B-Related News and Journal Items Weekly
Update
Week of October 7 to October 13, 2012
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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
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Providing synopses of key scientific articles and lay media reports on TB does not constitute
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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.
This Week’s Contents
TB-Related Announcements
News Items from the CDC HIV/Hepatitis/STD/TB Prevention News Update
Headlines
Journal Articles
Job Announcements
Upcoming Conferences, Trainings, and Other Events
TB-Related Announcements
1. CDC patient education brochure available: 12-Dose Regimen for Latent TB
Infection NEW
The Communications, Education, and Behavioral Studies Branch (CEBSB) in the Division of
Tuberculosis Elimination (DTBE) at CDC developed a patient education brochure on the 12dose treatment regimen for latent TB infection. This brochure was developed for clinicians to
use with patients while discussing the 12-dose regimen. The brochure contains information on
latent TB infection, the 12-dose regimen, treatment schedules, and adverse events. There is
space on this brochure to write in treatment schedules and clinic/office contact information. The
12-Dose Regimen for Latent TB Infection-Patient Education Brochure
(www.cdc.gov/tb/publications/pamphlets/12-doseregimen.htm) is available for download in two
sizes:

Letter sized (8.5x11) - To create brochure print on 2 pages (front and back) and staple.
www.cdc.gov/tb/publications/pamphlets/12DoseLTBITreatmentbrochure8.5x11.pdf

