MDR-TB Treatment & Prevention
Fwd: [tb-update] Week of July 25 to July 31, 2010
Fyi in this week's CDC Tb update: Global Drug Facility Seeks Expressions of
Interest from anti-TB Drug Manufacturers - see below for link. Thanks.
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Date: Fri, Jul 30, 2010 at 11:53 AM
Subject: [tb-update] Week of July 25 to July 31, 2010
TB-Related News and Journal Items Weekly Update Week of July 25 to July
31, 2010
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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. New Request for Applications (RFA) NEW*
The US FDA is launching an RFA on Scientific Priorities to Improve the
Diagnosis, Treatment, and Prevention of TB and other Tropical Diseases.
Closing date for applications is August 11, 2010. The full application and a
link to Grants.gov can be found on Critical Path Web page
http://www.fda.gov/criticalpath.
For more information, click The
RFA<http://stoptb.org/assets/documents/news/announcements/rfa-fd-10-016.pdf>
.
* *
*2. Global Drug Facility Seeks Expressions of Interest from anti-TB Drug
Manufacturers *
Stop TB Partnership, July 15, 2010
The Global Drug facility (GDF) has issued two invitations to manufacturers
of anti-TB medicines to submit an expression of interest for product
evaluation by an expert review panel (ERP).
The first, issued jointly with the Global Fund To Fight AIDS, TB and
Malaria, invites submissions of product dossiers on first-line drugs for
which there are less than three products of the same formulations that are
WHO-prequalified, SRA-approved, and available worldwide.
Read more at:
http://www.theglobalfund.org/documents/psm/GF_EOI_AntiTB_FV.pdf.
The second invitation is to manufacturers of second- and third-line anti-TB
drugs for which there are less than three products of the same formulations
that are WHO-prequalified, SRA-approved, and available in the global market.
Read more at:
http://www.stoptb.org/assets/documents/gdf/drugsupply/GDF_%20%20EoI%20for%20S...
.
The deadline for submission for expressions of interest in both categories
is *September 15, 2010, *5:00 p.m. Geneva time.
News Item(s) From the CDC HIV/Hepatitis/STD/TB Prevention News Update
*1. Health Watchdogs Sound Alarm over TB/HIV Deaths *
Agence France Presse, July 22, 2010
The scourge of co-infection with HIV and TB is the target of a health care
initiative launched at the 18th International AIDS Conference in Vienna.
UNAIDS and the public-private Stop TB Partnership joined forces in a
campaign to cut the annual number of deaths from HIV/TB to 200,000 by 2015,
half the number reported in 2004. “Every three minutes a person living with
HIV has his or her life cut off prematurely by TB,” said Jorge Sampaio, UN
Secretary-General Ban Ki-moon’s special envoy on TB. “This is completely
unacceptable. TB is a preventable and curable disease.” While acknowledging
that reaching the goal would require billions of dollars annually,
conference speakers focused on low-cost strategies that have been shown to
cut HIV/TB mortality. “There is a package of activities that, if properly
implemented by countries, will work,” said Stop TB Executive Secretary
Marcos Espinal. Health care facilities and laboratories should be designed
to handle both HIV and TB. To help identify and treat TB as early as
possible, health care workers should ask HIV-positive patients whether they
have had any recent coughing episodes. In addition, French and US
researchers reported trial results that suggest changes in the typical
treatment schedule for patients co-infected with HIV and TB. In a Cambodian
trial of seriously ill HIV patients newly infected with TB, researchers
compared the standard approach, starting TB treatment and then waiting eight
weeks to initiate antiretroviral therapy (ART), with an experimental
approach of waiting only two weeks to introduce HIV treatment. The team
recorded 59 deaths among the 332 patients who started ART at two weeks,
compared to 90 deaths among the 329 patients who started ART at eight weeks
(death rates of 18 percent and 27 percent, respectively).
*2. Nebraska Had 32 Reported Cases of TB in 2009 *
Associated Press, July 24, 2010
A new Department of Health and Human Services report shows Nebraska recorded
32 active TB cases in 2009. Most cases, 91 percent, were among foreign-born
residents and nearly a third were among residents ages 15-24. In 2008, the
state recorded 33 TB cases. Last year’s cases were reported in seven
counties: Douglas (16); Lancaster (seven); Dakota (five); and Buffalo,
Colfax, Madison, and Sarpy (one each).
Headlines
*1. German’s KfW Returns to Financing Tuberculosis Control Operations in
Azerbaijan (Azerbaijan)*
News.AZ, http://news.az, July 24, 2010
After negotiations between the German bank KfW and the Azerbaijani
government, the bank has resumed its participation in a program to fight TB
in Azerbaijan. David Bertolaza, Regional Director of KfW, acknowledged the
bank’s readiness to continue the program. The previous bank-ministry program
had proved its efficiency. Within the program TB laboratories were set up
and equipped with modern facilities in Baku and five regions of the country.
When the program ended there was a financing agreement between KfW and the
health ministry signed in August 2008. Additional financing enabled an
extension until 2012 as well as training of medical staff to detect TB at an
early stage.
*2. Prevent TB: IPT Works, IPT Is Safe (Lesotho)*
News Blaze, http://newsblaze.com, July 23, 2010, by Bobby Ramakant
Isoniazid preventive therapy (IPT) to treat latent TB infection (LTBI) and
prevent it from becoming active TB is only available for health workers in
Lesotho and not for ordinary citizens. The Global TB/HIV Working Group of
the Stop TB Partnership has stated that IPT works, is safe, and works with
antiretroviral treatment or by itself. IPT treatment lasts six to nine
months, is given to persons with confirmed LTBI, and is important for
preventing and reducing active TB in communities affected by HIV. IPT is one
of the key interventions recommended by the World Health Organization in
1998 to reduce the burden of TB in people living with HIV, but the response
has been very low. HIV affected communities and other stakeholders need to
be encouraged to integrate IPT as part of the package of health services.
*3. Ghana Health Service Seeks Collaboration to Fight TB (Ghana)*
Ghanaweb, www.ghanaweb.com, July 25, 2010
Dr. Koku Awoonor-Williams, Upper East Regional Director of Health Services,
Ghana, urged members of the Information Services Department (ISD) to join
with Ghana Health services in a TB public education campaign. He noted that
with a population of 100,000, the region should have been reporting more
than the 500 cases per year. Dr. Awoonor-Williams informed ISD personnel
from all nine districts in the region of the massive public education
program to encourage people with TB to get treated. He explained that there
are people with the disease who are unaware of its symptoms and others have
refused treatment because of the stigma attached to TB. The ISD officers
were advised to participate in a vigorous campaign against the disease at
the community level, particularly in the most remote regions of the country.
Mr. Nelson Mba, Regional Information Officer, suggested they use
interventions such as film shows, public forum, and drama to educate the
public. He reminded the information officers of their duty to educate the
public on government policies and programs that facilitate national
development. Mr. Mba noted that a successful campaign could result in a
reduction of government expenditure on fighting and treating TB.
*4. TB Breathalyzer Shows Promise in Field Test (United Kingdom)*
Examiner.com, www.examiner.com, July 24, 2010, by Robert Herriman
Researchers from the Department of Infectious and Tropical Diseases of the
London School of Hygiene & Tropical Medicine field tested a TB breathalyzer
in the outpatient clinic of Adama Hospital, Ethiopia. The breathalyzer test
was conducted with 60 individuals, and 29 (48 percent) had positive results.
Of 31 patients with a diagnosis of TB, 23 (74 percent) were found to be
positive on the breath test and 20 were smear positive for acid fast bacilli
in their sputum. Six patients had apparent false positive breathalyzer
results that did not match a TB diagnosis. According to researchers, the
breathalyzer test shows promise as a tool to investigate the shedding of *M.
tuberculosis* in cough. Further study is required to investigate the
sensitivity and specificity of the test and the relationship of excreted
Ag85B with smear positivity. Although the preliminary findings suggest that
the breathalyzer cannot replace sputum microcopy, it could be useful in
early identification of TB patients who were unable to produce sputum for
examination. Additional studies should include its value with populations
with restricted access to healthcare, and where screening with conventional
tools is not possible. The breathalyzer was developed by the Rapid Biosensor
Systems of Cambridge, England. The study was published in the journal, *BNC
Infectious Diseases* 2010, 10:161; doi:10.1186/1471-2334-10-1.
