Tb-related News and Journal Items Weekly Update Week of January 23 to January 29, 2011

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TB-Related News and Journal Items Weekly Update

Week of January 23 to January 29, 2011
To subscribe to the list, or to change your subscription options, please visit: https://www.cdcnpin.org/framework/ui/login.aspx?re=/lyris/ui/subscriptions.aspx , CDC provides the TB-Related News and Journal Items Weekly Update as a public service only. This update is a compilation of TB-related articles published for the benefit and information of people interested in TB, and we do not confirm the accuracy of the data in the articles that are abstracted. Providing synopses of key scientific articles and lay media reports on TB does not constitute CDC endorsement. This update may also include information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases, and announcements. Reproduction of this text is encouraged; however, copies may not be sold. For those items reproduced from the first section of the TB weekly update, the CDC HIV/Hepatitis/STD/TB Prevention News Update should be cited. For any other items in the TB weekly update, you may cite the CDC TB-Related News and Journal Items Weekly Update.
This Week's Contents

TB-Related Announcements

News Item(s) From the CDC HIV/Hepatitis/STD/TB Prevention News Update


Journal Articles

Job Announcements

Upcoming Conferences, Trainings, and Other Events
TB-Related Announcements

1. World TB Day Campaign 2011 Is Now Live NEW

Stop TB Partnership, January 24, 2011

2011 is the second year of the two-year campaign of the Stop TB Partnership, On the move against tuberculosis, whose goal is to galvanize innovation in TB care and research. It is inspired by the ambitious new objectives and targets of the Global Plan to Stop TB 2011-2015: Transforming the Fight-Towards Elimination of Tuberculosis, which was launched by the Stop TB Partnership in October 2010. This new plan for the first time identifies all the research gaps that need to be filled to bring rapid TB tests, faster treatment regimens, and a fully effective vaccine to market, and, therefore to the people who need them.

"It is with great pleasure that we launch the campaign for World TB Day, which has special meaning for me this year since I will observe it for the first time in my new role as Executive Secretary of the Stop TB Partnership," says Dr. Lucica Ditiu. "My hope is that all preparations will be done keeping in mind those affected by tuberculosis, the people most in need of our successful actions."

The campaign focuses on recognizing individuals - doctors, nurses, managers, patients, activists, advocates, and researchers around the world - who have found new ways to fight and stop TB in different settings, and can serve as an inspiration to others. The campaign challenges us to look at the fight against TB in an entirely new way: that every step we take should be a step that counts for people, and will lead us toward TB elimination.

The campaign site includes downloadable slogans, a helpful guide in all six official languages of the World Health Organization (Arabic, Chinese, English, French, Russian, and Spanish) for planning a World TB Day event; and a template for developing posters with the slogan On the move against tuberculosis.

The World TB Day 2011 campaign web site is at http://www.stoptb.org/events/world_tb_day/2011/ .

For more information, contact the Senior Communications Adviser, Judith Mandelbaum-Schmid. E-mail schmidj@who.int, or call +41 22 791 2967.

2. “Asking the Right Questions: A Visual Guide to Tuberculosis Case Management for Nurses” now available online

The Francis J. Curry National TB Center announces a new online educational toolkit: Asking the Right Questions: A Visual Guide to Tuberculosis Case Management for Nurses (http://www.nationaltbcenter.ucsf.edu/arq/index.cfm).

The primary target audience is nurses in the public and private health sectors, but the toolkit materials are also useful for TB outreach workers, health care workers in facilities where TB cases are found, and community-based providers who may identify TB suspects or help to treat patients with TB.

Learners can use the toolkit to:

Prompt critical thinking about TB case management

Find relevant basic national training materials and guidelines

Get an overview of the full TB case management timeline

The toolkit can be used for self-paced learning or for mixed classroom and self-paced learning. It has three components:

(1)The Visual Guide (poster) presents a timeline of the full TB case management process and suggests critical questions to ask throughout the process to ensure full assessment of TB suspects and completion of safe, effective treatment for TB disease.

(2) The Reference Guide takes the critical questions another level deeper and offers short topics that briefly explain relevant concepts, and provides hyperlinks to training materials from the CDC and Regional Training and Medical Consultation Centers and to current national guidelines and selected publications.

(3) The Web Guide offers several features for exploring questions and concepts. These features include: an interactive exploration of critical questions linking to Reference Guide topics and hyperlinks, a presentation about the TB case management timeline that is part of the Visual Guide, an online glossary, and downloadable learning guides with suggested curricula.

To put these materials to use, two learning guides suggest training curricula for self-paced learning and for a combination of self-paced and classroom-based learning, adaptable to the needs of your jurisdiction or agency. The Facilitator’s Guide offers suggestions for presenting a curriculum that combines self-paced study with classroom discussion and activities. The Self-Paced Learning Guide outlines a learning curriculum that can be completed by the learner at his or her own pace.

3. TB REACH Launches Call for Proposals for Wave 2 Funding

Stop TB Partnership, December 1, 2010

TB REACH is accepting proposals for the second wave of funding for projects that promote early and increased case detection of TB cases and ensure their timely treatment, while maintaining high cure rates within national TB programs.

TB REACH encourages the development and application of innovative, ground-breaking, and efficient approaches, interventions, and activities that result in increased TB case detection, reduced transmission, and prevention of the emergence of drug-resistant forms of TB. As suggested by its name, TB REACH focuses on reaching vulnerable people, people from poverty areas, and people who have limited or no access to TB services.

Eligibility criteria, examples of suitable interventions, technical guidance, the application form, and instructions for applicants are available on the TB REACH website.

The deadline for submitting proposals for Wave 2 is February 28, 2011.