Ledger sized (11x17) - To create a brochure, print on one sheet of paper and fold in
half.
www.cdc.gov/tb/publications/pamphlets/12DoseLTBITreatmentbrochure11x17.pdf
2. WHO/USAID MDR-TB Planning Toolkit Now Available
At the 62nd World Health Assembly held in May 2009, the member states committed to achieve
universal access to diagnosis and treatment of multidrug-resistant tuberculosis (MDR-TB) by
2015. This is an ambitious goal that requires comprehensive planning for the programmatic
management of MDR-TB.
To help countries develop or strengthen an MDR-TB component within their national TB plan,
World Health Organization (WHO) and PATH developed the MDR-TB Planning Toolkit, with
funding from the United States Agency for International Development (USAID).
The MDR-TB Planning Toolkit contains 8 tools with worksheets to assist the user through key
planning steps. The toolkit is available as a Microsoft Word file (for users who wish to modify it)
and as an Adobe PDF file (recommended for printing). The worksheets can be filled out on the
screen using the full toolkit or the worksheets-only version. The Excel version of Tool 2 has
built-in formulas that also generate graphs to show a country’s baseline performance and
targets for MDR-TB case detection, enrollment, and successful treatment. Each of these can be
downloaded from:www.path.org/publications/detail.php?i=1678
Hard copies of the toolkit will be available at the WHO Stop TB Department booth at the Union
conference in Malaysia in November. If you would like more information or have suggestions,
please contact:
Stefania Slabyj, TB Team Leader, PATH
Email: sslabyj@path.org
Tauhid Islam, MD, Medical Officer
WHO Western Pacific Regional Office
Email: islamt@wpro.who.int
Ernesto Jaramillo, Medical Officer
Stop TB Department, WHO
3. 2011 DTBE Annual TB Surveillance Report Now Available
The CDC/DTBE annual TB surveillance report for 2011, “Reported Tuberculosis in the United
States, 2011,” has now been released electronically and is accessible at:
www.cdc.gov/tb/statistics/reports/2011/
4. 43rd Union World Conference: Call for TB Education & Training Materials
You are invited to share your TB education and training materials at the 43rd Union World
Conference on Lung Health, Nov. 13-17, 2012, in Kuala Lumpur, Malaysia. Materials will be on
display during the entire conference in the exhibition area. Please bring materials to display and
distribute. Materials include brochures, fact sheets, training curricula, videos, and other such
materials.
In addition, on November 16, 2012, from 14:30 to 16:30, there will be an educational materials
discussion session, where you can find out about TB education and training materials from a
variety of programs and organizations, meet with material developers, and share your own TB
education and training materials.
To display materials, present materials at the discussion session, or if you have questions,
please contact:
Allison Maiuri by e-mail at: amaiuri@cdc.gov or by telephone at: 404-639-8043 - (USA)
Ahmed Al-Kabir by e-mail at: alkabir@rtm-international.org or by telephone at: 8802 8034814 (Bangladesh)
News Items from the CDC HIV/Hepatitis/STD/TB Prevention News Update
1.Ex-Miners Launch Court Action Against AngloGold Ashanti
Mining Weekly.com, Oct. 4, 2012, Idéle Esterhuizen
Former miners have filed a lawsuit against the South African mining company AngloGold
Ashanti in the Johannesburg High Court for health-related negligence. The 31 plaintiffs claim
that they contracted silicosis and silico-tuberculosis from exposure to excessive levels of dust
during their employment at the Vaal Reefs gold mine, which was owned and operated by Vaal
Reefs Exploration and Mining Company, now known as AngloGold Ashanti. The plaintiffs’ local
attorney, Zanele Mbuyisa, is being assisted by the law firm Leigh Day & Co. of London,
England. Leigh Day & Co. stated that they expect a large number of former Vaal Reefs miners
to join the lawsuit on an ongoing basis.
According to Mbuyisa, the company has been working extensively in communities in the
Eastern Cape, Lesotho, and the Free State. These areas have been devastated by the impact
of silicosis and TB. Former miners have been abandoned by the industry, and the vast majority
of workers have not even received the modest statutory compensation to which they are
entitled. Leigh Day & Co. has been assisting the Johannesburg branch of the Legal Resources
Centre since 2004 in a series of claims, including health-related negligence, against Anglo
American South Africa (AASA), another mining company, on behalf of 18 former miners who
worked at a gold mine in the Free State. Several former employees contracted silicosis and
silico-tuberculosis during their employment at the mine between 1970 and 1998.
Richard Meeran, a partner at Leigh Day & Co., announced that an arbitration hearing was set
for September 2, 2013, to determine whether AASA should be held liable for compensation to
the claimants. Also Leigh Day & Co is representing about 2,000 former gold miners and
potentially thousands more in a separate case against AASA in the English High Court. That
case may be heard by the end of 2012.
2. 100 Percent TB Treatment Strategy Achieved
Pakistan Observer, Oct. 9, 2012
According to official sources, the Pakistani government has achieved 100 percent coverage with
the DOTS (directly observed treatment, short course) strategy recommended by the World
Health Organization (WHO) for the detection and cure of TB within the country, resulting in the
treatment—without cost—of more than 700,000 TB patients. According to these sources,
approximately 982 microscopy centers throughout the country now provide free diagnostics to
TB patients. In addition, 40 districts in Pakistan have implemented external quality assurance
for sputum microscopy. Pakistan also has five reference laboratories, including one at the
federal level and the rest at the provincial level. Pakistan’s annual incidence of TB is 181 cases
per 100,000, and case notification is 150 per 100,000. Pakistan’s treatment success rate for TB
is 85 percent.
3. The Dangerous Communion of Tuberculosis and Diabetes
Asian Tribune, Oct. 10, 2012, Shobha Shukla
With its high rates of diabetes and tuberculosis, India faces challenges in controlling both
diseases. In India in 2011, there were 61.3 million people living with diabetes, and 983,000
deaths from the disease. India also has 1.98 million people developing TB and almost 300,000
people dying of it each year. Patients with diabetes are at greater risk of contracting TB, and
diabetes can worsen the course of TB. TB can worsen glycaemic control in patients with
diabetes. To address these diseases, strategies are needed to manage patients with both
diseases and cross-screen patients with each disease.
According to Professor (Dr.) Anthony Harries of the International Union Against Tuberculosis
and Lung Disease (The Union), “Diabetes upsets the immune system in different ways and if
the immune system is down, the risk of contracting TB as well as other infections increases. So
in patients with diabetes, we need to think about TB and screen them, and in patients with TB,
we need to think about diabetes. If we do not seriously think about the link between TB [and]
diabetes, it may begin to derail some of the good advances made in TB control, especially in
countries like China and India.”
The increasing incidence of diabetes, especially in low- and middle-income countries, is
threatening to have a negative impact on TB control, and vice versa. To address these two
diseases and their impact on each other, the World Health Assembly set the target “25 by 25” at
its May 2012 meeting. The goal is to reduce deaths from preventable non-communicable
diseases (NCDs), such as diabetes, by 25 percent by 2025.
The World Health Assembly and The Union published a Collaborative Framework on the Care
and Control of Tuberculosis and Diabetes in 2011 that guides national programs, clinicians, and
others engaged in the care of patients and prevention and control of diabetes and TB on how to
