MDR-TB Treatment & Prevention
Fwd: [tb-update] Week of January 2 to January 8, 2011
Dear All,
Please find below relevant TB news and updates from the CDC. Of note: TB
REACH Launches Call for Proposals for Wave 2 Funding: deadline for
submission is February 28, 2011 http://stoptb.org/global/awards/tbreach/
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Date: Fri, Jan 7, 2011 at 11:58 AM
Subject: [tb-update] Week of January 2 to January 8, 2011
TB-Related News and Journal Items Weekly Update Week of January 2 to
January 8, 2011
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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*
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 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
The toolkit 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.
*2. Pilot Testing for Online TB Refresher Course for Physicians*
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).
News Item(s) From the CDC HIV/Hepatitis/STD/TB Prevention News Update
*1. Health Department Offers TB Testing to Chester Upland School *
Philippine Daily Inquirer, December 24, 2010, by Mari A. Schaefer
State health workers recently offered TB testing at a Delaware County school
after a student there reported being exposed to the disease off campus.
Chester Upland district officials had earlier sent notices about the
precautionary testing to the parents of 293 students at the high school. The
district’s acting superintendent used a Dec. 15 school assembly to
disseminate information about the screening. “The students were calm and
comfortable,” said Joyce Wells. “No one was rattled by the situation.” Of
200 students screened on Dec. 17, 20 tested positive for TB infection,
falling within an expected latent infection rate of between 5 percent and 10
percent, state Department of Health (DOH) officials said. No one screened
has active disease, said Joel Avery, a district spokesperson. “Even if
someone develops the disease, it is very curable,” said Phyllis Britz,
district nurse administrator for DOH. Students who tested positive will be
offered follow-up X-ray exams and antibiotic treatment, Britz said. CDC
recommends treatment for latent TB infection. The district will offer
further TB screening in January. Parents who wished to have their child
tested over the break were free to call the DOH at 610-447-3250 for an
appointment, the district said.
*2. Patrick Henry High Student Tests Positive for TB *
San Diego Union-Tribune, December 20, 2010, by Janet Lavelle
A student at a high school in San Carlos has been diagnosed with TB,
prompting officials of the San Diego Unified School District and the county
Health and Human Services Agency to contact individuals who may be at risk.
The potential exposures would have taken place between Sept. 7 and Dec. 16.
Dr. Wilma Wooten, the county’s public health officer, said TB testing will
be conducted on campus on Jan. 11. The county logged 229 TB cases in 2009,
and has seen 190 so far this year. The current case is the only one detected
at the high school this year, according to county health spokesperson Tom
Christensen. For more information, telephone the San Diego County TB Control
Program at 619-692-8621.
*3. Tuberculosis Thriving in 'Victorian' London, Doctor Warns *
The Guardian (London), December 17, 2010, by Sarah Boseley
The United Kingdom logged 9,000 TB cases last year, 40 percent of them in
London, according to a new report. “The incidence in the UK has gradually
increased over the past 15 years,” Dr. Alimuddin Zumla, of the University
College-London medical school, wrote in the Lancet. “This pattern is
striking when compared with the general decline in other European
countries.” The increase was mostly among foreign-born persons; however, 85
percent had been living in the nation for at least two years. In London last
year, 172 TB cases were resistant to isoniazid, a typical treatment, and 58
cases were resistant to more than one antibiotic, Zumla noted. “Poor
housing, inadequate ventilation, and overcrowding - conditions prevalent in
Victorian Britain - are causes of the higher TB incidence rates in certain
London boroughs,” Zumla said. “The ominous situation in London is
reminiscent of the unexpected outbreaks of multidrug-resistant TB in New
York and California prisons in the early 1990s, which arose as a result of
complacency of the respective states’ surveillance and control programs,”
Zumla wrote in the commentary. “A large financial investment, with political
and legal support, was required to re-establish control,” Zumla said. The
same immediate and long-term commitments now should be made by the UK, Zumla
wrote. Zumla’s article, “The White Plague Returns to London - with a
Vengeance,” was published ahead of the print edition of the Lancet (2010;
doi:10.1016/S0140-6736(10)62176-9).
*4. TB Care Moves to the Community *
Inter Press Service, December 15, 2010, by Mantoe Phakathi
In Swaziland’s Shiselweni region, Doctors Without Borders (DWB) is promoting
task-shifting from medical personnel to trained community caregivers, in a
bid to treat rural TB patients who are too poor or weak to reach regional
health centers. DWB began assisting the Ministry of Health regarding TB and
HIV in Shiselweni in 2007. None of the region’s 21 clinics offered treatment
for either disease. Patients had to travel to the Hlathikhulu Government
Hospital or to health centers in the Matsanjeni and Nhlangano regions. In
Shiselweni, DWB trained 80 community caregivers on how to administer
injections for multidrug-resistant TB (MDR TB). DWB provided monitoring,
visiting the patients and caregivers to ensure proper medicine
administration. In addition, lay people were trained in sputum collection,
counseling, and education. Though the initiative has brought TB services to
more patients in Shiselweni, TB Program Manager Themba Dlamini has doubts.
MDR TB injections are given in the buttocks; improperly administered, the
injection could lead to permanent disability. The drug to counteract a bad
reaction “is only available at the health center,” he said. Sibusiso
Lushaba, general secretary for the Swaziland Nurses Association, agrees. A
lay person cannot stand in a court of law and explain what happened to a
patient when complications develop, said Lushaba. “We need a task shifting
policy in the country so that [non-governmental organizations] work in line
with this framework.” DWB is following national guidelines on the delivery
of MDR TB treatment and community support, said Aymeric Péguillan, its head
of mission in Swaziland. “Injecting patients at community level is not
regarded as the first option,” he said. But the harsh conditions -
overburdened health facilities and large numbers of drug-resistant TB
patients - warrant it. Lay providers are closely supervised daily by DWB
nurses, Péguillan said, adding that the program has 100 percent treatment
adherence.
*5. Canada Lacks ‘Will’ to Fight TB Properly: MD *
Edmonton Journal, December 13, 2010, by Jen Skerritt, Winnipeg Free Press
While Canada provides a significant amount of assistance to fight TB in
developing nations, advocates say this obscures a deplorable state of TB
prevention and control among remote Canadian First Nations populations.
Experts attribute the domestic TB problem to treatment and outreach gaps,
underlying poverty, crowded housing, and other social conditions the native
communities share with nations that have high TB rates. Canada spent nearly
$140 million (US $139 million) over the past year to fight TB in developing
nations. At home, where for over a century TB has disproportionately struck
First Nations communities, the nation spent $10.8 million (US $10.7 million)
for control efforts, experts and advocates say. "Canada is seen as a wealthy
country,” said Chief Wilton Littlechild, an attorney and activist from
Ermineskin Cree Nation in Alberta. “That perception masks the real situation
in indigenous communities. People think all communities are healthy and
wealthy, but that’s not true.” In some Manitoba communities, TB rates are up
to 100 times that of the national average, according to a Winnipeg Free
Press series on the disease. Canada has considered importing some TB
prevention and control components from programs that are successful in other
countries, Christelle Legault, a government spokesperson, wrote in an
e-mail. "There are a lot of things you could do, but there’s zero political
will to do anything,” says Dr. Earl Hershfield, Manitoba’s former TB control
director.
