Development of new vaccines for tuberculosis: recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET)

Tuberculosis (TB) remains a major, global public health problem, particularly in low-income countries. Better application of current diagnostic, treatment, and prevention strategies could lead to gradual decreases in the disease, but eliminating TB completely in the United States and internationally will require new tools. The greatest impact could come from a new vaccine, and recent technological advances have provided the basis for new vaccine development. However, sustained support is required to move the research from the laboratory to field trials of vaccines and to implement new vaccine programs. Recognizing the importance of TB vaccines, the Advisory Council for the Elimination of Tuberculosis (ACET) recommends that public agencies and vaccine manufacturers develop a comprehensive, consensual strategy to achieve these goals. This report outlines the elements that should be considered in devising a strategic plan for vaccine development.Introduction -- Current control measures -- Eliminating tuberculosis -- Progress in vaccine development -- Needs and recommendations -- Conclusion -- References.August 21, 1998.The following CDC staff member prepared this report: Richard J. O\ue2\u20ac\u2122Brien, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB PreventionIncludes bibliographical references (p. 6)

Tuberculosis elimination revisited: obstacles, opportunities, and a renewed commitment

Advisory Council for the Elimination of Tuberculosis (ACET).Cover title."August 13, 1999."Also available via the World Wide Web.Includes bibliographical references (p. 12-13)

Prevention and control of tuberculosis in migrant farm workers : recommendations of the Advisory Council for the Elimination of Tuberculosis

Farm workers are approximately six times more likely to develop tuberculosis (TB) than the general population of employed adults. These recommendations are presented to assist health-care providers serving migrant and seasonal farm workers. The following services, listed by priority, that should be available for migrant and seasonal farm workers and their family members are: a) detection and diagnosis of those with current symptoms of active TB; b) appropriate treatment and monitoring for those who have current disease; c) contact investigation and appropriate preventive therapy for those exposed to infectious persons; d) screening and appropriate preventive therapy for asymptomatically infected workers who may be immunosuppressed, such as those with human immunodeficiency virus (HIV) infection; e) screening and appropriate preventive therapy for children of migrant and seasonal farm workers; and f) widespread tuberculin test screening for workers and families with preventive therapy prescribed, as appropriate. Health-care providers should immediately perform appropriate diagnostic studies for persons with a productive, prolonged cough, or other symptoms suggestive of tuberculosis. Health departments should be immediately notified when TB is suspected or diagnosed to enable examination of contacts and initiation of other health department diagnostic, preventive, or patient management services. Workers and family members with uncomplicated pulmonary TB should be treated with a regimen that includes isoniazid, rifampin, pyrazinamide, and ethambutol (or streptomycin). Drug-resistant TB is an important consideration since it requires altered treatment regimes and because higher rates of resistance have been found in ethnic and social groups comprising much of the migrant farm worker-force. Patients should be monitored carefully for compliance, treatment response, and toxicity. Ideally, patients should be placed on directly observed therapy given by a well-trained, outreach worker from the same cultural/language background as the patients.At head of title: Centers for Disease Control.Includes bibliographical references (p. 12-13).Infectious DiseasePrevention and ControlCurrent163042

Tuberculosis control laws--United States, 1993: recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET)

Because of its communicable nature and because there are many state laws specific to the control of tuberculosis (TB), TB is managed differently than other airborne infectious diseases [corrected]. Many of these laws predate the current public health recommendations for the prevention and control of TB. In 1989, CDC published A Strategic Plan for the Elimination of Tuberculosis in the United States that was developed by the Advisory Committee (now Council) for the Elimination of Tuberculosis (ACET). The Plan called for the establishment of a national goal of TB elimination (i.e., achieving a case rate of < 1 per million population) by the year 2010. One of the methods for improving disease containment in the Plan was for the use of quarantine measures for nonadherent patients. The Plan called for revision of state and local laws to "facilitate the cure of persons with infectious tuberculosis". The issue of outdated state TB laws was also identified as a problem in the National Action Plan to Combat Multidrug-resistant Tuberculosis. In response to this issue, CDC conducted a survey of state TB control laws and ACET developed recommendations to address discrepancies between previously published recommendations and guidelines for the control of TB and state TB control laws. In order to address these discrepancies, states updating TB control laws should incorporate current recommendations and guidelines from CDC, ACET, and the American Thoracic Society. State laws should permit policies and practices to be rapidly reviewed and amended as new data becomes available and new recommendations and guidelines are published.November 12, 1993.The following CDC staff members prepared this report: Brian M. Willis, Office of the General Counsel Office of the Director; Lawrence Paul Schwartz, Division of Tuberculosis Elimination National Center for Prevention Services; Sarah B. Knowlton, Office of the General Counsel Office of the Director.Includes bibliographical references (p. 12-13)