*5. TB/HIV in the Spotlight at the International AIDS Conference (Austria)*
Stop TB Partnership, www.stoptb.org, July 22, 2010
At the XVIII International AIDS Conference in Vienna, Austria, a protest
march (TB cough-in/Coffin) called for an end to deaths from TB for people
living with HIV. The March, with persons coughing into handkerchiefs,
cardboard coffins, and special Stop TB handkerchiefs, proceeded from the
Global Village through the conference center to a session room where a
plenary session on TB/HIV was scheduled. The session was chaired by Michel
Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB, and
Malaria. Also participating were Dr. Jorge Sampaio, UN Secretary General
Special Envoy to Stop TB; Marcos Espinal, Executive Secretary of the Stop TB
Partnership; Michel Sidibé, Executive Director for UNAIDS; and Timur
Abdullaev, a human rights lawyer from Uzbekistan, who is coinfected with HIV
and TB. Dr. Sampaio emphasized that TB is the leading cause of death among
persons living with HIV and that TB accounted for over half a million
AIDS-related deaths, more than one in every four.. Dr. Sampaio presided over
the signing of a memorandum of understanding between the Stop TB Partnership
and UNAIDS with the common goal of halving the number of people living with
HIV who die from TB by 2015. The memorandum included provision of
life-saving antiretroviral drugs for all HIV-infected TB patients and how
Stop TB and UNAIDS will accomplish this. The signers stressed the needs of
marginalized groups such as females, orphans, displaced persons, migrants,
prisoners, men who have sex with men, and drug users. The leadership of Stop
TB and UNAIDS plan to make at least two joint visits to countries heavily
affected by TB/HIV a year and promote their new initiative at least at one
international event a year.
*6. Address TB Challenges Now or Lose Fight against TB: WHO Warns (The
Philippines)*
English.Xinhuanet.com, http;//news.xinhuanet.com, July 26, 2010
Recently Shin Young-soo, World Health Organization (WHO) Regional Director
for the Western Pacific, warned that the Western Pacific Region’s gains in
TB control over the last 10 years would be lost without more funding and
technical support. Young-soo said that TB control programs in the region
face significant challenges, and that the epidemic is concentrated in the
vulnerable and marginalized populations who have limited access to health
care and are hard to reach. Young-soo was addressing the Stop TB Technical
Advisory Group, which met July 26 to July 28 to discuss the draft regional
strategy to fight TB in the Western Pacific Region. Countries were advised
to strengthen early case detection and universal access to quality TB
service while maintaining DOTS.
*7. TB a ‘Tough’ Fight (Guyana)*
Stabroek News, www.stabroeknews.com, July 27, 2010
Dr. Leslie Ramsammy, Health Minister of Guyana, called TB a “tough fight”
and commented that of the health-related Millennium Development Goals, those
related to TB will present more serious challenges and the country may not
reach the targets. According to Ramsammy, Guyana is doing well in the TB
fight, but not well enough, reported cases are high, and progress has been
slow. He commented that the health sector has not done a good job of
educating the public about TB. Ramsammy complained that the nongovernmental
organizations (NGOs) are not willing to work on TB because of the lack of
funding for that disease compared to HIV. He also commented that TB had not
attracted much international funding. Ramsammy believes that part of the
problem is the small population of Guyana, as the number of cases might be a
problem for Guyana, but may seem minor compared with the number of cases in
countries with large populations. He noted that the country is paying the
price for poor decision making in the past when the TB program was
discontinued in the 1980s. Ramsammy explained that the country is
considering involuntary quarantine and is considering building a specialized
TB ward to treat patients. He stated that many of the problems are caused by
patients who will not observe voluntary quarantine and that people have been
treating the disease with some nonchalance. The Health Minister felt that
the time had come for the public to recognize the seriousness of the TB
problem. TB prevalence in Guyana is about 80 per 100,000, but the health
department is working on reducing prevalence to 20 per 100,000.
*8. Seegene Expects to Debut MDR-TB IVD Screen in US in 2011 (United States)
*
Genomeweb, www.genomeweb.com, July 22, 2010, by Kirell Lakhman
Seegene, a test maker based in Korea, plans to reveal an in vitro diagnostic
(IVD) device that screens for multidrug-resistant TB (MDR-TB), particularly
in individuals unresponsive to isoniazid (INH) and rifampicin (Rif). The
real-time polymerase chain reaction (PCR)-based Anyplex TB MDR-TB assay will
be able to detect the mutations of drug resistant genes to Rif (rpoB:
D516V/Y, H526D/Y, S531L) and INH (katG: S315T (2 cases); inhA promoter:
-15(C/T)) according to the company. The test takes four hours to run and is
currently available in the countries of the European Union.
Journal Articles
*1.* The Journal of Thoracic and Cardiovascular Surgery. 2010 Jun; Volume
139, Number 6: 1554-60. *Endobronchial Ultrasound Increases the Diagnostic
Yields of Polymerase Chain Reaction and Smear for Pulmonary Tuberculosis; *Lin,
S.M., Ni, Y.L., Kuo, C.H., Lin, T.Y., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20494195>
This study determined the contribution of endobronchial ultrasound in the
diagnostic yields of acid-fast bacillus smear, nucleic acid amplification
tests, and culture in bronchoalveolar lavage fluid for pulmonary TB. During
a 1-year interval, 99 patients who had initial sputum-negative acid-fast
bacillus smears or no sputum but were later proven to have a positive
culture for *Mycobacterium tuberculosis* in their sputum or bronchoalveolar
lavage fluid were retrospectively studied. Among them, 56 patients underwent
bronchoscopy with endobronchial ultrasound (EBUS group) and 43 patients
received conventional bronchoscopy for bronchoalveolar lavage (non-EBUS
group). The diagnostic yields of the nucleic acid amplification tests
(89.3%, 50/56; P = .006), acid-fast bacillus smear (30.4%, 17/56; P = .013),
and *M. tuberculosis* culture in bronchoalveolar lavage fluid (67.9%, 38/56;
P = .041) were significantly higher in the EBUS group of patients. The
results of those who underwent conventional bronchoscopy were 65.1% (28/43),
9.3% (4/43), and 46.5% (20/43), respectively. Combining bronchoalveolar
lavage fluid smear and nucleic acid amplification tests, the researchers
made a rapid diagnosis of pulmonary TB in 51 (91.1%) of the 56 EBUS patients
and 29 (67.4%; P = .004) of the 43 non-EBUS patients. The introduction of
endobronchial ultrasound increased the diagnostic yield of the nucleic acid
amplification tests, acid-fast bacillus smear, and *M. tuberculosis* culture
from bronchioalveolar lavage fluid in patients with pulmonary TB who have
negative sputum smear or no sputum production.
*2.* Journal of Ultrasound in Medicine. 2010 Jun; Volume 29, Number 6:
881-8. *The Nodular Form of Hepatic Tuberculosis: Contrast-Enhanced
Ultrasonographic Findings with Pathologic Correlation; *Cao, B.S., Li, X.L.,
Li, N., Wang, Z.Y.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20498462>
This study described the ultrasonographic findings in hepatic TB after
administration of a second-generation sulfur hexafluoride-filled microbubble
contrast agent and correlated these findings with pathologic
characteristics. Twenty-four hepatic TB lesions in 15 patients were studied
with conventional ultrasonography (CUS) and contrast-enhanced
ultrasonography (CEUS). Pathologic characteristics of the lesions were
evaluated and were then correlated with enhancement patterns. The appearance
of hepatic TB on CUS was variable and nonspecific with respect to the shape,
echogenicity, and boundary of the lesions. The diameters of the lesions
obtained from CEUS were statistically larger than those from CUS, with
largest diameters +/- SD of 4.2 +/- 1.8 and 3.1 +/- 1.9 cm, respectively.
During the arterial phase, 13 of 24 lesions (54.2%) showed a rapidly and
markedly enhanced rim with a hypoenhanced or nonenhanced center; 9 of 24
lesions (37.5%) showed transient enhancement of the whole lesion with
inconsistent intensities. During the portal phase, most lesions showed
distinct wash-out of the contrast agent and maintained a hypoechoic
appearance. Pathologic studies confirmed that the different appearances of
hepatic TB on CEUS were related to the different pathologic stages of the
lesions. Findings of hepatic TB on CEUS may be helpful in differentiating
the diagnosis from other hepatic focal lesions. Correlation with pathologic
findings would enrich the understanding of CEUS findings in hepatic TB.