Headlines
*1. Unusually Many TB Infections in Iceland (Iceland)*
Iceland Review Online, www.icelandreview.com, January 2, 2010
Compared to previous years, an unusual number of persons were diagnosed with
TB disease in Iceland in 2010. There were 21 TB patients in 2010, nine in
2009, and six in 2008. Of the 21 patients in 2010, 16 (76 percent) were
foreign born, mostly from Asia, and were between ages 20 and 70 years old,
with the average age being 34 years. None of the patients had
multidrug-resistant TB, but one was diagnosed with bovine TB.
*2. Israel to Tailor AIDS and TB Care to Migrant Workers (Israel)*
Haaretz Daily Newspaper, www.haaretz.com, December 22, 2010, by Dan Even
Israel’s Health Ministry plans to begin treatment programs for migrant
workers and asylum seekers with TB and HIV/AIDS because there seems to be an
increase in these diseases among those communities. According to the Health
Ministry, over the last 10 years, 586 migrant workers and asylum seekers
have been diagnosed with TB, comprising 13 percent of all TB patients; and
584 migrant workers and asylum seekers have been diagnosed with HIV,
comprising 17 percent of all new HIV diagnoses. This means that there was an
annual increase of between 2 percent and 3 percent in these diseases over
the last five years. At present, the Health Ministry only funds treatment
for TB and HIV/AIDS for pregnant patients and up to six months post partum.
Children are eligible if they have insurance coverage through the Meuhedet
HMO. Physicians for Human Rights (PFHR) question the Health Ministry’s
statistics and comment that using disease to label populations is
counterproductive. Figures from the refugee clinic run by PFHR show that
there were 122 persons with HIV over the past two years; 1.19 percent of all
refugees were treated at the clinic, and there were 215 AIDS cases out of
25,500 patients. Ran Cohen, Director General of PFHR, said that the Health
Ministry has taken no significant action to treat refugees and HIV carriers.
The Health Ministry recently approved the first study of records of asylum
seekers and migrant workers treated by clinics in the South Tel Aviv and
Ichilov hospitals. In June 2009, an interministerial committee was organized
to consider granting rights to medical treatment to all non-citizens of
Israel.
*3. Change in TB Test Coming for Ark Foreign Students (United States)*
Kspr.com, www.kspr.com, January 3, 2011, by Associated Press
At their January 11 meeting, the Arkansas Board of Health will decide
whether to use a blood test for diagnosing TB in foreign students, instead
of the usual skin test. Federal health regulators have approved the blood
test, which measures the immune system’s response to TB bacteria. Follow-up
testing is required after a positive result to determine whether the patient
has active TB disease. Foreign students from countries where TB is endemic
will be required to have the test as a condition of enrollment.
*4. Awards in Two Categories for Reporting on TB (India)*
The Hindu, www.thehindu.com, January 1, 2011
In anticipation of World TB Day on March 24th, REACH, a city-based
non-profit organization, has announced the REACH Lilly MDR-TB Partnership
Media Awards for journalists who have produced effective, in-depth, and
relevant stories about TB to a wide audience. This year, there will be two
categories: English and Indian language print journalists. The two best
entries in each category will receive 30,000 and 20,000 rupees,
approximately US $668 and $445. All entries must have a byline and must have
been published in a news publication in India between January 2010 and
January 2011. The stories must sensitively and accurately highlight aspects
of TB or TB-related complications. According to Alnurag Khera, Director,
Corporate Affairs, Lilly India, the awards recognize outstanding reporting
and commentary in print that increase the public’s knowledge and
understanding of TB and multidrug-resistant TB. Entries must be submitted by
January 25, 2011, and the awards will be presented in March. REACH can be
contacted by E-mail at . Details can be found at
www.media4tb.org/blog. www.media4tb.org/blog .
*5. Parents Outraged School Wasn’t Notified of TB Case (United States)*
NECN, www.necn.com, December 23, 2010, by Katie Daly
Parents of children attending a Worcester, Massachusetts, school are upset
that a teacher, who was diagnosed with TB in October, continued to work for
months exposing their children to the disease. The teacher recently informed
school officials of the diagnosis. Although officials do not think there is
a threat, about 100 students and staff will be tested. Letters were sent
home with students notifying parents about the situation, and public health
officials have had an informational meeting at the school.
*6. Immunitor Publishes Interim Data from Phase IIb Imm01 TB Trial (The
Ukraine)*
Benzinga, www.benzinga.com, December 30, 2010
A study by Dr. Olga Arjanova and colleagues at Lisichansk TB Dispensary in
Eastern Ukraine compared the impact of V5 immunotherapy to placebo among
refractory TB patients, including patients in retreatment, patients with
multidrug-resistant TB (MDR TB), and patients coinfected with TB and HIV.
The study showed that V5 was safe and had not resulted in any adverse
effects or reactivation of TB. Concurrent treatment with V5 and first- or
second-line TB drugs resulted in clearance of M. tuberculosis in sputum
smears of 96.3 percent of patients, compared to 25 percent of controls.
Sputum conversion was rapid after only one month of treatment. There was no
difference with easy-to-treat TB compared to re-treated TB, MDR TB, or
HIV/TB coinfection; the proportion of converted patients and time to
conversion were identical. Also, outcome was the same with both first-line
and second-line TB drugs. One pill of V5, given once daily, produced other
statistically significant clinical benefits, including reversal of
TB-associated wasting, and the elimination of TB-associated fever in 100
percent versus 39.3 percent of controls. The drug also had a marked
anti-inflammatory effect. Immunitor’s V5 immunomodulator reduced the
hepatoxicity induced by chemotherapy for TB, MDR TB, and XDR TB. It is
concluded that V5 offers a drastically shorter, more efficacious, and safer
treatment. It is inexpensive, easy to administer, stable in tropical
temperatures, and made from readily available sources. The study was
published online in the journal Immunotherapy, 2010 Dec 24, 2010.
*7. Lupin Inks Pact with Brazil for TB Drug Supply (India) *
The Hindu, www.thehindu.com, January 5, 2011
The drug company Lupin, based in Mumbai, India, announced the signing of an
agreement to supply Brazil with its four-in-one-combination drug to treat
TB. The agreement was made with the Department of Health of the Government
of Brazil, and Farmanguinhos, Brazil’s drug and technology institute. In
addition to Lupin supplying the drug for the next five years, the agreement
included Lupin providing Farmanguinhos with support for future set up of its
local manufacturing of the drug. The drug is a combination of rifampicin,
isoniazid, ethambutol, and pyrazinamide. Farmanguinhos will later produce
and supply the drug to the Department of Health, which will increase savings
for the government of Brazil.
