lunes, 2 de mayo de 2016

Updates from the Field: Investing in People

REVISED: Updates from the Field: Investing in People
Updates from the Field: Investing in People

Updates From the Field: Protecting Health and Building Capacity Globally
In This Issue
FETP residents check children for vaccination status

In This Issue
EIS Officer Alaine Knipes with DRC FETP graduate Jacques Likofata

CDC Director Dr. Tom Frieden on top of a water tank in Tanzania with public health colleagues

TB Notes Newsletter | TB Notes 2, 2016 | TB | CDC

TB Notes Newsletter | TB Notes 2, 2016 | TB | CDC

TB Notes 2, 2016April 28, 2016

Notes from the Director

Dear Colleague:
Last month, the Division of Tuberculosis Elimination (DTBE) released preliminary TB surveillance data 
for the United States. According to data from the CDC National TB Surveillance System, TB rates in the 
United States remained approximately 3.0 cases per 100,000 persons during 2013–2015. In 2015, a total 
of 9,563 TB cases were reported. This represents an increase of 157 cases from the 9,406 cases reported
in 2014.
Although we have seen two decades of declining incidence, progress toward TB elimination in the U.S. appears to have stalled. We know there has been much success in the early diagnosis, isolation, and treatment of those with infectious TB disease. However, to move the needle toward continued declines in TB incidence in the U.S., we must also focus on diagnosing persons with latent TB infection (LTBI) and treating them before they can progress to active TB disease.
The U.S. Preventive Services Task Force (USPSTF) supported this expanded approach toward TB elimination with its recent draft recommendation statement. The USPSTF issued a draft recommendation statement that calls for testing for adults who are at increased risk of having latent TB infection. The period for public comments on the statement was March 8th through April 4th.
DTBE has announced a funding opportunity to support these efforts. The project seeks feasible and scalable programs that expand LTBI testing and treatment to persons at high risk. The announcement was released on February 29th, but there is still time to apply. The closing date for applications is May 4th.
Philip LoBue, MD, FACP, FCCP
Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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Highlights from State and Local Programscollapse

Heartland National TB Center Offers Web-Series, Effects of Co-morbidities on TB Nurse Case Management
Heartland National TB Center (HNTC) is offering a five-part web series entitled Effects of Co-morbidities on TB Nurse Case Management. This series is intended for nurses and health care staff who care for persons diagnosed with TB and one or more co-morbidities.
The goal of this web series is to provide information from experts in the field of the identified co-morbidity which can affect TB treatment. Each session will also include a case study of a patient diagnosed with TB and an identified co-morbidity by a TB nurse expert to highlight considerations in case management.
Each session will provide 1.0 nursing continuation education contact hours.
Registration is FREE and required for each session; applicants will receive notification of their enrollment status via email. Additional details can be found on our website at
Catalina Navarro, RN, BSN and Debbie Onofre, RN, BSN are nurse consultants and educators at Heartland National TB Center with a combined total of 20 years’ experience in TB case management.
Part II: Substance AbuseApril 12, 2016 (Archived)
Dr. Heather Gotham is a licensed clinical psychologist and Associate Research Professor within the Collaborative for Excellence in Behavioral Health Research and Practice. She leads a Substance Abuse and Mental Health Services Administration (SAMHSA)-funded project to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use into nursing and social work programs.
Part III: Behavioral HealthMay 18, 2016 (Open)
Dr. Carolyn Harvey is currently the Assistant Professor of Community Health and Preventive Medicine at UT Health Northeast.  She is also the Program Manager for the Behavioral Health Integration Program where her primary role is to assist residents, primary care providers, and clinic staff in the management of mild to moderate behavioral health disorders within the ambulatory clinic setting.
Part IV: DiabetesNovember 14, 2016 (Open)
Dr. Adelita Cantu is an Associate Professor with the University of Texas Health Science Center San Antonio (UTHSCSA) and President of the American Diabetes Association Community (ADA) Leadership Board.
Part V: HIV/AIDSDecember 1, 2016 (Open)
Speaker to be announced, provided by the South Central AIDS Education and Training Center (SCAETC).
Submitted by Jessica Quintero, M.Ed., Heartland National TB Center