*3.* Japanese Journal of Infectious Diseases. 2010 May; Volume 63, Number 3:
199-203. *Management of a Nosocomial Outbreak of Mycobacterium
tuberculosisBeijing/W Genotype in Taiwan: An Emphasis on Case Tracing
with
High-Resolution Computed Tomography; *Chen, T.C., Lu, P.L., Yang, C.J., Lin,
W.R., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20495275>
A nosocomial outbreak of *Mycobacterium tuberculosis* Beijing/W genotype
infected 15 healthcare workers (HCWs) at a medical center in Taiwan, where
there is a high prevalence of TB and a high rate of positive tuberculin skin
tests. An index patient with laryngeal cancer and a lung abscess was
identified by epidemiological investigation and it was found that an *M.
tuberculosis* isolate from his lung tissue sample had an identical IS6110
restriction fragment length polymorphism pattern to the isolates from 3
HCWs. Confirmation of the identity of this strain as Beijing/W genotype was
made using spoligotyping. Seven hundred and eighty-five HCWs potentially
exposed to the probable index patient received contact investigation and
chest X-ray screening. The researchers used chest high-resolution computed
tomography (HRCT) to clarify trivial lesions in chest X-rays. Nine HCWs with
smear-negative pulmonary TB were diagnosed by HRCT. Fifteen of the 35
(42.9%) HCWs with documented exposure to the index patient developed
pulmonary TB within 11 months after exposure. The outbreak was successfully
controlled by active case finding and enforcement of infection control
strategies. It is concluded that intervention to detect the potential TB
source is helpful in the prevention and control of a nosocomial TB outbreak.
HRCT can be a useful tool for TB diagnosis of contacts in an outbreak
situation.
*4.* The Lancet Infectious Diseases. 2010 Jun; Volume 10, Number 6: 387-94.
*Sputum Monitoring during Tuberculosis Treatment for Predicting Outcome:
Systematic Review and Meta-Analysis; *Horne, D.J., Royce, S.E., Gooze, L.,
Narita, M., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20510279>
The World Health Organization (WHO) has previously recommended sputum-smear
examination at the end of the second month of treatment in patients with
recently diagnosed pulmonary TB, and, if positive, extension of the
intensive therapy phase. The researchers did a systematic review and
meta-analysis to assess the accuracy of a positive sputum smear or culture
during treatment for predicting failure or relapse in pulmonary TB. The
researchers searched PubMed, Embase, and the Cochrane Library for studies
published in English through December, 2009. They included randomized
controlled trials, cohort, and case-control studies of previously untreated
pulmonary TB patients who had received a standardized regimen with
rifampicin in the initial phase. Accuracy results were summarized in forest
plots and pooled by use of a hierarchical regression approach. Fifteen
papers (28 studies) met the inclusion criteria. The pooled sensitivities for
both 2-month smear (24% [95% CI 12-42%], six studies) and culture (40% [95%
CI 25-56%], four studies) to predict relapse were low. Corresponding
specificities (85% [95% CI 72-90%] and 85% [95% CI 77-91%]) were higher, but
modest. For failure, 2-month smear (seven studies) had low sensitivity (57%
[95% CI 41-73%]) and higher, although modest, specificity (81% [95% CI
72-87%]). Both sputum-smear microscopy and mycobacterial culture during TB
treatment have low sensitivity and modest specificity for predicting failure
and relapse. Although the researchers pooled a diverse group of patients,
the individual studies had similar performance characteristics. Better
predictive markers are needed.
*5.* The Malaysian Journal of Pathology. 2009 Dec; Volume 31, Number 2:
93-7. *The Manual MGIT System for the Detection of M. tuberculosis in
Respiratory Specimens: An Experience in the University Malaya Medical
Centre; *Fadzilah, M.N., Ng, K.P., Ngeow, Y.F.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20514851>
A prospective study was conducted on 510 respiratory specimens for the
presence of *M. tuberculosis* detected by direct acid-fast bacilli (AFB)
smear examination, culture in the Manual Mycobacteria Growth Indicator Tube
(BBL MGIT, Becton-Dickinson) and culture on Lowenstein-Jensen (LJ) medium.
>From positive BBL MGIT tubes, Ziehl-Neelsen and Gram stains were performed
and subcultures were put up on LJ medium. A total of 101 (19.8%) specimens
were positive by the BBL MGIT, 60 (11.8%) by primary LJ medium culture, 31
(6.1%) by direct smear examination, and 29 (5.7%) by all three methods.
Using primary LJ culture as the gold standard, the sensitivity and
specificity of the BBL MGIT were 90% and 89.6% respectively but the
sensitivity of AFB smear microscopy was only 48.3%. About half (51.1%) of
the BBL MGIT false positives were due to contamination by non-AFB bacteria.
The remaining false positives comprised specimens that were AFB microscopy
positive but LJ culture negative. Of the AFB isolates obtained on LJ primary
and sub-cultures, almost all (93.3%) were identified as *Mycobacterium
tuberculosis* complex. The mean time-to-detection was significantly shorter
(p < 0.0001) for the BBL MGIT than for LJ culture. For the former, positive
results were available within 14 days for both AFB smear-positive and AFB
smear-negative specimens. On the average, positive results were obtained 1.8
days earlier for direct AFB smear-positive samples than for AFB
smear-negative samples. On the other hand, positive growth on LJ medium
appeared after at least 33 days of incubation. Findings suggest that the BBL
MGIT system will be a suitable alternative to LJ culture for the routine
diagnosis of pulmonary TB, but a combination of liquid and solid cultures is
still required for the highest diagnostic accuracy.
*6.* Medical Science Monitor. 2010 Jun; Volume 16, Number 6: PH57-62. *Risk
Factors for Multidrug-Resistant Tuberculosis in Diyarbakir, Turkey; *Tanrikulu,
A.C., Abakay, A., Abakay, O.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20512101>
Multidrug-resistant (MDR) TB is a serious public health problem. This study
investigated probable risk factors for developing MDR TB in TB patients
treated at TB Control Dispensaries (TCDs) in Diyarbakir, Turkey. The records
of 34 patients with MDR TB and 70 patients with TB sensitive to all
first-line drugs (DS), who were treated at TCDs between January 2002 and
December 2008, were reviewed retrospectively. The mean age was 34.47+/-16.99
(32.35+/-14.21 in the MDR group and 35.50+/-18.19 in control group) with the
range from 2 to 76 years. Of the patients, 63 were male and 41 were female.
When risk factors for MDR TB were evaluated with univariate analysis
methods, low socioeconomic status, the presence of accompanying disease,
previous TB history, previously administered TB treatment, inappropriate TB
treatment, and noncompliance with TB treatment were all found to be
significant risk factors. When these risk factors were analyzed with
logistic regression analysis, regardless of other risk factors, MDR risk was
significantly increased with previous TB history by 22.31, with previously
taking TB medication by 13.19, and with low socioeconomic status by 6.03.
Socioeconomic factors also played an important role in this issue. To
minimize the effect of patients' risk factors, health workers should be able
to reach all patients, and therapies must be given under direct observation.
*7.* Medical Science Monitor. 2010 Jun; Volume 16, Number 6: CR289-95.
*Comparative
Evaluation of a PCR Assay with an In-House ELISA Method for Diagnosis of
Tuberculous Meningitis; *Nagdev, K.J., Kashyap, R.S., Deshpande, P.S.,
Purohit, H.J., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20512092>
Despite the availability of many investigational methods, diagnosis of
tuberculous meningitis (TBM) is extremely difficult. Polymerase chain
reaction (PCR), using specific primers for *Mycobacterium
tuberculosis*(MTB), shows variable sensitivity and specificity. In
this study, the
researchers assessed the usefulness of the PCR assay for TBM diagnosis and
compared it to their in-house enzyme-linked immunosorbent assay (ELISA)
based on antigen 85 complex detection. Cerebrospinal fluid (CSF) samples
were obtained from 189 patients in 3 different groups: confirmed TBM (n=13),
clinically suspected TBM (n=37), and non-TBM (n=139). A PCR assay was
performed using a specific pair of primers designed to amplify the insertion
sequence IS6110 in the MTB genome, and it was compared to ELISA, using
monoclonal antibodies against the purified Ag 85 complex, to analyze CSF
samples and diagnose TBM. The PCR assay yielded sensitivity and specificity
values of 80% and 84%, which are slightly less, but comfortable to the
values obtained for the ELISA method (84% and 91%). Interestingly, a
combinatorial approach using both methods provided sensitivity and
specificity of 88% and 93%. The PCR assay was found to be as sensitive and
specific as the well-established in-house ELISA technique, suggesting that
it can be used for TBM diagnosis.