Journal Articles
*1.* American Journal of Public Health. 2010 Dec; Volume 100, Number 12:
2481-6. Epub 2010 Feb 18. *Tuberculosis Transmission and Use of
Methamphetamines in Snohomish County, WA, 1991-2006;* Pevzner, E.S.,
Robison, S., Donovan, J., Allis, D., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20167896>
The researchers investigated a cluster of TB cases among persons using
methamphetamines in Snohomish County, Washington, to determine the extent of
the outbreak, examine whether methamphetamine use contributed to TB
transmission, and implement strategies to prevent further infections. The
researchers screened contacts to find and treat persons with TB disease or
infection. They then formed a multidisciplinary team to engage substance
abuse services partners and implement outreach strategies including novel
methods for finding contacts and a system of incentives and enablers to
promote finding, screening, and treating patients with TB and their infected
contacts. The researchers diagnosed and completed treatment with 10 persons
with TB disease. Eight of 9 adult patients and 67% of their adult contacts
reported using methamphetamines. Of the 372 contacts, 319 (85.8%) were
screened, 80 (25.1%) were infected, 71 (88.8%) started treatment for latent
infection, and 57 (80.3%) completed treatment for latent infection.
Collaborative approaches integrating TB control, outreach, incentives, and
enablers resulted in high rates of treatment adherence and completion among
patients and infected contacts. TB control programs should collaborate with
substance abuse programs to address addiction, overcome substance
abuse-related barriers to treatment, treat TB, and prevent ongoing
transmission.
*2.* Arquivos de Neuro-Psiquiatria. 2010 Oct; Volume 68, Number 5:
755-60. *Prognostic
Factors Predicting a Fatal Outcome in HIV-Negative Children with
Neurotuberculosis;* Rodrigues, M.G., Lin, J., Masruha, M.R., Vilanova, L.C.,
et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21049188>
This study identified prognostic factors predicting a fatal outcome in
HIV-negative children with neurotuberculosis based on clinical,
epidemiological, and laboratory findings. The clinical records of all
inpatients diagnosed with neurotuberculosis from 1982 to 2005 were evaluated
retrospectively. The following prognostic parameters were examined: gender,
age, close contact with a TB-infected individual, vaccination for bacille
Calmette-Guérin, purified protein derivative (PPD) of tuberculin results,
concomitant miliary TB, seizures, CSF results, and hydrocephalus. One
hundred forty-one patients diagnosed with neurotuberculosis were included.
Seventeen percent of the cases resulted in death. The factors that were
correlated with a negative outcome included lack of contact with a
TB-infected individual, negative PPD reaction, coma, and longer
hospitalization time. A multiple logistic regression analysis was performed
to identify which of these factors most often resulted in death. Coma at
diagnosis, lack of TB contact, and a non-reactive PPD were the most
important predictors of fatality in patients with neurotuberculosis.
*3.* Central European Journal of Public Health. 2010 Sep; Volume 18, Number
3: 132-8. *Alcohol Consumption among Men and Women with Tuberculosis in
Tomsk, Russia; Shin,* S.S., Mathew, T.A., Yanova, G.V., Fitzmaurice, G.M.,
et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21033607>
Drinking behavior among Russian women remains poorly described. The
researchers analyzed gender differences in alcohol use among 374 TB patients
in Tomsk, Siberia. Twenty-six (28.3%) women had lifetime alcohol abuse or
dependence, compared with 70.6% of men. Women with alcohol use disorders
drank 12.7 +/- 14.0 standard drinks per day and > or = 34.6% drank 2 three
days per week. Among individuals with a lifetime alcohol use disorder, age
of onset and typical consumption did not differ significantly by gender. It
is concluded that Russian women with alcohol use disorders consume almost as
much alcohol as men and may be at greater risk for negative social and
medical consequences.
*4.* Chinese Medical Journal (Engl). 2010 Oct; Volume 123, Number 20:
2786-91. *IFN-γ Release Assay: A Diagnostic Assistance Tool of Tuberculin
Skin Test in Pediatric Tuberculosis in China;* Sun, L., Yan, H.M., Hu, Y.H.,
Jiao, W.W., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21034583>
Prompt diagnosis of *Mycobacterium tuberculosis* (MTB) infection is an
essential step in TB control and elimination. However, it is often difficult
to accurately diagnose pediatric TB. The tuberculin test (TST) may have a
low specificity because of cross-reactivity with antigens present in
*Mycobacterium
bovis* bacille Calmette-Guerin (BCG) and other mycobacteria, especially in
China with a predominantly BCG-vaccinated population. Early-secreted
antigenic target 6-kDa protein (ESAT-6) and culture filtrate protein 10
(CFP-10), stand out as suitable antigens that induce an interferon-gamma
(IFN-γ) secreting, T-cell-mediated immune response to infection. While,
considered the higher costs and complexity of the IFN-γ release assay
(TSPOT), the researchers evaluated the TSPOT and TST test in the clinical
diagnosis of pediatric TB and established a diagnostic process suitable for
China. The sensitivity and specificity of the assay were evaluated in a
total of 74 children with active TB disease and 51 nontuberculous children
with other diseases, and then the results were compared with TST. Logistic
regression models were used to identify variables that were associated with
positive results for each assay. The independent variables included sex,
age, birth place, vaccination history, and close contact with an active TB
disease patient. The sensitivity of TSPOT was higher than that of TST in
children with active TB disease with or without BCG vaccination, as well as
in children with culture-confirmed TB. But the difference was not
significant statistically. Combining results of the TSPOT and TST improved
the sensitivity to 94.6%. Agreement of the TST and TSPOT was low (77.0%, κ =
0.203) in active TB disease patients. The difference in specificity between
TSPOT and TST test was statistically significant (94.1% vs. 70.6%, P =
0.006). Specificity of the two tests in patients without prior BCG
vaccination history was similar (80.0% vs. 60.0%). The concordance between
the two tests results in BCG vaccinated subjects was low (71.7%, κ = 0.063).
For TSPOT, none of the included risk factors was significantly associated
with positive results. For TST, BCG vaccination (OR: 1.78; 95%CI: 1.30 -
2.00) was significantly associated with positive results. Although IFN-γ
release assay had relatively high sensitivity and specificity, the
researchers also should consider the higher costs and complexity of this
test. Therefore, TSPOT could be used as the complementary tool of TST in
circumstances when a suspected patient with negative TST results, or to
exclude a positive TST result caused by BCG vaccination.