establish a coordinated response to both diseases at organizational and clinical levels. The
Union and its China partners conducted an initiative in a few hospitals in China to increase
screening of TB patients for diabetes and diabetes patients for TB. A similar initiative is being
conducted in India.
4. USAID Allocates $18 Million for New 5-Year Anti-Tuberculosis Project in Ukraine
Ukrainian News, Oct. 9, 2012
US Agency for the International Development (USAID) Mission Director for Ukraine, Belarus
and Moldova Jed Barton reports a new 5-year project for the reinforcement of control over
tuberculosis (TB) in the Ukraine worth $18 million. The new aid package, intended to assist with
the control of TB, will improve the quality of service to diagnose and treat TB using short-term
treatment courses through the introduction of the project to 10 regions in the Ukraine with the
goal of increasing successful case treatment in the country to the global target of 85 percent. To
achieve this, the project intends to undertake several improvements, including creating safe
conditions for patients and medical staff, improving access to medical diagnostics through the
improvement of laboratories, and following strict treatment regimes.
5. Tracking TB-HIV Coinfection in the United States
blog.AIDS.gov, Oct. 10, 2012, Kevin Fenton, MD, PhD, CDC
The incidence of TB has decreased in the United States. In 2011, there were 10,528 TB cases;
a reduction from 11,171 cases in 2010. However, TB is still a serious threat, particularly to
people with HIV, and TB remains the leading cause of death in people with HIV. Recent data
brings into clearer focus the intersection of TB and HIV, showing that more people with TB are
being tested for HIV. In 2011, the percentage of TB patients tested for HIV rose to 82 percent,
from 67 percent in 2010. The percentage of TB patients with HIV-positive results declined from
15 percent in 1993 to 6 percent in 2008, and has held steady at 6 percent for the past four
years. The TB and HIV co-infection underscores the need to integrate HIV testing programs for
all people starting TB treatment and timely TB testing for people with HIV.
CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)
works to improve outcomes for people at risk for multiple diseases through program
collaboration and service integration. Effective treatment for HIV patients who have either latent
TB infection or TB disease is available. The first step, however, is to ensure that people with
HIV are tested for TB.
6. GSK and Aeras to Test Vaccine in Africa, India
Chicago Tribune, Oct. 10, 2012, Ben Hirschler, Reuters
In Africa and India, GlaxoSmithKline (GSK) and Aeras, a nonprofit biotechnology group, will
work together to assess an experimental tuberculosis (TB) vaccine in “proof of concept” tests.
The partners plan to start a mid-stage Phase IIb clinical study in Kenya, South Africa, and India
in 2013, after successful initial tests with the GSK product, Aeras said on October 10.
TB is spreading in spite of the widespread use of the currently available TB vaccine Bacille
Calmette-Guerin (BCG), which prevents some forms of TB. BCG, however, does not prevent
pulmonary TB, which accounts for the majority of infections and deaths. The new GSK-Aeras
vaccine candidate is intended to be used together with BCG. Aeras and GSK will conduct the
clinical trial in healthy adults aged 18 to 50 years old. Both partners will provide resources for
the trial, which is scheduled to start in 2013, pending approvals from authorities.
Headlines
1. Scarecrows in the Garden stuffed with lighthearted allusions
AccessAtlanta, Oct. 11, 2012, by Howard Pousner
Clearly serious cerebral labor, along with no shortage of cheek, went into creating Scarecrows
in the Garden, the 11th annual Halloween display at the Atlanta Botanical Garden. Among the
117 displays — hand-crafted by businesses, organizations, schools and individuals — that have
sprouted up along the winding paths of the gardens, one of the highlights is “Scare-let
Crow’Hara,” which morphs the curtains-costumed “Gone With the Wind” heroine while
encouraging TB’s elimination. As the accompanying gravestone notes, the disease took the life
of star Vivien Leigh in 1967. This scarecrow is credited to the Tuberculosis Elimination Team.
2. Tuberculosis outbreak to be investigated
theaustralian.com.au, Oct. 11, 2012, by Rebecca Le May
The North Metropolitan Health Service (Australia), which manages the hospital where a TB
outbreak occurred, has said that 110 staff were sent letters advising them that they may have
been exposed to the disease “within days” of it being discovered that a former patient had been
diagnosed with TB. The letters encouraged staff to get tested and 100 staff did so, a NMHS
spokeswoman said. Of these, 9 tested positive, she said. However, it was a latent variety of the
disease, so most would not become ill, the spokeswoman said.
The spokeswoman said the infected man had been in a general ward and there was nothing to
suggest he had contact with the hospital's maternity ward. She said the NMHS had followed up
with patients and visitors who may have been exposed to the infected man, and would also
follow up with the 10 staff who did not get tested. The spokeswoman also rejected the
Australian Nurses Federation's claims that the outbreak had been mismanaged.
It appeared the correct procedure was followed “but we are going to do an investigation just to
double check everything,” she said. "It looks like the system in place has worked.'' The outbreak
follows a TB scare at ABC Perth last month after a staff member tested positive.
3. Indian Bureaucracy slows treatment of tuberculosis
The Wall Street Journal, Oct. 11, 2012, by Geeta Anand and Shreya Shah
Rahima Sheikh, an Indian TB patient carrying a nearly untreatable strain of the disease, is
perilously close to running out of the medicines that appear to be saving her life. Mrs. Sheikh,
whose 6-year descent to ever-more-resistant TB was reported last month in a front-page article
in The Wall Street Journal, is one of 16 patients identified by Mumbai doctors to be resistant to
virtually all traditional TB treatments. Rahima Sheikh's years-long effort to beat her TB left her,
in the end, all but untreatable.This year Mrs. Sheikh returned to her home village, about 1,000
miles from Mumbai, expecting to die, only to find that her unorthodox drug regimen was finally
able to keep her disease at bay.
On Wednesday, Dr. Kumar, the national official, reiterated that the government would keep
providing her medication. He said he now has instructed his staff to tell Mumbai officials to
continue to courier Mrs. Sheikh's medicines to her in Uttar Pradesh, the state where she now
lives, until that state is able to take over her treatment. Dr. Kumar said he is rapidly expanding
India's capacity to diagnose and treat multidrug resistance. India now has 42 labs that can make
the diagnosis, he said. However, Mrs. Sheikh's area of Uttar Pradesh—India's most populous
state—isn't yet served. By March, Dr. Kumar said, he plans to have the country covered.
It was unclear Wednesday night when more medicines might reach Mrs. Sheikh. She has 10
days' supply left. In the past, medicines from Mumbai have arrived several weeks late. A recent
donation to Mrs. Sheikh of 20,000 rupees, about $400, allowed her to purchase medicines and
tide herself over. That money is now depleted.
In Mrs. Sheikh's case, Mumbai TB expert Zarir Udwadia prescribed an experimental treatment,
including drugs for leprosy and psychosis. It has held her disease in check for the past six
months. Mrs. Sheikh needs to continue treatment at least an additional 18 months for a chance
of being cured.
4. Will GlaxoSmithKline's transparency pledge force pharma rivals to open up?
Fiercebiotech.com, Oct. 11, 2012, by John Carroll
Stung by intense criticism of its past penchant for secrecy and data manipulation,
GlaxoSmithKline CEO Andrew Witty vowed to shine a light on all trial results--good and bad-while welcoming outside investigators into its data vaults and offering up some 200 potential
