
This study reviewed the current knowledge about TB and diabetes, assessing
the implication of the global increase of diabetes for TB control and
patient care. The researchers conducted a systematic literature review.
Using public databases, it can be estimated that 12.6% (95% CI 9.2-17.3%) of
new TB cases in the 10 countries with the highest TB burden will be
attributable to TB in 2030, a relative increase of 25.5% compared to 2010.
Diabetes is associated with a higher age and body weight among patients with
TB, but probably not with a specific clinical presentation of TB. Rifampicin
hampers glycemic control by increasing the metabolism of most oral
antidiabetic drugs, while diabetes patients may have lower concentrations of
anti-TB drugs. This might be one factor contributing to higher TB treatment
failure rates. The global epidemic of diabetes has implications for control
and treatment of TB. Prospective studies are needed to improve prevention,
early detection, and treatment of concomitant diabetes and TB, especially in
developing countries.
> Job Announcements
All job announcements will be posted for two months. Please notify us if a
job is filled before the end of the two-month posting period, and we will
remove the job announcement. Thank you.
2. Director, Tuberculosis Programs (Tracking code 4307)
Sponsor: PATH
Location: Hanoi, Vietnam
PATH seeks a dynamic and experienced public health professional to lead and
manage its increasingly large and complex portfolio of TB Control projects;
represent PATH to donors, partners, and government agencies;, and serve as a
member of PATH Vietnam’s senior management team.
With support from the Global Fund to Fight AIDS, TB and Malaria and the
United States Agency for International Development (USAID) and in
partnership with the National TB Program, PATH is expanding its TB control
program in Vietnam with two major initiatives. The Global Fund project is
designed to scale up technical components and partnerships to increase TB
control impact while the USAID-funded project will reduce diagnostic delays,
increase case detection, and improve adherence to TB treatment through
strengthened stakeholder involvement in TB control activities at the
district, provincial, and national levels. The Global Fund project will
implement a public-private partnership model for TB case detection, and both
projects will strengthen capacity for advocacy, communication, and social
mobilization toward the goal of eliminating TB as a public health threat.
Reporting to the Country Program Leader, the incumbent will oversee a
combined budget of nearly nine million USD and 24 staff, including six
direct reports.
Specific responsibilities include:
(1) Project Leadership, Management and Oversight:
- Assume strategic leadership and direct planning, implementation, and
management for Global Fund project and oversight for USAID TB project,
including strategic support for program objectives, key interventions, and
evaluation strategies.
- Liaise with Global TB program staff integrating TB work in Vietnam with
overall PATH strategy for TB Control.
- Oversee rapid start-up of project activities for each initiative: hiring
staff and initiating and building relationships with key stakeholders.
- Develop and coordinate the annual budgeting process for each project;
ensure prudent management of project funds; coordinate each project’s
accounting, monitoring, and reporting systems, including establishing
internal control systems in accordance with PATH’s standard operating
procedures.
- Represent PATH to donors, partners, and government agencies, and oversee
coordination activities with the National TB Program.
- Support the Country Program Leader in managing all donor-related
compliance matters, ensuring that project teams achieve project goals and
objectives according to donor expectations and within approved project
budgets.
- Work with staff to develop strategy for each project and identify
issues/challenges for effective implementation of work plan activities.
- Oversee preparation of required reports to Headquarters and donors.
- Maintain updated technical knowledge in TB and related public health
topics to be able to provide vision and input to strategy development and
technical assistance to project staff.
(2) PATH Representation:
- On delegation, serve as the PATH representative to donors, collaboration
institutions, other potential clients and partners, and the press.
- Serve as a member of the senior management team contributing to strategic
policy and program directions and decisions.
- Represent PATH on national working groups and task forces as appropriate
and maintain contacts with other organizations engaged in TB control
activities.
- Identify and participate in new business opportunities and activities for
PATH including proposal writing.
If interested, forward resume to Sue Wallace. E-mail , or
apply online at http://www.path.org.