*5.* Indian Journal of Pathology & Microbiology. 2010 Oct-Dec; Volume 53,
Number 4: 745-9. *CD4 Cell Count Recovery in HIV/TB Co-Infected Patients
versus TB Uninfected HIV Patients;* Wanchu, A., Kuttiatt, V.S., Sharma, A.,
Singh, S., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21045406>
There is lack of data comparing the improvement in CD4 count following
antitubercular (ATT) and antiretroviral therapy (ART) in patients presenting
with HIV/TB dual infection compared with CD4 matched cohort of TB uninfected
HIV patients initiated on ART. The researchers tested the hypothesis that TB
additionally contributes to reduction in CD4 count in HIV/TB coinfected
patients and this would result in greater improvement in count following
treatment compared with CD4 matched TB uninfected individuals. In a
retrospective cohort study design the researchers studied the change in CD4
cell counts in two groups of patients - those with CD4 cell count >100
cells/mm 3 (Group 1) and <100/mm 3 (Group 2) at presentation. In each group
the change in CD4 cell count in dually infected patients following six-month
ATT and ART was compared to that of cohorts of CD4 matched TB uninfected
patients initiated on ART. In Group 1 (52 patients), dually infected
subjects' CD4 count improved from 150 cells/mm 3 to 345 cells/mm 3
(P=0.001). In the control TB uninfected patients, the change was from 159
cells/mm 3 to 317 cells/mm 3 (P=0.001). Additional improvement in dually
infected patients compared to the control group was not statistically
significant (P=0.24). In Group 2 (65 patients), dually infected subjects’
count improved from 49 cells/mm3 to 249 cells/mm 3 (P=0.001) whereas in the
control TB uninfected patients, improvement was from 50 cells/mm 3 to 205
cells/mm 3 (P=0.001), there being statistically significant additional
improvement in dually infected subjects (P=0.01). Greater increment in CD4
counts with ATT and ART in dually infected patients suggests that TB
additionally influences the reduction of CD4 counts in HIV-infected
patients.
*6.* Indian Journal of Pathology & Microbiology. 2010 Oct-Dec; Volume 53,
Number 4: 714-7. *Efficacy of an In-House Polymerase Chain Reaction Assay
for Rapid Diagnosis of Mycobacterium tuberculosis in Patients with
Tubercular Lymphadenitis: Comparison with Fine Needle Aspiration Cytology
and Conventional Techniques;* Sharma, M., Sethi, S., Mishra, A.K.,
Chatterjee, S.S., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21045399>
Tubercular lymphadenitis (TB-L) is the most common manifestation of
extrapulmonary TB. Excisional biopsy with histopathological examination,
Ziehl-Neelsen staining (ZNS) and culture, and fine needle aspiration (FNA)
cytology, although useful in the diagnosis of TB-L, cannot diagnose a
substantial proportion of cases. The researchers investigated the role of an
in-house polymerase chain reaction (PCR) assay targeting the IS6110 gene
from the FNA material in the diagnosis of the disease. The clinical profile
of 150 patients with lymphadenopathy was noted and the fine needle aspirate
was collected. After cytological processing, ZNS and culture on
Lowenstein-Jensen media, mycobacterial DNA was isolated from the residual
aspirate material and IS6110 gene PCR was performed. Results of cytology,
ZNS, culture, and IS6110 gene PCR were compared. There were 49 confirmed
patients of TB-L based on laboratory parameters (either culture isolation of
*Mycobacterium tuberculosis* or any two of cytology, ZNS, PCR positive) and
clinical response to therapy. Sensitivity and specificity of FNA was 89.8%
and 96%, of ZNS was 40.8% and 99%, of culture was 40.8% and 100%, and of
IS6110 gene PCR test was 100% and 92.1%. IS6110 PCR can be considered a
valuable adjunct to cytology, ZNS, and culture techniques in the diagnosis
of TB-L.
*7.* The Indian Journal of Tuberculosis. 2010 Jul; Volume 57, Number 3:
128-33. *Evaluation of Polymerase Chain Reaction (PCR) Using hupB Gene in
Diagnosis of Tuberculous Lymphadenitis in Fine Needle Aspirates; *Verma, P.,
Jain, A., Patra, S.K., Gandhi, S., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21043310>
Although pulmonary TB (PTB) is the most common manifestation of TB,
extrapulmonary TB (EPTB) has equal significance. Among the extrapulmonary
manifestations, tubercular lymphadenitis (TBL) is the most common form. This
study performed PCR on fine needle aspirates of lymph node by using the hupB
gene as a target and compared the sensitivity and specificity of PCR with
culture, cytology, serology, and clinical response to therapy. After
processing the samples by Universal Sample Processing (USP) method, two-step
nested PCR was performed using two sets of primers (N1S1 & CTFR) of hupB
gene. All patients were put on ATT and were followed up for two months. The
response to therapy was considered as the gold standard in the study. The
PCR assay for hupB gene was positive in 85 patients. Of these, 82% patients
showed infection with *M. tuberculosis*, 1% was positive for *M. bovis* and
2% showed coinfection with both *M. tuberculosis* and *M. bovis*. The PCR
assay of hupB gene in the study showed a sensitivity of 87.4% and
specificity of 66.7%. PCR assay for hup B gene is a rapid means of
diagnosis of tubercular lymphadenitis.
*8.* Internal Medicine. 2010; Volume 49, Number 21: 2297-301. Epub 2010 Nov
1. *Desensitization Therapy for Allergic Reactions to Antituberculous Drugs;
* Kobashi, Y., Abe, T., Shigeto, E., Yano, S., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21048363>
The researchers retrospectively evaluated the clinical usefulness of
desensitization therapy for many patients showing allergic reactions to
anti-mycobacterial drugs (INH and RFP) according to the proposition reported
by the Japanese Society for TB (JST). Desensitization therapy for
anti-mycobacterial drugs was performed according to the propositions of JST
for forty-six patients with mycobacterial disease in several hospitals
participating in the Chugoku-Shikoku Mycobacterial Disease Committee between
January 1999 and December 2009. Adverse reactions occurred as drug-induced
skin eruptions in 23 patients, drug-induced fever in 16, and drug-induced
fever plus eruption in 7. The causative drugs suggested by the clinical
course or DLST were RFP in 30 patients and INH in 16. The clinical effects
of desensitization therapy for individual drugs was good in 23 of 30
patients (77%) receiving RFP, and in 13 of 16 (81%) receiving INH. Ten
patients showing failure of desensitization included 5 elderly patients and
2 patients with a history of drug allergies. The interval until initiation
of desensitization therapy ranged from 5 to 30 days after the disappearance
of adverse reactions and the interval until the appearance of adverse
reactions during desensitization therapy ranged from 3 to 18 days. A
comparative study between the patient group with successful desensitization
therapy and that with failure of desensitization did not show any
significant differences except for the interval until initiation of
desensitization therapy. The researchers confirmed the clinical
effectiveness of desensitization therapy for anti-mycobacterial drugs
according to the propositions of JST in this multicenter study.