Corrections Liaison Partnership Committee
CDC has recommended that a corrections liaison be appointed by the State TB program for each state and territory in the U.S.  The National TB Controllers Association (NTCA) Corrections Liaison Partnership Committee is a resource for states and correctional liaisons. This group maintains aList of Corrections Liaisons by State.  The list was last published in July 2015 and is currently under revision. 
Additionally, the liaisons hold quarterly calls to discuss working through the Public Health Corrections Liaison Competencies and identifying how they work with TB programs, correctional facilities, and the corrections culture. Items covered in these calls include case scenarios, how to work with inmates, and challenges with medical and custody staff.  Callers have the opportunity to ask questions and identify training opportunities within each state and at national conferences.  The group has discussed tips for speaking at sheriff and jail conferences and how to use case scenarios to tailor training to specific audiences.  They meet quarterly and keep the National Corrections Committee apprised of the workgroup’s initiatives.  If you are a correctional liaison and would like to be added to the liaison list and/or the quarterly calls, please contact Ellen Murray.
Submitted by Ellen Murray, BSN, RN, Southeastern National Tuberculosis Center

NTCA Corrections Workgroup Activities
For those searching for TB materials to use in correctional settings, the NTCA Corrections Education and Training Workgroup developed a new repository of materials, called CorrectTB. The team is looking for additional materials to add to the site.  If you have tools or educational materials that you find useful in a correctional setting, please send them to the Corrections Committee at  with the subject line “CorrectTB Resource(s).”
Submitted by Ann Sittig, RN, PHN, MPH, Minnesota Department of Health and Molly Dowling, MPH, CHES, DTBE

3HP Explored in a National Webinar
On March 17, 2016, the Curry International Tuberculosis Center (CITC) hosted a national webinar titled, INH and Rifapentine Treatment for LTBI: Expert Opinions About 3HP Utilization. The 90-minute event featured a panel of experts discussing key issues faced by healthcare providers when using 3 months of isoniazid and rifapentine once weekly (3HP) to treat latent TB infection (LTBI). 
The topic of the 3HP treatment protocol is closely aligned with the national TB elimination strategy of reducing TB cases by addressing the reservoir of LTBI.  Training needs assessments conducted by CITC have long indicated a strong interest among health providers for more information about the 3HP regimen. Nevertheless, when CITC staff opened registration for the webinar, they were astonished by the overwhelming response; there were over 900 registrants within the first 2 weeks.
The live webinar featured Heidi Behm, RN, MPH, TB Controller for the Oregon Health Authority, who facilitated an expert panel comprised of:Marcos Burgos, MD, New Mexico Department of Health; Neha Shah, MD, MPH, CDC/California Department of Public Health; and Mai Vu, PharmD, San Francisco VA Medical Center.  
After Dr. Shah provided an overview of findings from clinical studies related to 3HP, the panel directly explored an array of questions often posed by providers who are using (or considering) the 3HP regimen for their patients:  How should missed doses be handled?; What are the most common drug-drug interactions?; How can side effects be minimized?;  How does 3HP compare with other LTBI regimens in terms of hepatotoxicity?; How does 3HP work for special patient populations such as those who are elderly, diabetic, HIV-positive, methadone users, coumadin users, and patients on dialysis?
During the webinar, participants commented about the U.S. Preventive Services Task Force Draft Recommendation Statement on LTBI Screeningthat will recommend testing for LTBI in at-risk adults. This recommendation could pave the way for insurance coverage of TB testing.  
According to data gleaned from 411 participant evaluation responses, three-fourths of attendees (77%) were nurses who work for TB control/public health programs. The webinar was highly-rated by participants (average 8.94 of a maximum of 10), who participated from all 50 states.  Many attendees indicated the webinar content validated their current experience with 3HP; others commented that the webinar left them better-equipped to initiate a 3HP program in their facilities.  As one participant noted, “We are in the process of implementing 3HP in our ambulatory care setting, so this was very helpful in terms of ideas for protocols, monitoring, etc.”
The INH and Rifapentine Treatment for LTBI: Expert Opinions About 3HP Utilization webinar is archived on the CITC website and available for viewing.
Submitted by Kelly Musoke, MPH, Curry International Tuberculosis Center

Office of the Director Updatesexpand

Communications, Education, and Behavioral Studies Branch Updatesexpand

Data Management, Statistics, and Evaluation Branch (proposed) Updatesexpand

Laboratory Branch Updatesexpand

New CDC Publicationsexpand

High Blood Pressure | National Institute on Aging

High Blood Pressure | National Institute on Aging

e-Update from the National Institute on Aging

You can have high blood pressure, or hypertension, and still feel just fine.
High blood pressure is common in older people and, if not controlled, can lead to serious health problems, like stroke. A stroke is a blood clot or broken blood vessel in your brain.
Have your blood pressure checked regularly. If you are diagnosed with high blood pressure, talk to your doctor about managing your blood pressure to lower your risk of stroke.