Eligible applications will be reviewed by the Proposal Review Committee, an independent group of experts, during March 2011. All proposals recommended for funding will be presented for approval to the Stop TB Partnership Coordinating Board at its next meeting. The final results of the review are likely to be made available to all applicants by May 2011.

TB REACH was launched officially on January 25, 2010. Thirty projects in 19 eligible countries, which aimed to detect and treat an additional 40,000 new smear-positive TB cases, received funding under Wave 1. The TB REACH initiative receives support from the Canadian International Development Agency (CIDA).

News Item(s) From the CDC HIV/Hepatitis/STD/TB Prevention News Update

1. Tarnished Aid Fund Says Others in Worse Shape

Associated Press, January 24, 2011, by John Heilprin

The Global Fund to Fight AIDS, TB, and Malaria said January 24 that it is aggressively pursuing corruption and graft among several recipient nations in Africa, but the vast majority of funds are being spent appropriately, based on results showing lives saved. The fund’s new investigative unit is led by Robert Appleton, a former US prosecutor hired last fall to monitor grant programs. Appleton already has more than 100 cases, including 63 yet to be assigned due to lack of staff. “We are vigilantly seeking to protect funds that are earmarked to save lives,” said Appleton, responding to an Associated Press story about $34 million in losses in several African nations. Up to two thirds of some grants have been lost to graft, with much of the money accounted for by forged documents or improper bookkeeping. Fund officials and several outside anti-corruption experts note that most of the world’s largest aid agencies, such as the UN, do not even look for irregularities for fear it would turn away donors. “The others should follow our lead,” said Global Fund Inspector General John Parsons. A recent report by Berlin-based Transparency International found that “accountability in development aid has been low” at the UN, the World Bank and other non-governmental organizations and international bodies. “All aid agencies need to practice greater transparency,” said Robin Hodess, Transparency International’s director of policy and research. From 2006 to 2008, Appleton chaired the UN’s Procurement Task Force; it was dismantled at the end of 2008. Unlike the UN’s secrecy over its investigations, the Global Fund is posting corruption investigations on its website, and making efforts to recoup some of the losses. “The Global Fund should be lauded, not criticized, for promoting transparency, having a strong inspector general, and publicly identifying the issues and trying to get the fund’s money back,” said Appleton.

Headlines1. New TB Test to Be Simple, Fast (United States)

The Rocky Mountain Collegian, www.collegian.com, January 20, 2011, by Rachel Childs

Researchers at Colorado State University (CSU) led by Nick Fisk, Assistant Professor in the Department of Chemical and Biological Engineering, are working on engineering a virus that would detect TB in a urine test. The virus would act as a sensor to detect the proteins associated with active TB disease, revealing whether a person has TB or not. The virus would be inserted into the urine, and then a laser on colored glass would be used to illuminate the fluorescent glow. The researchers believe it will reduce costs and minimize the use of equipment associated with highly specialized DNA and immunology tests. According to John Belisle, CSU Professor of Bacteriology, the test would find bacterial cells, as well as products being produced and released by the bacteria. The project received a $100,000 grant from the Bill and Melinda Gates Foundation, as part of the Grand Challenges Explorations Initiative to expand testing for the world’s most pressing global health problems.

2. Benefactors of Free TB Drug for Discharge (Nigeria)

Nigerian Tribune, http://tribune.com, January 20, 2011, Sade Oguntola

Dr. Osman Eltayeb of the Damien Foundation, Belgium, announced that 10 of 22 patients who were treated at the multidrug-resistant TB (MDR TB) clinic in Nigeria were ready to return home after completing the intensive phase of their treatment. The patients will receive the last phase of treatment at home. Dr. Eltayeb made the announcement at the fourth quarter Oyo State TB/Leprosy program (TBL) supervisors meeting. He noted that the clinic, which is funded by the Damien Foundation, is the only center in Nigeria currently treating MDR TB. A two-day training program will be held for 31 medical officers from Nigeria. The program will train them in the continuation phase of MDR TB care, and link MDR TB patients being discharged with medical officers in the respective states of the country. The doctors will continue caring for the MDR TB patients through the local TB centers. Dr. Eltayeb commented on problems with TB control in 2010, including TB drug availability, stigmatization, and HIV. He urged that political commitment be given by Ondo state, and asked that the state pay its part of the TB control fund. Dr. Oyewole Lawal, Oyo State TB Program Officer, said that in the last quarter of 2010, 6,780 individuals were tested for TB, compared to 4,000 in the third quarter of the year. Also 5,340 and 6,018 patients were registered for treatment in 2009 and 2010 respectively. He attributed the increase to TB awareness, better referral services, and reduction in stigmatization. Mr. Jide Faleye, South West Logistic Officer, assured attendees of the availability of TB drugs in 2011. Between 2006 and 2009, there were 106 reported MDR TB cases in Nigeria.

3. CDD Announces Extension of Grant to Discover Effective Tuberculosis Drugs (United States)

iStockAnalyst, www.istockanalyst.com, January 17, 2011

Collaborative Drug Discovery, Inc., (CDD) announced that its grant has been extended to five years by the Bill and Melinda Gates Foundation. The total amount has been increased to $2,796,000. The grant enables CDD to create a database that sparks collaborative efforts to discover more effective drugs to fight TB. In the last two years, the CDD TB database has integrated the work of academic, non-profit, government, and corporate laboratories worldwide to accelerate the efforts to discover new treatments for the disease. Barry Bunin, CEO and President of CDD, said that the CDD projects enable natural yet secure real-time collaborations among researchers that imitate the way people work in the pharmaceutical industry.