*9.* Neurology India. 2010 Sep-Oct; Volume 58, Number 5: 723-6. *Duration of
Anti-Tubercular Treatment in Tuberculous Meningitis: Challenges and
Opportunity;* Prasad, K., Sahu, J.K.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21045495>
The duration of antituberculous therapy in tuberculous meningitis is
controversial. There is variation in recommendations by different societies
and expert groups on this issue. This study determined the strength of
evidence for short-term therapy in tuberculous meningitis through review of
literature and critical appraisal. Cochrane CENTRAL (Issue 4, 2010), TRIP
database, and PubMed (from 1966 to present) were searched for relevant
papers with keywords “meningeal tuberculosis” and “tuberculous meningitis”
combined with “chemotherapy.” A critical appraisal of a systematic review
was done using standard criteria. A total of 10 relevant papers were
identified. All papers were included in a systematic review. The systematic
review did not specify study design of studies to be included, had only case
series but no randomized controlled trial, and unclear definition of
endpoints. The evidence base for short-term therapy for tuberculous
meningitis is weak. There is a need to conduct a randomized controlled trial
with non-inferiority hypothesis of adequate sample size with well-defined
end points and adequate follow-up. This is a challenge as well as
opportunity for Indian neurologists.
*10.* PLoS One. 2010 Jun 21; Volume 5, Number 6: e11237. *Expanded
Polyfunctional T Cell Response to Mycobacterial Antigens in TB Disease and
Contraction Post-Treatment;* Young, J.M., Adetifa, I.M., Ota, M.O.,
Sutherland, J.S.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20574540>
T cells producing multiple factors have been shown to be required for
protection from disease progression in HIV, but the researchers have
recently shown this not to be the case in TB. Subjects with active disease
had a greater proportion of polyfunctional cells responding to ESAT-6/CFP-10
stimulation than their infected but non-diseased household contacts (HHC).
The researchers therefore assessed this profile in subjects who had
successfully completed standard TB chemotherapy. They performed a
cross-sectional study using PBMC from TB cases (pre- and post-treatment) and
HHC. Samples were stimulated overnight with TB antigens (ESAT-6/CFP-10 and
PPD) and their CD4+ and CD8+ T cells were assessed for production of CD107a,
IFN-gamma, IL-2 and TNF-alpha and the complexity of the responses was
determined using SPICE and PESTLE software. It was found that an increase in
complexity (i.e., production of more than 1 factor simultaneously) of the T
cell profile was associated with TB disease and that this was significantly
reduced following TB treatment. This implies that T cells are able to
respond adequately to TB antigens with active disease (at least initially),
but the ability of this response to protect the host from disease
progression is hampered, presumably due to immune evasion strategies by the
bacteria. These findings have implications for the development of new
diagnostics and vaccine strategies.
*11.* PLoS One. 2010 Oct 25; Volume 5, Number 10: e13594. *Innate Immune
Response to Mycobacterium tuberculosis Beijing and Other Genotypes;* Wang,
C., Peyron, P., Mestre, O., Kaplan, G., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21049036>
As a species, *Mycobacterium tuberculosis* is more diverse than previously
thought. In particular, the Beijing family of *M. tuberculosis* strains is
spreading and evolving throughout the world and this is giving rise to
public health concerns. Genetic diversity within this family has recently
been delineated further and a specific genotype, called Bmyc10, has been
shown to represent over 60% of all Beijing clinical isolates in several
parts of the world. How the host immune system senses and responds to
various *M. tuberculosis* strains may profoundly influence clinical outcome
and the relative epidemiological success of the different mycobacterial
lineages. The researchers hypothesized that the success of the Bmyc10 group
may, at least in part, rely upon its ability to alter innate immune
responses and the secretion of cytokines and chemokines by host phagocytes.
The researchers infected human macrophages and dendritic cells with a
collection of genetically well-defined *M. tuberculosis* clinical isolates
belonging to various mycobacterial families, including Beijing. They
analyzed cytokine and chemokine secretion on a semi-global level using
antibody arrays allowing the detection of 65 immunity-related soluble
molecules. The data indicate that Beijing strains induce significantly less
interleukin (IL)-6, tumor necrosis factor (TNF), IL-10 and GRO-α than the
H37Rv reference strain, a feature that is variously shared by other modern
and ancient *M. tuberculosis* families and which constitutes a signature of
the Beijing family as a whole. However, Beijing strains did not differ
relative to each other in their ability to modulate cytokine secretion.
Results confirm and expand upon previous reports showing that *M.
tuberculosis* Beijing strains in general are poor in vitro cytokine inducers
in human phagocytes. The results suggest that the epidemiological success of
the Beijing Bmyc10 is unlikely to rely upon any specific ability of this
group of strains to impair anti-mycobacterial innate immunity.
*12.* PLoS One. 2010 Oct 26; Volume 5, Number 10: e13356. *Nitrate
Respiration Protects Hypoxic Mycobacterium tuberculosis Against Acid- and
Reactive Nitrogen Species Stresses; *Tan, M.P., Sequeira, P., Lin, W.W.,
Phong, W.Y., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21048946>
There are strong evidences that *Mycobacterium tuberculosis* survives in a
non-replicating state in the absence of oxygen in closed lesions and
granuloma in vivo. In addition, *M. tuberculosis* is acid-resistant,
allowing mycobacteria to survive in acidic, inflamed lesions. The ability of
*M. tuberculosis* to resist to acid was recently shown to contribute to the
bacillus virulence although the mechanisms involved have yet to be
deciphered. In this study, the researchers reported that *M.
tuberculosis*resistance to acid is oxygen-dependent; whereas aerobic
mycobacteria were
resistant to a mild acid challenge (pH 5.5) as previously reported, the
researchers found microaerophilic and hypoxic mycobacteria to be more
sensitive to acid. In hypoxic conditions, mild-acidity promoted the
dissipation of the protonmotive force, rapid ATP depletion, and cell death.
Exogenous nitrate, the most effective alternate terminal electron acceptor
after molecular oxygen, protected hypoxic mycobacteria from acid stress.
Nitrate-mediated resistance to acidity was not observed for a respiratory
nitrate reductase NarGH knock-out mutant strain. Furthermore, the
researchers found that nitrate respiration was equally important in
protecting hypoxic non-replicating mycobacteria from radical nitrogen
species toxicity. Overall, these data shed light on a new role for nitrate
respiration in protecting *M. tuberculosis* from acidity and reactive
nitrogen species, two environmental stresses likely encountered by the
pathogen during the course of infection.
*13.* PLoS One. 2010 Oct 29; Volume 5, Number 10: e13773. *Protective
Efficacy of BCG Overexpressing an L,D-Transpeptidase against M.
tuberculosisInfection;
* Nolan, S.T., Lamichhane, G.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21048936>
*M. bovis* Bacille Calmette-Guérin (BCG), currently the only available
vaccine against TB, fails to adequately protect individuals from active and
latent TB infection. New vaccines are desperately needed to decrease the
worldwide burden of TB. The researchers created a recombinant strain of BCG
that overproduces an L,D-transpeptidase in order to alter the bacterial
peptidoglycan layer and consequently increase the ability of this immunogen
to protect against virulent *M. tuberculosis* (Mtb). The researchers
demonstrate that this novel recombinant BCG protects mice against virulent
Mtb at least as well as control BCG, as measured by its ability to reduce
bacterial burden in lungs and spleen, reduce lung histopathology, and
prolong survival. A nutrient starved recombinant BCG preparation, while
offering comparable protection, elicited a response characterized by
elevated levels of select Th1 cytokines. Recombinant BCG overexpressing a
L,D-transpeptidase that is nutrient starved elicits a stronger Th1 type
response and is at least as protective as parent BCG. Results from this
study suggest that nutrient starvation treatment of live BCG vaccines should
be further investigated as a way to increase host induction of Th-1 related
cytokines in the development of experimental anti-TB vaccines.