*8.* Nature Genetics. 2010 Jun; Volume 42, Number 6: 498-503. Epub 2010 May
23. *Human T Cell Epitopes of Mycobacterium tuberculosis Are Evolutionarily
Hyperconserved; *Comas, I., Chakravartti, J., Small, P.M., Galagan, J., et
al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20495566>
*Mycobacterium tuberculosis* is an obligate human pathogen capable of
persisting in individual hosts for decades. The researchers sequenced the
genomes of 21 strains representative of the global diversity and six major
lineages of the *M. tuberculosis* complex (MTBC) at 40- to 90-fold coverage
using Illumina next-generation DNA sequencing. The researchers constructed a
genome-wide phylogeny based on these genome sequences. Comparative analyses
of the sequences showed, as expected, that essential genes in MTBC were more
evolutionarily conserved than nonessential genes. Notably, however, most of
the 491 experimentally confirmed human T cell epitopes showed little
sequence variation and had a lower ratio of nonsynonymous to synonymous
changes than seen in essential and nonessential genes. The researchers
confirmed these findings in an additional data set consisting of 16 antigens
in 99 MTBC strains. These findings are consistent with strong purifying
selection acting on these epitopes, implying that MTBC might benefit from
recognition by human T cells.
*9.* The New Microbiologica. 2010 Apr; Volume 33, Number 2: 93-107. *Rational
Use of Immunodiagnostic Tools for Tuberculosis Infection: Guidelines and
Cost Effectiveness Studies; *Amicosante, M., Ciccozzi, M., Markova, R.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20518271>
TB remains a public health challenge and its control requires the use
efficient diagnostic tools. *Mycobacterium tuberculosis* (MTB) elicits a
strong immune response upon infection, a phenomenon measured by the old
tuberculin skin test (TST). However, this test has many limitations and a
high rate of positivity in BCG-vaccinated subjects. Recent studies have
identified several MTB-antigens for diagnostic use, including the ESAT-6 and
CFP-10 proteins. Based on these antigens, one of the most significant
developments in the diagnostic armamentarium for TB has been the assays
based on IFN- determination (IGRAs). The assays stem from the principle that
T-cells of infected individuals produce IFN-gamma when they re-encounter the
MTB antigens in vitro and this can be measured by a conventional ELISA test.
The evaluation of IGRAs in different clinical settings showed many
advantages over the TST. The worldwide diffusion of IGRAs has increased the
knowledge of their clinical use and a number of guidelines have been devised
for their application. The two-step approach (first using TST followed by
IGRA for confirmation) is the most favored strategy for IGRA-use in the
general population, while the use of IGRAs alone is suggested in particular
clinical settings and/or patient groups. Even if these tests are still
costly there are a number of cost effective advantages in the "targeted" use
of IGRAs over the TST. This study summarizes all these aspects.
*10.* PLoS One. 2010 May 27; Volume 5, Number 5: e10860. *Mycobacterium
tuberculosis Transcriptional Adaptation, Growth Arrest and Dormancy
Phenotype Development Is Triggered by Vitamin C; *Taneja, N.K., Dhingra, S.,
Mittal, A., Naresh, M., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20523728>
Tubercle bacilli are thought to persist in a dormant state during latent TB
infection. Although little is known about the host factors that induce and
maintain *Mycobacterium tuberculosis* (M. tb) within latent lesions, O(2)
depletion, nutrient limitation, and acidification are some of the stresses
implicated in bacterial dormancy development/growth arrest. Adaptation to
hypoxia and exposure to NO/CO is implemented through the DevRS/DosT
two-component system which induces the dormancy regulon. In this study, the
researchers showed that vitamin C (ascorbic acid/AA) can serve as an
additional signal to induce the DevR regulon. Physiological levels of AA
scavenge O(2) and rapidly induce the DevR regulon at an estimated O(2)
saturation of <30%. The kinetics and magnitude of the response suggests an
initial involvement of DosT and a sustained DevS-mediated response during
bacterial adaptation to increasing hypoxia. In addition to inducing DevR
regulon mechanisms, vitamin C induces the expression of selected genes
previously shown to be responsive to low pH and oxidative stress, triggers
bacterial growth arrest, and promotes dormancy phenotype development in M.
tb grown in axenic culture and intracellularly in THP-1 cells. Vitamin C
mimics multiple intracellular stresses and has wide-ranging regulatory
effects on gene expression and physiology of M. tb which leads to growth
arrest and a 'dormant' drug-tolerant phenotype, but in a manner independent
of the DevRS/DosT sytem. The 'AA-dormancy infection model' offers a
potential alternative to other models of non-replicating persistence of M.
tb and may be useful for investigating host-'dormant' M. tb interactions.
Findings offer a new perspective on the role of nutritional factors in TB
and suggest a possible role for vitamin C in TB.
*11.* PLoS One. 2010 May 24; Volume 5, Number 5: e10799. *Follow-up of
Patients with Multidrug Resistant Tuberculosis Four Years after Standardized
First-Line Drug Treatment; *He, G.X., Xie, Y.G., Wang, L.X., Borgdorff,
M.W., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20520720>
In 2004, an anti-tuberculosis (TB) drug resistance survey in Heilongjiang
province, China, enrolled 1,574 (79%) new and 421 (21%) retreatment
patients. Multidrug-resistant (MDR) TB was detected in 7.2% of new and 30.4%
of retreatment patients. All received treatment with standardized first-line
drug (FLD) regimens. The researchers reported treatment outcomes of the 2004
cohort, and long-term outcomes as assessed in the second half of 2008. The
reported cure rate for MDR TB patients was 83% (94/113) among new and 66%
(85/128) among retreatment patients (P<0.001). Ten of the 241 MDR TB
patients died during treatment. Of the remaining 231 patients, 129 (56%)
could be traced in 2008. The overall recurrence rates among new and
retreatment cases were 46% and 66%, respectively (P = 0.03). The overall
death rates among new and retreatment cases were 25% and 46%, respectively
(P = 0.02). Forty percent of the traced new cases and 24% of the retreatment
cases were alive and without recurrent TB (P = 0.01). Of the 16 patients who
failed or defaulted from treatment in 2004, only two patients were not
re-diagnosed with TB by 2008. Of the 111 (86%) patients with an initial
successful treatment outcome 63 (57%) had developed recurrent TB, 40 (36%)
had died, 27 (24%) of them died of TB. The follow-up period of four years
precluded follow-up of all patients. In a highly conservative sensitivity
analysis in which we assumed that all non-included patients were alive and
did not have recurrent TB, the recurrence and death rate were 33% and 21%.
Documentation of cure based on conventional smear microscopy was a poor
predictor of long term outcomes. MDR TB patients in Heilongjiang province in
China had high recurrence and death rates four years after treatment with
standardized FLD regimens, reinforcing the need for early diagnosis and
treatment of MDR TB, including assessment of treatment outcomes with more
sensitive laboratory methods.
*12.* PLoS One. 2010 May 21; Volume 5, Number 5: e10759. *Pulmonary
Tuberculosis and Drug Resistance in Dhaka Central Jail, the Largest Prison
in Bangladesh; *Banu, S., Hossain, A., Uddin, M.K., Uddin, M.R., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20505826>
There are limited data on TB among prison inmates in Bangladesh. This study
determined the prevalence of pulmonary TB, its drug resistance and risk
factors in Dhaka Central Jail, the largest prison in Bangladesh. A cross
sectional survey was conducted with active screening of a total number of
11,001 inmates over a period of 2 years. Sputum samples from TB suspects
were taken for acid- fast bacilli (AFB) microscopy, culture, and drug
susceptibility testing. Among 1,781 TB suspects, 245 (13.8%) were positive
for AFB on microscopy and/or culture. The prevalence rate of sputum-
positive pulmonary TB was 2,227/100,000. Fifty three cases (21.6% of 245
cases) were AFB- negative on microscopy but were found positive on culture.
Resistance to isoniazid, rifampicin, streptomycin, and ethambutol was 11.4%,
0.8%, 22.4%, and 6.5% respectively. No multidrug resistance was observed.