4. RecipharmCobra Oral TB Vax Produces Good Immune Response (United Kingdom)

FierceVaccines, www.fiercevaccines.com, January 20, 2011, by Liz Jones Hollis

A study by researchers from RecipharmCobra Biologics in collaboration with the Royal Holloway College, University of London and the Universita Cattolica del Sacro Cuore of Rome, Italy, showed that orally delivered ORT-VAC DNA vaccine produced higher immune responses in mice than the injected DNA vaccine. RecipharmCobra’s vaccine delivery system, ORT-VAC, uses live salmonella bacteria to deliver TB vaccine orally. The bacteria are modified to avoid causing disease. ORT-VAC stabilizes plasmids without the need for antibiotics, so no antibiotic resistance genes are present on the plasmid, and the potential transfer risk to pathogens is reduced, so that it does not result in antibiotic-resistant superbugs. According to Simon Saxby of RecipharmCobra Biologics, the study illustrates the versatility of the ORT-VAC technology to provide a delivery route for needle-free administration of a DNA vaccine. Saxby commented that a vaccine based on ORT-VAC could be inexpensive to produce, simple to distribute, and easy to administer, which is important in fighting TB in developing countries.

5. HCM City Hospitals to Set Up TB Units (Viet Nam)

Viet Nam News, http://vietnamnews.vnagency.com.vn, January 21, 2011

According to officials of Pham Ngoc Thach Hospital, which manages Ho Chi Minh City’s TB prevention program, nine more hospitals in the city will open TB departments this year to fight the disease. At present, a network of 21 hospitals have TB departments. TB prevention teams in the city’s 24 districts will begin to coordinate their activities more and work more closely with hospitals. Phan Ngoc Thach Hospital has suggested that the city’s department of health create outpatient clinics to diagnose TB in HIV-infected patients in the five districts that do not yet have such clinics. The clinics in Districts 6, Binh Thanh, Binh Tan, and Thu Duc, will begin providing isoniazid preventive therapy to prevent TB in people with HIV infection. In 2010, 16,145 TB patients were treated in Ho Chi Minh City.

6. Thomas Memorial Notifies Patients of Potential TB Exposure (United States)

Charleston Gazette, www.wvgazette.com, January 21, 2011, by Veronica Nett veroni@wvgazette.com

Officials at Thomas Memorial Hospital, Charleston, West Virginia, have notified certain patients and medical staff of potential exposure to TB, after an individual who was treated as an outpatient was later diagnosed with active TB disease. Those who were contacted need to undergo two tests. The first test is conducted soon after the documented contact with TB, the other about 12 weeks later. Janet Briscoe, Director of the Division of Epidemiology for the Kanawha-Charleston Health Department, commented that the exposure was relatively short and the risk is low, but she recommended that individuals follow up and get tested.

7. TB Vaccine Protects Before and After Exposure (Denmark)

BBC News, www.bbc.co.uk, January 23, 2011

A team of Danish scientists at the Statens Serum Institute, Copenhagen, Denmark, have developed a new TB vaccine that works before and after infection has developed. It combines proteins that trigger an immune response to both active and latent forms of TB. The current BCG TB vaccine works if given prior to exposure, does not prevent infection, but prevents acute symptoms and disease from emerging, and has no effect on latent TB infection. It is of no use in protecting infected adults. The new vaccine has been tested in animals. The study is reported online in the journal Nature Medicine, 2011doi:10.1038/nm.2285.

Journal Articles

1. Acta Medica Iranica. 2010 Jan-Feb; Volume 48, Number 1: 67-71. Frequency of Mycobacterium tuberculosis Infection among Iranian Patients with HIV/AIDS by PPD Test; Jam, S., Sabzvari, D., SeyedAlinaghi, S., Fattahi, F., et al.

Click here for PubMed abstract: PubMed

Persons infected with the HIV are particularly susceptible to TB, either by latent infection reactivation or by a primary infection with rapid progression to active disease. This study was done to determine the frequency of tuberculosis infection among Iranian patients with HIV/AIDS. A total of 262 HIV/AIDS patients attending all three HIV/AIDS health care centers of Tehran, Iran were enrolled in this study. A detailed history and physical examination were obtained from all HIV patients suspected of having pulmonary M. tuberculosis. A positive PPD skin test was used as a diagnostic parameter for probability of TB infection. Out of 262 HIV/AIDS patients, a total of 63 (24%) were shown to have the TB infection based on a positive PPD skin test. Of the patients with positive PPD skin test, 22 (35%) had pulmonary TB, 2 (3.2%) had extrapulmonary TB, and 39 (53%) had no evidence of M. tuberculosis infection (latent infection). Also 8 (12.7%) had history of long term residence in a foreign country, 32 (50.8%) were exposed to an index case, and 9 (14.3%) had past history of pulmonary TB, while only 33.3% had clinical manifestations of TB (active disease). There was no resistant case of TB. The study showed that near 24% of Iranian patients with HIV/AIDS were infected with M. tuberculosis. This finding denotes the need to improve the diagnostic and preventive measures, and also prompt treatment of this type of infection in the HIV infected individuals.

2. Acta Medica Iranica. 2010 Jan-Feb; Volume 48, Number 1: 21-6. Evaluation of Serological Tests Using A60 Antigen for Diagnosis of Tuberculosis; Kochak, H.E., SeyedAlinaghi, S., Zarghom, O., Hekmat, S., et al.

