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All CA TB Programs will receive We Are TB flyers in early 2022 with a request to give at least one flier to each TB patient in 2022.  These flyers are being provided to encourage, remind and support public health TB program staff to provide TB patients with the opportunity to connect with the TB peer support volunteer members of We Are TB.

Each TB program will be asked to provide a contact in the program with whom CTCA staff can follow up about promoting this opportunity.

By connecting TB patients with We Are TB volunteers, we are supporting We Are TB and their mission to provide TB patients with support through the ongoing challenges and isolation of TB treatment to improve the experience of TB patients through these challenges.

Throughout this project, promoting this connection of CA TB patients with We Are TB member volunteers we want to thank our public health TB care and prevention team members across the state for continuing to provide the excellent care and support they provide to their patients, their contacts and families while controlling the spread of this still life threatening infectious disease. You are the backbone of public health in California.

On November 5, Approximately 150 TB medical professionals gathered for two hours  to participate in the following educational offering:

COVID/TB: Case Intersection, Outcomes, Impact of COVID on TB, Scott Nabity, MD, CDC Medical Officer, California Department of Public Health (CDPH)Tuberculosis Control Branch (TBCB)

Update on Short Course MDR TB Treatment, Pennan Barry, MD, MPH, Surveillance & Epidemiology Section Chief, CDPH TBCB

 San Francisco Department of Public Health Population Health Division, Disease Prevention and Control, Tuberculosis Control Study 31 CA Implementation Process, Janice Louie, MD, Medical Director and Rocio Agraz-Lara, MSN, RN, PHN, Nurse Manager

Report on the U.S. Health Screening of Afghans during Operation Allies Welcome Resettlement and the Potential Impact on Public Health TB Control Programs, Emily Jentes, PhD, MPH, and Kim Skrobarcek, MD, Medical Officers, Medical Assessment and Policy Team (MAP), Immigrant, Refugee, and Migrant Health Branch (IRMH), Division of Global Migration and Quarantine (DGMQ), Centers for Disease Prevention and Control (CDC)

Participants who preregistered, participate in the full conference session and complete an evaluation within two weeks of this offering will receive 2.0 CEs in January or February from the Current International TB Center (CITC).

Serial TB testing is protective when a person with a risk for TB and a positive TB test starts and completes treatment to prevent TB disease.  Recently CTCA was asked to provide input on updates needed to the CalOSHA Aerosol Transmittable Disease (ATD) Standard. We prepared the following testimony and continue to make ourselves available to help provide the best protections for healthcare professionals against TB.

Cal/OSHA Standards Board, October 21, 2021, ATD Standards Board Petition 590 Hearing California TB Controllers Association Testimony
Prepared October 05, 2021

The California TB Controllers Association (CTCA) supports a review and update to the Aerosol Transmissible Diseases (ATD) Standard to minimize TB testing of health care personnel (HCP) without an elevated risk for acquiring TB due to the risk in their facility or in their specific job, encouraging use of the best FDA approved test for TB, i.e. IGRAs for those with a history of BCG, encouraging treatment of latent TB infection (LTBI) when identified to prevent TB disease and transmission, and removing outdated CTCA and CDPH guidelines referenced in the ATD Standard.

Background

In 2005, the Centers for Disease Control and Prevention (CDC) published Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Healthcare Settings. CTCA did not, at the time, support the recommended changes to TB testing of HCP. CTCA members wanted to review California TB data for HCPs before making any changes to testing practices. In 2016, CTCA members, confident that in general HCPs are not more at risk for acquiring TB than the general public, published the CTCA Position Statement on Annual TB Screening of Health Care Workers, October 17, 2016.  And again, after publication TB Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, CTCA reiterated our support of these updates to policies and practice in

the California Tuberculosis Controllers Association response to the release of new recommendations for Tuberculosis Screening, Testing and Treatment of U.S. Health Care Personnel, May 22, 2019.

In general, HCP are protected from TB through baseline testing on hire, contact investigation testing, and taking treatment for latent TB infection (LTBI) when found. Treatment is prevention. Treating LTBI prevents TB disease and TB transmission. CTCA supports TB testing of any HCP when the HCP requests a test for fear of exposure. Again, LTBI treatment is recommended when LTBI is identified in a HCP.

CTCA supports the HCP guidance published this year by the Los Angeles County Department of Public Health (LACDPH) TB Control Program identifying select HCP for serial testing whose regular job duties may place them at higher risk for TB exposure. These duties include performing high hazard procedures (e.g., sputum induction, nebulization, bronchoscopy, endoscopy, autopsy), working in pre-triage patient care areas in urgent care and emergency medicine settings, or working in the mycobacteriology sections of clinical microbiology laboratories.The LACDPH guidance is linked here http://ph.lacounty.gov/tb/docs/HCP_COVID19_interimguidance.pdf. This guidance concurs with the ACOEM GUIDANCE STATEMENT Tuberculosis Screening, Testing, and Treatment ofUS Health Care Personnel ACOEM and NTCA Joint Task Force on Implementation of the 2019 MMWRRecommendations published in July 2020.