The main risk factors of TB in prison were exposure to TB patients (adjusted
odds ratio 3.16, 95% CI 2.36-4.21), previous imprisonment (1.86, 1.38-2.50),
longer duration of stay in prison (17.5 months for TB cases; 1.004,
1.001-1.006), and low body mass index which is less than 18.5 kg/m(2) (5.37,
4.02-7.16). The study results revealed a very high prevalence of TB in the
prison population in Dhaka Central Jail. Entry examinations and active
symptom screening among inmates are important to control TB transmission
inside the prison. Identifying undiagnosed smear-negative TB cases remains a
challenge to combat this deadly disease in this difficult setting.
*13.* PLoS One. 2010 May 20; Volume 5, Number 5: e10753. *Influence of M.
tuberculosis Lineage Variability within a Clinical Trial for Pulmonary
Tuberculosis; *Nahid, P., Bliven, E.E., Kim, E.Y., Mac Kenzie, W.R., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20505778>
Recent studies suggest that *M. tuberculosis* lineage and host genetics
interact to impact how active TB presents clinically. The researchers
determined the phylogenetic lineages of *M. tuberculosis* isolates from
participants enrolled in the TB Trials Consortium Study 28, conducted in
Brazil, Canada, South Africa, Spain, Uganda, and the United States, and
secondarily explored the relationship between lineage, clinical
presentation, and response to treatment. Large sequence polymorphisms and
single nucleotide polymorphisms were analyzed to determine lineage and
sublineage of isolates. Of 306 isolates genotyped, 246 (80.4%) belonged to
the Euro-American lineage, with sublineage 724 predominating at African
sites (99/192, 51.5%), and the Euro-American strains other than 724
predominating at non-African sites (89/114, 78.1%). Uneven distribution of
lineages across regions limited the researchers’ ability to discern
significant associations, nonetheless, in univariate analyses, Euro-American
sublineage 724 was associated with more severe disease at baseline, and
along with the East Asian lineage was associated with lower bacteriologic
conversion after 8 weeks of treatment. Disease presentation and response to
drug treatment varied by lineage, but these associations were no longer
statistically significant after adjustment for other variables associated
with week-8 culture status.
*14.* Scandinavian Journal of Immunology. 2010 May; Volume 71, Number 5:
353-61. *Molecular Cloning, Expression, Purification and Immunological
Characterization of Three Low-Molecular Weight Proteins Encoded by Genes in
Genomic Regions of Difference of Mycobacterium tuberculosis; *Hanif, S.N.,
Al-Attiyah, R., Mustafa, A.S.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20500686>
This study cloned, expressed, and purified three major antigenic proteins,
i.e. Rv3874, Rv3875, and Rv3619c, encoded by genes located in regions of
difference of *Mycobacterium tuberculosis* and characterized them for
immunogenicity in rabbits. The respective genes were amplified using
gene-specific primers and genomic DNA of *M. tuberculosis* by polymerase
chain reaction. The amplified DNA were cloned into pGEM-T Easy and subcloned
into pGES-TH-1 vector for high-level expression in *Escherichia coli* and
efficient purification. The results showed that the three fusion proteins,
i.e. glutathione-S-transferase (GST)-Rv3874, GST-Rv3875, and GST-Rv3619c,
were expressed at high levels and were purified (free of the GST fusion
partner) to homogeneity using glutathione-Sepharose and Ni-NTA agarose
affinity matrix after cleavage of the column-bound fusion proteins by
thrombin protease. The purified recombinant Rv3874, Rv3875, and Rv3619c
proteins were immunogenic and induced antigen-specific antibodies in
rabbits. Testing of the rabbit sera with overlapping synthetic peptides
showed that the antibodies were induced to several epitopes that were
scattered throughout the sequence of each protein. These results show
immunogenicity of all the proteins for inducing antigen-specific antibodies
in rabbits and demonstrate the usefulness of pGES-TH-1 vector for obtaining
purified recombinant proteins of *M. tuberculosis* for immunological
characterization.
*15.* Tuberkuloz ve Toraks. 2010 Jan; Volume 58, Number 1: 59-63. *Tuberculosis
in Children with Congenital Immunodeficiency Syndromes; *Doğru, D., Kiper,
N., Ozçelik, U., Yalçin, E., et aI.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20517730>
Patients with congenital immunodeficiency (CID) syndromes are susceptible to
various microorganisms. However, relatively few CID disorders develop
mycobacterial disease. The researchers describe clinical features,
laboratory findings, and therapeutic outcome of children with CID who had TB
disease. Medical reports of 10 patients were reviewed. Three patients had
chronic granulomatous disease, two had common variable immunodeficiency, the
others had cyclic neutropenia, combined immunodeficiency,
hyperimmunoglobulin E syndrome, selective IgA deficiency and X-linked
agammaglobulinemia. Eight patients presented with pulmonary TB, one had TB
arthritis, one had TB osteomyelitis. There was acid fast bacilli in sputum
of two, bone marrow aspiration in one, and postmortem lung biopsy specimen
in one patient. *Mycobacterium tuberculosis* grew in sputum of one and
articular fluid aspirate of another patient. One patient was diagnosed with
bone biopsy specimens characteristic for TB. The remaining three patients
were diagnosed with TB disease as they had positive tuberculin skin test and
clinical and radiologic findings unresponsive to non-specific treatment. All
patients were treated with antituberculous drugs. Mycobacterium species may
be important pathogens in children with CID, especially in endemic regions.
*16.* Tuberkuloz ve Toraks. 2010 Jan; Volume 58, Number 1: 44-52. *Factors
That Effect Sputum Culture Conversion Rate in Hospitalized Patients with
Pulmonary Tuberculosis Who Were Applied Directly Observation Therapy and
Non-Directly Observation Therapy; *Uzundağ Işeri, A., Dulkar, G., Selçuk
Sönmez, O., Yilmaz Aydin, L., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20517728>
DOT has been accepted as the basic method for controlling TB. This study
determined the risk factors that affect sputum culture conversion rate in
the DOT managed and non-DOT managed hospitalized patients. The study
included 50 cases with positive sputum cultures between the dates April 2001
and April 2002 when DOT was not used and 60 cases between the dates May 2002
and May 2003 when DOT was used. The relation between sputum culture
conversion rate and the risk factors of age, gender, cough, hemoptysis,
primary drug sensitivity, high initial bacillary load, smoking and alcohol
consumption, presence of diabetes mellitus (DM), and radiological
dissemination were determined. In the present study, sputum culture
conversion rate was found to be 68.3% in DOT managed patients, 62% in
non-DOT managed patients. In DOT managed and non-DOT managed patients; there
was no statistically significant difference between complaints of cough,
sputum, night sweating, hemoptysis, DM, bacillary load, primary drug
resistance, and culture conversion rate. In DOT managed patients; a
significant difference was determined between smoking and alcohol
consumption and culture conversion rate. The factors determined above as
being related with the sputum culture conversion rate were similar to the
results of the other studies investigating the same topic. Despite no
statistical significance, an increase was determined in the sputum culture
conversion rate in DOT managed patients, when compared with non-DOT managed
patients.
*17.* World Journal of Gastroenterology. 2010 May 28; Volume 16, Number 20:
2496-503. *Histopathology and TB-PCR Kit Analysis in Differentiating the
Diagnosis of Intestinal Tuberculosis and Crohn's Disease; *Jin, X.J., Kim,
J.M., Kim, H.K., Kim, L., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/20503449>
This study compared the histopathologic features of intestinal TB (ITB) and
Crohn's disease (CD) and determined whether polymerase chain reaction
for *Mycobacterium
tuberculosis* (TB-PCR) would be helpful for differential diagnosis between
ITB and CD. The researchers selected 97 patients with established diagnoses
(55 cases of ITB and 42 cases of CD) who underwent colonoscopic biopsies.
Microscopic features of ITB and CD were reviewed, and eight pathologic
parameters were evaluated. Nine cases of acid fast bacilli culture-positive
specimens and 10 normal colonic tissue specimens were evaluated as the
positive and negative control of the TB-PCR test, respectively. PCR assays
were done using two commercial kits: kit <A> detected IS6110 and MPB64, and
kit <B> detected IS6110 only; a manual in-house PCR method was also
performed on formalin-fixed, paraffin-embedded colonoscopic biopsy
specimens. Statistically significant differences were noted between ITB and
CD with regard histopathologic criteria: size of granulomas (P = 0.000),
giant cells (P = 0.015), caseation necrosis (P = 0.003), confluent
granulomas (P = 0.001), discrete granulomas (P = 0.000), and granulomas with
lymphoid cuffs (P = 0.037). However, 29 cases (52.7%) of ITB showed less
than five kinds of pathologic parameters, resulting in confusion with CD.