Be prepared! Learn the signs of stroke:
  • Sudden numbness or weakness in the face, arm, or leg—especially on one side of the body
  • Sudden confusion or trouble speaking or understanding
  • Sudden problems seeing in one eye or both eyes
  • Sudden dizziness, loss of balance or coordination, or trouble walking
  • Sudden severe headache with no known cause
DON’T IGNORE THE SIGNS OF STROKE! Call 911 right away if you see or feel any symptoms.
Everyone should know the stroke warning signs. Forward this email to your friends and relatives—you could save a life.


High Blood Pressure

Thumbnail of High Blood Pressure (print version)
You can have high blood pressure, or hypertension, and still feel just fine. That’s because high blood pressure often does not cause signs of illness that you can see or feel. But, high blood pressure, sometimes called “the silent killer,” is very common in older people and a major health problem. If high blood pressure isn’t controlled with lifestyle changes and medicine, it can lead to stroke, heart disease,eye problemskidney failure, and other health problems. High blood pressure can also cause shortness of breath during light physical activity or exercise.

What Is Blood Pressure?

Blood pressure is the force of blood pushing against the walls of arteries. When the doctor measures your blood pressure, the results are given in two numbers. The first number, called systolic blood pressure, is the pressure caused by your heart pushing out blood. The second number, called diastolic blood pressure, is the pressure when your heart fills with blood. The safest range, often called normal blood pressure, is a systolic blood pressure of less than 120 and a diastolic blood pressure of less than 80. This is stated as 120/80.

Do You Have High Blood Pressure?

One reason to have regular visits to the doctor is to have your blood pressure checked. The doctor will say your blood pressure is high when it measures 140/90 or higher at two or more checkups. He or she may ask you to check your blood pressure at home at different times of the day. If the pressure stays high, even when you are relaxed, the doctor may suggest exercise, changes in your diet, andmedications.
The term “prehypertension” describes people whose blood pressure is slightly higher than normal—for example, the first number (systolic) is between 120 and 139, or the second number (diastolic) is between 80 and 89. Prehypertension can put you at risk for developing high blood pressure. Your doctor will probably want you to make changes in your day-to-day habits to try to lower your blood pressure.
What Do the Numbers Mean?
(first number)
(second number)
Normal Blood PressureLess than 120Less than 80
PrehypertensionBetween 120–139Between 80–89
High Blood Pressure140 or more90 or more
Isolated Systolic Hypertension140 or moreLess than 90

What if Just the First Number Is High?

For older people, the first number (systolic) often is 140 or greater, but the second number (diastolic) is less than 90. This problem is called isolated systolic hypertension. It is the most common form of high blood pressure in older people and can lead to serious health problems. Isolated systolic hypertension is treated in the same way as regular high blood pressure but often requires more than one type of blood pressure medication. If your systolic pressure is 140 or higher, ask your doctor how you can lower it.

What if Your Blood Pressure Is Low?

If your systolic blood pressure is less than 90, you may have low blood pressure. You may feel lightheaded, dizzy, or even faint. Low blood pressure, or hypotension, can be caused by not drinking enough liquids (dehydration), blood loss, or too much medication.

Some Risks You Can’t Change

Anyone can get high blood pressure. But, some people have a greater chance of having it because of things they can’t change. These are:
  • Age. The chance of having high blood pressure increases as you get older.
  • Gender. Before age 55, men have a greater chance of having high blood pressure. Women are more likely to have high blood pressure after menopause.
  • Family history. High blood pressure tends to run in some families.
  • Race. African-Americans are at increased risk for high blood pressure.

How Can I Control My Blood Pressure?