Click here for PubMed abstract: PubMed

Identification of acid-fast bacilli (AFB) in sputum or tissue samples is among definite diagnostic methods of TB. However, this method of diagnosis is restricted by certain limitations. Serologic diagnosis of TB has been used for a long time. This study determined the sensitivity and, specificity of Antigen 60 (A60) IgG, IgA, IgM test results in TB diagnosis. Mycobacterial A60-based ELISA was used to measure specific IgA, IgM and IgG antibodies in the sera of 127 adult TB patients (consisted of 74 pulmonary and 53 extra-pulmonary cases), and 95 controls (46 healthy volunteers and 49 patients with various acute or chronic diseases other than TB). Data from A60 IgG-based ELISA, chest radiography, AFB culture and pathologic evaluation for AFB were obtained .The cutoff value of A60 IgG, IgA and IgM were chosen according to a receiver operating characteristic (ROC) analysis. The sensitivity, specificity and positive likelihood ratio were determined. The mean levels of IgG, IgA and IgM were significantly higher in patients with pulmonary TB when compared with control groups. Sensitivity of IgG test was 54.3 %, while the specificity was 84.2%. The IgA test showed a sensitivity of 70.1% with a specificity of 80 %. Combination of the IgG and IgA tests showed a total sensitivity of 45.7 % and a specificity of 94.7% and the positive likelihood ratio of 8.62. Chosen cutoff values of IgG, IgA, and IgM sets were 285,265 and 0.9 ELISA units respectively. The study results showed a good specificity (94.7%) and a reasonable positive likelihood ratio (8.62) of the test when combined IgA and IgG with new cutoff points were considered on diagnosis of TB in adult patients. Combined use of both IgG and IgA tests results allows an increased accuracy in diagnostic of TB.

3. Korean Journal of Radiology. 2010 Nov-Dec; Volume 11, Number 6: 612-7. Epub 2010 Oct 29. Chest Radiographic Findings in Primary Pulmonary Tuberculosis: Observations from High School Outbreaks; Koh, W.J., Jeong, Y.J., Kwon, O.J., Kim, H.J., et al.

Click here for PubMed abstract: PubMed

This study describes the radiographic findings of primary pulmonary TB in previously healthy adolescent patients. The Institutional Review Board approved this retrospective study, with a waiver of informed consent from the patients. TB outbreaks occurred in 15 senior high schools and chest radiographs from 58 students with identical strains of TB were analyzed by restriction fragment length polymorphism analysis by two independent observers. Lesions of nodule(s), consolidation, or cavitation in the upper lung zones were classified as typical TB. Mediastinal lymph node enlargement; lesions of nodule(s), consolidation, or cavitation in lower lung zones; or pleural effusion were classified as atypical TB. Inter-observer agreement for the presence of each radiographic finding was examined by kappa statistics. Of 58 patients, three (5%) had normal chest radiographs. Cavitary lesions were present in 25 (45%) of 55 students. Lesions with upper lung zone predominance were observed in 27 (49%) patients, whereas lower lung zone predominance was noted in 18 (33%) patients. The remaining 10 (18%) patients had lesions in both upper and lower lung zones. Pleural effusion was not observed in any patient, nor was the mediastinal lymph node enlargement. Hilar lymph node enlargement was seen in only one (2%) patient. Overall, 37 (67%) students had the typical form of TB, whereas 18 (33%) had TB lesions of the atypical form. The most common radiographic findings in primary pulmonary TB by recent infection in previously healthy adolescents are upper lung lesions, which were thought to be radiographic findings of reactivation pulmonary TB by remote infection.

4. The Lancet Infectious Diseases. 2010 Nov; Volume 10, Number 11: 803-12. Epub 2010 Sep 6. Tuberculous Meningitis: A Uniform Case Definition for Use in Clinical Research; Marais, S., Thwaites, G., Schoeman, J.F., Török, M.E., et al.

Click here for PubMed abstract: PubMed

Tuberculous meningitis causes substantial mortality and morbidity in children and adults. More research is urgently needed to better understand the pathogenesis of disease and to improve its clinical management and outcome. A major stumbling block is the absence of standardized diagnostic criteria. The different case definitions used in various studies makes comparison of research findings difficult, prevents the best use of existing data, and limits the management of disease. To address this problem, a three-day tuberculous meningitis workshop was conducted in Cape Town, South Africa, and was attended by 41 international participants experienced in the research or management of tuberculous meningitis. During the meeting, diagnostic criteria were assessed and discussed, after which a writing committee was appointed to finalize a consensus case definition for tuberculous meningitis for use in future clinical research. The researchers present the consensus case definition together with the rationale behind the recommendations. This case definition is applicable irrespective of the patient's age, HIV infection status, or the resources available in the research setting. Consistent use of the proposed case definition will aid comparison of studies, improve scientific communication, and ultimately improve care.

5. Lung India. 2010 Oct; Volume 27, Number 4:196-201. Adult Thoracic Empyema: A Comparative Analysis of Tuberculous and Nontuberculous Etiology in 75 Patients; Kundu, S., Mitra, S., Mukherjee, S., Das, S.

Click here for PubMed abstract: PubMed

Thoracic empyema is a disease of significant morbidity and mortality, especially in the developing world where TB remains a common cause. Clinical outcomes in tuberculous empyema are complicated by the presence of concomitant fibrocavitary parenchymal disease and frequent bronchopleural fistulae. The researchers performed a prospective study over a one-and-a-half-year period with the objective of comparing the clinical profiles and outcomes of patients with tuberculous and nontuberculous empyema. A prospective study of adult cases of nonsurgical thoracic empyema admitted in a tertiary care hospital in eastern India was performed over a period of 18 months. A comparative analysis of clinical characteristics, treatment modalities, and outcomes of patients with tuberculous and nontuberculous empyema was carried out. Seventy-five cases of empyema were seen during the study period, of which 46 (61.3%) were of nontuberculous etiology while TB constituted 29 (38.7%) cases. Among the nontuberculous empyema patients, Staphylococcus aureus (11, 23.93%) was the most frequent pathogen isolated, followed by Gram-negative bacilli. Tuberculous empyema was more frequent in younger population compared to nontuberculous empyema (mean age of 32.7 years vs. 46.5 years). Duration of illness and mean duration of chest tube drainage were longer (48.7 vs. 23.2 days) in patients with tuberculous empyema. Also the presence of parenchymal lesions and bronchopleural fistula often requiring surgical drainage procedures was more in tuberculous empyema patients. Tuberculous empyema remains a common cause of empyema thoracis in a country like India. Tuberculous empyema differs from nontuberculous empyema in the age profile, clinical presentation, management issues, and has a significantly poorer outcome.

