July 2024

How to find patient materials in other languages Check out these organizations and agencies for TB educational materials in multiple languages:   CDC TB General Public Communication and Education Resources CDC Find TB Resources Explain TB Explain TB Bilingual Handout Maker BC Centre for Disease Control Minnesota Department of Health  Oregon Health Authority

TB medication information is also available in many languages:

• Oregon Health Authority TB Program has TB medication information sheets available in multiple languages, such as Chuukese, Marshallese, Russian, and Ukrainian, and many other languages for commonly used TB medications. (Use full medication name in search box, not abbreviations).
• Explain TB, an international platform, includes basic information on all 4 standard TB drugs in about 30 languages (see list in webpage dropdown upper left). You can view and/or print materials. The information is written in low-technical terms at basic literacy level. It is intended to be used as a phone app (both Android & iOS) There is info for all 4 RIPE medications, plus fluoroquinolones, moxifloxacin and levofloxacin.
• Minnesota State TB Program has Active TB flyers that include medication side effects, what happens if the patient doesn't take all their medication, and other medication tips for patients available in about 15 different languages.
• For WA LHJs, these links and information can be found on the TB Partners SharePoint TB Medications page.

Did you know dental services are covered under #AppleHealth? DentistLink is a free referral tool to help find a dental provider in your county.  This tool is available to use whether you have insurance, including Apple Health, or not.

Changes to CDEpi main phone line On Tuesday, June 25, 2024, a phone tree began in place for the DOH CDEpi main telephone number (206-418-5500).

Starting June 25^th when you call our main number during business hours, a voice announcement will prompt you to select “1” if you are a member of the public or health care provider or select “2” if you are a public health partner.

When you select “2”:

• If there are no other callers on hold, you will immediately be connected to our admin team.
• If there are other callers on hold, you will have the option to remain on the line until our admin staff pick up OR you can press “1” to leave a voice message.

FYI, when members of the public or health care providers select “1”:

• They will hear a second announcement advising them to call their local health department (including how to find that number)
• They will also have an option to leave a voice message

For all callers, outside of business hours, the current voicemail will remain the same. If you do encounter issues, please let us know via email at: CDEpiAdminTeam@doh.wa.gov or by leaving a message when you call us.

TB Drug Shortages Continue, Why? If we had hoped because life as resumed a somewhat normal since the COVID response has stabilized that it would improve the drug supply chain, we were overly optimistic.   The medication shortages and supply chain issues pre-existed COVID-19.   According to a US Food and Drug Administration (FDA) report released in October that references this 2019 report on Drug Shortages: Root Causes and Potential Solutions, drug shortages have the potential to adversely affect health outcomes by leading to delays in treatment regimens or alternative drug therapies.

In this June 2024 Medscape article, Drug Shortages Are Killing Our Patients, TB meds are not the only drugs that are continuing to experience shortages, resulting in impacts on providers and their patients. 

In this January 2020 Medscape article, 'Frustration and Disbelief' Over Drug Shortages, the FDA created a “critical” drug list for manufacturers to prioritize and this was the result: Executive Order 13944 List of Essential Medicines, Medical Countermeasures, and Critical Inputs | FDA

Most TB medications were not included in this list released in May 2022. Rifampin in IV format was listed in the report but not the pill form and none of the other first 4-line TB meds were included. Linezolid is included with other antimicrobials. 

Bedaquiline FDA Approval Upgrade

FDA Converts Tuberculosis Treatment Sirturo to Traditional Approval (drugs.com) (June 21, 2024)

While Bedaquiline/Sirturo was initially on the FDA’s Accelerated Approval pathway, it has now been converted to Traditional Approval.  Here’s what that means:

The FDA instituted its Accelerated Approval Program to allow for earlier approval of drugs that treat serious conditions, and fill an unmet medical need based on a surrogate endpoint. Drug companies are still required to conduct studies to confirm the anticipated clinical benefit.

• If the confirmatory trial shows that the drug actually provides a clinical benefit, then the FDA grants traditional approval for the drug. 
• If the confirmatory trial does not show that the drug provides clinical benefit, FDA has regulatory procedures in place that could lead to removing the drug from the market. This would mean it would be unavailable to use in the BPaL regimen.

Information for Local Health Jurisdictions (LHJs)

STSADJ Arriver Type Reminders

This is a reminder that LHJ Partners are seeing STSADJ (status adjuster applicant) Arriver types in EDN. Please remember that civil surgeons are now required to enter I-693 data for status adjusters with TB classifications into EDN. This data flows into the EDN system and triggers alerts that look very similar to alerts received for new arrivers with TB class A and class B classifications as determined by overseas Panel Physicians. For more info on what to look out for and how to handle these notifications, please read through our TB Manual: TB Manual: Chapter 4 Class B Notifications (sharepoint.com) If you would like to set up a one on one with a Class B Workgroup team member, please email tbservices@doh.wa.gov.

Managed File Transfer

Service Notification MFT will be undergoing routine updates and will not be available on Sunday, August 11th from 8:30 am to 9:30 am.    What is MFT? Do you have issues sending and/or receiving encrypted email attachments to the DOH TB Program? MFT is a service for agency authorized users to have an approved secure means of transmitting and receiving confidential and restricted information. Requires a web browser to access the service. LHJs can contact tbservices@doh.wa.gov to request an account.