tuberculosis-fighting compounds for public use.
GSK has already posted a summary of the results from 4,500 trials on a public web site. Now
an independent group will be given the authority to provide access to all the data it has on its
drugs, whether the data supports the drug or not, to approved researchers to help in the pursuit
of new therapies and better understand approved drugs.
Three years after it offered up its compound library for malaria, GSK is now doing the same on
tuberculosis. After screening two million compounds for TB inhibitors, about 200 showed signs
of potential. And researchers outside the company can now start testing to see which might be
able to halt an epidemic of new cases.
GlaxoSmithKline recently agreed to a $3 billion settlement with the feds over charges that
included the claim that it hid safety data on one of its blockbuster drugs. But some high-profile
investigators heralded today's announcement, encouraged that the company has vowed to turn
a new leaf and hopeful that its rivals will now be forced to follow suit.
5. Washburn student diagnosed with TB
CJOnline.com, Oct. 11, 2012, The Capital-Journal
Health officials have confirmed a Washburn University (Kansas) student has been identified and
diagnosed with infectious TB disease. Washburn officials on Thursday said the student is
responding to treatment and a full recovery is expected. Washburn officials are working with the
Kansas Department of Health and Environment and the Shawnee County Health Agency to
identify and evaluate individuals who may have had significant close contact with this student.
“Washburn officials are fully cooperating with public health efforts and following best practice
guidelines to effectively address this investigation,” said Phil Griffin, TB controller at the Kansas
Department of Health and Environment.
A contact investigation is under way and all students, staff and faculty at risk for exposure are
being screened and evaluated through the Shawnee County Health Agency, said Shirley Dinkel,
director of Washburn student health services. “The safety and well-being of all of our students,
staff and faculty is our highest priority and we are taking every precaution to maintain a healthy
campus,” she said.
For information about TB please visit www.cdc.gov. Any questions about TB testing related to
this situation should be directed to the Shawnee County Health Agency at 291-2488.
6. Tuberculosis stalks South African prisons
Aljazeera.com, Oct. 8, 2012
Dudley Lee, 59, walked out of Pollsmoor Prison in Cape Town, South Africa, a free man in
2003. He is now a prisoner of the disease he acquired there. Awaiting trial, Lee was
incarcerated for 4 years and contracted TB in the prison's unsanitary conditions. Although Lee
was exonerated for a lack of evidence, he received no apology from the South African
government. After his stint in prison, his lungs were scarred and he had aged dramatically. By
the time he got out, he had lost his health, family and business.
Tuberculosis has become a major killer in South Africa's prison system. Last year, 78 inmates
died of TB - making the infectious disease the leading cause of death in most of the country's
prisons, according to the government-appointed Judicial Inspectorate of Correctional Services.
Pollsmoor, where Lee was held, has a TB transmission rate of 90 per cent per year, according
to research by Professor Robin Wood, director of the Desmond Tutu HIV Centre.
Wood has labelled the prison a "breeding ground" for the disease, mostly because of
overcrowding and a lack of ventilation. With 160,545 inmates, South Africa has one of the
highest incarceration rates on the continent. Prisons are overcrowded by 136 per cent on
average. Pollsmoor Maximum is overcrowded by 230 per cent, according to the Judicial
Inspectorate. Those convicted of stealing an apple are put in the same cells as mass
murderers, and juvenile facilities often house prisoners in their 30s.
Lee took the minister of Correctional Services to the Constitutional Court. He is demanding
damages for the harm he suffered from the disease, alleging prison authorities are directly
responsible. During the trial, the state acknowledged when it comes to prisons, the law gets
broken on a regular basis. New prisoners are supposed to be screened for disease when
entering Pollsmoor - and quarantined if found to be ill. But no such screening or segregation
process actually exists.
Lee - now in his late 60s - is unemployed and living in an old-age home. He says while in
prison, after months of coughing and asking for medical attention, he was only diagnosed with
TB when he was taken to hospital for a hernia. Once in the prison facility, he adds, there were
not enough nurses to monitor his medicine intake. During his incarceration, Lee was held in
cells designed to hold 20 people, but were in fact holding 80. Lee was taken to court 70 times
during his stay. While there, he was kept in a holding cell where people from different prisons many of whom were visibly ill - were kept together in heavily overcrowded conditions. "You are
always surrounded by people coughing and spluttering," he says. "If I needed to see the doctor,
I would have to pay the warder to open my cell and take me there."
Paul Theron was the doctor in charge at Pollsmoor Medium A from 1997 to 2007, during the
time that Lee was in prison. He was suspended when he blew the whistle on health and human
rights abuses in Pollsmoor. Theron says Pollsmoor is largely controlled by prison gangs, which
the authorities are unable to control. "By definition," says Theron, "safe custody is not possible
in an environment which is largely controlled by destructive elements dedicated to their own
preservation. The ongoing toleration of destructive and criminal elements within the prison
disallow any progress in terms of health management."
Lee won his case at the High Court in 2010, but it was overturned on appeal, as Lee could not
prove that he would not have contracted TB even if the prison authorities had fulfilled their
duties. Lee's lawyer, Adila Hassim, argued at the Constitutional Court that this requirement for
an "impossible calculation" would "immunise the state" from being held accountable. The state
made the case that a ruling for it to pay damages to Lee would open up the possibility for
"unlimited liability" to complaining offenders.
Nooshin Erfani-Ghadimi, of Wits Justice Project, says TB in prisons has the potential to affect
society as a whole. "Prison walls are porous, and what happens inside will come out," ErfaniGhadimi says. "Right now the state is getting away with impunity, and if we don't make sure
conditions that inmates living in are in line with the Constitution - we are facing a disaster."
7. Alberta urged to stamp out tuberculosis
Calgary Herald, Oct. 9, 2012, by Jamie Komarnicki
With the majority of TB cases in Alberta occurring among refugees and immigrants, the province
must step up its efforts to stamp out the infectious disease among foreign-born residents, a new
public health report urges. The TB surveillance report from the Alberta chief medical officer of
health’s office shows the disease — long the scourge of First Nations reserves — is now on
track to be eliminated among the province’s Canadian-born residents. But, between 2005 and
2009, 75 per cent of TB in Alberta involved immigrants, refugees and other foreign-born
residents, including many from countries with worrisome rates of the disease.
Alberta’s top doctor says the province plans to expand screening and preventive strategies to
reach out to the vulnerable population and get a better handle on the treatable disease. “We’re
overall pleased rates continue to come down. They’re essentially flat in non-aboriginal, nonimmigrant Canadians,” said Dr. James Talbot, Alberta’s chief medical officer of health. “One
cause for concern is amount of disease in people immigrating from countries where TB is more
common. It’s the one where we still have work to do.”
