Hillary Clinton: Senator Clinton Calls on CDC to Improve Communication Systems for Combating Tuberculosis

Senate Hearing Today Continues to Raise Questions About Failures to Monitor, Treat and Control Diseases like Drug-Resistant TB

June 6, 2007 -- Washington, DC - Senator Hillary Rodham Clinton today called on Dr. Julie Gerberding, Director of the Centers for Disease Control and Prevention (CDC), to immediately develop protocols to guide the actions of national, state and local health officials when suspected cases of extensively drug resistant tuberculosis (XDR-TB) or multidrug resistant tuberculosis (MDR-TB) arise.

In sending her letter to Dr. Gerberding today, the Senator drew attention to the continuing lack of clear answers from government agencies tasked with dealing with this kind of health crisis, a problem which was only affirmed by testimony before a hearing today of the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

“This recent case of XDR-TB has shed a glaring light on how our public health departments identify, monitor and treat the disease and today’s Senate hearing again raised more questions than it provided answers. Diagnosis, treatment and education regarding XDR-TB requires a unified national response, involving the CDC partnering not only with its public health colleagues at the state and local level, but also with other federal agencies that help to protect our nation’s health. We must fix the communications breakdown,” Senator Clinton said. “We need to ensure that our state and local public health departments have the resources they need to respond in the case of a crisis. It is obviously past time for the CDC to develop a clear protocol for state and local health officials to follow when cases of XDR-TB and MDR-TB are suspected.”

Senator Clinton’s letter comes in addition to her recent sponsorship of the “Stop Tuberculosis (TB) Now Act of 2007”, and the “Comprehensive TB Elimination Act of 2007”, legislation aimed at preventing further cases of TB and fighting the disease on a global and a national scale.

From 1993 to 2006, there were 49 reported cases of XDR-TB in the United States, more than half of which occurred in New York State. Globally, almost 40 countries have reported cases of XDR-TB to the World Health Organization. In 2006, more than 13,000 cases of active tuberculosis were reported in the U.S.

Senator Clinton’s letter to Dr. Gerberding follows –

June 6, 2007

Julie Louise Gerberding, M.D., M.P.H.
Director
Centers for Disease Control and Prevention
Department of Health & Human Services
1600 Clifton Road, N.W.
Atlanta, Georgia 30329

Dear Dr. Gerberding:

The recent, well-publicized case of Andrew Speaker’s extensively drug-resistant tuberculosis (XDR-TB) discovered in the United States has raised awareness about this disease and the ways in which it is monitored and treated and controlled by our public health departments. Like you, I am gravely concerned by the public health threat posed by both XDR-TB and multidrug-resistant tuberculosis (MDR-TB), and I believe the events of the past few weeks should spur you to make improvements in our public health infrastructure, particularly in the areas of coordination between federal, state and local health departments and between the Centers for Disease Control (CDC) and other federal agencies that play a role in protecting public health.

Your testimony and the testimony of others, including Mr. Speaker, before the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the Senate Appropriations Committee only raises more questions about significant breakdowns in communication that occurred with this case.

Although both XDR-TB and MDR-TB make up less than 2% of the over 13,000 cases of tuberculosis reported in the United States on an annual basis, they present a grave public health threat. Tuberculosis used to be a leading cause of death in the United States. With the advent of antibiotics, our health care providers were largely able to treat and cure this condition through regimens that involved months of treatment. However, the rise of MDR-TB in the 1990s challenged our clinical protocols, requiring treatment protocols that are roughly twice as long as those necessary for non-drug resistant TB – thus increasing concerns around adherence to regimens. The treatment outlook for XDR-TB is even more complicated. Less than 1/3 of those infected with this type of tuberculosis are expected to be cured. If we do not take steps to address both MDR-TB and XDR-TB, we may once again face a situation where tuberculosis is a leading cause of death in our nation.

I am particularly concerned about this disease because of its disproportionate impact on New York. Of the 49 cases of XDR-TB that have been identified in the United States since 1993, more than half were identified in New York State or New York City. Indeed, the work done by health care professionals in New York City was critical in assessing the risks presented by the most recent case of XDR-TB.

In the face of antibiotic resistance, we must rely on early diagnosis, rigorous infection control practices, and strong public awareness campaigns to limit the spread of XDR-TB. I understand that most cases of tuberculosis infection are handled at the state or local level, and that the CDC only become involved when greater expertise is needed. However, I believe that we need to ensure that state and local health departments are able to handle cases appropriately from the moment that they are identified as XDR-TB. To date, only about 10 states have reported cases of XDR-TB, and as you know, there is much misinformation about the condition. We should never again have a situation where delays in communication between the CDC and other domestic public health officials lead to needless exposure and risk. I would urge you to develop a protocol based upon our best available knowledge to guide the actions of state and local health officials that clearly delineates the actions that should be taken when suspected cases of MDR-TB or XDR-TB appear.

Such action would be in keeping with global efforts to improve response to this condition. In October 2006, the World Health Organization (WHO) Global Task Force on Tuberculosis released 9 recommendations for addressing XDR-TB around the world. Several of those recommendations address actions that can and should be taken at the country level, including management of patients, strengthening of laboratory capacity, and enhancement of advocacy, communication and social mobilization efforts. I know that you are very familiar with those recommendations, and according to the March 23, 2007, edition of the CDC’s Morbidity and Mortality Weekly Report, the Federal Tuberculosis Task Force is working on a response to both the domestic and global epidemics. I also understand that senior-level officials are working on an interagency response, which is particularly important given the fact that lack of interagency collaboration and communication has been identified as a problem in this particular case.

I would ask that you provide me with an update on the work of both the Task Force and the interagency response, with a focus on the following questions:

1. In what ways is the United States using the WHO recommendations to guide its response to the epidemic? What is the timeline for implementing such recommendations to address domestic preparedness for XDR-TB?

2. How are you working with state and local health departments to ensure that there exists adequate capacity at all levels of government to diagnosis and properly treat MDR-TB and XDR-TB?

Thank you for your attention to this issue. I look forward to working with you to improve our local, state and federal response to all forms of tuberculosis.

Sincerely yours,

Hillary Rodham Clinton

Source: Senator Hillary Rodham Clinton

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