High blood pressure is very common in older people—over time most people find that aging causes changes to their heart. This is true even for people who have heart healthy habits. The good news is that blood pressure can be controlled in most people.
There are many lifestyle changes you can make to lower your risk of high blood pressure, including:
  • Keep a healthy weight. Being overweight adds to your risk of high blood pressure. Ask your doctor if you need to lose weight.
  • Exercise every day. Moderate exercise can lower your risk of high blood pressure. Set some goals for yourself so that you can exercise safely and work your way up to exercising at least 30 minutes a day most days of the week. You should check with your doctor before starting an exercise plan if you have any health problems that are not being treated. You can find more information about exercise and physical activity from the National Institute on Aging at
  • Eat a healthy diet. A diet rich in fruitsvegetableswhole grains, and low-fat dairy products may help to lower blood pressure. Ask your doctor about following a healthy diet.
  • Cut down on salt. Many Americans eat more salt (sodium) than they need. Most of the salt comes from processed food (for example, soup and baked goods). A low-salt diet might help lower your blood pressure. Talk with your doctor about eating less salt.
  • Drink less alcohol. Drinking alcohol can affect your blood pressure. Most men should not have more than two drinks a day; most women should not have more than one drink a day.
  • Don’t smoke. Smoking increases your risk for high blood pressure, heart disease, stroke, and other health problems. If you smoke, quit.
  • Get a good night’s sleep. Tell your doctor if you’ve been told you snore or sound like you stop breathing for moments when you sleep. This may be a sign of a problem called sleep apnea. Treating sleep apnea and getting a good night’s sleep can help to lower blood pressure.
If these lifestyle changes don’t lower your blood pressure enough to a safe level, your doctor will also prescribe medicine. You may try several kinds or combinations of medicines before finding a plan that works best for you. Medicine can control your blood pressure, but it can’t cure it. You will likely need to take medicine for the rest of your life. Plan with your doctor how to manage your blood pressure.

High Blood Pressure Facts

High blood pressure is serious because it can lead to major health problems. Make a point of learning what blood pressure should be. And, remember:
  • High blood pressure may not make you feel sick, but it is serious. See a doctor to treat it.
  • You can lower your blood pressure by changing your day-to-day habits and by taking medicine, if needed.
  • If you take high blood pressure medicine, making some lifestyle changes may help lower the dose you need.
  • If you take blood pressure medicine and your blood pressure is 120 or less, that’s good. It means medicine and lifestyle changes are working. If another doctor asks if you have high blood pressure, the answer is, “Yes, but it is being treated.”
  • Tell your doctor about all the drugs you take. Don’t forget to mention over-the-counter drugs, vitamins, and dietary supplements. They may affect your blood pressure. They also can change how well your blood pressure medicine works.
  • Blood pressure pills should be taken at the same time each day. For example, take your medicine in the morning with breakfast or in the evening after brushing your teeth. If you miss a dose, do not double the dose the next day.
  • Don’t take more of your blood pressure medicine than your doctor prescribes. Do not stop taking your high blood pressure medicine unless your doctor tells you to stop. Don’t skip a day or take half a pill. Remember to refill your medicine before you run out of pills.
  • Before having surgery, ask your doctor if you should take your blood pressure medicine on that day.
  • Get up slowly from a seated or lying position and stand for a bit. This lets your blood pressure adjust before walking to prevent dizziness, fainting, or a fall.
If your doctor asks you to take your blood pressure at home, keep in mind:
  • There are many blood pressure home monitors for sale. Ask your doctor, nurse, or pharmacist to see which monitor you need and to show you how to use it. Have your monitor checked at the doctor’s office to make sure it works correctly.
  • Avoid smoking, exercise, and caffeine 30 minutes before taking your blood pressure.
  • Make sure you are sitting with your feet on the floor and your back is against something.
  • Relax quietly for 5 minutes before checking your blood pressure.
  • Keep a list of your blood pressure numbers to share with your doctor, physician’s assistant, or nurse.

For More Information About High Blood Pressure

Here are some helpful resources:
National Heart, Lung, and Blood Institute
Health Information Center
1-301-592-8573 (email)
National Library of Medicine
Search for: “high blood pressure”

American Heart Association
1-800-242-8721 (toll-free) (email)

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) (email)

Sign up for regular email alerts about new publications and find other information from the NIA.
Visit, a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.
National Institute on Aging
National Institutes of Health
U.S. Department of Health and Huma