The medical team at the Calgary refugee health program clinic does dozens of skin tests for TB
every year, said medical director Dr. Annalee Coakley. Many patients are escaping troubled
pasts at refugee camps and prisons in war-torn countries. It’s not always easy to pry out a full
list of symptoms, Coakley said.
Before coming to Canada, immigrants older than 11 are all screened with chest X-rays. But the
tests don’t pick up non-pulmonary TB, or whether the illness will emerge months after the
patient arrives in Canada; refugee claimants, meanwhile, don’t go through the same screening.
For years, the northeast Calgary clinic has automatically tested everyone 15 and younger. But
those guidelines have just changed so that all patients 50 and under will now be screened,
Coakley said. “People from the developing world with higher incidence of TB — it always has to
be at the forefront of your mind,” she said. Coakley worries about what effect changes to federal
health benefits for refugees will have on TB screening and other urgent medical tests.
Talbot said his office is part of a cross-ministry group in the province monitoring possible fallout
from the federal changes. Work is also underway to strengthen Alberta’s TB control program, he
added, including a new lab test and outreaches to make sure immigrants and refugees get
connected to the health-care system as quickly as possible. Talbot said the province is
considering expanding pilot projects in Edmonton and Calgary aimed at early testing and
treatment. “With those looking like they’re effective, we’ll be looking to try to expand that
approach,” Talbot said. “In the end, the real solution is to get better control programs in the
countries they’re coming from,” he added.
A former Alberta director of tuberculosis services said the province must embrace efforts to
address tuberculosis on a global stage. “Canada is fabulously equipped with programs to deal
with TB and is so advantaged over other areas of the world where there are greater challenges
and where most of the tuberculosis is,” said Dr. Anne Fanning, a University of Alberta professor
emeritus and TB expert. “As we benefit from immigration into Canada, we have to accept there
will be challenges. That’s one of the challenges and we have to meet it.”
Journal Articles
1. Clin Infect Dis. 2012 Oct 5. [Epub ahead of print]. Tuberculosis in pregnant and
postpartum women: epidemiology, management, and research gaps. Mathad JS, Gupta A.
Authors review the available data on (1) the global burden of TB in women of reproductive age;
(2) how pregnancy and the postpartum period affect the course of TB; (3) how to screen and
diagnose pregnant and postpartum women for active and latent TB; (4) the management of
active and latent TB in pregnancy and the postpartum period, including the safety of TB
medications; and (5) infant outcomes. They include data on HIV/TB coinfection and drugresistant TB, and highlight research gaps in TB in pregnant and postpartum women.
2. BMJ Case Rep. 2012 Oct 9;2012(oct08_1). pii: bcr0120125475. doi: 10.1136/bcr-01-20125475. Nasopharyngeal tuberculosis presenting with auditory symptoms. Pankhania M,
Elloy M, Conboy PJ.
Authors present an unusual case of a 54-year-old Chinese lady presenting to the ears, nose
and throat clinic after family members noticed that her hearing had progressively deteriorated
over the preceding weeks. She also complained of tinnitus. Examination of the ears, nose and
throat was unremarkable. Flexible nasoendoscopy demonstrated swelling in the postnasal
space, which, following biopsy, was shown to be pathognomonic of TB. This was successfully
treated with multidisciplinary input and the patient made a complete recovery.
3. BMJ Case Rep. 2012 Oct 6;2012. pii: bcr2012006984. doi: 10.1136/bcr-2012-006984.
Tuberculous cerebellar abscess in immunocompetent individuals. Roopesh Kumar VR,
Gundamaneni SK, Biswas R, Madhugiri VS.
Tubercular abscess of the brain is a rare form of central nervous system TB. The lesions usually
occur in the supratentorial compartment and are associated with immunodeficiency. Authors
report two immunocompetent individuals with tubercular abscess of the cerebellum and discuss
management of these lesions.
4. Antivir Ther. 2012 Oct 5. doi: 10.3851/IMP2413. [Epub ahead of print]. Efavirenz, tenofovir
and emtricitabine combined with first line tuberculosis treatment in TB-HIV-coinfected
Tanzania patients: a pharmacokinetic and safety study. Semvua HH, Mtabho CM, Fillekes
Q, van den Boogaard J, Kisonga RM, Mleoh L, Ndaro A, Kisanga ER, van der Ven A, Aarnoutse
RE, Kibiki GS, Boeree MJ, Burger DM.
Authors aimed to evaluate the effect of rifampicin-based TB treatment on the pharmacokinetics
of efavirenz/ tenofovir/ emtricitabine in a fixed-dose combination tablet, and vice versa, in
Tanzanian TB/HIV co-infected patients. They carried out a phase II, open label, multiple doses,
pharmacokinetic and safety study in TB/HIV co-infected Tanzanian patients who took TB
treatment (rifampicin/isoniazid/pyrazinamide/ethambutol), week 1 to week 8, and continued with
rifampicin and isoniazid for another 16 weeks. Antiretroviral treatment (ART) of
efavirenz/tenofovir/emtricitabine in a fixed dose combination tablet was started at week 4 after
initiation of TB treatment. They conclude that co-administration of efavirenz, tenofovir and
emtricitabine with a standard first line TB treatment regimen did not significantly alter the
pharmacokinetic parameters of these drugs and was tolerated well by Tanzanian TB patients
co-infected with HIV.
5. Clin Infect Dis. 2012 Oct 5. [Epub ahead of print]. Sustainable tuberculosis drug
development. Wallis RS.
Six new anti-TB compounds in 4 classes are presently in clinical trials. Although these show
substantial promise for drug-resistant (DR) tuberculosis, the presently planned studies of these
compounds will not inform their optimal use, as each will be tested singly vs. placebo with
existing drugs, rather than in new regimens. Each successive regulatory approval will increase
the size, cost, and complexity of trials for those that follow, causing delays during which
suboptimal use will occur and resistance will emerge. Author proposes the development of a
novel regimen with the potential for use in both drug sensitive (DS) and DR-TB. Adaptive
licensing for DR-TB based on 2-month sputum culture would shorten time to initial approval by
several years. A global outcomes registry would confirm safety and effectiveness in both DS
and DR-TB, making possible the second transformation of TB treatment.
6. ChemMedChem. 2012 Oct 5. doi: 10.1002/cmdc.201200339. [Epub ahead of print]. Recent
advances in the research of heterocyclic compounds as antitubercular agents. Yan M, Ma
S.
A number of new potential antitubercular candidate drugs with heterocyclic rings, which are
most likely to be effective against resistant strains, have entered clinical trials in recent years.
This review highlights recent advances in the research of novel heterocyclic compounds, with
particular focus on their antimycobacterial activity, mechanisms of action, toxicity, and structureactivity relationships (SARs).
7. Am J Phys Anthropol. 2012 Oct 5. doi: 10.1002/ajpa.22137. [Epub ahead of print]. Rib
lesions in skeletons from early neolithic sites in Central Germany: On the trail of
tuberculosis at the onset of agriculture. Nicklisch N, Maixner F, Ganslmeier R, Friederich S,
Dresely V, Meller H, Zink A, Alt KW.
Authors sought to better understand the role of TB during periods of social and nutritional
change such as the Neolithic. In this study, 118 individuals from three sites in Germany dating
to the Linear Pottery Culture (5400-4800 BC) were examined macroscopically to identify TBrelated bone lesions. In two individuals, Pott's disease was detected. In addition, periosteal
reactions of varying degrees and frequency were observed mainly along the neck of the ribs in
6.5% (2/31) of subadults and 35.1% (20/57) of adults. Rib lesions, however, can also be caused
by other diseases; so additional investigations were undertaken using histology and micro-CT