3. Lead Scientist/Medical Officer (Branch Chief), KEMRI/CDC TB Research
Branch
Sponsor: Department of Health and Human Services - CDC
Announcement No.: HHS-CDC-T3-2010-0159 (Internal)
HHS-CDC-D3-2010-0148 (External)
Location: Kisumu, Kenya
Due Date: Open for two weeks
The successful applicant for this job will:
(1) serve as a Medical Officer assisting in the expansion, improvement, and
monitoring of effective diagnosis, treatment, and monitoring of TB, with
particular emphasis on HIV-related TB. The assignee will be funded 80% by
CDC’s Division of TB Elimination and 20% by CDC’s Division of Global HIV/
AIDS. The assignee will provide medical and epidemiologic advice,
consultation, and training as an international expert in TB as it applies to
countries with a high TB burden;
(2) guide the further development of the KEMRI/CDC TB and TB/HIV research
and program implementation strategy, focusing on global gaps in knowledge,
addressing TB and HIV program priorities, and building upon strengths of the
epidemiological setting and the research capacity at KEMRI/CDC;
(3) provide leadership, direction, and technical expertise to the Kenya
Ministry of Health National TB and HIV Programs, non-governmental
organizations, universities, medical institutions, and other participating
agencies in leading the implementation of the KEMRI/CDC TB and TB/HIV
research and program implementation strategy, in close liaison with PEPFAR,
and CDC Divisions of Global HIV/AIDS and TB Elimination;
(4) in close collaboration with KEMRI and MOH, develop protocols, initiate
and implement studies, analyze study data using statistical methods, and
disseminate study results through scientific journals, periodic reports, and
public presentations, as well as designing and conducting additional special
epidemiologic studies as warranted;
(5) support and mentor the leads of on-going/planned TB vaccine trials and
planned Tuberculosis Clinical Trials Consortium (TBTC) drug trials, and
personally lead intensified TB case finding studies;
(6) mentor PhD students at KEMRI/CDC involved in TB and TB/HIV research;
(7) guide study-associated Kenyan researchers and staff;
(8) seek grant support for further studies;
(9) represent the USG through CDC, in conjunction with USAID, in a combined
effort to meet the USG commitment to fight the global TB and TB/HIV
epidemics. This position will also contribute directly to the Global Health
Initiative, which has defined targets for TB and HIV reduction.
Furthermore, the assignee will contribute to the CDC-Kenya platform model
and will assist in capacity development of KEMRI’s epidemiology, laboratory
services, disease monitoring, provision of technical assistance,
communications, and management.
To apply for this job, please go to USA Jobs at
http://www.usajobs.gov/infocenter/ and search by using the applicable job
announcement number of HHS-CDC-T3-2010-0159 (Internal); or
HHS-CDC-D3-2010-0148 (External).
For information, contact:
Kayla Laserson
Director
KEMRI/CDC Research and Public Health Collaboration
Kisumu, Kenya
;
+254 722 772 609
> Upcoming Conferences, Trainings, and Other Events
4. Targeted Testing and Treatment of Latent TB Infection: An Online
Presentation (60 minutes)
Sponsor: The Francis J. Curry National Tuberculosis Center
This slide presentation is presented by L. Masae Kawamura, M.D., TB
Controller of the San Francisco Department of Public Health and co-principal
investigator of the Francis J. Curry National TB Center/UCSF. Dr. Kawamura
explores the diagnosis and treatment of LTBI, including: the rationale for
TB screening and what is meant by "targeted testing," risk factors for TB,
the tuberculin skin test and new interferon gamma release assays (IGRAs),
current LTBI treatment guidelines, and how to counsel and motivate patients.
This slide presentation with streaming audio provides information on how to
effectively target test for TB as well as how to treat latent TB infection
(LTBI). A question and answer guide, a printable PowerPoint slide file, and
other useful resources are also included as supplemental materials.
For more information, visit
http://www.nationaltbcenter.ucsf.edu/testing_ltbi/ .
5. Practical Solutions for TB Infection Control: Infectiousness and
Isolation
Sponsor: Francis J. Curry National Tuberculosis Center
Location: Online Course
Length: 60 minutes
This 60-minute Flash presentation with streaming audio provides information
on how to determine whether a TB patient is infectious and demonstrates
practical ways to prevent TB transmission in the clinic, in transit, and in
the patient's home. Throughout the training, interactive questions allow
participants to test and apply what has been learned. At the end of the
presentation, there is a list of additional resources that includes links to
further written information as well as links to the Regional Training and
Medical Consultation Centers (RTMCCs).
For further assistance, contact Francis J. Curry National Tuberculosis
Center. E-mail ; telephone (415) 502-4600;
or fax (415) 502-4620.
For course, visit http://www.nationaltbcenter.ucsf.edu/tbicweb/ .
6. Medical Management of Tuberculosis: An Online Presentation
Sponsor: Francis J. Curry National Tuberculosis Center
Length: 30 minutes
Credit: 0.5 contact hour CME/CNE
This slide presentation with streaming audio will provide information on how
to manage treatment of TB. A question and answer guide, a printable
PowerPoint slide file, and other useful resources are also included as
supplemental reading materials. This 30-minute lecture, conducted by Dr.
