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Northeastern Spotlight
December 2013
Volume 8 - Number 3

Dear Colleague,

This has been a year of many changes here at GTBI, and also a year of many successes.  As always, we have been very pleased to work closely with all of you, our partners in the Northeast region, to provide TB training, technical assistance, and medical consultation.  This year we trained nearly 1700 people through a combination of web-based seminars and in-person trainings.  Twelve of our 15 in-person trainings were provided off-site, and we truly appreciate the collaborative efforts of the TB programs in the Northeast in working together to plan and implement these off-site trainings.

We also celebrated our 20th anniversary here at GTBI this month by hosting a mini-symposium, Rutgers and Tuberculosis, the Legacy: Past, Present, and Future.  As many of you know, we became part of the Rutgers family this year, and are very pleased to be part of an institution with a long history in the fight against TB. The symposium included a presentation from Dr. Douglas E. Eveleigh, which highlighted the discovery of Streptomycin by Dr. Selman Waksman of Rutgers.  Dr. Waksman was awarded a Nobel Prize for this discovery, which changed the landscape of TB treatment here in he US and around the world. I spoke about the clinical, research, and educational work we do here at GTBI, and Dr. Barry Kreiswirth of the Public Health Research Institute at Rutgers gave a presentation on molecular epidemiology and TB.  Finally, Dr. David Alland from the Center for Emerging Pathogens spoke about his ground breaking research and the development of the GeneXpert test, which is poised to revolutionize how TB is diagnosed globally.

This symposium felt like a fitting way to close this year, reflecting on the past, with an eye towards the future. In that vein, we’d like to thank you all for all your hard work in TB control and prevention this year, and say that we look forward to working with you and seeing you at trainings in 2014.  Warm wishes for Happy New Year from all of us here at GTBI.

Sincerely,

Dr. Lee B. Reichman

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Training Highlights

7th Annual TB Medical Consultant’s Meeting

GTBI held its 7th Annual TB Medical Consultant’s meeting on October 9-10, 2013. A total of 25 physicians attended the meeting with representation from 13 of the 15 TB Programs in the Northeast. The meeting provided an opportunity for discussing current and emerging TB issues and building TB medical consultation capacity. The keynote address by Dr. Barbara Seaworth, Medical Director of the Heartland National TB Center, explored treatment, programmatic and ethical challenges of multi-drug resistant TB. Didactic sessions addressed the surgical management of TB, co-morbidities with diabetes and HIV, and TB and organ transplantation. In addition, participants had the opportunity to present cases for clinical discussion and input from colleagues. The meeting was highly rated for content, quality of speakers, practical information, collegial atmosphere, and as in previous years, the attendees found this meeting to be relevant for their role as TB medical consultants. This meeting continues to be a key strategy in GTBI’s efforts to serve the TB medical consultants in our region and will continue to evolve to meet the changing needs of medical consultants in the Northeast.   

Submitted by Anita Khilall, MPH - Senior Training & Consultation Specialist

Maine TB Update

On September 11th we held a one-day TB Update in Lewiston, Maine in collaboration with the Maine Center for Disease Control and Prevention (Maine CDC).  Participants also had the opportunity to attend the training online using Adobe Connect.  This was the second time GTBI worked with the Maine CDC to have a webcast of a live collaborative training, and we continue to be very impressed at how well it works!  Maine CDC has been using Adobe Connect for some time to provide education and training to public health nurses, and they consider it an essential resource given both the current travel budget and resource constraints and the size of the state. From the GTBI side, we appreciated how seamlessly the Maine CDC team handled the webcast. Registrants had the opportunity to view each speaker and their PowerPoint slides and ask questions of the presenter as if they were sitting in the audience!  They even had a choice of two breakout sessions to attend.  A designated Maine CDC team member coordinated the technical side of the training the entire day of the event. This included monitoring the questions that came in via the web, setting up webcams, troubleshooting etc. The moderator also tried to draw online participants in periodically in order to keep them engaged.

We were thrilled to have expert faculty from throughout New England presenting on a wide range of topics including TB case management, managing complex TB cases, legal interventions, pediatric TB, and collaborative community efforts in TB diagnosis and treatment.  A total of 51 people attended the training; 30 attended in person, and 21 attended online. The training was very well evaluated, and we look forward to working with the Maine TB program on future in-person and online trainings!

Submitted by Nisha Ahamed, MPH, CHES - Program Director, Education and Training

NY State TB Update
In October we collaborated with the New York State Department of Health, Bureau of TB Control and the Nassau County Department of Health to offer a one-day training on October 24th on Long Island. We have worked collaboratively with the New York State Department of Health on trainings in the past, but this was our first training on Long Island!  The location was chosen to make it accessible to attendees from that area as well as Westchester and Rockland counties and New York City. A total of 73 participants attended this training and were brought up to date on the new 12- dose regimen for LTBI. This included an overview of the new recommendations as well as the experiences of the New York City and Rockland County TB Programs.  The training also included presentations on MDR-TB, TB in children, TB genotyping, and a laboratory update. Finally, there was a case presentation that addressed some of the challenges associated with TB nurse case management. 