6. Orthopaedic Nursing. 2010 Nov-Dec; Volume 29, Number 6: 400-6. Osteoarticular Manifestations of Mycobacterium tuberculosis Infection; Zychowicz, M.E.

Click here for PubMed abstract: PubMed

Mycobacterium tuberculosis has affected humans for much of our existence. The incidence of global TB infection continues to rise, especially in concert with HIV coinfection. Many disease processes, such as diabetes, increase the likelihood of TB infection. TB bacteria can infect any bone, joint, tendon, or bursa; however, the most common musculoskeletal site for infection includes the spine and weight-bearing joints of the hip and knee. Many patients who present with osteoarticular TB infection will have a gradual onset of pain at the site of infection. Many patients who develop a musculoskeletal TB infection will have no evidence of a pulmonary TB infection on X-ray film and many will have very mild symptoms with the initial infection. Health care providers must remember that many patients who develop TB infection do not progress to active TB disease; however, the latent infection may become active with immune compromise.

7. Pharmacognosy Magazine. 2010 Oct; Volume 6, Number 24: 339-44. Phytoconstituents from Alpinia purpurata and Their in Vitro Inhibitory Activity against Mycobacterium tuberculosis; Villaflores, O.B., Macabeo, A.P., Gehle, D., Krohn, K., et al.

Click here for PubMed abstract: PubMed

Alpinia purpurata or red ginger was studied for its phytochemical constituents as part of the researchers’ growing interest on Philippine Zingiberaceae plants that may exhibit antimycobacterial activity. The hexane and dichloromethane subextracts of the leaves were fractionated and purified using silica gel chromatography to afford a mixture of C(28)-C(32) fatty alcohols, a 3-methoxyflavone and two steroidal glycosides. The two latter metabolites were spectroscopically identified as kumatakenin (1), sitosteryl-3-O-6-palmitoyl-β-D-glucoside (2) and b-sitosteryl galactoside (3) using ultraviolet (UV), infrared (IR), electron impact mass spectrometer (EIMS) and nuclear magnetic resonance (NMR) experiments, and by comparison with literature data. This study demonstrates for the first time the isolation of these constituents from A. purpurata. In addition to the purported anti-inflammatory activity, its phytomedicinal potential to treat TB is also described.

8. PLoS Computational Biology. 2010 Nov 4; Volume 6, Number 11: e1000976. The Mycobacterium tuberculosis Drugome and Its Polypharmacological Implications; Kinnings, S.L., Xie, L., Fung, K.H., Jackson, R.M., et al.

Click here for PubMed abstract: PubMed

The researchers report a computational approach that integrates structural bioinformatics, molecular modeling and systems biology to construct a drug-target network on a structural proteome-wide scale. The approach has been applied to the genome of Mycobacterium tuberculosis (M.tb), the causative agent of one of today's most widely spread infectious diseases. The researchers referred to the resulting drug-target interaction network for all structurally characterized approved drugs bound to putative M.tb receptors, as the “TB-drugome.” The TB-drugome reveals that approximately one third of the drugs examined have the potential to be repositioned to treat TB and that many currently unexploited M.tb receptors may be chemically druggable and could serve as novel antitubercular targets. Furthermore, a detailed analysis of the TB-drugome has shed new light on the controversial issues surrounding drug-target networks [1]-[3]. Indeed, the results support the idea that drug-target networks are inherently modular, and further that any observed randomness is mainly caused by biased target coverage. The TB-drugome (http://funsite.sdsc.edu/drugome/TB) has the potential to be a valuable resource in the development of safe and efficient antitubercular drugs. More generally the methodology may be applied to other pathogens of interest with results improving as more of their structural proteomes are determined through the continued efforts of structural biology/genomics.

9. PLoS One. 2010 Nov 29; Volume 5, Number 11: e15043. Syringe Free Vaccination with CAF01 Adjuvated Ag85B-ESAT-6 in Bioneedles Provides Strong and Prolonged Protection Against Tuberculosis; Christensen, D., Lindenstrøm, T., van de Wijdeven, G., Andersen, P., et al.

Click here for PubMed abstract: PubMed

Bioneedles are small hollow sugar based needles administered with a simple compressed air device. In this study the researchers investigated how incorporation of a subunit vaccine based on TB vaccine hybrid Ag85B-ESAT-6 adjuvated with CAF01 into Bioneedles affected its immunogenicity as well as its ability to protect against TB in a mouse model. The CMI response measured by IFN-γ and antigen specific CD4+ T-cells was, two weeks after the last vaccination, significantly lower in the group immunized with Bioneedle-incorporated vaccine compared to the conventional vaccine, using syringe and needle. However, at four, nine and 52 weeks after vaccination the researchers observed similar high IFN-γ levels in the Bioneedle group and the group vaccinated using syringe and needle and comparable levels of antigen specific T-cells. Furthermore, the protective efficacy for the two vaccination methods was comparable and similar to BCG vaccination both six and 52 weeks after vaccination. These results therefore advocate the further development of the Bioneedle devices and applicators for the delivery of human vaccines.