*14.* Scandinavian Journal of Immunology. 2010 Nov; Volume 72, Number 5:
460-8. doi: 10.1111/j.1365-3083.2010.02459.x. *Immunological Diagnosis of
Tuberculosis Based on Recombinant Antigens ESAT-6 and CFP-10 in Children
from an Endemic Area in Northeast Brazil; *Van-Lume, D.S., De Souza, J.R.,
Cabral, M.M., Rego, J.C., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21039742>
Diagnostic tests for TB using interferon gamma (IFN-γ) responses produced by
T lymphocytes after stimulation by early secretory antigen target 6
(ESAT-6), culture filtrate protein 10 (CFP-10) or purified protein derivate
(PPD) were carried out using ELISA (enzyme-linked immunosorbent assay) in
whole blood culture supernatants from children with suspected TB disease
(n = 21), latent TB infection (LTBI; n = 17), and negative controls (NC;
n = 21) from Recife, Pernambuco, Brazil. The results were analyzed using the
ROC (receiver operating characteristic) curves and the areas under the curve
(AUC) generated varied from 0.5 to 1.0 with higher values indicating
increased discriminatory ability. Comparisons of AUCs were made using
non-parametric assumptions, and the differences were considered significant
if P < 0.05. The ROC curve showed a statistical difference (P = 0.015)
between the LTBI and NC groups with an AUC of 0.731, TB disease and NC
(AUC = 0.780; P = 0.002), and a group with TB (latent infection + disease,
n = 38) and NC (AUC = 0.758; P = 0.001) when the antigen used was ESAT-6. No
statistical difference was found between the groups when CFP-10 or PPD was
used. In conclusion, the ESAT-6 test may be the most appropriate for
diagnosis of childhood TB, both LTBI and TB disease, when associated with
epidemiological and clinical data, especially in endemic areas such as
Brazil.
*15.* Scandinavian Journal of Immunology. 2010 Nov; Volume 72, Number 5:
408-15. doi: 10.1111/j.1365-3083.2010.02452.x. *DNA Vaccine Constructs
Expressing Mycobacterium tuberculosis-Specific Genes Induce Immune
Responses;* Hanif, S.N., Al-Attiyah, R., Mustafa, A.S.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21039735>
RD1 PE35, PPE68, EsxA, EsxB and RD9 EsxV genes are present in *Mycobacterium
tuberculosis* genome but deleted in *Mycobacterium bovis* BCG. This study
cloned these genes into DNA vaccine vectors capable of expressing them in
eukaryotic cells as fusion proteins, fused with immunostimulatory signal
peptides of human interleukin-2 (hIL-2) and tissue plasminogen activator
(tPA), and evaluated the recombinant DNA vaccine constructs for induction of
antigen-specific cellular immune responses in mice. DNA corresponding to the
aforementioned RD1 and RD9 genes was cloned into DNA vaccine plasmid vectors
pUMVC6 and pUMVC7 (with hIL-2 and tPA signal peptides, respectively), and a
total of 10 recombinant DNA vaccine constructs were obtained. BALB/c mice
were immunized with the parent and recombinant plasmids and their spleen
cells were tested for antigen-induced proliferation with antigens of *M.
tuberculosis* and pure proteins corresponding to the cloned genes. The
results showed that antigen-specific proliferation responses were observed
for a given antigen only with spleen cells of mice immunized with the
homologous recombinant DNA vaccine construct. The mice immunized with the
parent plasmids did not show positive immune responses to any of the
antigens of the cloned genes. The ability of the DNA vaccine constructs to
elicit cellular immune responses makes them an attractive weapon as a safer
vaccine candidate for preventive and therapeutic applications against TB.
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. *
*1. Health Scientist GS-601-13* *NEW*
*Sponsor: DHHS, Centers for Disease Control and Prevention*
Job Announcement Number: HHS-CDC-DE-11-413708
Location: Atlanta, Georgia
Application deadline: January 17, 2011
JOB SUMMARY:
Become a part of the Department that touches the lives of every American! At
the Department of Health and Human Services (HHS) you can give back to your
community, state, and country by making a difference in the lives of
Americans everywhere. It is the principal agency for protecting the health
of citizens. Join HHS and help to make our world healthier, safer, and
better for all Americans.
This position is located in the Department of Health and Human Services
(DHHS), National Center for HIV, Hepatitis, STD and TB Prevention, Division
of Tuberculosis Elimination (DTBE), Field Services and Evaluation Branch,
Atlanta, GA.
This vacancy is also being announced concurrently with vacancy announcement
HHS-CDC-MP-11-422644 under merit promotion procedures. Please review that
announcement to see if you are eligible for consideration under merit
promotion procedures. NOTE: Applicants must apply separately for each
announcement in order to be considered.
PHS Commissioned Corps Officers interested in performing the duties of this
position within the Commissioned Corps (not as a career/career-conditional
employee) are encouraged to apply under the merit promotion announcement
indicated above.
Additional selections may be made from this announcement.
Duties:
Incumbent designs, oversees, implements and conducts major scientific
survey/studies or projects to identify and solve public health problems.
Identifies and analyzes public health issues and their impact on operations
that are critical to the public health community at large. Develops and or
uses innovative methodologies and techniques. Searches, synthesizes and
interprets information relevant to public health. Reviews and analyzes
studies and projects assessing major and or sensitive public health issues
in order to make recommendations for processes, procedures and/or policies
related to public health programs, practices, and research. Provides
technical advice and assistance to national, state, and local health
agencies and to various other organizations. Prepares scientific and other
articles and technical reports for publication. Makes presentation at
international and national meetings.
Develop collaborative relationships with program evaluation professionals.
Work with the DTBE and TB control program to develop health economics and
cost-effectiveness studies and successfully implement them. Contribute to
the development of technical content for the DTBE on health systems reform
issues. Develop with partners state-of-the art technical materials in the
health services/systems/economics area, and develop learning materials on
instruments and policy options for improving the performance of health
services.
More information and application instructions are available at: USAJOBS -
Job Details<http://jobview.usajobs.gov/GetJob.aspx?JobID=94617066&JobTitle=Health+Scientist&FedEmp=Y&FedPub=Y&sort=rv%2c-dtex&vw=d&re=134&caller=basic.aspx&jbf574=HE39&AVSDM=2011-01-04+00%3a03%3a00>
*2. Training and Consultation Specialist *
*Sponsor: New Jersey Medical School Global Tuberculosis Institute*
Job Number: 10NS963549
Location: Newark, New Jersey
The New Jersey Medical School Global TB Institute is currently accepting
applications for a Training and Consultation Specialist.