The sensitivities and specificities of the TB-PCR test by kit <A>, kit <B>,
and the in-house PCR method were 88.9% and 100%, 88.9% and 100%, and 66.7%
and 100% in positive and negative controls, respectively. The PCR test done
on endoscopic biopsy specimens of ITB and CD were significantly different
with kit <A> (P = 0.000) and kit <B> (P = 0.000). The sensitivities and
specificities of TB-PCR were 45.5% and 88.1%, 36.4% and 100%, and 5.8% and
100%, for kit <A> and kit <B> and in-house PCR method on endoscopic biopsy
specimens. Among the 29 cases of histopathologically confusing CD, 10 cases
assayed using kit <A> and 6 cases assayed using kit <B> were TB-PCR
positive. A combination of histologic findings and TB-PCR testing led to an
increase of diagnostic sensitivity and the increase (from 47.3% to 58.2) was
statistically significant with kit <B> (P = 0.000). The TB-PCR test combined
with histopathologic factors appears to be a helpful technique in
formulating the differential diagnosis of ITB and CD in endoscopic biopsy
samples.
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. 4 New Job Positions *
*Sponsor: PATH, *Tuberculosis Team, HIV/AIDS & Tuberculosis Global Program
PATH is an international, nonprofit organization that creates sustainable,
culturally relevant solutions, enabling communities worldwide to break
longstanding cycles of poor health. PATH's mission is to improve the health
of people around the world by advancing technologies, strengthening systems,
and encouraging healthy behaviors.
Based within the HIV/TB Global Program, PATH's TB portfolio consists of a
dynamic and growing set of both global and country-focused technical
assistance projects and short-term assignments. Such projects include
supporting DOTS expansion and quality improvement, laboratory strengthening,
surveillance, TB/HIV service integration, infection control, programmatic
management of drug-resistant TB, public-private sector collaboration, and
advocacy, communication, and social mobilization.
PATH is currently seeking a Sr. Technical Officer, Project Administrator,
and two Technical Officers to join the TB team. Please see below for a brief
description of each position. For additional information and to apply
online, please visit the employment website at
http://www.path.org/employment.php and search for the corresponding
position. PATH is dedicated to diversity and is an equal opportunity
employer.
* *
*(i) Project Administrator (PADM) (4184)*
Location: Washington, DC
* *
The new Project Administrator will provide financial and contractual
management for several activities within the TB Team’s portfolio, including
those in the Democratic Republic of the Congo. PATH is seeking candidates
who have at least 5 years of experience with grants and contract
administration and are fluent in French.
See Job Details<http://hostedjobs.openhire.com/epostings/submit.cfm?fuseaction=app.jobinfo&jobid=298446&company_id=15780&version=1&source=ONLINE&jobOwner=988958&aid=1>
* *
*(ii) Technical Officer (4186)*
Location: Washington, DC
PATH is also seeking a Technical Officer with experience managing USAID
projects, excellent organizational and leadership skills, and TB expertise
to provide program management support for activities in a range of countries
including those in Southeast Asia, Europe and Eurasia, and East Africa.
See Job Details<http://hostedjobs.openhire.com/epostings/submit.cfm?fuseaction=app.jobinfo&jobid=298448&company_id=15780&version=1&source=ONLINE&jobOwner=988958&aid=1>
* *
*(iii) Sr. Technical Officer (4187)*
Location: TBD
* *
The Senior Technical Officer will provide high-level technical expertise and
leadership for the TB Team’s growing portfolio.
See Job Details<http://hostedjobs.openhire.com/epostings/submit.cfm?fuseaction=app.jobinfo&jobid=298449&company_id=15780&version=1&source=ONLINE&jobOwner=988958&aid=1>
* *
*(iv) Technical Officer (4188)*
Location: TBD
The DRC Technical Officer will provide management support to PATH TB
activities in the Democratic Republic of the Congo. PATH is seeking
candidates with experience managing USAID projects, excellent organizational
and leadership skills, fluency in French, and TB expertise.
See Job Details<http://hostedjobs.openhire.com/epostings/submit.cfm?fuseaction=app.jobinfo&jobid=298450&company_id=15780&version=1&source=ONLINE&jobOwner=988958&aid=1>
* *
* *
*2. Technical Officer *
*Sponsor: WHO Stop TB Department,** TB Strategy and Operations*
Vacancy Notice No: HQ/10/STB/FT251
Location: Geneva Switzerland
The WHO Stop TB Department aims to guide the global response to the TB
epidemic and facilitate partnerships; provide evidence-based norms,
standards, and policies; support Member States in adapting and adopting the
Stop TB Strategy within strengthened health systems; measure global
progress, monitor and assess national program performance, financing, and
impact; and, enable progress across the continuum of TB research, linked
within a wider health research strategy. The WHO Stop TB Strategy aims to
achieve: universal access to quality diagnosis and patient-centered
treatment; reduce the human suffering and socioeconomic burden associated
with TB; protect vulnerable populations from TB, TB/HIV, and drug-resistant
TB; support development of new tools and enable their timely and effective
use; and protect and promote human rights in TB prevention, car, and
control. Within STB, the Stop TB Strategy (TBS) team is responsible for
improving TB control within strengthened health system by developing new
evidence-based strategies and policies that support the
implementation of the Stop TB Strategy and supporting their timely adoption
by Member States and partners.
Description of duties:
1. Facilitate the operations of the Global Project through the revision and
implementation of drug resistance survey protocols, and management of drug
resistance surveillance data.
2. Coordinate technical assistance activities in the area of drug resistance
surveillance in order to ensure optimal use of resources.
3. Coordinate collection of standardized drug resistance surveillance data
in collaboration with the UNITAID/GLI project for global laboratory capacity
strengthening.
4. Facilitate periodical analysis and publication of global data on
anti-tuberculosis drug resistance.
5. Coordinate activities of the Advisory Body to the Global Project.
6. In collaboration with the GLI Secretariat strengthen links between
national laboratories and the Supranational Reference Laboratory network for
national-level capacity building for drug resistance surveillance.
7. Facilitate the activities of the Subgroup on Research of the Working
Group on Multi-Drug Resistant Tuberculosis and operational research
activities in the Team.
8. Perform other duties as required.
A written test and interviews may be used as a form of screening.
Online applications are strongly encouraged to enable WHO to store your
profile in a permanent database.
Please visit WHO's e-Recruitment website at
http://www.who.int/employment/en/ . The system provides instructions for
online application procedures.
All applicants are encouraged to apply online as soon as possible after the
vacancy has been posted and well before the deadline stated in the vacancy
announcement.
*3. Health Education Specialist (Training Specialist III – Job #2761) *
*Sponsor: The Heartland National TB Center (HNTC) *
Location: San Antonio, Texas
Responsibilities:
Performs duties to plan, develop, coordinate, participate in, and evaluate
all aspects of education and training provided by the Center, including
educational design, curriculum development, and development of goals,
objectives, and content; identify educational needs and target audiences;
travel to conduct presentations/workshops; participate in
workgroups/planning committees; prepare narrative/statistical reports; and
write articles. The candidate will be required to travel throughout the HNTC
region and nation. Bachelor’s degree with 5 years experience in related
duties. Experience in lieu of education may be substituted. Three years
experience in initiating health care based education, educational design,
and curriculum development. Masters in health education or public health
preferred. CHES certification preferred.
Competitive Salary + excellent benefits. Apply on-line http://www.uthct.edu/.
For more information on the HNTC project, call 1-800-TEX-LUNG, or visit our
website http://www.heartlandntbc.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. Advanced TB Nurse Case Management NEW*
Sponsor: Heartland National TB Center
Date: October 19, 2010
Location: St. Paul, Minnesota
This course is intended for TB program managers, TB nurse case managers, and
local health department nurses responsible for the management of patients
with, or suspected of, TB. This is not an introductory course. It is
recommended that nursing participants attend a Nurse Case Management course
before attending this training or have extensive experience managing TB
patients.
There is no fee, but enrollment is limited. Pre-registration is required.
Continuing education credits are available.
For more information, contact Jessica Quintero, Heartland National TB
Center, E-mail:
; Phone: (210) 531-4568; or access the Web site:
http://www.heartlandntbc.org/training.asp .
* *
2. 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/ .