Karen Smith, covers the general principles of TB treatment, the drugs used
to cure TB, alternative regimens, monitoring, and potential adverse
reactions to therapy. It targets audiences of clinicians and health care
professionals.
For a course description or to receive continuing medical education (CME) or
continuing nursing education (CNE) contact hours, please visit
http://www.nationaltbcenter.edu/med_mgmt/ .
7. Legal Interventions in TB Control: A Web-Based Seminar
Sponsor: New Jersey Medical School Global Tuberculosis Institute
Location: Web-Based Seminar
This web-based seminar, presented by the Global TB Institute, was originally
held on September 11, 2007 and explored successful and innovative approaches
to implementing legal interventions in TB control programs in the US.
Experts shared legal and ethical considerations, as well as hands-on
experiences, practical steps, and legal tools that can be used to improve
outcomes of case management, treatment outcomes, and contact investigations.
Points were illustrated using lectures and case presentations
Please follow the link below to view this web-based seminar:
http://www.umdnj.edu/globaltb/audioarchives/legal.htm .
8. Medical Update: Diagnosis and Management of Tuberculosis in the Pregnant
Patient
Sponsor: New Jersey Medical School Global Tuberculosis Institute
Date: December 15, 2010
The management of patients infected with M. tuberculosis can be complicated
and challenging in the presence of other medical conditions. This web-based
seminar will specifically cover screening, diagnosis, treatment, and
management of TB patients who are pregnant. The seminar will consist of an
overview of the current practices and recommendation related to this
population, as well as issues around TB in women of childbearing age. A case
presentation will be included along with time for discussion.
This conference is free, registration is limited. You may register by
visiting: http://tinyurl.com/3ag2job .
For more information, contact Rajita Bhavaraju. E-mail ;
phone (973) 972-4811, or access the Web site at
http://www.umdnj.edu/globaltb/courses/brochures/medicalupdate-2010.html.
10. Tuberculosis: Immunology, Cell Biology and Novel Vaccination Strategies
Sponsor: Keystone Symposia
Dates: January 15 – 20, 2011
Location: Vancouver, BC, Canada
This Keystone Symposium on TB will focus on the relationships covering basic
and clinical research. Topics include the molecular genetics and
biochemistry of the pathogen, with emphasis on unique lineage and growth
state-specific features, and the immunology and molecular genetics of the
host during latency, reactivation, and active disease. Because the outcomes
of TB are influenced by genetic, epigenetic, and environmental influences on
both host and pathogen, the meeting will highlight research on host-pathogen
crosstalk at the basic cellular and molecular level, as well as human
studies that determine the basis of susceptibility to and severity of TB.
The most recent results on clinical trials of drug and vaccine candidates
will be discussed in depth.
Abstract submission deadline: October 18, 2010. Early registration deadline:
November 15, 2010. Online registration deadline: January 15, 2011.
For more information, contact Keystone Symposia. E-mail
; phone (800) 253-0685 or (970) 262-1230; fax:
(970) 262-1525; or access the Web site at
http://www.tbvi.eu/news-agenda/events/event/tuberculosis-immunology-cell-biol....
13. 15th Annual Conference of the Union - North American Region (IUATLD-NAR)
Sponsor: British Columbia Lung Association; International Union Against TB
and Lung Disease (IUATLD) - North American Region
Dates: February 24 – 26, 2011
Location: Vancouver, BC, Canada
This year's theme, "Engaging Vulnerable Populations: Tools and Strategies to
Halt TB," highlights the crucial importance of developing effective
partnerships with those most impacted by TB. The keynote speakers are both
internationally recognized experts in their fields. Dr. Anthony Harries, the
George Comstock lecturer, and Sharon Venne, Beyond TB lecturer, will open
the conference by addressing two global populations who have been the most
impacted by TB. Plenary sessions will focus on several of the region's most
at risk for TB, including indigenous, migrant and immigrant populations, and
those affected by diabetes.
Registration fee (Canadian $): Physicians/PhDs: $500/Non-member,
$450/Member; Nurses and Allied Health Care professionals: $450/Non-member,
$400/Member; Students/Fellows: $250/Non-Member. Continuing education credits
are available.
For more information, contact Menn Biagtan, MD, MPH, British Columbia Lung
Association. E-mail ; phone (604) 731-5864; fax (604)
731-5810; or access the Web site at
http://www.bc.lung.ca/association_and_services/union.html .
