About
TB Notes is a quarterly newsletter from the Division of Tuberculosis Elimination, featuring director's notes, updates from branches, activity overviews, and recent publications to keep you informed on CDC's tuberculosis prevention efforts and advancements.
Notes from the Director
Dear Colleague,
On March 24th, we came together with our global colleagues to observe World TB Day. CDC also published provisional 2023 U.S. TB data in CDC’s Morbidity and Mortality Weekly Report (MMWR) that showed a continued increase in U.S. TB cases in 2023. Continued recovery from pandemic-related healthcare disruptions, global increases in TB, and increases in post-pandemic travel and migration are likely contributing to these increases. Nonetheless, the United States continues to maintain one of the lowest TB incidence rates in the world, and domestic TB transmission remains uncommon. This is a testament to the tireless efforts of TB programs and partners working with communities throughout our nation. CDC was proud to recognize the efforts of over 30 U.S. TB Elimination Champions who are working to end TB in their communities.
Our progress towards TB elimination was the subject of a Surveillance Summary published in MMWR in June. CDC examined data from the National Tuberculosis Indicators Project to compare TB program trends over a 5-year period (up to 2022). These results suggest that TB programs are making improvements in identifying people with TB disease and latent TB infection and ensuring patients complete treatment in a timely manner. I encourage state and local health departments to use these data to improve TB programs, monitor progress toward national targets, allocate resources effectively, and communicate with other health departments about successes and challenges.
We have also had several opportunities for the Division of Tuberculosis Elimination (DTBE) staff to connect with partners. In April, many CDC staff attended the National TB Conference sponsored by the Union-North America Region (NAR) and the National Tuberculosis Coalition of America (NTCA) in Baltimore, Maryland. In May, the TB Trials Consortium held their spring meeting. The Advisory Council for the Elimination of Tuberculosis met in June and discussed topics ranging from laboratory tests to community isolation guidelines.
In addition, we have been contributing changes to CDC’s TB website as a part of the agency’s “Moving Forward” initiative to streamline web content for our users. These changes include a new look and feel for the TB Notes webpage. CDC has additional information to help partners navigate these updates.
These are just a few highlights from our work so far in 2024. I invite you to read further for additional news and resources from across DTBE.
Thank you for your continued efforts towards our goal of TB elimination.
Philip LoBue, MD, FACP, FCCP
Director
Division of Tuberculosis Elimination
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Office of the Director
CDC Joins Partners for Capitol Hill Briefing
On March 14, 2024, DTBE Division Director Dr. Philip LoBue joined TB advocate Shaka Brown, USAID Assistant Administrator Dr. Atul Gawande, and author and TB advocate John Green at a standing-room only, partner-sponsored briefing on Capitol Hill hosted by Senator Sherrod Brown. Dr. LoBue provided an update on TB in the United States.
Submitted by Susan McClure, MPH, Associate Director for Policy and Issues Management
National TB Conference
DTBE staff and partners actively engaged in the 2024 National TB Conference. The National Tuberculosis Coalition of America and the International Union Against Tuberculosis and Lung Disease – North America Region co-sponsored the event. The organizers held the conference in Baltimore, Maryland, from April 16-19, 2024. CDC staff served as representatives on the program committee and as abstract reviewers and presenters. They also hosted exhibitions and distributed educational materials to attendees.
Submitted by Carla Winston, PhD, MA, Associate Director for Science
Clinical Research Branch
Tuberculosis Trials Consortium Study 33 Data
Tuberculosis Trials Consortium (TBTC) Study 33: Adherence to Latent Tuberculosis Infection Treatment 3HP SAT Versus 3HP DOT (iAdhere) data are now available for public use. These data can be accessed through TB-PACTS data platform.
The TB-PACTS data platform is designed to catalyze and accelerate TB research by curating and standardizing tuberculosis (TB) clinical trial data and making this data publicly available to qualified researchers. Data can be accessed at: TB-PACTS | Critical Path Institute (c-path.org) Study ID: TB-1034.
Submitted by Carla Jeffries, JD, MPH, Deputy Chief, Clinical Research Branch
Communications, Education, and Behavioral Studies Branch
New Find TB Resources website
DTBE launched the updated Find TB Resources website, which features a searchable database of over 1,700 TB-related education and training materials. This revamped platform includes:
- an updated design,
- improved search features,
- an online form for submitting TB education and training materials to the database,
- links to additional resources, and
- the ability for users to customize a list of their favorite resources.