Programmatic Impact of QuantiFERON-TB Gold In-Tube Implementation on Latent Tuberculosis Diagnosis and Treatment in a Public Health Clinic

Background: QuantiFERON-TB Gold In-Tube (QFT-GIT) is considered an alternative to the tuberculin skin test (TST) for the diagnosis of tuberculosis (TB) infection, but the programmatic impact of QFT-GIT implementation is largely unknown. In March, 2010, the Baltimore City Health Department (BCHD) introduced routine QFT-GIT testing for individuals referred to the TB program for suspected latent TB infection (LTBI). Design: Retrospective study comparing LTBI diagnosis and treatment during the 13 months before and after QFT-GIT implementation at the BCHD TB clinic. Results: 607 and 750 individuals were referred by community-providers for suspected LTBI in the pre- and post-QFT-GIT periods, respectively. Most individuals in the pre- and post-QFT-GIT periods were referred on the basis of a positive TST (597/607 [98%] vs. 690/750 [92%], respectively) and were foreign-born (363/607[59%] vs. 507/750[68%], respectively). BCHD performed QFT-GIT testing for 375/543 (69%) eligible individuals in the post-QFT-GIT period, of which 185 (49%) were positive, 178 (47%) were negative, 1 (0.25%) was indeterminate, and 11 (3%) did not yield results. Concordance of QFT-GIT with TST was low (183/352[52%]). Foreign-born individuals had higher proportions of QFT-GIT positivity (57%) than US-born individuals (36%; AOR 3.3 [95%CI 1.7–6.2]). Significantly fewer individuals received a final diagnosis of LTBI in the post-QFT-GIT period (397/567 [70%]) compared to the pre-QFT-GIT period (445/452 [98%], p,0.001). In the post-QFT-GIT period, onl

Initial therapy for tuberculosis in the era of multidrug resistance: recommendations of the Advisory Council for the Elimination of Tuberculosis

These recommendations update previous CDC/American Thoracic Society (ATS) recommendations for the treatment of tuberculosis (TB) among adults and children [American Thoracic Society, CDC. Treatment of TB and TB infection in adults and children. Am Rev Respir Dis 1986;134:355\u201363.] The most notable changes are in response to the increasing prevalence of drug-resistant TB in the United States. These recommendations include the need for a) in vitro drug susceptibility testing of Mycobacterium tuberculosis isolates from all patients and reporting of these results to the health department, b) initial four-drug regiments for the treatment of TB, and c) initial directly observed therapy for persons with TB. Adherence to these recommendations will help prevent the occurrence of more cases of drug-resistant TB, reduce the occurrence of treatment failure, and reduce the transmission of TB in the United States.Includes bibliographical references.Infectious DiseaseTreatment and InterventionSuperseded841315

Advisory Council for the Elimination of Tuberculosis

The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) Division of Tuberculosis Elimination (DTBE) convened a meeting of the Advisory Council for the Elimination of Tuberculosis (ACET). The proceedings were held on June 29-30, 2010.Attachment 1: List of participants -- Attachment 2: Glossary of acronyms -- Meeting minutes: June 29, 2010 -- Meeting minutes: June 30, 2010"Version 03/22/2010."Available via the World Wide Web as an Acrobat .pdf file (256.24 KB, 57 p.).Includes bibliographical references (p. 85-88)