CTCA also finds all of the guidelines referred to in the current ATD Standard to be out of date, in need of removal.More general language is recommended, such as see current CTCA CDPH Joint Guidance on the control and prevention of TB in California published on www.ctca.org….

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Peer Support Navigator Jackie Cuen interviewed retired TB specialist Dr. Catanzaro in March of 2021 about tuberculosis, testing, treatment and recovery. The interview has been broken down into short clips to make it easier to find each area covered during the 1.5 hour conversation. Most of the clips are 2-3 min long, but the longest one does not exceed 7 min.

1. https://youtu.be/010E3kUClXc Intro What is TB?
2. https://youtu.be/NMeE3mS9BW8 LTBI v TB
3. https://youtu.be/7lphJf42HTA Primary disease
4. https://youtu.be/N4yrXishqY0 Vaccine
5. https://youtu.be/8cC71L30Drk Dr. Cantanzaro discloses work on Quantiferon (QFT) first blood test for TB. Now there is also the TSpot.
6.  https://youtu.be/Hb9bl8slzh8  Skin Test Facts, negative rules out TB, positive could be BCG or nontuberculous microbacteria disease, which is not transmitted from person to person, for theses reasons the blood test is preferred to identify
7. https://youtu.be/Q3IIAtU3VBg Drug Resistance
8. https://youtu.be/byNMbq2DNJ0 DOT
9. https://youtu.be/ZqOZhoGNuwE Infection v Disease
10. https://youtu.be/YSHoxvB3_ng Immunosuppressants
11. https://youtu.be/SZcs_Ac7OIg Other TB Tests
12. https://youtu.be/ya7ggnynvBw 12 weeks to diagnosis
13. https://youtu.be/kAzDJ_wZHWw TB treatment
14. https://youtu.be/NGbpR7Wdj3w On isolation
15. https://youtu.be/NGbpR7Wdj3w TB acquisition/transmission
16. https://youtu.be/3ZuS-yXqkfQ Pregnancy and newborns
17. https://youtu.be/_z63z3Fqfmk Medication side effects
18. https://youtu.be/9RNPhX_LglU Comfortable asking your medical provider
19. https://youtu.be/4X9eKcj_K0s Variation of symptoms
20. https://youtu.be/Qv7CUOSR3Xg Lingering symptoms
21. https://youtu.be/oKMJE0Gp3pg Pediatric TB
22. https://youtu.be/010E3kUClXc How does being treated for TB impact future TB tests, thank you, and lastly a question about contact tracing: “if you love them, you’ll turn them in.”

The virtual 2021 National TB Conference, Recalibration: TB Elimination Beyond COVID-19 began on Wednesday June 9^th and ran Wednesdays and Fridays through July 23^rd. This dynamic 11 session virtual conference delivered excellent content to nearly 1000 attendees, and those who register for the conference can access recorded sessions and earn CEs for this rich TB care and prevention content for a full year.

The opening session addressed what it will take and what we all can do to reboot ourselves and our TB programs in a post COVID-19 emergency response landscape, beyond the challenges of siphoned staff and the prolonged and persistent draining of energy and focus.

Please consider supporting the National TB Controllers Association and this virtual enduring event by registering through the link above and joining us in our efforts to eliminate the threat of TB.

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On July 13, 2021, The Stop TB Partnership, a global network of organizations working to eliminate the threat of TB worldwide, launched an education campaign calling for a new, more effective vaccine for TB by 2025 because BCG is 100 years old this month and provides poor lifetime protection against TB.  Leading advocates from the Stop TB Partnership explained why this is an important commitment right now on a Facebook Live Event recorded here.

The anchoring message of this campaign follows here:

The BCG vaccine—which was first administered on July 18, 1921, has proven effective against TB meningitis and in protecting against severe TB in infants and young children. However, it offers variable and mostly poor protection against lung disease in adolescents and adults, the populations that are more likely to spread TB in the community. Every year, an estimated 10 million people get sick with TB, the majority living in developing countries. 

The Stop TB Partnership encourages everyone to participate in this social media campaign this year, sharing their campaign materials here.

CTCA’s Communication Committee members commit to joining this campaign on CTCA social media outlets over the next six months, starting with this post. Please join us in raising awareness about the limitations of the BCG vaccine and the need for better protection against TB.

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Earlier this year, Ryan Clary, a seasoned Coalition Consultant relaunched the Coalition for a TB-Free California (CTC). The CTC is made up of members, leaders, and representatives of communities most impacted by TB in California, and partners from California public health departments. Ryan joins us as an experienced infectious disease control and prevention advocate, specifically working on Hep C, HIV/AIDS coalitions. Ryan will work with the CTC to bring together partners, leading and serving those disproportionately impacted by TB in California to increase routine screening for TB risks, routine testing for those with a risk for TB, and encouraging routine treatment for those with TB before it makes them sick.  Together, we can eliminate the threat of TB and create a TB-free California for all. Find out more and join the Coalition for a TB-free California.