Submitted by DJ McCabe, RN, MSN - Trainer & Consultant Clinical Programs

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Product Updates/Revisions:

Tuberculosis Handbook for School Nurses

We are pleased to announce that a revision of this often requested material will be available online shortly. School nurses can play an integral role in the screening and management of children with LTBI and TB disease. This may include implementing tuberculin testing programs in their schools or working in collaboration with community providers in both the public and private sectors to provide DOT and manage the care of a child with TB disease or LTBI. The original version of the TB School Nurse Handbook was issued in 1998 and it was revised in 2001 and 2011. The booklet includes a section on TB fundamentals as well as suggestions for applying them in a school setting. While much of the TB fundamental information remains unchanged, recommendations for additional LTBI options have emerged. So, we’ve taken the opportunity to carefully and thoroughly review the entire document with the help of several external reviewers. These 2013 revisions will make the handbook an even more useful resource for school nurses. It will be accessible on our website and can be downloaded and printed in either regular or booklet format.

Submitted by DJ McCabe, RN, MSN - Trainer & Consultant Clinical Programs

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Faculty Profile-Jaime Comella, MPH

Jaime Comella took a global path to her current position as the Program Manager for Tuberculosis (TB) and Sexually Transmitted Diseases (STDs) at the Rhode Island Department of Health, Division of Infectious Disease and Epidemiology. After graduating from Colby College in Maine, she volunteered with the Peace Corps in El Salvador.  Jaime was a Municipal Development Volunteer and helped communities to organize so they could draft proposals to non-governmental organizations for municipal projects.  However, she found community members had urgent health concerns that limited their participation.  She remembers one community member had to cancel a meeting about an upcoming proposal because their infant had diarrhea and they had to walk 2 hours to get to the local health clinic. Tuberculosis was endemic in El Salvador and Jaime remembers seeing billboards about the disease while she was there.  These experiences in El Salvador led to her interest in public health as a career. 

When she returned to the United States (US), Jaime worked as an HIV case manager in Taunton, Massachusetts.  That experience solidified her interest in public health and she enrolled at the Tulane School of Public Health and Tropical Medicine and earned her Master’s in Public Health.  Next, Jaime worked with UNICEF in Sierra Leone on a variety of projects including a needs assessment of a therapeutic feeding center for severely malnourished children.  At the time, Sierra Leone had the highest under 5 and infant mortality rates in the world.  Malnourishment was one of the largest contributing factors to the high rates of death in these age groups.  After her return to the US, Jaime worked for 5 years at the Salvation Army as Director of Social Services in Rhode Island.  Through all of her experiences, both global and local, Jaime saw that those who are disadvantaged are usually those at the highest risk for many health concerns.

Jaime has been with the Rhode Island Department of Health for the last year.  She remembers the job description was very vague when she applied for the position.  However, at the interview, she was thrilled to hear she would be working with TB and STDs, her “two hats.”  While she had broad public health experience, she has had to learn the technical clinical aspects of TB by fire.  She counts herself lucky to have such a great network of colleagues at the Rhode Island Department of Health and the RISE Clinic at The Miriam Hospital. 

Jaime greatly enjoys her experiences in TB and finds her work rewarding.  Through Directly Observed Therapy (DOT) and case management, she feels connected to patients.  As a manager, she can see the ramifications and results of her decisions in patient care.  That connection is important to Jaime because of her background in grassroots projects and social services.

When she is not working, Jaime is busy with her two daughters aged two and a half and four and a half.  She also enjoys going to the beach, and running when she has the time.  Jaime still loves to travel and likes to go somewhere every year.  This past year she went to Lake Winnipesaukee in New Hampshire, and next year she plans on visiting coastal Maine.

Submitted by Jennifer K. Campbell, MPH CHES - Training and Consultation Specialist

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Announcements

Don’t miss the latest technology ……..

Free CDC Mobile App for Latent Tuberculosis Infection. This app includes:

  • CDC guidelines on latent TB infection
  • Treatment table outlining regimen options
  • TB testing and diagnosis recommendations
  • TB education and training resources
  • Sample documentation forms for TB testing
  • Ability to personalize your experience with highlighting, annotation, and bookmark options

We hope you download this app and share the content with others through social media, such as Facebook!

Click here to learn how to get this new app.

Read the latest on PPD shortages ……..

MMWR December 13, 2013 / 62(49);1014-1015
Extent and Effects of Recurrent Shortages of Purified-Protein Derivative Tuberculin Skin Test Antigen Solutions – United States, 2013

Read the latest on TB drug shortages...

NTCA Responds to the Shortages of TB Drugs and Diagnostics

TB drugs and diagnostics are truly a lifeline for TB control. However, shortages and price increases periodically make these tools inaccessible to health care providers. A series of shortages and price increases in TB drugs and diagnostics started in the fall of 2012 and continued in 2013. To address these problems nationally, federal agencies and advocacy organizations need real-time, verifiable information about the scope and effects of these shortages.