*3. Medical Management of TB: An Online Presentation (30 minutes) *
Sponsor: The Francis J. Curry National Tuberculosis Center
This slide presentation is presented by Karen Smith, M.D., M.P.H., Public
Health Officer for Napa County Public Health in Napa, California. Dr. Smith
covers the basic information that every nurse case-managing a TB patient
must understand, including the four basic TB drugs, the role they play in TB
treatment, and the adverse reactions most commonly associated with them;
alternative regimens; and how to monitor patients. Dr. Smith also briefly
discusses drug-resistant TB and extrapulmonary TB.
This slide presentation with streaming audio provides information on how to
manage treatment of TB. A question and answer session, a printable
PowerPoint slide file, and other useful resources are also included as
supplemental materials.
For more information visit: http://www.nationaltbcenter.ucsf.edu/med_mgmt/ .
*4. Understanding Tuberculosis *
Sponsor: The Tuberculosis Survival Response
Paul (Mayho) Thorn, author of The Tuberculosis Survival Handbook is offering
a half-day workshop to raise awareness of TB among key front-line workers,
and anyone else who comes into contact with the public and clients in the UK
who may be at a higher risk of developing active TB disease.
Do you work with people with alcohol and drug problems; the homeless;
prisoners; or people who live in poverty, poor or overcrowded living
conditions, or have other health issues such as HIV?
Are you concerned about the risks to yourself? Do you need to know more
about the disease?
The outcome of attending the workshop will be a better understanding of TB,
its prevention and treatment. It will provide an insight into the impact of
the disease on individuals and society today, and an informed understanding
of your risks while working with people who may be at a higher risk of
developing active TB disease.
Cost per person £22.50. The Tuberculosis Survival Response can deliver the
workshop to your team at your place of work, or alternatively organize an
external venue. To find out more, e-mail
For more information about this workshop, visit
http://www.understandingtb.org/ .
*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. Email ; telephone (415) 502-4600;
or fax (415) 502-4620.
For a course description, 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 receiving 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. TB Management in HIV Patients: A Webinar Series *
Sponsor: Heartland National TB Center
Dates: July 27, 2010; August 3, 2010; August 17, 2010
Location: Nationwide, USA
The webinar series is intended for TB program staff and clinical personnel
including physicians, nurses, and other healthcare staff who manage and
treat patients infected with TB and HIV. The series will provide health care
professionals with the knowledge to competently diagnose and manage patients
that are coinfected with TB and HIV. Registration for Part 1 automatically
registers the participant for the whole series.
This webinar includes 3 parts: Part 1: Diagnosis of TB in the HIV Patient -
July 27, 2010; Part 2: Treatment of TB in the HIV Patient - August 3, 2010;
Part 3: Special Topics in the Management of TB in the HIV Patient - August
17, 2010. (Time: 12:00 – 1:30 pm CST).
For more information, contact Robert Granger, Heartland National TB Center.
E-mail
; phone (210) 531-4509; or access the Web site at
http://www.heartlandntbc.org/training.asp .
*9. TB Education and Training Network (TB ETN) Conference *
Sponsor: Centers for Disease Control and Prevention (CDC), Division of
Tuberculosis Elimination (DTBE).
Dates: August 10 – 12, 2010
Location: Atlanta, GA
The 10th annual TB Education and Training Network (TB ETN) Conference, "TB
Education, Training, and Evaluation: Fitting the Pieces Together," will be
held in Atlanta, Georgia, August 10-12, 2010, at the Westin Atlanta
Perimeter North. For a second year, TB ETN and the TB Program Evaluation
Network (TB PEN) will join forces to highlight the common aspects of TB
education, training, and evaluation. The conference will focus on a variety
of topics, including partnerships, social determinants of health, capacity
building, and tools of the trade that enhance TB education, training, and
program evaluation. Conference activities will include skills-based
workshops, informational presentations, and networking opportunities.
10th Anniversary Celebration of TB ETN: TB ETN will be celebrating the 10th
anniversary of bringing TB professionals together to network, share
resources, and build education and training skills. In recognition of this
milestone, a special reception will be held on August 10, 2010, at the
Westin Atlanta Perimeter North, in Atlanta, GA, from 5:00-7:00 pm.
For more information, contact CDC DTBE, 1600 Clifton Rd., NE MS E10,
Atlanta, GA 30333. E-mail ; phone 800-CDC-INFO
(800-232-4636); TTY (888) 232-6348; or access the Web site at
http://www.cdc.gov/tb/education/tbetn/conference.htm .
Registration fee: $50.00/TB ETN members; $75.00/Non-members. Continuing
education credits are available.
*10. Tuberculosis Program Manager's Intensive *
Sponsor: The Francis J. Curry National Tuberculosis Center
Dates: August 17 – 20, 2010
Location: San Francisco, California
This course is for nurses, physicians, and other health professionals
working as TB program managers. The training will cover: role of the program
manager, epidemiology of TB, treatment completion strategies, TB outbreaks,
contact investigation, quality assurance, staff training and budgeting,
infection control, program planning/grants, and program evaluation.
Enrollment is limited, and pre-registration is required. There is no fee for
this course. Continuing education credits are available.
For more information, contact the Francis J. Curry National Tuberculosis
Center. E-mail ; phone (415) 502-4600;
fax (415) 502-4620; or access the Web site at
http://www.nationaltbcenter.ucsf.edu/training/tbpmi10.cfm .
*11. Open Forum 4 — Key Issues in TB Drug Development*
Sponsor: The Global Alliance for TB Drug Development (TB Alliance)
Dates: August 18 – 19, 2010
Location: Addis Ababa, Ethiopia
This two-day Open Forum will be the fourth in a series of meetings aimed to
raise and address key issues in TB drug development, with a special focus on
regulatory affairs.
The Forum will include sessions on the current global TB drug development
portfolio, key issues in the critical path to TB drug registration,
designing pivotal trials, conducting registration trials in high TB burden
countries, challenges in TB drug development for resistant disease, and
developing regimens containing multiple novel agents.
These meetings are designed to bring together regulators, TB drug
developers, and other interested stakeholders, such as TB care providers,
public health policy makers, and community advocates from both major
industrialized and high burden countries. Open Forum 4 will have a special
focus on Africa and the regulatory challenges it faces.
For inquiries about this event, please contact: .
Registration for the event is free and currently open at:
http://www.tballiance.org/events/openforum4.php .
*12. Understanding and Managing Latent TB Infection *
Sponsor: Heartland National TB Center
Date: August 24, 2010
Location: Arnold, Missouri
Application Deadline: August 6, 2010
This course is intended for local health department nurses and DOT workers
who are tasked with the responsibility to identify and manage patients with,
or at risk of, latent TB infection (LTBI). The course will enhance their
ability to differentiate LTBI from TB disease and competently manage and
treat LTBI patients. In addition, the last part of the course will include a
hands-on skill building session on the tuberculin skin test.
There is no fee, but enrollment is limited. Pre-registration is required.
Continuing education credits are available.
For more information, contact Elizabeth Mauldin, Heartland National TB
Center. E-mail
; phone (210) 531-4580; or access the Web site at
http://www.heartlandntbc.org/training.asp .
*13. Contact Investigation Overview and Updates: A Webinar*
Sponsor: Heartland National TB Center
Date: August 26, 2010
Location: Nationwide, USA
Application Deadline: August 20, 2010
This webinar is intended for TB program staff, including nurses and
healthcare workers, who conduct or manage TB contact investigations. It will
provide an overview of how to manage and document a contact investigation in
high and low incidence areas.
For more information, contact Jessica Quintero, Heartland National TB
Center. E-mail ; phone (210) 531-4568; or access
the Web site at
http://www.heartlandntbc.org/training.asp.
*14. Comprehensive Clinical TB Course*
Sponsor: Southeastern National Tuberculosis Center
Dates: September 13 – 16, 2010
Location: Lantana, Florida
This four-day training program will familiarize the clinician with all
aspects of TB infection, disease, and clinical care, using an
interdisciplinary and interactive approach. Course objectives are
accomplished through a combination of didactic lectures and interactive case
management discussions. The course is conducted at A.G. Holley Hospital, one
of the last free-standing TB sanatoriums in the United States.
Registration Fee: $300. Continuing education credits are available.
For more information, including registration, e-mail
or visit: http://sntc.medicine.ufl.e
du/Training.aspx <http://sntc.medicine.ufl.edu/Training.aspx> .
