January 16, 2015 - The CDC Division of Tuberculosis Elimination announced today that the California Microbial Diseases Laboratory (MDL) will serve as a Drug Susceptibility Testing Reference Center for Mycobacterium tuberculosis. MDL will serve as an extension of the CDC DTBE Laboratory Branch Reference Laboratory, providing services complementary to those at CDC for low volume public health laboratories with low volumes of drug susceptibility testing. Services are expected to begin in March, 2015. Read the January 16 announcement letter here.
Please see the attached letters from the CDC describing issues related to tuberculosis control efforts for unaccompanied children who come into the care and custody of the Department of Health and Human Services after being apprehended by immigration authorities.
If you have questions about TB control for unaccompanied children in your jurisdiction, please contact the CDC TB Program Consultant in the Field Services and Evaluation Branch, Division of Tuberculosis Elimination who is assigned to your jurisdiction.
In recognition of World tuberculosis Day, the Kaiser Family Foundation convened a public forum that focused on the global health challenge presented by tuberculosis. Included in this event were a FRONTLINE television documentary, TB Silent Killer, and a discussion with a panel of experts. The documentary presented a portrait of people living in Swaziland, a country in Southern Africa with the dubious distinction of having the world’s highest incidence of tuberculosis.
The panel of experts for the subsequent discussion included: Jezza Neumann, producer, writer and director of TB Silent Killer; Josh Michaud, associate director for global health policy at the Kaiser Family Foundation; Christine F. Sizemore, chief of the Tuberculosis, Leprosy and other Mycobacterial Diseases Section at the National Institute of Allergy and Infectious Diseases, National Institutes of Health; and Jonathon Gass, monitoring and evaluation specialist at Ariadne Labs, who worked as an epidemiologist for Médecins Sans Frontières/Doctors Without Borders.
We are pleased to inform you that the Division of Tuberculosis Elimination Molecular Detection of Drug Resistance (MDDR) service has received approval from the CDC Laboratory Safety Improvement Workgroup to resume operation and are able to transfer biological material from the BSL-3 into the BSL-2 laboratory space to perform clinical testing. For more information please see the document below.
The communication regarding the attached document involves a temporary moratorium from the CDC on the movement of biological material from biosafety level 3 (BSL-3) or BSL-4 facilities in any laboratory at CDC, in which the DTBE Laboratory Branch is temporarily unable to transfer crude DNA preparations from specified isolates or clinical sediments into the BSL-2 lab space. Please read the communication in full and contact Angela Starks, Laboratory Branch Chief (firstname.lastname@example.org), 404-639-3205 with any questions or concerns.
7th International Workshop on Clinical Pharmacology of Tuberculosis Drugs
5 September 2014, Washington DC, USA
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On June 10, the National Society of TB Clinicians (NSTC) and the National TB Nurse Coalition (NTNC) will be holding their annual meetings. The annual meetings provide quality educational content and CE credits.
· For the latest agenda and registration information please visit: https://www.signup4.net/public/ap.aspx?EID=20141830E&OID=163
For the National TB Conference that follows Wednesday, June 11, to Friday, June 13, registration information for the conference is available online at https://www.signup4.net/Public/ap.aspx?EID=20141830E
We invite you to join the Mayo Clinic Center for Tuberculosis Breakout Session June 12, from 8:15-9:45 a.m.
All events will be held at the Grand Hyatt Atlanta in Buckhead, 3300 Peachtree Road, NE, Atlanta, GA 30305.
Announcement: Updated Guidelines on Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis
Morbidity and Mortality Weekly Report (MMWR)
March 28, 2014 / 63(12);272
Guidelines for managing pharmacologic interactions that can result when patients receive antiretroviral drugs for treatment of human immunodeficiency virus (HIV) infection together with rifamycin antibiotics for treatment of tuberculosis (TB) have been published previously (1–4). Newly updated guidelines, developed by CDC in collaboration with experts from other key national and international institutions, are now available athttp://www.cdc.gov/tb/publications/guidelines/tb_hiv_drugs/default.htm.
The updated guidelines include recommendations for use of newer antiretroviral drugs, including those in new classes, such as CCR5 receptor antagonists and integrase inhibitors. The new guidelines provide additional recommendations regarding use of rifampin with antiretroviral therapy; these recommendations are critical in regions where rifabutin is unavailable. New features of the guidelines include 1) summaries of clinical experience with use of specific antiretroviral regimens during TB treatment (in addition to pharmacokinetic data), 2) a table summarizing clinical experience with key antiretroviral regimens and providing recommended regimens, and 3) sections on treatment for special populations, including persons with latent TB infection, young children, pregnant women, and patients with drug-resistant TB. The online guidelines will be updated as necessary to provide clinicians with the latest information.
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Autologous mesenchymal stromal cell infusion as adjunct treatment in patients with multidrug and extensively drug-resistant tuberculosis: an open-label phase 1 safety trial
A recent article in The Lancet Respiratory Medicine, early online publication from 9 January 2014, offers new insights into much-needed novel treatments for multi-drug resistant and extensively drug-resistant tuberculosis.
Aliaksandr Skrahin M.D., Raija K. Ahmed Ph.D., Giovanni Ferrara M.D., Lalit Rane M.Sc., Thomas Poiret M.Sc., Yanina Isaikina Ph.D., Alena Skrahina M.D., Alimuddin Zumla FRCP, Markus J Maeurer M.D.
Novel treatment options are urgently needed for multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis, which are associated with immune dysfunction and poor treatment outcomes. Mesenchymal stromal cells (MSCs) are immunomodulatory and adjunct autologous treatment with bone marrow-derived MSCs might improve clinical outcome by transforming chronic inflammation into productive immune responses. Our aim was to assess the safety of infusion of autologous MSCs as an adjunct treatment in patients with tuberculosis.
30 patients with microbiologically confirmed MDR or XDR tuberculosis were treated with single-dose autologous bone marrow-derived MSCs (aimed for 1×106 cells per kg), within 4 weeks of the start of antituberculosis-drug treatment in a specialist centre in Minsk, Belarus. Inclusion patients were those with pulmonary tuberculosis confirmed by sputum smear microscopy, culture, or both; MDR or XDR tuberculosis confirmed by drug-susceptibility testing to first-line and second-line drugs; age older than 21 years to 65 years or younger; and absence of lesion compatible with a malignant process or ongoing tuberculosis in organs other than the lungs and pleura. In addition to the inclusion criteria, patients were excluded if they were pregnant, coinfected with HIV, or infected with hepatitis B, C, or both. The primary endpoint was safety measured by MSC-infusion related events; any tuberculosis-related event within the 6 month observation period that related to a worsening of the underlying infectious disease, measured by conversion of Mycobacterium tuberculosis culture or microscopic examination; or any adverse event defined clinically or by changes in blood haematology and biochemistry variables, measured monthly for 6 months after MSC infusion per protocol. This study is registered with the German Clinical Trials Registry, number DRKS00000763.
The most common (grade 1 or 2) adverse events were high cholesterol levels (14 of 30 patients), nausea (11 of 30 patients), and lymphopenia or diarrhoea (ten of 30 patients). There were no serious adverse events reported. We recorded two grade 3 events that were transitory—ie, increased plasma potassium ion concentrations in one patient and a transitory grade 3 γ-glutamyltransferase elevation in another patient.
MSCs as an adjunct therapy are safe and can now be explored further for the treatment of patients with MDR or XDR tuberculosis in combination with standard drug regimens. Adjunct treatment with MSCs needs to be evaluated in controlled phase 2 trials to assess effects on immune responses and clinical and microbiological outcomes.