The primary purpose of the Training and Consultation Specialist position is
to develop, implement, and evaluate educational programs and materials
related to TB to meet the needs of health care professionals and TB
patients. These activities will be consistent with the goals and objectives
of the CDC funded Regional Training and Medical Consultation Centers
initiative, or with other national or international TB control
projects. These programs may include training courses, lectures, symposia,
preceptorships, and enduring materials, including curricula and self study
materials. Responsibilities will include developing and implementing
training courses for TB Program staff and developing patient and provider
educational materials for use in domestic and international
settings. Previous experience in international TB training and education is
desired.
More information and an online application are available at:
http://umdnj.hodesiq.com/job_detail.asp?JobID=2194623&user_id=
*3. 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.
Upcoming Conferences, Trainings, and Other Events Find up-to-date
information on TB-related conferences, US training opportunities, and other
events at the DTBE Monthly Calendar<http://www.cdc.gov/tb/events/default.htm>
.
*1. Best Practices in TB Control #2: Key Activities and Roles in the TB
Cohort Review Process* *NEW*
Sponsor: NJMS Global Tuberculosis Institute
Date: January 20, 2011
Location: Nationwide, USA
The purpose of this one and one-half-hour web-based seminar is to further
the process of providing TB program leaders, managers, clinicians, and case
managers with the necessary knowledge and skills to participate in TB cohort
reviews in their program areas. The seminar will explore in depth the
activities key leaders and case managers do to prepare, present, and
follow-up cohort reviews. The format includes presentations by experienced
practitioners, discussion of implementation and follow-up issues, and
examples from programs in Columbus OH, Philadelphia PA, Washington DC, and
Washington State.
Please register online at:
https://www323.livemeeting.com/lrs/8001122164/Registration.aspx?pageName=ps2q....
There is no limit to the number of participants at one location
viewing
from one room and computer. However, each site must identify a contact
person to receive conference information, submit the sign-in sheet, and
share the link to the online conference evaluation after the seminar.
For more information contact Bill Bower, E-mail: ; Phone:
(646) 448-0945; or access the Web site:
http://www.umdnj.edu/globaltb/courses/brochures/2011/cohortreview2.html .
*2. Best Practices in TB Control #3: TB Cohort Review in Action: Putting It
All Together* *NEW*
Sponsor: NJMS Global Tuberculosis Institute
Date: February 10, 2011
Location: Nationwide, USA
This web-based seminar will present the entire picture of a cohort review
from start to finish. The format features a simulated cohort review session
including case presentations, feedback, and comments by a program director
and medical reviewer; analysis and summary of outcomes by an epidemiologist;
and plans for each person to follow up on the findings. Presenters are
experienced practitioners from programs in Columbus OH, Philadelphia PA,
Washington DC, and Washington State.
Please register online at:
https://www323.livemeeting.com/lrs/8001122164/Registration.aspx?pageName=qhn3....
There is no limit to the number of participants at one location
viewing
from one room and computer. However, each site must identify a contact
person to receive conference information, submit the sign-in sheet, and
share the link to the online conference evaluation after the seminar.
Contact: For more information contact Bill Bower, E-mail: ;
Phone: (646) 448-0945; or access the Web site:
http://www.umdnj.edu/globaltb/courses/brochures/2011/cohortreview3.html .
*3. Influencing, Networking and Collaboration * *NEW*
Sponsor: International Union Against Tuberculosis and Lung Disease (The
Union)
Dates: April 25 – 30, 2011
Location: Singapore
Application deadline: March 25, 2011
Creating partnerships and networks is an important element to the success of
a TB program. Participants in this course will learn how relationship
building and developing strong partnerships can boost health program
results. The course will address the following key topics: Creating
empowered teams and moving away from the command and control structure,
facilitating large stakeholders meeting and managing conflict, negotiating
and partnering with stakeholders within health programs, and building
consensus within large groups of distinct and diverse personalities.
Application deadline: March 25, 2011. Late applications accepted on a
space-available basis. To register, email .
For more information, Email: ; or visit the
Web site:
http://www.union-imdp.org/courses/influencing-networking-collaboration .
*4. Leading Management Teams* *NEW*
Sponsor: International Union Against Tuberculosis and Lung Disease (The
Union)
Dates: June 27 – July 9, 2011
Location: Bangkok, Thailand
Application deadline: May 25, 2011
Bringing measurable changes within a TB program requires a comprehensive
approach to performance management. Participants in this course will learn
how to more effectively guide groups of personnel through advanced
management training by examining their own leadership styles. Key topics the
course addresses include: (1) Creating measurable results in a TB program
through long-term planning; (2) Leading changes in a health organization
that build greater staff commitment, competence, and confidence; (3)
Achieving higher success rates through enhanced team performance; and (4)
Developing team members through coaching and mentoring.
Late applications accepted on a space-available basis. To register, E-mail
.
For more information, E-mail: ; or visit the
Web site: http://www.union-imdp.org/courses/leading-management-teams.
5. 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/ .
*6. 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 a course description, visit
http://www.nationaltbcenter.ucsf.edu/tbicweb/ .
*7. 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/ .
*8. 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 .
*9. Alcohol, Cigarettes, and Tuberculosis *
Sponsor: The Francis J. Curry National Tuberculosis Center (CNTC)
Date: January 12, 2011
Location: Nationwide, US
The Francis J. Curry National TB Center announces a 75-minute web-based
seminar, followed by a 15-minute question and answer period. The seminar
will be broadcast live via the Internet on Wednesday, January 12, 2011. This
training will (1) identify US populations with significant alcohol and/or
tobacco use with underlying socioeconomic factors that put them at risk for
acquiring TB infection or progressing to TB disease once infected; (2)
describe physiological and psychological aspects of alcohol and/or tobacco
addiction that can affect treatment and exacerbate TB; and (3) identify
resources that can be used by health departments to help patients overcome
their alcohol and tobacco addictions.
There is no fee for this course. Applicants will be informed of their
registration status after the application deadline. Continuing education
credits are available.
For more information, contact the CNTC. E-mail
; phone (415) 502-4600; fax (415) 502-4620; or
access the Web site at
http://www.nationaltbcenter.ucsf.edu/training/nationalwebseminar.cfm.
*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....
*11. Arresting TB: Best Practices for Controlling TB in Corrections *
Sponsor: Southeastern National Tuberculosis Center (SNTC)
Date: January 27, 2011
Location: Forsyth, Georgia
Registration deadline: January 15, 2011
This course highlights best practices for recognizing and controlling TB in
correctional settings and is designed to enhance communication and
collaboration between the local health department and correctional facility
staff. Presented in an interactive case-based lecture format, attendees join
in group discussions and actively participate in exercises designed to
foster skills for managing TB in correctional settings.
Enrollment is limited to 50 participants from the southeastern region.