Additionally, the website includes an updated TB Behavioral Science Resources webpage, providing essential tools for TB professionals and researchers.
Submitted by Carissa Bisnath, MS, CHES Education, Training, and Behavioral Studies Team Lead
TB ETN and TB Program Evaluation Network (PEN) Conference
Mark your calendars for the 2024 TB Education and Training Network (TB ETN) and TB Program Evaluation Network (TB PEN) Conference, which will take place from September 17–19 in Atlanta, Georgia. This joint conference offers TB program staff a unique opportunity to deepen their understanding of TB education, training, and program evaluation. All participants must register by August 16, 2024. For more details on registration, abstract submission guidelines, and conference logistics, visit the TB ETN website.
Submitted by Carissa Bisnath MS, CHES, Education, Training, and Behavioral Studies Team Lead
A New Look and Feel for CDC.gov
On May 15, 2024, CDC launched a new website as part of an agency-wide effort to modernize and transform digital communication at CDC. In the process, CDC streamlined web content, updated navigation, and designed a new look and feel. As part of this initiative, the Division of Tuberculosis Elimination has updated web content included in this initial launch of the new CDC.gov:
We will continue to move TB content into the new website structure over the next several months. Visit the CDC Moving Forward webpage for more information about URLs and accessing older content.
Submitted by Leeanna Allen, MPH, Communications Team Lead
Data Management, Statistics, and Evaluation Branch
Tuberculosis Data Examined Over a 5-Year Period Reveal Both Progress and Room for Improvement
CDC recently published the report, “Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance – National Tuberculosis Indicators Project, 2016-2022” in the Morbidity and Mortality Weekly Report. CDC used data from the National Tuberculosis Indicators Project to compare TB program trends over a 5-year period (up to 2022) to gain a better understanding of program performance and identify areas for improvement. This is the first report to describe relative change in TB program performance.
During the 5-year period for which the most recent data were available, most TB programs (71%) had improvements in reducing overall TB incidence, and over half of TB programs (56%) increased the percentage of contacts diagnosed with latent TB infection who completed treatment. More than 60% of TB programs were above the national average for the percentage of patients completing TB treatment within a year of diagnosis.
Submitted by Maureen Kolasa, MPH, Evaluation Team Lead
Laboratory Branch
Tuberculosis Laboratory Aggregate Report: Seventh Edition
The DTBE Laboratory Branch released the Tuberculosis Laboratory Aggregate Report: Seventh Edition. As part of the CDC TB Elimination and Laboratory Cooperative Agreement (CoAg) PS-20-2001, 58 supported state, local, and territorial public health laboratories (PHLs) submit an Annual Performance Report (APR). The cooperative agreement focuses on strengthening these laboratories.
In each APR, PHLs self-report their performed TB testing methods and algorithms, describe progress made, or barriers faced in three focus areas defined in the CoAg, and report laboratory workload volume and turnaround time (TAT) performance data. These data are then compiled and presented in the aggregate report.
This report helps PHLs assess their progress in meeting national TB testing benchmarks. It allows for peer comparison with other PHLs with comparable specimen or testing volume, using similar methods, or in a similar geographical location. Laboratories should monitor and evaluate TB workload volume and TAT indicators with a goal of improving performance by setting realistic, incremental laboratory-specific goals. Additionally, PHLs should regularly assess laboratory practices to identify, address, and evaluate quality improvements.
The TB Laboratory Aggregate Report: Seventh Edition compares workload volume data, Mycobacterium tuberculosis complex culture positivity, nucleic acid amplification testing trends, and TAT data for calendar years 2020 –2022. It also includes the latest information on TB testing methods for calendar year 2023.
Submitted by: Stephanie Johnston, MS, Laboratory Capacity Team Lead
Surveillance, Epidemiology, & Outbreak Investigations Branch
SEOIB selects Dr. Jonathan Wortham as Branch Chief and Becky Stewart as Surveillance Team, Team Lead
DTBE is pleased to announce the selection of CDR Jonathan Wortham, MD, FAAP as Chief of the Surveillance, Epidemiology and Outbreak Investigations Branch (SEOIB). He officially assumed this role on April 1, 2024.