10. PLoS One. 2010 Nov 19; Volume 5, Number 11: e14066. A Longitudinal Study of BCG Vaccination in Early Childhood: The Development of Innate and Adaptive Immune Responses; Djuardi, Y., Sartono, E., Wibowo, H., Supali, T., et al.

Click here for PubMed abstract: PubMed

BCG vaccine drives a strong T helper 1 cellular immunity which is essential for the protection against mycobacteria, however recent studies suggest that BCG vaccination can have non-specific beneficial effects unrelated to TB. In the present cohort study the development of cytokine profiles following BCG vaccination was investigated. Immune responses to PPD were assessed before vaccination and at ages of 5 months, 1 year, and 2 years, followed by BCG scar measurement at 4 years of age. BCG was shown to induce both Th1 and Th2 type responses against PPD at about 5 months of age after vaccination, and while Th1 response was sustained, Th2 responses declined over time. However, BCG scar size was strongly correlated with Th2 responses to PPD at 5 months of age. Importantly, the researchers observed no clear effects of BCG vaccination on innate immune responses in terms of early IL-10 or TNF-α production whereas some alterations in general adaptive immune responses to PHA were observed.

11. PLoS One. 2010 Nov 17; Volume 5, Number 11: e14014. Patients' Costs and Cost-Effectiveness of Tuberculosis Treatment in DOTS and Non-DOTS Facilities in Rio de Janeiro, Brazil; Steffen, R., Menzies, D., Oxlade, O., Pinto, M., et al.

Click here for PubMed abstract: PubMed

Costs of TB diagnosis and treatment may represent a significant burden for the poor and for the health system in resource-poor countries. This study analyzed patients' costs of TB care and estimated the incremental cost-effectiveness ratio (ICER) of the DOT per completed treatment in Rio de Janeiro, Brazil. The researchers interviewed 218 adult patients with bacteriologically confirmed pulmonary TB. Information on direct (out-of-pocket expenses) and indirect (hours lost) costs, loss in income, and costs with extra help were gathered through a questionnaire. Health care system additional costs due to supervision of pill-intake were calculated considering staff salaries. Effectiveness was measured by treatment completion rate. The ICER of DOT compared to self-administered therapy (SAT) was calculated. DOT increased costs during the treatment phase, while SAT increased costs in the pre-diagnostic phase, for both the patient and the health system. Treatment completion rates were 71% in SAT facilities and 79% in DOT facilities. Costs per completed treatment were US $194 for patients and US $189 for the health system in SAT facilities, compared to US $336 and US $726 in DOT facilities. The ICER was US $6,616 per completed DOT treatment compared to SAT. Costs incurred by TB patients are high in Rio de Janeiro, especially for those under DOT. The DOT strategy doubles patients' costs and increases by fourfold the health system costs per completed treatment. The additional costs for DOT may be one of the contributing factors to the completion rates below the targeted 85% recommended by WHO.

12. Public Health Reports. 2010 Nov-Dec; Volume 125, Number 6: 843-50. Real-Time Surveillance for Tuberculosis Using Electronic Health Record Data from an Ambulatory Practice in Eastern Massachusetts; Calderwood, M.S., Platt, R., Hou, X., Malenfant, J., et al.

Click here for PubMed abstract: PubMed

Electronic health records (EHRs) have the potential to improve completeness and timeliness of TB surveillance relative to traditional reporting, particularly for culture-negative disease. The researchers reported on the development and validation of a TB detection algorithm for EHR data followed by implementation in a live surveillance and reporting system. The researchers used structured electronic data from an ambulatory practice in eastern Massachusetts to develop a screening algorithm aimed at achieving 100% sensitivity for confirmed active TB disease with the highest possible positive predictive value (PPV) for physician-suspected disease. They validated the algorithm in 16 years of retrospective electronic data and then implemented it in a real-time EHR-based surveillance system. They assessed PPV and the completeness of case capture relative to conventional reporting in 18 months of prospective surveillance. The final algorithm required a prescription for pyrazinamide, an International Classification of Diseases, Ninth Revision (ICD-9) code for TB and prescriptions for two antituberculous medications, or an ICD-9 code for TB and an order for a TB diagnostic test. During validation, this algorithm had a PPV of 84% (95% confidence interval 78, 88) for physician-suspected disease. One-third of confirmed cases were culture-negative. All false-positives were instances of latent TB. In 18 months of prospective EHR-based surveillance with this algorithm, seven additional cases of physician-suspected active TB disease were detected, including two patients with culture-negative disease. A review of state health department records revealed no cases missed by the algorithm. It is concluded that live, prospective TB surveillance using EHR data is feasible and promising.

13. Revista Latino-Americana de Enfermagem. 2010 Sep-Oct; Volume 18, Number 5: 983-9. Tuberculosis Control: Patient Perception Regarding Orientation for the Community and Community Participation; Curto, M., Scatena, L.M., Andrade, R.L., Palha, P.F., et al.

Click here for PubMed abstract: PubMed

This study evaluated, from the patient's perspective, actions of orientation for the community and community participation carried out in TB control in health services in Ribeirão Preto - SP. This was an evaluative quantitative exploratory study which used part of the Primary Care Assessment Tool, adapted and validated for TB care, applied through interview, with 100 patients. Indicators of the instrument and analysis of variance were used. The realization of social partnerships for delivery of the sputum pot together with the community, the delivery of the sputum pot to the community by professionals, and the participation of the community to discuss the problem of TB were identified, 5%, 6%, and 5%, respectively. The health services with fewer patients in treatment showed the best indicators. The actions of social partnerships, searching for respiratory symptomatics in the community and community participation in TB control are poorly incorporated by health services.