TB Partners SharePoint Updated Resources

TB Community Health Worker Training   Email tbservices@doh.wa.gov with any questions or concerns or to request access to the SharePoint.

Upcoming Events and Education Opportunities

Active TB Qualitative Assessment - Project Participation Request

Martha's Vineyard & Nantucket Public Health are hoping to learn from their public health peers in rural settings (specifically local health departments where less than 40 hours of collective staff time per week is spent on active TB management) to identify areas of success and innovation as well as document the most common and difficult challenges to managing active TB in resource-constrained environments. They are aiming to coalesce best practice tools and models for TB case management in rural settings which can then be shared with participants and rural health departments.  If you would like to participate in this project being done by Claire Myers, an intern with the local health departments in Nantucket and Martha's Vineyard in Massachusetts, please reach out to her at Claire.Myers@emory.edu. This project will be open between now and August 31, 2024.

June 7 - September 6, 2024 | TB 101 Series

This Rutgers Global TB Center 14-part webinar series will provide an introduction to the fundamentals of tuberculosis (TB). The live sessions are held on Fridays. More information here.

Innovations in Tuberculosis (TB) Webinar Series

This Mayo Clinic Center for TB monthly webinar series offers healthcare professionals the latest insights in tuberculosis (TB).

• July 26, 2024: TB Contact Investigation Essentials for Healthcare Professionals

July 17, 2024 | Fundamentals of Medical & Case Management of Drug-Susceptible TB

This is the third in a series of Curry International TB Center's virtual TB Case Management and Contact Investigation Intensive (CMCI) trainings occurring during 2024. Register here.

Bridges to Build: TB in the Pacific Islander Community within the Continental US

This Curry International TB Center training is intended for healthcare professionals, tuberculosis survivors and anyone impacted by tuberculosis. Register here.

September 9-13, 2024 | UW Advanced TB Research Training Course

Registration is now open for the virtual 2024 UW Advanced TB Research Training Course presented by the University of Washington's Department of Global Health, SEATRAC, and the Tuberculosis Research and Training Center (TRTC). Attendance rate is $100 per participant. Register here.

September 17–19, 2024 | TB ETN and TB Program Evaluation Network (PEN) Conference

This conference is jointly sponsored by TB ETN and TB PEN. It presents a unique opportunity for TB program staff to expand their understanding of TB education, training, and program evaluation. Register here.

Washington's TB Project ECHO

On Tuesdays 12:30-1:30 pm PT, join our lunch-time virtual discussion about real TB cases with your peers. This free interactive event is guided by a panel of local TB experts. For more information about this local project and our partners who make this ongoing event possible.

SEATRAC Seminar Series

SEATRAC hosts and promotes seminars, one Friday session per month from 12 - 1 PM, focused on TB basic and clinical sciences by local trainees', local and visiting faculty, and special guests.

2024 ECHO Colorado Newcomer Health Series

In partnership with ECHO Colorado, the Minnesota Center of Excellence hosts a monthly training on newcomer health on the last Tuesday of each month at 8:00 AM, PT. This series is designed to increase medical providers' knowledge of the resettlement and health issues of newcomers, including refugee, immigrant, and migrant (RIM) populations. More information here.

Articles

Treatment Outcomes for Tuberculosis Infection and Disease Among Persons Deprived of Liberty, Uganda, 2020
CDC Emerging Infectious Diseases | 7/2024 | doi #: 10.3201/eid3007.230611

Video Recordings and Education Opportunities

Kitsap Public Health District Recording

• June 12, 2024 | Tuberculosis on the Radar Presentation

CITC Archived Webinars
CME/CE units will not be offered for these trainings. Access here.

Rutgers TB Institute Webinar Archives
CE units are not available for these archives. Access here.

SNTC Archived Webinars
CME/CE units are not offered for these trainings. Access here.

SNTC Online Courses
CME units are offered for these trainings. Access here.

Mayo Clinic Center for TB Courses
CME/CE units are offered for these trainings. Access here. Enter "Public Health" into Specialty to filter through TB courses.

CDC: TB 101 for Health Care Workers
CE units expire on 11/6/2025 and are available at no cost. Access here.

TB ECHO Recorded Archives
Missed a TB ECHO^® session? TB ECHO^® has didactic presentations available for viewing on YouTube. Handouts related to the presentation are included where appropriate. Watch recorded TB ECHO®.

Tools and Resources

Minnesota's Center of Excellence in Newcomer Health

• Access helpful tools, trainings, and updates for newcomers and refugee health here.

CDC

• CDC Learning Connection.
• CDC TRAIN is a comprehensive catalog of free public health training opportunities from the Public Health Foundation. For TB-related trainings, click here.
• FindTBResources.cdc.gov - TB educational materials for patients and providers.
• Visit Everyday Words for Public Health Communication to find plain language alternatives for public health jargon.
• TB Personal Stories patient videos to help raise awareness about TB in the US.
• we are TB offers comprehensive peer support for current TB patients and TB clinics, including weekly live support group sessions.
• Subscribe to the CDC's quarterly newsletter, TB Notes!

DOH Refugee Health Program

• Afghan Health Resources - Fact sheets, webinars, videos, and other health resources (scroll down for TB resources).
• Ukrainian Health Resources - Fact sheets, webinars, videos, and other health resources to support new arrivals from Ukraine (scroll down for TB resources).

Southeastern National TB Center

• Individualized Country Guides

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