CITC Newsletter – Winter 2020

An electronic newsletter from the Curry International Tuberculosis Center (CITC)

To our friends, colleagues and partners…

As we close 2020, we reflect on a year like no other. During these months of upheaval and unspeakable loss, our health care community responded with fortitude, grace, compassion and true grit.  We end the year in alternating states of fatigue and hope, grief and gratitude. The Curry team will be forever inspired by your unwavering dedication to our public health mission. The winter has not yet passed, but a new year beckons with the promise of brighter days. May your holidays be joyous and healthy.  

Curry 2020 Holiday Curry Staff Photo

 

TB and COVID-19: Potential synergies

The public health response to the COVID-19 emergency has been significantly informed by the knowledge and expertise of the TB control community.  TB programs, in turn, have been hard hit by the pandemic’s demands. Looking ahead to a post-crisis horizon, public health leaders analyze the intersection of TB and COVID-19 and the potential for beneficial synergies – at the state, national, and international levels.

Jenny Flood, MD, MPH

Jennifer Flood, MD, MPH

On November 12, Jennifer Flood, MD, MPH, Chief of the TB Control Branch at the California Department of Public Health, presented her annual overview of TB in California at the Fall Meeting of the California TB Controllers Association (CTCA).  Her remarks included results from a CTCA member survey in which local health jurisdictions were asked how the COVID pandemic had affected their TB programs. Impacts included: Deprioritized local TB control and prevention activities; redirected staffing; limited access to clinical services and physician consultation; and gaps in case management, contact investigations, and TB prevention.

Looking ahead, Dr. Flood highlighted several ways that sustained investment in COVID innovations could strengthen TB control:

 

  • Increased access to health care: Tele-health; drive-thru and in-home testing; linkage to care; universal testing and treatment payment
  • Testing and tracing: Rapid contact investigation at massive scale; novel tracking systems, expanded workforce; streamlined referral systems
  • Public awareness: Outreach to overlapping communities; massive education campaigns; vaccine promotion

CITC co-founder Phil Hopewell collaborated with two other renowned TB leaders (Drs. Ken Castro and Lee Reichman) to explore “the underappreciated synergies” between COVID-19 and TB in a “Perspective” article, now in early release in Emerging Infectious Diseases. The three long-time colleagues note: “…COVID-19 and TB share commonalities in transmission and public health response: case finding, contact investigation, and evaluation. Data supporting interventions for either disease are, understandably, vastly different, given the diseases’ different histories. However, many of the evolving issues affecting these diseases are increasingly similar. As previously done for TB, all aspects of congregate investigations and preventive and therapeutic measures for COVID-19 must be prospectively studied for optimal evidence-based interventions.”

Mike Reid, MD

Commentators also reflect on the impact of TB/COVID synergies within the international arena. In the October 24 issue of The Lancet, Drs. Michael Reid and Eric Goosby (both with the Institute for Global Health Sciences/UCSF) contributed to Building a tuberculosis-free world while responding to the COVID-19 pandemic. Acknowledging the negative short-term impact of COVID-19 on TB services and potential increase in TB burden and incidence, the authors conclude: “Now is the time to leverage the political capital that exists for the global COVID-19 response to enable lasting change in the tuberculosis response. COVID-19, like tuberculosis, reminds us of the importance of prioritising health and allocating financial and human resources for universal health coverage and addressing the needs of vulnerable populations.  With sound science, effective collaboration, smart investments, and efficient synergies, COVID-19 efforts could strengthen the global tuberculosis response and not undermine it.” Drs. Sachin Silva (Harvard) and Nimalan Arinaminpathy (Imperial College London) were co-authors.

  

Rifampin and Rifapentine: Impurities and shortages?

orange transparent pill containers

Reports of impurities and shortages may impact the availability of two important drugs used to treat active TB disease and latent TB infection (LTBI).

Rifampin (RIF) is the “R” in RIPE/HRZE, the standard four-drug regimen prescribed to treat drug-susceptible TB disease. RIF is also a mainstay in various LTBI treatment regimens (3HR, 4R). Rifapentine (RPT) comprises half of the 3-month regimen of weekly RPT with isoniazid (3HP) for treating LTBI. Short-course regimens like 3HP are associated with better patient adherence and higher treatment completion, and have gained favor in updated LTBI treatment guidelines.

Recently the FDA adopted a new regulatory standard to test all medications for nitrosamines, compounds that have been implicated as possible carcinogens in long-term animal studies. Elevated levels of nitrosamines (origin currently unknown) were found in RIF and RPT. Most nitrosamine exposure in humans comes from dietary sources (cured meats and alcoholic beverages).

In a “Dear Colleague Letter” released by the CDC’s Division of TB Elimination, Dr. Terrance Chorba said: “In June 2020, shipments of rifapentine (supplied as Priftin® 150 mg film-coated tablets manufactured by Sanofi) were paused after a nitrosamine impurity was found. FDA and Sanofi have not announced when shipments will resume, and FDA still lists rifapentine as ‘Currently in Shortage.’”