14. The Southeast Asian Journal of Tropical Medicine and Public Health. 2010 Sep; Volume 41, Number 5: 1153-7. Factors Affecting Tuberculosis Retreatment Defaults in Nanded, India; Bhagat, V.M., Gattani, P.L.

Click here for PubMed abstract: PubMed

This study was carried out to determine factors affecting TB retreatment defaults in Nanded, India. All patients registered as TB retreatment cases (n = 107 excluding deaths during treatment) were interviewed by home visits. Their sociodemographic characteristics and treatment history were recorded and later compared with their treatment outcomes. Among the patients registered for re-treatment of TB (n = 112), 24 (21.4%) defaulted on treatment. The rate of default was 25.8% among those who had previously defaulted on treatment. Those who were employed, illiterate, and alcoholics were 3.5, 3.5 and 3.4 times more likely to default, respectively, than others; these differences were significant.

15. Tropical Medicine & International Health. 2010 Dec; Volume 15, Number 12: 1475-80. doi: 10.1111/j.1365-3156.2010.02645.x. Duration of Cough, TB Suspects' Characteristics and Service Factors Determine the Yield of Smear Microscopy; Otero, L., Ugaz, R., Dieltiens, G., González, E., et al.

Click here for PubMed abstract: PubMed

To determine the efficiency of routine TB case detection by examining sputum smear positivity for acid-fast bacilli in relation to duration of cough, characteristics of TB suspects examined and health service factors. The researchers combined patient interviews with routine data from laboratory registers in 6 health care facilities in San Juan de Lurigancho district, Lima, Peru. A TB case was defined as a TB suspect with at least one positive sputum smear. The researchers calculated adjusted odds ratios with 95% confidence intervals for the association between smear positivity and health service and patient's characteristics. Smear positivity was 7.3% (321/4376). Of the 4,376 adults submitting sputa, 55.3% (2,418) reported cough for <14 days. In this group, smear microscopy yielded 3.2% (78/2418) positive results vs. 12.4% (243/1958) in patients coughing for 14 or more days. Having cough for >2 weeks, being referred by health care staff, attending a secondary-level health care facility, male sex and age between 15 and 44 years were independent determinants of smear positivity. Routine case detection yields a low proportion of smear-positive cases because of the inclusion of a high proportion of patients without cough or coughing for <2 weeks. Adherence to the national TB control program guidelines on the selection of TB suspects would have a positive impact on the smear positivity rate, reduce laboratory costs and workload, and possibly improve the reading quality of smear microscopy.

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. Stop TB Advocacy Officer - Washington (DC)-based

Sponsors: RESULTS Educational Fund; Stop TB Partnership Secretariat

Location: Washington, DC

The Stop TB Partnership (TBP) Coordinating Board endorsed the enhancement of the TBP’s advocacy influence, including strategy, coordination, communications, support, and leadership engagement. The Board mandated TBP to clearly define the responsibilities and the budget implications of a Washington-based position, and to open discussions with partners regarding the creation of such a position within their organization.

These discussions have resulted in the proposed grant to RESULTS Educational Fund (REF) as partial funding for a Stop TB Advocacy Officer—additional to the staff currently working at REF on TB advocacy—to be hosted at their offices in Washington, DC. The grant will be for an initial period of 1 year. Subject to results achieved and availability of funds, a similar arrangement may be considered subsequently.

For more information, including the objectives of this position, duties, qualifications, experience, and skills, interested applicants should e-mail action_jobs@results.org. Applications will be reviewed on a rolling basis, so early submission is recommended. No phone calls please, qualified candidates will be contacted.

2. Training and Consultation Specialist

Sponsor: New Jersey Medical School Global Tuberculosis Institute

Job Number: 10NS963549

Location: Newark, New Jersey

The New Jersey Medical School Global TB Institute is currently accepting applications for a Training and Consultation Specialist.

The primary purpose of the Training and Consultation Specialist position is to develop, implement, and evaluate educational programs and materials related to TB to meet the needs of health care professionals and TB patients. These activities will be consistent with the goals and objectives of the CDC funded Regional Training and Medical Consultation Centers initiative, or with other national or international TB control projects. These programs may include training courses, lectures, symposia, preceptorships, and enduring materials, including curricula and self study materials. Responsibilities will include developing and implementing training courses for TB Program staff and developing patient and provider educational materials for use in domestic and international settings. Previous experience in international TB training and education is desired.

More information and an online application are available at: http://umdnj.hodesiq.com/job_detail.asp?JobID=2194623&user_id=

3. Director, Tuberculosis Programs (Tracking code 4307)

Sponsor: PATH

Location: Hanoi, Vietnam

PATH seeks a dynamic and experienced public health professional to lead and manage its increasingly large and complex portfolio of TB Control projects; represent PATH to donors, partners, and government agencies;, and serve as a member of PATH Vietnam’s senior management team.

With support from the Global Fund to Fight AIDS, TB and Malaria and the United States Agency for International Development (USAID) and in partnership with the National TB Program, PATH is expanding its TB control program in Vietnam with two major initiatives. The Global Fund project is designed to scale up technical components and partnerships to increase TB control impact while the USAID-funded project will reduce diagnostic delays, increase case detection, and improve adherence to TB treatment through strengthened stakeholder involvement in TB control activities at the district, provincial, and national levels. The Global Fund project will implement a public-private partnership model for TB case detection, and both projects will strengthen capacity for advocacy, communication, and social mobilization toward the goal of eliminating TB as a public health threat. Reporting to the Country Program Leader, the incumbent will oversee a combined budget of nearly nine million USD and 24 staff, including six direct reports.