scans. Further analyses indicated the presence of pathogens belonging to the Mycobacterium
tuberculosis complex in individuals of all sites. Furthermore, authors discuss the occurrence and
spread of TB during the Neolithic with regard to nutritional aspects and possible risks of
infection. The data presented provide important insights into the health status of Early Neolithic
populations in Central Germany.
8. Org Biomol Chem. 2012 Oct 7;10(37):7584-93. Epub 2012 Aug 16. Syntheses of
mycobactin analogs as potent and selective inhibitors of Mycobacterium
tuberculosis. Juárez-Hernández RE, Franzblau SG, Miller MJ.
Three analogs of mycobactin T were synthesized and screened for their antibiotic activity
against Mtb H(37)Rv and a broad panel of Gram-positive and Gram-negative bacteria. The
synthetic mycobactins were potent and selective Mtb inhibitors, with no inhibitory activity
observed against any other of the microorganisms tested. The maleimide-containing analog 40
represents a versatile platform for the development of mycobactin-drug conjugates, as well as
other applications.
9. Clin Chim Acta. 2012 Oct 9;413(19-20):1637-40. Epub 2012 May 10. Development of a
rapid, microplate-based kinetic assay for measuring adenosine deaminase activity in
body fluids. Lu J, Grenache DG.
Adenosine deaminase (ADA) helps convert adenosine to inosine. The activity of ADA in body
fluids has clinical utility in the assessment of suspected TB. Authors conclude that the
microplate-based kinetic ADA assay has favorable performance characteristics. This method
eliminates the need for assay calibration and allows 96 samples to be tested simultaneously.
10. AIDS 2012 Sep 25. [Epub ahead of print]. No impact of rifamycin selection on
tuberculosis treatment outcome in HIV co-infected patients. Singh R, Marshall N, Smith CJ,
Reynolds CJ, Breen RA, Bhagani S, Cropley I, Hopkins S, Swaden L, Johnson MA, Lipman MC.
Rifabutin has been substituted for rifampicin when treating TB/HIV co-infection. However,
despite reports of anti-TB treatment failure and acquired rifamycin resistance, long-term clinical
outcome data are lacking. Observational analyses in a UK TB/HIV cohort showed no difference
in severe adverse events, anti-TB treatment completion, relapse frequency or subsequent
rifamycin resistance between rifampicin and rifabutin, using different combinations of antiretroviral therapy. These data support the wider use of rifabutin in TB/HIV co-infection.
11. PLoS One 2012;7(10):e47072. doi: 10.1371/journal.pone.0047072. Epub 2012 Oct 9.
Smoking, BCG and employment and the risk of tuberculosis infection in HIV-infected
persons in South Africa. Oni T, Gideon HP, Bangani N, Tsekela R, Seldon R, Wood K,
Wilkinson KA, Goliath RT, Ottenhoff TH, Wilkinson RJ.
Authors aimed to evaluate LTBI predictors in a generalized HIV/TB epidemic setting. They
recruited 335 HIV-infected participants from Khayelitsha, Cape Town, February 2008 through
November 2010. Tuberculin skin tests and interferon-gamma release assays were performed
on all participants and active TB excluded using a symptom screen, TB microscopy, and
culture. LTBI prevalence was 52.7% (TST) and 61.2% (IGRA). Recent TB contact was
associated with TST positivity. Participants with a CD4>200 had 2-fold higher risk of IGRA
positivity compared to those with CD4 counts <200. There was a 19% increase in IGRA
positivity risk for every additional year of schooling and strong association between years of
schooling and employment. A decreased risk of IGRA positivity was observed in persons with a
BCG and in smokers. They report the novel findings of a decreased risk of IGRA positivity in
HIV-infected smokers, possibly due to decreased interferon production, and in the persons with
a BCG scar suggesting a protective role for BCG in this population. They also found an
increased risk of TST positivity in employed persons, possibly due to ongoing transmission in
public transport.
12. J Antimicrob Chemother. 2012 Oct 10. [Epub ahead of print]. Outcomes of clofazimine for
the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis. Dey
T, Brigden G, Cox H, Shubber Z, Cooke G, Ford N.
Authors investigated the idea of repurposing clofazimine for drug-resistant (DR)-TB treatment to
increase TB therapeutic options. They conducted a systematic review of studies reporting on
the efficacy and safety of clofazimine as part of combination therapy for DR-TB. They reviewed
12 studies, comprising 3489 patients across 10 countries. Treatment success ranged from
16.5% to 87.8%, with an overall pooled proportion of 61.96% achieving treatment success.
Mortality, treatment interruptions, defaulting, and adverse events were all in line with DR-TB
treatment outcomes overall. The most commonly reported adverse events were gastrointestinal
disturbances and skin pigmentation. They conclude that clofazimine could be considered as an
additional therapeutic option in the treatment of DR-TB. The optimal dose and duration of use
require further investigation.
13. J Antimicrob Chemother. 2012 Oct 10. [Epub ahead of print]. From multidrug-resistant to
extensively drug-resistant tuberculosis in Lisbon, Portugal: the stepwise mode of
resistance acquisition. Perdigão J, Macedo R, Silva C, Machado D, Couto I, Viveiros M,
Jordao L, Portugal I.
Authors aimed to further elucidate the dynamics of acquiring resistance to second-line drugs
and to investigate an eventual role for eis promoter mutations in aminoglycoside resistance.
They studied a set of multidrug-resistant (MDR)/XDR-TB isolates circulating in Lisbon, Portugal.
The analysis of the distribution of the mutations found by genetic clustering showed that in the
Q1 cluster, two mutations, gyrA D94A and rrs A1401G, were enough to ensure development of
XDR-TB from an MDR strain. Moreover, in the Lisboa3 cluster it was possible to elaborate a
model in which the development of low-level kanamycin resistance was at the origin of the
emergence of XDR-TB strains that can be discriminated by tlyA mutations.
14. Eur Spine J. 2012 Oct 11. [Epub ahead of print]. Ultra-short-course chemotherapy for
spinal tuberculosis: five years of observation. Wang Z, Shi J, Geng G, Qiu H.
Authors aimed to explore the feasibility of ultra-short-course chemotherapy in the treatment of
spinal TB. They included 185 patients with confirmed spinal TB and surgical indication. The
regimen was 2SHRZ/XHRZ. Patients were divided into 2 groups: ultra-short-course
chemotherapy, average duration=4.5 months, and standard chemotherapy, average duration=9
months. The same surgery was performed for the 2 groups. Follow-up ranged from 61 to 87
months, with an average of 69.1 months. There was no significant difference in postoperative
bone graft healing between the two groups. The drug side effects differed significantly between
the 2 groups. They conclude that with thorough focus debridement, bone grafting, and internal
fixation, the efficacy of ultra-short chemotherapy was similar to that of standard chemotherapy
for treatment of spinal TB. Ultra-short-course chemotherapy can shorten the course of treatment
and reduce drug side effects.
15. J Health Polit Policy Law. 2012 Oct 10. [Epub ahead of print]. An interdependent
analytical approach to explaining the evolution of NGOs, social movements, and biased
government response to AIDS and tuberculosis in Brazil. Gómez EJ.
Author introduces an interdependent analytic framework of government response to epidemics.
Article illustrates how social science theories can be interdependently linked and applied to help
explain the evolutionary role of interest groups and social movements in response to HIV/AIDS
and TB in Brazil. Author discusses when and why the government eventually responded more
aggressively to HIV/AIDS but not TB. Evidence from Brazil suggests that the policy influence of
interest groups and social movements evolves over time and is more influential after the
national government implements new policies. This response is also triggered by the rise of
international pressures and government reputation building, not civil society. New areas of