Click here to read more

 

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Upcoming NE RTMCC Training
The New Jersey Medical School Global Tuberculosis Institute (GTBI) sponsors courses and web-based seminars on tuberculosis.  GTBI web-based seminars are open to all participants in the United States.  For in-person courses, GTBI prioritizes participants from the Northeast Region (Baltimore, Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York City, New York State, Pennsylvania, Philadelphia, Rhode Island, Vermont, and Washington, DC), which is served by GTBI.

Click here for the list of upcoming courses.

2014 New York City World TB Day Walk and Conference: One City. One World. Zero TB.

To commemorate World TB Day we will again co-sponsor a TB Update with the New York City Department of Health and Mental Hygiene. On March 21st a one-day training for nurses and physicians and other healthcare professionals will be held in Long Island City, NY with topics related to updates in LTBI testing and treatment, the effects of the Affordable Care Act on care of patients with TB, and advocacy for TB patients.

The first World TB Day Walk in the NYC area was held last year and the 2014 awareness-raising event promises to be bigger and better! It is scheduled for Saturday, March 22nd, when marchers will be led by a band from Union Square Park to Washington Square Park. After the march, complete with placards and chants and slogans to alert the public that TB is still a health issue in the United States, we will continue with activities for children, speakers, snacks and goodie bags. Please consider joining us if you can!

You can see photos from this year’s walk at http://on.fb.me/1bKFzPK. Register for the walk here.

Submitted by DJ McCabe, RN, MSN - Trainer & Consultant Clinical Programs

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Medical Consultation

GTBI faculty and staff respond to requests from healthcare providers seeking medical consultation. Consultants can be reached by calling the TB Infoline: 1-800-4TB-DOCS or by Email.

During each consultation, the GTBI consultants will advise callers about resources/TB Programs http://www.cdc.gov/tb/links/tboffices.htm in their jurisdiction. In addition, TB programs will be informed of TB cases with public health implications such as MDR/XDR-TB, pediatric TB in children <5, or potential outbreak situations.

More information about our consultation service, including downloadable Core TB Resources, is available at http://globaltb.njms.rutgers.edu/services/medicalconsultation.html

Medical Consultant Web-Based Grand Rounds

Periodically, designated TB program medical consultants are invited to participate in a web-based TB case conference (Grand Rounds). Consultants are encouraged to present challenging TB cases and get feedback from their colleagues throughout the Region. TB program Medical Consultants who would like to present a case should contact Dr. Alfred Lardizabal at 973-972-8452 or lardizaa@njms.rutgers.edu.

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Links - Other TB Resources

Division of Tuberculosis Elimination
The mission of the Division of Tuberculosis Elimination (DTBE) is to promote health and quality of life by preventing, controlling, and eventually eliminating tuberculosis from the United States, and by collaborating with other countries and international partners in controlling tuberculosis worldwide.

Find TB Resources Website
This website provides a central, comprehensive searchable database of international, national, state, and local TB-related education and training materials for TB healthcare workers, health professionals, patients, and the general public. Users can also submit their education and training materials as well find information on funding opportunities, TB organizations, TB mailing lists, and TB images.

TB Education & Training Network (TB ETN)
The TB Education and Training Network (TB ETN) was formed to bring TB professionals together to network, share resources, and build education and training skills.

Regional Training and Medical Consultation Centers' TB Training and Education Products
This website provides a searchable list of all RTMCCs' resources.

TB Wire Newsletter

  • Announcements
  • Washington Update
  • Linkable Journal Abstracts
  • Resources/Training
  • Selected TB Reports 
  • Grants, Job Opportunities
  • Meetings, Conferences & Events
  • To subscribe to this service, click here

TB Behavioral and Social Science Listserv
Sponsored by the DTBE of the CDC and the CDC National Prevention Information Network (NPIN), this Listserv provides subscribers the opportunity to exchange information and engage in ongoing discussions about behavioral and social science issues as they relate to tuberculosis prevention and control.

Other RTMCCs  
The Curry International Tuberculosis Center serves: Alaska, California, Colorado, Hawaii, Idaho, Nevada, Oregon, Utah, Washington, Federated State of Micronesia, Northern Mariana Islands, Republic of Marshall Islands, American Samoa, Guam, and the Republic of Palau.

The Heartland National Tuberculosis Center serves: Arizona, Arkansas, Kansas, Louisiana, Missouri, New Mexico, Nebraska, Oklahoma, and Texas.

The Mayo Clinic Center for Tuberculosis serves:  Illinois, Indiana, Iowa, Michigan, Minnesota, Montana, North Dakota, Ohio, South Dakota, Wisconsin, and Wyoming

The Southeastern National Tuberculosis Center serves: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Puerto Rico, West Virginia, and the U.S. Virgin Islands.

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Key Contacts

  • Lee B. Reichman, MD, MPH - Executive Director
  • Eileen C. Napolitano - Deputy Director
  • Alfred Lardizabal, MD – Associate Director
  • Reynard J. McDonald, MD - Medical Director
  • Bonita T. Mangura, MD - Director of International Activities
  • Nisha Ahamed, MPH - Program Director, Education and Training
  • D.J. McCabe, RN, MSN – Spotlight Editor

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