Specific responsibilities include:

(1) Project Leadership, Management and Oversight:

- Assume strategic leadership and direct planning, implementation, and management for Global Fund project and oversight for USAID TB project, including strategic support for program objectives, key interventions, and evaluation strategies.

- Liaise with Global TB program staff integrating TB work in Vietnam with overall PATH strategy for TB Control.

- Oversee rapid start-up of project activities for each initiative: hiring staff and initiating and building relationships with key stakeholders.

- Develop and coordinate the annual budgeting process for each project; ensure prudent management of project funds; coordinate each project’s accounting, monitoring, and reporting systems, including establishing internal control systems in accordance with PATH’s standard operating procedures.

- Represent PATH to donors, partners, and government agencies, and oversee coordination activities with the National TB Program.

- Support the Country Program Leader in managing all donor-related compliance matters, ensuring that project teams achieve project goals and objectives according to donor expectations and within approved project budgets.

- Work with staff to develop strategy for each project and identify issues/challenges for effective implementation of work plan activities.

- Oversee preparation of required reports to Headquarters and donors.

- Maintain updated technical knowledge in TB and related public health topics to be able to provide vision and input to strategy development and technical assistance to project staff.

(2) PATH Representation:

- On delegation, serve as the PATH representative to donors, collaboration institutions, other potential clients and partners, and the press.

- Serve as a member of the senior management team contributing to strategic policy and program directions and decisions.

- Represent PATH on national working groups and task forces as appropriate and maintain contacts with other organizations engaged in TB control activities.

- Identify and participate in new business opportunities and activities for PATH including proposal writing.

If interested, forward resume to Sue Wallace. E-mail swallace@path.org, or apply online at http://www.path.org.

Upcoming Conferences, Trainings, and Other Events

Find up-to-date information on TB-related conferences, US training opportunities, and other events at the DTBE Monthly Calendar.

1. TB Cohort Review NEW

Sponsor: Heartland National TB Center

Date: March 23, 2011

Location: Phoenix, Arizona

Registration deadline: March 10, 2011

The goal of this training is to introduce health care workers to the TB Cohort Review process through CDC guidelines, case examples, and group exercises. Using interactive lectures as well as case presentations and group exercises, participants will be able to list elements of a cohort review; identify key participants and their role, prepare for and conduct a practice cohort review; demonstrate an actual cohort review, and analyze the data to understand outcomes and programmatic follow-up. There is no charge to attend this workshop, but pre-registration is mandatory. Space is limited to 35 participants. Register at http://www.heartlandntbc.org/training.asp . Continuing education credits are available.

For more information, contact Jessica Quintero. E-mail Jessica.quintero@uthct.edu;

call (210) 531-4568; or access the Web site at http://www.heartlandntbc.org/training/brochure_phoenix_az_23_mar_2011.pdf .

2. Budget Planning and Project Management NEW

Sponsor: International Union Against Tuberculosis and Lung Disease (The Union)

Dates: September 19 – October 1, 2011

Location: Bangkok, Thailand

Application deadline: August 20, 2011

Developing and managing budgets is an essential quality to a well managed TB program. Participants in this course will receive advanced training in budget development and project management, which will increase their confidence in the creation and management of budgets for national health programs.

Application deadline: August 20, 2011. Late applications accepted on a space-available basis. To register, E-mail imdp@theunion.org.

For more information, E-mail: technical-courses@heunion.org; or visit the Web site at http://www.union-imdp.org/courses/budget-planning-project-management.

3. 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/ .

4. Practical Solutions for TB Infection Control: Infectiousness and Isolation

Sponsor: Francis J. Curry National Tuberculosis Center

Location: Online Course

Length: 60 minutes

This 60-minute Flash presentation with streaming audio provides information on how to determine whether a TB patient is infectious and demonstrates practical ways to prevent TB transmission in the clinic, in transit, and in the patient's home. Throughout the training, interactive questions allow participants to test and apply what has been learned. At the end of the presentation, there is a list of additional resources that includes links to further written information as well as links to the Regional Training and Medical Consultation Centers (RTMCCs).

For further assistance, contact Francis J. Curry National Tuberculosis Center. E-mail tbcenter@nationaltbcenter.ucsf.edu; telephone (415) 502-4600; or fax (415) 502-4620.

For a course description, visit http://www.nationaltbcenter.ucsf.edu/tbicweb/ .

5. Medical Management of Tuberculosis: An Online Presentation

Sponsor: Francis J. Curry National Tuberculosis Center

Length: 30 minutes

Credit: 0.5 contact hour CME/CNE

This slide presentation with streaming audio will provide information on how to manage treatment of TB. A question and answer guide, a printable PowerPoint slide file, and other useful resources are also included as supplemental reading materials. This 30-minute lecture, conducted by Dr. Karen Smith, covers the general principles of TB treatment, the drugs used to cure TB, alternative regimens, monitoring, and potential adverse reactions to therapy. It targets audiences of clinicians and health care professionals.

For a course description or to receive continuing medical education (CME) or continuing nursing education (CNE) contact hours, please visit http://www.nationaltbcenter.edu/med_mgmt/ .

6. 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 .

7. Webinar: Understanding Mycobacterium bovis

Sponsor: Heartland National TB Center

Date: February 2, 2011

Location: Nationwide, US

Registration deadline: January 31, 2011

This webinar will describe the epidemiologic risk factors and transmission of Mycobacterium bovis, discuss the differences between Mycobacterium bovis and Mycobacterium tuberculosis, and identify case management best practices during treatment of Mycobacterium bovis.

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