Jonathan is a pediatrician and medical epidemiologist who has served as lead for SEOIB’s Molecular Epidemiology and Outbreak Investigations Team since 2020. Under his leadership, the team has assisted state and local TB programs with hundreds of TB clusters and outbreak responses. They have also made substantial improvements to molecular surveillance for TB outbreaks and mentored more than a dozen public health trainees.
Jonathan is from San Antonio, Texas. He graduated from Washington and Lee University with a bachelor’s degree in chemistry and completed medical school and a pediatric residency at Baylor College of Medicine in Houston, Texas. Jonathan is a member of the Epidemic Intelligence Service (EIS) class of 2011. He has authored or co-authored more than 30 published scientific manuscripts.
DTBE is also pleased to announce the selection of CDR Rebekah (Becky) Stewart, MPH, FNP, FAANP as Surveillance Team Lead within the Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB). She officially assumed this role on June 4, 2024.
Becky is a board-certified family nurse practitioner and epidemiologist who has served as the Acting Surveillance Team Lead since December 11, 2023. Prior to that, she was a member of DTBE’s Molecular Epidemiology and Outbreak Investigations Team since 2017.
Becky was raised in Grand Rapids, Michigan. She earned a bachelor’s degree in nursing from Hope College in Holland, MI, and a master’s in public health and a master’s in nursing from Emory University in Atlanta, GA. She completed the Epidemic Intelligence Service (EIS) Fellowship as part of the class of 2015. She has authored or co-authored more than 25 published government reports and peer-reviewed scientific manuscripts.
Submitted by Divia P. Forbes, MPH, Epidemiologist
DTBE-Authored Publications
Asare-Baah M, Salmon-Trejo LAT, Venkatappa T, Garfein RS, Aiona K, Haas M, Séraphin MN. Factors Associated With the Discontinuation of Two Short-Course Tuberculosis Preventive Therapies in Programmatic Settings in the United States. Open Forum Infect Dis. 2024 Jun 6;11(6):ofae313. doi: 10.1093/ofid/ofae313. PMID: 38915338; PMCID: PMC11194754.
Ayers T, Hill AN, Raykin J, Mohanty S, Belknap RW, Brostrom R, Khurana R, Lauzardo M, Miller TL, Narita M, Pettit AC, Pyan A, Salcedo KL, Polony A, Flood J; CDC Tuberculosis Epidemiologic Studies Consortium. Comparison of Tuberculin Skin Testing and Interferon-γ Release Assays in Predicting Tuberculosis Disease. JAMA Netw Open. 2024 Apr 1;7(4):e244769. doi: 10.1001/jamanetworkopen.2024.4769. PMID: 38568690; PMCID: PMC10993073.
Beeler Asay GR, Woodruff R, Sanderson DM, Fisher CF, Marks SM, Green VD, Tibbs AM, Hill AN, Haptu HH, McManus D, Paradise RK, Auguste-Nelson C, Cochran JJ. Cost-effectiveness of expanded latent TB infection testing and treatment: Lynn City, Massachusetts, USA. USA. Int J Tuberc Lung Dis. 2024 Jan 1;28(1):21-28. doi: 10.5588/ijtld.22.0654. PMID: 38178297.
Brostrom RJ, Largen A, Nasa JN, Jeadrik G, Yamada S, Yadav S, Ko E, Warkentin JV, Chorba TL. TB-free Ebeye: Results from integrated TB and noncommunicable disease case finding in Ebeye, Marshall Islands. J Clin Tuberc Other Mycobact Dis. 2024 Feb 3;35:100418. doi: 10.1016/j.jctube.2024.100418. PMID: 38356926; PMCID: PMC10863304.
Carter JJ, Walker TM, Walker AS, Whitfield MG, Morlock GP, Lynch CI, Adlard D, Peto TEA, Posey JE, Crook DW, Fowler PW. Prediction of pyrazinamide resistance in Mycobacterium tuberculosis using structure-based machine-learning approaches. JAC Antimicrob Resist. 2024 Mar 18;6(2):dlae037. doi: 10.1093/jacamr/dlae037. PMID: 38500518; PMCID: PMC10946228.
Gonzalez-Reyes R, Katz D, Lambert L, Sorri Y, Narita M, Horne DJ; Tuberculosis Epidemiologic Studies Consortium. Interpreter usage and associations with latent tuberculosis infection treatment acceptance and completion in the USA among non-U.S.-born persons, 2012-2017. PLoS One. 2024 Apr 16;19(4):e0298628. doi: 10.1371/journal.pone.0298628. PMID: 38625902.