research are highlighted and examples provided of how this approach can help explain civil
societal and biased government responses to different types of epidemics in other nations.
16. Clin Infect Dis. 2012 Oct 9. [Epub ahead of print]. Recurrent tuberculosis risk among HIVinfected adults in Tanzania with prior active tuberculosis. Lahey T, Mackenzie T, Arbeit RD,
Bakari M, Mtei L, Matee M, Maro I, Horsburgh CR, Pallangyo K, von Reyn CF.
Among HIV-infected, BCG-immunized adults with CD4 counts ≥200 cells/μL who received
placebo in the DarDar TB vaccine trial in Tanzania, authors compared the prospective risk of
active TB between subjects who did and who did not report prior active TB. All subjects with a
positive tuberculin skin test without prior active TB were offered isoniazid preventive treatment.
They diagnosed 52 cases of definite and 92 cases of definite/probable TB among 979 subjects
during a median follow-up of 3.2 years. Among 80 subjects who reported prior active TB, 11
subsequently developed definite TB and 17 developed definite/probable TB, vs. 41 and 75,
respectively, of 899 subjects without prior active TB. In a Cox regression model adjusting for
age, CD4 count, and isoniazid receipt, subjects with prior active TB had substantially greater
hazard of subsequent definite TB and definite/probable TB. They conclude that compared to
subjects without prior TB, the hazard of active TB is increased 3-fold among HIV-infected adults
with prior active TB.
17. BMC Res Notes 2012 Oct 10;5(1):2101791285670504. [Epub ahead of print]. Implications
of the impact of prevalence on test thresholds and outcomes: lessons from
tuberculosis. Bentley TG, Catanzaro A, Ganiats TG.
Authors aimed to quantify the impact of varying prevalence rates on performance of TB infection
tests for given sensitivity and specificity values. They compared true-positive (TP) and falsepositive (FP) results when varying prevalence and test sensitivity and specificity. They used
estimates from published literature to estimate 2 tests' sensitivity (81%, QuantiFERON-TB Gold
In-Tube; 88%, T-SPOT.TB) and specificity (99%; 88%), and used World Health Organization
data to estimate disease prevalence in 5 countries. Varying sensitivity impacted outcomes most
in high-prevalence settings; change in specificity had greater impact in low-prevalence settings.
Lower-prevalence settings paid a greater "price" of more FPs for each TP gained, with 37.7 FPs
per TP in the United States (5% prevalence) versus 2.5 in the Ivory Coast (55% prevalence).
They conclude that prevalence affects test performance for given sensitivity and specificity
values. To optimize test performance, disease prevalence should be incorporated in testing
decisions, and sensitivity and specificity should be set locally not globally. In lower-prevalence
settings, using highly specific assays may optimize outcomes.
Job Announcements
All job announcements will be posted for 2 months. Please notify us if a job is filled before the
end of the 2-month posting period, and we will remove the job announcement. Thank you.
1. Supervisory Public Health Advisor, GS-685-14 (Lead, Field Operations Team II)
Sponsor/agency: CDC/DTBE/Field Services and Evaluation Branch
Location: Atlanta, GA
Job Announcement Number: HHS-CDC-MP-13-759696
Closing Date: Tuesday, October 23, 2012
NEW
The incumbent serves as a principle advisor in the development and implementation of program
plans, objectives, policies, methods, and procedures for carrying out productive programs for
the control, prevention, elimination of tuberculosis. Provides direct supervision and evaluation of
section headquarters staff, determining needed direction, work assignments, evaluating
performance, and selecting or participating in the selection of staff vacancies as they occur.
Provides oversight for provision of consultation to state, local and territorial health departments
in the methodology and application of tuberculosis prevention and control techniques. Provides
guidance to subordinate staff in the identification and investigation of specific management and
operational staff and performance problems and their causes. Serves as immediate supervisor
for senior public health advisor field staff; recommends training, assignment and transfer of
Public Health Advisors with NCHHSTP and with State and local Health departments; provides
for their technical supervision, and recruits, interviews and recommends Public Health Advisors
for the DTBE. Recommends to the Chief, Field Services and Evaluation Branch, optimum
allocation of Branch resources (both financial and personnel) to achieve Branch objectives, both
long and short range goals. Ensures that appropriate in-depth analyses and reviews are
performed for TB prevention and control programs; reviews and evaluates program/staff
productivity and costs and makes or oversees initiation of recommendations for changes that
will increase the productivity and cost effectiveness of programs Provides supervision for
oversight of more than $30 million in cooperative agreement resources to the states in assigned
areas; tracks the use of cooperative agreement funds on a regular basis to ensure program
effectiveness and the appropriate use of grant funds as outlined in the grantee's application.
Who may apply: This vacancy is open to current CDC and ATSDR employees with competitive
status only. Competitive status refers to employees who are serving on a career or career
conditional appointment.
Note: U.S. citizenship is required.
For more information: https://www.usajobs.gov/GetJob/ViewDetails/328040700
2. Supervisory Public Health Advisor, GS-0685-14 (Deputy Branch Chief, FSEB)
Sponsor/agency: CDC/DTBE/Field Services and Evaluation Branch
Location: Atlanta, GA
Job Announcement Number: HHS-CDC-MP-13-761499
Closing date: Tuesday, October 23, 2012
NEW
Serves as a principal advisor to the branch chief on the operation and management of fieldbased tuberculosis programs in the United States. Reviews and participates in the formulation
and revision of policies and procedures affecting new and existing projects and TB cooperative
agreement activities performed on a nationwide basis. Administers the branch's human
resource management activities. Participates with the chief, team leads, and senior
management staff of DTBE, NCHHSTP, and CDC in formulating goals, objectives, and broad
operating policies related to the recruitment, training, career development, and overall
management of the division's field staff. Has delegated authority to direct, coordinate, or
oversee the work of subordinate staff. Directly supervises a field staff training coordinator,
training specialist, program and management analyst, and two contract support staff. In
accordance with CDC policy, ensures the existence of a work environment that is free of
discrimination and harassment of any kind. Promotes and furthers the goals of equal
employment opportunity (EEO) by taking positive steps to ensure the accomplishment of
workforce diversity and affirmative action objectives. Develops a system to manage and ensure
the integrity and quality of the Performance Management Appraisal System (PMAS) for the
branch's headquarters and field staff.
Who may apply: This vacancy is open to current CDC and ATSDR employees with competitive
status only. Competitive status refers to employees who are serving on a career or career
conditional appointment.
Note: U.S. citizenship is required.
For more information: https://www.usajobs.gov/GetJob/ViewDetails/328201300
3. Assistant Commissioner/Director, Bureau of Tuberculosis Control – job ID# 1114091
Department of Health/Mental Hygiene
Agency Medical Director
Location: 42-09 28th Street, Long Island City, New York
As Assistant Commissioner/Director of the Bureau of TB Control working under the direction of
the Deputy Commissioner for the Division of Disease Control, employee will oversee this
program of $19 million and approximately 280 employees and will direct all activities as well as
provide medical supervision for its multi-faceted operations, including:

