ACET March 20-21, 2007 DTBE Director’s Report

Kenneth G. Castro, M.D.

Assistant Surgeon General, USPHS

Director, Division of Tuberculosis Elimination

National Center for HIV, Hepatitis, STD, and TB Prevention*

Coordinating Center for Infectious Diseases

* Proposed

Recent Activities (Not Covered by ACET Agenda)

• Mar 6, 7 OGAC meeting

• Mar 7 XDR TB briefing requested by5 Senators (Durbin, Brown)

• Mar 15,16 BSC subcommittee (XDR TB)

• Mar 21 CDC testimony (Dr. JLG) to House Foreign Affairs Comm.

• Next weeks White House interagency team on XDR TB

World TB Day 2007

• WHO/IUATLD theme

“TB anywhere is TB everywhere”

• MMWR March 23rd box, 3 articles

• First TB Awareness Walk March 24, Atlanta’s Grant Park (~ 450 registrants)

http://www.cdc.gov/

National TB Case Rate, 2005-2006

Year Incidence/100,000 pop. 2005 4.82006† 4.6

† Data provisional and embargoed until March 22

3.2% decline

†Data provisional and embaroed until March 22

Figure 2. Number of persons with and rate* of tuberculosis (TB), by origin of birth and year ─ U.S.,

1993–2006†

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Nu

mb

er

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Ra

te

No. of U.S.-born persons with TBNo. of foreign-born persons with TBU.S.-born case rateForeign-born case rate

* Per 100,000 population.† Data for 2006 are provisional and embargoed until March 22.

MDR TB*: 2004–2005§

2004 (n=11,132)

2005†

(n=10,662)

No. (%) No. (%)

MDR Cases 129 (1.2) 124 (1.2)

US born 31 (24.0) 22 (17.7)

Foreign born 98 (76.0) 101 (81.5)

* Denominators based on culture confirmed cases with ISUS to INH and RIF† Missing origin of birth for one MDR case in 2005§ 2005 is the latest year with complete drug susceptibility test results

1993–1999

(NMDR = 2005)

2000–2006†

(NMDR = 922)

No. (%) No. (%)

XDR Cases (% of MDR) 32 (1.6) 17 (1.8)

US born 19 (59.4) 4 (23.5)

Foreign born 12 (40.6) 13 (76.5)

Characteristics of Extensively Drug-Resistant (XDR) Tuberculosis Cases,

1993–1999 vs. 2000–2006

†Data provisional and embargoed until March 22

FSEB Branch Chief Announcement: 3/14/07, closes 3/27/07        

HHS-CDC-D3-2007-0236, Medical Officer (PH), GS-602-15, NCHSTP, DTBE, FSEB  (External)

HHS-CCD-T3-2007-0784, Medical Officer (PH), GS-602-15, NCHSTP, DTBE, FSEB (Internal)

HHS-CDC-D3-2007-0233, Supervisory Health Scientist, GS-601-15, NCHSTP, DTBE, FSEB (External)

HHS-CDC-T3-2007-0785, Supervisory Health Scientist, GS-601-15, NCHSTP, DTBE, FSEB (Internal)

Medical Officer: Must submit copy of medical school transcript, copy of medical license, or copy of medical diploma.

Supervisory Health Scientist: Must submit copy of official college transcript with the application.

Link to the CDC jobs website: http://www.cdc.gov/employment/findcareer.htm

NEDSS TB PAM Update

• NEDSS PAM Platform (NPP), containing TB PAM, no longer supported by CDC. PHIN/NEDSS standards and Base System will be supported by CDC

 • DTBE response

• TIMS and its import utility continued to support national TB surveillance system (short-term)

• Collaborate with NCPHI/NEDSS Program to: • speed enhanced NEDSS TB message development (for

reporting areas already developing their own systems)• explore adding TB module to existing NEDSS Base

System (for reporting areas needing CDC data entry tool)• survey availability TB software applications developed

by private vendors • Communication to NTCA, TB Program Directors and TB

Surveillance Coordinators and conference call/webinar (Mar 23) to agree on action plan

 

Remaining TB Program Challenges

• Reductions in TB control program funds

• Improve efficiency and accountability

• Decline in cases/ increase in complexity

• Loss of expertise

0

20

40

60

80

100

120

2001 2002 2003 2004 2005 2006

Unadjusted Adjusted

CDC TB Cooperative Agreement Funds FY2001-FY2006

US

D $

in M

illio

ns

Year

TB CoAg Fund Redistribution Plans

• Second phase redistribution FY2008

– 20% redistributed in FY 2005

– 35% to be redistributed

• NTCA/CDC workgroup

• Scheduled discussions allow for adjustments based on new factors

• Strategic planning for future policies

Mycobacteriology Lab Branch

• NLTN last mycobacteriology course Apr/03 (1-2 hr audio conferences since)

• Lab course Summer 2007– 30+ applicants; can only take 16 – If successful, repeat

• Course to be held in the new CDC training labs/classroom facility

Probable Receipt of FY 2007CDC Emerging Infections Funds

• One-time funding ~ $2 million

• Support laboratory enhancements

• Support active outbreak response

• Implement BSC recommendations