Goswami N, Reed C. Duration of Effective Tuberculosis Treatment, not Acid-Fast Bacilli (AFB) Smear Status, as the Determinant for Deisolation in Community Settings. 2024 Apr 18:ciae198. doi: 10.1093/cid/ciae198. Epub ahead of print. PMID: 38632833.
Han E, Nabity SA, Dasgupta-Tsinikas S, Guevara RE, Moore M, Kadakia A, Henry H, Cilnis M, Buhain S, Chitnis A, Chakrabarty M, Ky A, Nguyen Q, Low J, Jain S, Higashi J, Barry PM, Flood J. Tuberculosis Diagnostic Delays and Treatment Outcomes among Patients with COVID-19, California, USA, 2020. Emerg Infect Dis. 2024 Jan;30(1):136-140. doi: 10.3201/eid3001.230924. PMID: 38147063; PMCID: PMC10756354.
Li Y, Regan M, Swartwood NA, Barham T, Beeler Asay GR, Cohen T, Hill AN, Horsburgh CR Jr, Khan A, Marks SM, Myles RL, Salomon JA, Self JL, Menzies NA. Disparities in Tuberculosis Incidence by Race and Ethnicity Among the U.S.-Born Population in the United States, 2011 to 2021 : An Analysis of National Disease Registry Data. Ann Intern Med. 2024 Apr 2. doi: 10.7326/M23-2975. Epub ahead of print. PMID: 38560914.
Mangan JM, Hedges KNC, Salerno MM, Tatum K, Bouwkamp B, Frick MW, McKenna L, Muzanyi G, Engle M, Coetzee J, Yvetot J, Elskamp M, Lamunu D, Tizora MET, Namutamba D, Chaisson RE, Swindells S, Nahid P, Dorman SE, Kurbatova E. Facilitators and barriers to adolescent participation in a TB clinical trial. Int J Tuberc Lung Dis. 2024 May 1;28(5):243-248. doi: 10.5588/ijtld.23.0519. PMID: 38659142.
Miyakawa R, Louie J, Keh C, Chen L, Javid B, Ernst JD, Goswami N, Chow FC. A teenage girl with altered mental status and paraparesis. J Clin Tuberc Other Mycobact Dis. 2024 Mar 1;35:100425. doi: 10.1016/j.jctube.2024.100425. PMID: 38468819; PMCID: PMC10926304.
Nabity SA, Agraz-Lara R, Bravo A, Benjamin R, Fong V, Lam CK, Keh C, Mase S, Flood J. Notes from the Field: Supply Interruptions of First- and Second-Line Oral Drugs to Treat Tuberculosis During the Previous 12 Months - California, January-March, 2023. MMWR Morb Mortal Wkly Rep. 2024 Jan 5;72(5253):1390-1391. doi: 10.15585/mmwr.mm725253a2. PMID: 38175801.
Ngo HX, Xu AY, Velásquez GE, Zhang N, Chang VK, Kurbatova EV, Whitworth WC, Sizemore E, Bryant K, Carr W, Weiner M, Dooley KE, Engle M, Dorman SE, Nahid P, Swindells S, Chaisson RE, Nsubuga P, Lourens M, Dawson R, Savic RM. Pharmacokinetic-Pharmacodynamic Evidence from a Phase 3 Trial to Support Flat-Dosing of Rifampicin for Tuberculosis. Clin Infect Dis. 2024 Mar 11:ciae119. doi: 10.1093/cid/ciae119. Epub ahead of print. PMID: 38462673.
Rautman LH, Kammerer JS, Silk BJ, Marconi VC, Youngblood ME, Edwards JA, Wortham JM, Self JL. Characteristics of TB cases without documented sputum culture in the United States, 2011-2021. Int J Tuberc Lung Dis. 2024 May 1;28(5):231-236. doi: 10.5588/ijtld.23.0432. PMID: 38659143; PMCID: PMC11103590.
Regan M, Li Y, Swartwood NA, Barham T, Asay GRB, Cohen T, Hill AN, Horsburgh CR, Khan A, Marks SM, Myles RL, Salomon JA, Self JL, Menzies NA. Racial and ethnic disparities in diagnosis and treatment outcomes among US-born people diagnosed with tuberculosis, 2003-19: an analysis of national surveillance data. Lancet Public Health. 2024 Jan;9(1):e47-e56. doi: 10.1016/S2468-2667(23)00276-1. PMID: 38176842.