Develop and manage the strategy to reduce TB rates in New York City that is consistent
with national approaches and that includes: treatment (often with directly observed
therapy) of persons with known or suspected TB; identification, evaluation, and
treatment of persons who may develop infection or disease; and outreach to
populations at unusually high risk of disease such as certain foreign-born populations.

Develop a budget that balances Bureau mission, priorities, and funding.

Implement sound surveillance, containment, assessment methodologies and
operational research directly related to disease management.

Develop TB-specific clinical guidelines and policies for NYC practitioners and provide
expert consultation as needed.

Serve as advisor to the Commissioner of Health and Mental Hygiene and all deputy and
associate commissioners regarding TB.

Provide expert advice and recommendations to other health department programs and
other city agencies as well as to outside organizations, institutions, and health care
providers regarding TB, multidrug-resistant TB, and issues concerning control,
diagnosis, treatment and prevention strategies.

Implement and oversee activities between the program and various public and private
medical care facilities as well as voluntary agencies and groups interested and/ or
involved in tuberculosis control efforts.

Oversee the Tuberculosis Bureau's administrative and budgetary operations.

Direct the evaluation and monitoring of the impact of local, state, and federal regulations
procedures and programs on the operations, plans, and goals of the Tuberculosis
Bureau.

Represent New York City and serve as an expert on TB care on CDC and other medical
organization panels.

Propose appropriate modifications and changes in local, state, and federal regulations
pertaining to the operation of the Bureau.

Represent the Commissioner of Health and Mental Hygiene and the Deputy
Commissioner for Disease Control at local state, and federal and international meetings
and conferences on matters related to TB control.

Participate in emergency preparedness activities and response as appropriate
Please apply online with a cover letter to https://a127-jobs.nyc.gov . In the Job ID search bar,
enter the job ID number: 1114091.
4. Program Administrator – SES
Sponsor: Florida Department of Health
Location: Tallahassee, Florida
Closing date: October 19, 2012
The incumbent in this highly responsible professional position will be responsible for providing
programmatic guidance and oversight of the Statewide Tuberculosis (TB) Control Program. The
position will be assigned to the Bureau of Communicable Disease, Tuberculosis Section located
in Tallahassee. The incumbent will report directly to the TB Section Chief. The position requires
the ability to work independently, to manage multiple program and policy issues simultaneously
and provide leadership and direction to TB program staff at Central Office and County Health
Departments.
Major responsibilities include the following:







Serves as the TB Program Administrator for statewide policy, planning, and
development.
Plans and develops legislative budget requests and annual federal grant requests.
Allocates and evaluates the use of funds distributed to the county health departments.
Provides analysis and technical direction for an integrated system of information
collection for the production of basic data on disease prevalence and incidence, disease
distribution, flow of infection resulting from influences inside and outside the state and
epidemiologic services rendered.
Provides a staff development program for personnel designed to integrate service
delivery for TB control.
Plans a comprehensive program for the control, prevention, and elimination of TB by
establishing and maintaining an intensive program of surveillance, epidemiology,
treatment, education, and health promotion activities.
Provides technical assistance to county health departments and other health care
providers for the delivery of TB prevention and control services. Assists in the
preparation of legislation for TB. Provides bill analysis for legislative committee reviews
and during the legislative session and represents the agency at hearings and committee
meetings.
Participates in research and studies with the Centers for Disease Control and
Prevention, Florid