“Unrelated to the detection of nitrosamines, in June 2020 the manufacturer of RIF (Sanofi) announced the discontinuation of three oral rifampin-containing products: Rifadin® (rifampin 150 mg and 300 mg capsules); Rifamate® (a fixed-drug combination of isoniazid and rifampin), and Rifater® (a fixed-drug combination of isoniazid, rifampin, and pyrazinamide). FDA is working with other manufacturers to maintain availability of rifampin, and there is no national shortage of rifampin at present.”

FDA logo

In an October 29, 2020 update, the FDA announced it “…will not object to certain manufacturers temporarily distributing the medicine containing 1-cyclopentyl-4-nitrosopiperazine (CPNP) above the acceptable intake limit of 0.1 parts per million (ppm) and at or below 20 ppm until they can reduce or eliminate the impurity.” This adjustment in acceptable levels was implemented “to mitigate or avoid a shortage and to help ensure patients have access to rifapentine.” The FDA further noted, “the risk of not taking the medicine outweighs any potential risk from CPNP.”

CDC recommends that any program experiencing or expecting a shortage of RIF or RPT notify FDA directly by e-mail (drugshortages@fda.hhs.gov) or telephone (240-402-7770). Shortages may also be reported on a form found on the National Tuberculosis Controllers Association (NTCA) home page.

 

Eric Goosby named to Biden-Harris COVID-19 Advisory Board

Eric Goosby, MD

Eric Goosby, MD, was one of three UCSF faculty recently named to the Biden-Harris Transition COVID-19 Advisory Board. The Board is a 13-member panel of public health and scientific experts that will consult with state and local officials to determine the steps necessary to get the virus under control, to address ongoing racial and ethnic disparities, and to safely reopen schools and businesses.

A distinguished leader within the TB community, Dr. Goosby is an internationally recognized expert on infectious diseases who served as the UN Special Envoy for Tuberculosis from 2015 to 2019. In the Obama administration, he was Ambassador-at-Large and implemented the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

 

President-elect Joe Biden and Vice President-elect Kamala Harris listen during a meeting with the Transition COVID-19 Advisory Board on Nov. 9 in Wilmington, Delaware. Credit: AP Photo/Carolyn Kaster


In a statement released by the Biden-Harris Transition, President-elect Biden said, “Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts.”

Two other UCSF faculty named to the Advisory Board were David A. Kessler, MD, JD, co-chair for the Board, and Robert M. Rodriguez, MD.

 

 

 

Union Medal awarded to CITC founder Phil Hopewell

Union Medal awarded to Phil Hopewell, MD


In October the International Union Against TB and Lung Disease (The Union) awarded its highest honor to CITC founder Phil Hopewell, MD. “The Union Medal” (pictured) is awarded to members who have made an outstanding contribution to the control of TB or lung health by their scientific work and/or actions in the field. Dr. Hopewell received the award at the 51st Union World Conference on Lung Health, held virtually for the first time in its history on October 20-24. According to a Union statement, “Professor Hopewell is well recognised in the global TB community as an expert physician scientist, with his reach extending significantly further through the countless leading TB experts who have benefitted from his mentorship and guidance. Professor Hopewell has devoted five decades of tireless commitment to work on advancing global TB control.”

A co-developer of the International Standards for Tuberculosis Care, Dr. Hopewell provides consultation and technical assistance to the World Health Organization and numerous TB programs in high-burden countries. He continues to practice clinical pulmonary and critical care medicine at San Francisco General Hospital.

 

Upcoming trainings

Information on CITC’s 2021 schedule of courses will be available on the CITC website soon.

Upcoming trainings of interest include:

Study 31 Webinar (in collaboration with CDC and all TB COEs)
Date: To be announced
National webinar

IUATLD NAR TB COE Post Graduate Training (in collaboration with CDC and all TB COEs)
February 24, 2021
Virtual event

World TB Day Webinar (in collaboration with the UCSF Center for Tuberculosis)
March 24, 2021
National webinar

 

About CITC

CITC logo

 

 

 

 

CITC creates, enhances, and disseminates resources and models of excellence, and performs research to control and eliminate TB in the United States and internationally. The Curry Center opened in 1994 and is now designated by the CDC as a TB Center of Excellence (TB COE) for the Western Region, serving Alaska, Arizona, California (including Los Angeles, San Diego, and San Francisco), Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming, and the U.S. Pacific Island Territories. Committed to the belief that everyone deserves the highest quality of care in a manner consistent with his or her culture, values and language, CITC develops and delivers highly versatile, culturally appropriate trainings, educational products, medical consultation, and technical assistance.

 

CITC staff

Principal Investigator / Medical Director: Lisa Chen, MD
Associate Medical Director/Nurse Consultant: Ann Raftery, RN, PHN, MS
Deputy Director: Kelly Musoke, MPH
Director of Education: Elisha Couchman, MA
Program Manager: Jeannie Fong
Program Manager: Amelia Alonis
Web Developer: Mari Griffin, MS
Special Projects Manager/Newsletter Editor:
Kay Wallis, MPH

 

Contact us

Curry International Tuberculosis Center
University of California, San Francisco
2001 Center Street, 7th floor
Berkeley, CA 94704

(510) 238-5100

Warmline TB Medical Consultation: 877-390-6682 (toll-free) or 415-502-4700
CurryTBCenter@ucsf.edu
https://www.currytbcenter.ucsf.edu
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