Registration is free; online pre-registration is required by January 15,
2011. Continuing education credits are available.
For more information, contact the SNTC. E-mail ;
phone (352) 273-9385 or toll free (888) 265-7682; fax (352) 273-9275; or
access the Web site at http://sntc.medicine.ufl.edu/Training.aspx?Id=9242.
*12. Management, Finance and Logistics *
*Sponsor: International Union Against Tuberculosis and Lung Disease (The
Union)*
Dates: February 14 – 26, 2011
Location: Bangkok, Thailand
Application deadline: January 15, 2011
This course will cover the basics of managing a national health program.
Participants in this course will build financial comprehension, learn how to
communicate more effectively, practice multi-party negotiation, and develop
fundamental budgeting skills. Key topics of the course address: Learning to
develop and understand budgets, Working with financial concepts in order to
make more confident decisions in health projects, Improving procurement of
drug supplies and logistics management through quality assurance and
supply-chain management, and Assessing leadership strengths and building
managerial skills. Combining practical exercises, in-class discussions,
presentations, and lectures, participants will gain a greater understanding
of proven and effective management methods and how they can be directly
applied to public health.
This course is also offered in French. Continuing education credits are
available.
For more information, Email: ; or visit the
Web site: http://www.union-imdp.org/courses/management-finance-logistics .
*13. Tuberculosis Clinical Intensive *
Sponsor: The Francis J. Curry National Tuberculosis Center (CNTC)
Dates: February 15 – 17, 2011
Location: San Francisco, California
Application deadline: January 11, 2011
This three-day course is designed for physicians and other licensed medical
professionals who diagnose and treat TB. The course will cover: diagnosis,
management, and treatment of active TB and latent TB infection; TB
transmission and pathogenesis; pediatric TB; drug-resistant TB; TB and HIV
coinfection; and more.
Enrollment is limited and pre-registration is required. There is no fee for
this course. Continuing education credits are available.
For a complete course description and application information, visit:
http://www.nationaltbcenter.ucsf.edu/training/tb_clinical_intensive.cfm.
*14. 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 .
*15. TB Case Management and Contact Investigation Intensive*
Sponsor: Francis J. Curry National Tuberculosis Center
Dates: March 15 – 18, 2011
Location: San Francisco, California
Application deadline: January 17, 2011
This course is intended for physicians, nurses, and other licensed medical
care providers who manage patients with TB or who are at risk for TB. Topics
covered include: Epidemiology of TB; Fundamentals of TB case management;
Completion of care; TB contact investigation; The role of the laboratory;
Medical management of TB; Quality assurance in TB control programs; Targeted
testing for TB; Treatment of latent TB infection (LTBI); Culture, community,
and TB care; Working with special populations; and Interviewing skills.
There is no fee for this course. Enrollment is limited, and pre-registration
is required.
For more information, contact Jennifer Kanouse, Program Manager. E-mail
; phone (415) 502-2712; or access the Web
site at
http://www.nationaltbcenter.ucsf.edu/training/tbcmcimar11.cfm.
*16. Mass Media and Communications*
*Sponsor: International Union Against Tuberculosis and Lung Disease (The
Union)*
Dates: March 21 – 25, 2011
Location: Singapore
Application deadline: February 21, 2011
Communication exchange has never been so easily accessible and so critical
to the success of a national health program. Gain a greater understanding of
how effective communications strategies can help promote TB and HIV programs
and further disseminate important health messages to the public. During this
course participants will receive training on how to write a professional
press release, develop useful promotional tools, conduct media outreach, and
discover how to build positive public awareness around an organization’s
work. Learning directly from experts working in mass communications,
participants will engage in class exercises, discussions, and real-life
simulations that demonstrate how skillful use of the media and
communications can propel any health program to excellence.
To register or receive more information, email or visit
http://www.union-imdp.org/courses/mass-media-communications . Late
applications accepted on a space-available basis.
*17. Critical Care and Pulmonary Medicine: An Update and Review*
Sponsor: American Medical Seminars, Inc.
Dates: March 28 – April 1, 2011
Location: Sarasota, Florida
Following this course, the participant should be able to assess the common
presentation and patient complaints for the various pulmonary disorders
described; implement a diagnostic work-up appropriate for each presented
disorder, considering a practical and cost-effective approach; employ a
cost-effective method of treatment, follow-up, and long-term care when
indicated. This activity is expected to result in improved competence in
making an appropriate diagnosis and providing effective treatment and
referral or follow-up care with the overall goal of improving patient
outcomes. The emphasis will be on aligning physician behavior with current
guidelines and evidence-based medicine, as indicated within each topic’s
specific objectives, with a focus on diagnosis, treatment, and when to
refer.
To receive regular registration rate, fees must be received or postmarked at
least 30 days prior to program start date. Registration fee: Regular -
$745/Physician; $645/Non Physician; Late - $795/Physician; $695/Non
Physician. Continuing education credits are available.
For more information contact the American Medical Seminars, Inc., E-Mail:
; Phone: (941) 388-1766; Toll Free: (866) ams4cme
(866-267-4263); Fax: (941) 365-7073; or access the Web site:
http://www.ams4cme.com/www/LiveSeminars/SEMLA-2520110328.aspx .
*18. The Denver TB Course*
Sponsor: National Jewish Health
Dates: April 13 – 16, 2011
Location: Denver, Colorado
The purpose of this course is to present knowledge about the management of
TB to general internists, public health workers, infectious diseases and
chest specialists, registered nurses, and other healthcare providers who
will be responsible for the management and care of patients with TB. This
event includes the following course highlights: Transmission and
pathogenesis of adult and pediatric TB; MDR TB and XDR TB; Screening for and
treatment of latent TB infection; Factors influencing infections of TB;
Planning TB control programs with particular emphasis on organization of
outpatient chemotherapy; TB and HIV co-infection; and Mycobacteriology
Laboratory Tour.
Continuing education credits are available.
For more information contact Nicole Austin Ross, National Jewish Health,
E-mail: ;
Phone: (303) 398-1110; Fax: (303) 270-2239; or access the Web site:
http://www.njhealth.org/TBCourse.
*19.* *The Denver TB Course*
Sponsor: National Jewish Health
Dates: October 12 – 15, 2011
Location: Denver, Colorado
The purpose of this course is to present knowledge about the management of
TB to general internists, public health workers, infectious diseases and
chest specialists, registered nurses, and other healthcare providers who
will be responsible for the management and care of patients with TB. This
event includes the following course highlights: Transmission and
pathogenesis of adult and pediatric TB; MDR TB and XDR TB; Screening for and
treatment of latent TB infection; Factors influencing TB infections;
Planning TB control programs with particular emphasis on organization of
outpatient chemotherapy; TB and HIV co-infection; and Mycobacteriology
Laboratory Tour.
Continuing education credits are available.
For more information contact Nicole Austin Ross, National Jewish Health,
E-mail: ;
Phone: (303) 398-1110; Fax: (303) 270-2239; or access the Web site:
http://www.njhealth.org/TBCourse.
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