*15. Handling TB and HIV Co-Infection *
Sponsor: Heartland National TB Center
Dates: September 15 – 16, 2010
Location: Fargo, North Dakota
Application Deadline: August 25, 2010
This course is designed for physicians, nurses, and other health care
workers (counseling nurses, HIV case managers) who manage TB patients
coinfected with HIV. It will enhance the clinician’s knowledge and skills
through an overview of HIV infection, latent TB infection, and TB disease by
discussing diagnosis and treatment; jointly managing HIV and TB drug
therapies; drug side effects and toxicities; and HIV Opt Out policies and
recommendations.
There is no fee, but enrollment is limited. Pre-registration is required.
Continuing education credits are available.
For more information, contact Robert Granger, Heartland National TB Center.
E-mail
; phone (210) 531-4509; or access the Web site at
http://www.heartlandntbc.org/training.asp .
*16. Tuberculosis Clinical Intensive *
Sponsor: The Francis J. Curry National Tuberculosis Center (CNTC)
Dates: September 21 – 23, 2010
Location: San Francisco, California
Application deadline: August 5, 2010
This course is for physicians and other licensed medical professionals who
diagnose and treat TB. The course will cover: epidemiology of TB; diagnosis,
management, and treatment of TB; transmission and pathogenesis; TB and HIV
coinfection; TB targeted testing and laboratory testing; pediatric TB;
treatment of latent TB infection; multiple drug resistance; legal and
ethical issues in TB control; and TB radiology.
Enrollment is limited and pre-registration is required. There is no fee for
this course. Continuing education credits are available.
For more information contact the Francis J. Curry National Tuberculosis
Center, E-mail: ; Phone: (415) 502-4600; Fax:
(415) 502-4620; or access the Web site:
http://www.nationaltbcenter.edu/training/tb_clinical_intensive.cfm .
* *
*17. The Second Global Forum on TB Vaccines: A Framework for Introducing
Improved TB Vaccines to the World Community*
Sponsor: Aeras Global TB Vaccine Foundation
Dates: September 21 – 24, 2010
Location: Tallinn, Estonia
Registration Deadline: September 1, 2010
This international conference promises to be the premiere TB vaccine meeting
of 2010.
New TB vaccines hold the promise of preventing TB globally and overcoming
the challenges of drug-resistant TB and TB/HIV coinfection.
This scientific conference will include international experts chairing
sessions on: Basic Research,
Applied Research, Clinical Studies on TB Vaccines, Manufacturing, Regulation
and Vaccine Access,
Partnerships, and Communication & Coordination.
Participants will review progress on TB vaccines over the past ten years,
assess challenges, propose solutions, and reframe the global agenda for TB
vaccines for the next decade.
For more information, contact Mike Brennan at Aeras Global TB Vaccine
Foundation, by e-mailing ; phoning (301) 547-2959; or
visiting http://www.tbvaccine2010.org/.
Online registration is at http://www.tbvaccine2010.org/Register.html .
* *
* *
*18. TB Case Management and Contact Investigation Intensive *
Sponsor: The Francis J. Curry National Tuberculosis Center (CNTC)
Dates: October 12 – 15, 2010
Location: San Francisco, California
Application deadline: August 30, 2010
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. This
course covers many aspects of TB case management and contact investigation,
including epidemiology of TB, medical management of TB, targeted testing for
TB, treatment of latent TB infection (LTBI), and more.
Enrollment is limited, and pre-registration is required. A few days after
the application deadline, applicants will receive a letter indicating
whether or not their application is approved. Directions will be included
with acceptance letters. There is no fee for this course. Continuing
education credits are available.
For more informatio , contact Jennifer Kanouse, Program Manager. E-mail:
; phone (415)502-2712; or access the Web
site at http://www.nationaltbcenter.edu/training/tbcmcioct10.cfm .
* *
* *
*19. 41st Union World Conference on Lung Health *
Sponsor: International Union Against Tuberculosis and Lung Disease (The
Union)
Dates: November 11 - 15, 2010
Location: Berlin, Germany
The Union announces that the 41st Union World Conference on Lung Health,
organized by the International Union Against Tuberculosis and Lung Disease,
will be hosted in Berlin, Germany, from November 11 to 15, 2010.
Scientific sessions selected for this year’s program intend to highlight
innovation in TB, HIV, and lung health, setting a course for future health
solutions. As a link from the past to present, and the central role of
research, the theme of the conference is “Tuberculosis, HIV and lung health:
from research and innovation to solutions”.
The 41st Union World Conference will also provide the opportunity to
demonstrate continued commitment to the Year of the Lung, which was launched
on Sunday, December 6, 2009, at the 40th Union World Conference in Cancun,
Mexico. This campaign, organized by the Forum of International Respiratory
Societies (FIRS), seeks to raise awareness that hundreds of millions of
people around the world suffer each year from treatable and preventable
respiratory diseases.
The official languages for this conference are English and French.
Registration for the Conference can be made as of May 2010 using the online
registration service available on the conference website:
http://www.worldlunghealth.org/confBerlin/
The registration fee varies according to the dates registered and membership
status.
For more information, contact The Union, 68 Boulevard Saint-Michel, 75006
Paris, France; E-mail: e-mail address is being
protected from spambots. You need JavaScript enabled to view it for
registration and exhibition, and for scientific
program and abstracts. Telephone (+33) 1 44 32 03 60; fax (+33) 1 53 10 85
54 / (+33) 1 43 29 45 10; or access the website at
http://www.worldlunghealth.org/confBerlin/ .
*20. Late-Breaker Session on Tuberculosis at the 41st World Conference on
Lung Health *
Sponsors: International Union Against Tuberculosis and Lung Disease (The
Union). Centers for Disease Control and Prevention (CDC)
Date: November 15, 2010
Location: Berlin, Germany
Abstracts submission deadline: July 30, 2010
The 41st Union World Conference on Lung Health and the Centers for Disease
Control and Prevention (CDC) announce co-sponsorship of a late-breaker
session related to TB.
All aspects of TB control, elimination, and research (including basic and
clinical science, epidemiology, social, behavioral, psychosocial,
educational aspects, health care delivery, and public health) are welcomed
for presentation during the late-breaker session. In keeping with the spirit
of a late-breaker session we ask that only new, innovative, and significant
findings that have occurred as of April 1, 2010, or for which information
has just become available, be submitted for late-breaker presentations in
the form of a 1-page electronic file.
The late-breaker session will consist of 8 oral presentations of 10 minutes
each, followed by 5 minutes of questions. The presentations will be selected
from abstracts submitted to the late-breaker co-chairs by July 30, 2010.
Persons submitting abstracts will be notified of acceptance or rejection of
their abstract by September 3, 2010.
A small number of travel grants are available for presenters of accepted
abstracts who require funding to attend the conference. If you intend to
request support, an indication of your desire and rationale for
consideration for a travel grant must be submitted with the abstract. The
reviewing committee will be blinded to the request for travel funds.
Submissions should include a cover letter with (i) a statement that the work
has not been previously submitted for consideration to the general portion
of The Union meeting, (ii) the date by which the work/analysis was mostly
complete, (iii) a request and rationale for travel support if so desired,
and (iv) the address, phone and FAX number, and e-mail address where the
submitter may be contacted the week of September 6, 2010.
For more information, contact Ed Nardell (The Union), Phil LoBue (CDC), or
Elsa Villarino (CDC); TB Late-Breaker Session, Division of TB Elimination,
CDC, 1600 Clifton Rd, NE, MS E-10, Atlanta, Georgia 30333 USA; E-mail:
<>; Tel: (404) 639-8123; or Fax: (404)
639-8961; or visit the website:
http://www.cdc.gov/tb/events/unionlatebreaker.htm .
*21. TB: What We Know... and What Lies Below *
Sponsor: The Lung Association
Dates: November 15 – 16, 2010
Location: Toronto, Ontario, Canada
Early-bird registration deadline: October 15, 2010
The goal of this conference is to provide advanced information to health
care providers on the
complexity of tuberculosis management.
Conference Objectives include:
(1) To identify current TB management strategies in the context of emerging
issues and co-morbidities;
(2) To heighten awareness of the challenges of preventing and managing TB;
and
(3) To highlight innovations in TB diagnosis and care.
Health and social service professionals, and others in such fields as
medicine, nursing, public health, community health, institutional health,
communicable disease, and correctional services, working with populations at
high risk of tuberculosis are encouraged to attend.
Watch for the Call for Poster Abstracts which will be available during the
summer months.
A detailed program package and registration form will be distributed in the
early Fall. For registration information, contact .
For more information, visit http://www.on.lung.ca.
*
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