On May 6^th, CTCA hosted an open call for new and existing members of the coalition. In addition to public health program staff, the following groups were present: Association of Asian Pacific Community Health Organizations (AAPCHO), Asian American Drug Abuse Program, Asian Americans Advancing Justice – Los Angeles, Asian Pacific Islander Health Forum, Breathe California, Bridging Group (Corrections/health care advocacy), California Black Health Network, California Hepatitis Alliance, San Francisco AIDS Foundation, Hepatitis C and Latino Health Programs, San Francisco Hep B Free, Urban Street Angels

During this first meeting, members discussed potential activities for the coalition. Partners wanted:

• access to brochures and fact sheets about TB for at risk individuals
• education for medical providers, like Project ECHO, focused on TB
• adaptation of the Hep B Coalition model for education, outreach and advocacy
• outreach to elected officials to keep them informed about TB; and
• more focus on the most vulnerable populations (e.g. those living in congregate settings such as prisons or jails)

And, on this call in May, a first relaunching action of the CTC was agreed upon, to educate California Delegates in Washington, D.C. about TB in their districts, and urging them to stay informed about TB by joining the Congressional Tuberculosis Elimination Caucus, co-chaired by Representative Ami Bera, MD (CA-07), Representative Don Young (AK-At Large), and Senator Sherrod Brown (OH) to stay informed about TB. The bulk of this letter follows below:

In April, the California TB Controllers Association (CTCA) and the Association of Asian Pacific Community Health Organizations (AAPCHO) hosted a webinar for public health staff and partner organizations to share up to date information about the impact of disease on California and those most at-risk for TB. The following details were shared:

• 1,703 Californians were diagnosed with tuberculosis in 2020.
• 84% of those diagnosed with tuberculosis in California in 2020 were born outside of the U.S.
• 52% identified as Asian American, Native Hawaiian, or Pacific Islander (AANHPI).
• There are more than 2 million individuals living with Latent Tuberculosis Infection (LTBI) and are likely unaware of it. A person with LTBI has no symptoms and is not contagious. However, LTBI can develop into active tuberculosis at any time.
• 85% of active tuberculosis diagnosed in California is due to LTBI progression, which is preventable.
• Preventing this deadly airborne infectious disease from threatening Californians requires identification and treatment of LTBI before it becomes active tuberculosis.

The coalition will meet monthly. If you’d like to be invited to future CTC meetings, please let us know through the Contact Us button at the bottom of the page.

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The Association of Asian Pacific Community Health Organizations (AAPCHO) co-hosted a World TB Day webinar for TB elimination partners and public health TB program staff entitled The Tuberculosis Epidemic: Impact in California and Strategies to Reach Elimination on April 8th.

The meeting opened with introductions from co-host representatives, the current CTCA President and Orange County TB Program Manager Angelito Bravo, MD,  and Joe Lee the Director of Strategic Initiatives and Partnerships at AAPCHO. For our first presentation, we heard from Jackie Cuen, CTCA TB Patient Peer Support Navigator, as she shared her story of TB diagnosis and treatment in San Diego County. After we heard from Jackie, we heard about the number and distribution of TB cases in California in 2020.

AAPCHO representative, Joe Lee, provided a comprehensive overview of their TB elimination strategies and efforts, explaining that AAPCHO provides advocacy, collaboration, and leadership to drive health equity for Asian Americans, Native Hawaiian and Pacific Islanders (AANHPI) who have been marginalized and minoritized. AAPCHO is addressing TB because, nationwide, nearly 35% of all TB cases reported each year in the U.S. are among the AANHPI communities. TB impacts the over 50 ethnic subgroups with more than 100 languages spoken differently. AAPCHO is closely examining which subgroups are most disproportionately impacted to better target their enhanced prevention services. AAPCHO created the TB Elimination Alliance (TEA), a coalition funded by the CDC to eliminate TB and LTBI inequities among AANHPI populations, through education, awareness raising, innovation to achieve health communities free of TB.

We are excited to continue to build on this partnership and work together to achieve TB elimination.

This webinar was recorded and can be accessed here.

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/TB-Disease-Data.aspx

Each year in March, the number of TB cases diagnosed the year before are reported to the public. Tracking TB diagnoses and subpopulations affected disproportionately directs public health department efforts statewide to allocate resources and strategies to prevent and control TB.

Below is a summary of TB by the numbers in California 2020:

There are more than 2 million Californians living with latent TB infection (LTBI). LTBI is when the TB bacteria are found in the body but not causing symptoms, illness and cannot be spread to others.

85% of those diagnosed with TB disease in California in 2020 developed TB from LTBI.

84% of those diagnosed with TB disease in California in 2020 were born outside of the U.S.

52% of those diagnosed with TB disease in California in 2020 were born in Asia.

40% of adult TB cases had diabetes, end stage renal disease, HIV infection, or another health condition that increases the likelihood that LTBI will progress to TB disease.

Only 20% of those with LTBI are aware that they are living with LTBI.

11 (1.0%) of those diagnosed with TB in California in 2020 had multidrug resistant (MDR) TB.

California has not seen an increase in MDR TB diagnoses since routine testing for TB drug sensitivity began in 1993.

If you want to know more about TB in your area, contact us.