Springer YP, Filardo TD, Woodruff RS, Self JL. Racial and Ethnic Disaggregation of Tuberculosis Incidence and Risk Factors Among American Indian and Alaska Native Persons-United States, 2001-2020. Am J Public Health. 2024 Feb;114(2):226-236. doi: 10.2105/AJPH.2023.307498. PMID: 38335486; PMCID: PMC10862211.
Springer YP, Kammerer JS, Felix D, Newell K, Tompkins ML, Allison J, Castrodale LJ, Chandler B, Helfrich K, Rothoff M, McLaughlin JB, Silk BJ. Using Geographic Disaggregation to Compare Tuberculosis Epidemiology Among American Indian and Alaska Native Persons-USA, 2010-2020. J Racial Ethn Health Disparities. 2024 Feb 9. doi: 10.1007/s40615-024-01919-z. Epub ahead of print. PMID: 38334874.
Springer YP, Tompkins ML, Newell K, Jones M, Burns S, Chandler B, Cowan LS, Kammerer JS, Posey JE, Raz KM, Rothoff M, Silk BJ, Vergnetti YL, McLaughlin JB, Talarico S. Characterizing the etiology of recurrent tuberculosis using whole genome sequencing-Alaska, USA, 2008-2020. J Infect Dis. 2024 May 24:jiae275. doi: 10.1093/infdis/jiae275. Epub ahead of print. PMID: 38794931.
Swisher SD, Taetzsch SJ, Laughlin ME, Walker WL, Langer AJ, Thacker TC, Rinsky JL, Lehman KA, Taffe A, Burton N, Bravo DM, McDonald E, Brown CM, Pieracci EG. Outbreak of Mycobacterium orygis in a Shipment of Cynomolgus Macaques Imported from Southeast Asia - United States, February-May 2023. MMWR Morb Mortal Wkly Rep. 2024 Feb 22;73(7):145-148. doi: 10.15585/mmwr.mm7307a2. PMID: 38386802; PMCID: PMC10899076.
Vonnahme LA, Shaw KM, Gulati RK, Hollberg MR, Posey DL, Regan JJ. Tuberculosis Disease Among Nonimmigrant Visa Holders Reported to US Quarantine Stations, January 2011-June 2016. J Immigr Minor Health. 2024 Jun 5. doi: 10.1007/s10903-024-01601-w. Epub ahead of print. PMID: 38834868.
Williams PM, Pratt RH, Walker WL, Price SF, Stewart RJ, Feng PI. Tuberculosis - United States, 2023. MMWR Morb Mortal Wkly Rep. 2024 Mar 28;73(12):265-270. doi: 10.15585/mmwr.mm7312a4. PMID: 38547024; PMCID: PMC10986816.
Woodruff R, Pratt R, Kolasa M. Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance - National Tuberculosis Indicators Project, 2016-2022. MMWR Surveill Summ. 2024 Jun 6;73(4):1-18. doi: 10.15585/mmwr.ss7304a1. PMID: 38833409; PMCID: PMC11166372.
Wortham JM, Haddad MB, Stewart RJ, Annambhotla P, Basavaraju SV, Nabity SA, Griffin IS, McDonald E, Beshearse EM, Grossman MK, Schildknecht KR, Calvet HM, Keh CE, Percak JM, Coloma M, Shaw T, Davidson PJ, Smith SR, Dickson RP, Kaul DR, Gonzalez AR, Rai S, Rodriguez G, Morris S, Armitige LY, Stapleton J, Lacassagne M, Young LR, Ariail K, Behm H, Jordan HT, Spencer M, Nilsen DM, Denison BM, Burgos M, Leonard JM, Cortes E, Thacker TC, Lehman KA, Langer AJ, Cowan LS, Starks AM, LoBue PA. Second Nationwide Tuberculosis Outbreak Caused by Bone Allografts Containing Live Cells - United States, 2023. MMWR Morb Mortal Wkly Rep. 2024 Jan 5;72(5253):1385-1389. doi: 10.15585/mmwr.mm725253a1. PMID: 38175804.
Yamkovoy K, Self JL, Jenkins HE, Horsburgh CR, White LF. Patterns of TB transmission in the United States, 2011-2017. Int J Tuberc Lung Dis. 2024 Mar 1;28(3):154-156. doi: 10.5588/ijtld.23.0422. PMID: 38454181.