Minnesota Department of Health (MDH)
Tuberculosis (TB) Advisory Committee (TBAC)
Minutes of the March 24, 2011 Meeting
Members present:
Dave Golden
Betty Hanna
Sue Husby
Carol Klitz
Kevin McCoy
Tom Michaels
Alberto Ricart.
Patty Seflow
Ann Settgast
Sharon Traen
Arnold Vang (for Karen Marienau)
Will Wilson
Organization:
Student Health Services – Boynton Health Service
Community Clinics - NorthPoint Health & Wellness
MN Association of Occupational Health Nurses
Hennepin County Public Health Clinic
Olmsted County Public Health TB Program
Council of Health Plans – U Care Minnesota
Andover Park Clinic
St. Paul-Ramsey County Department of Public Health
Center for International Health – HealthPartners
Dakota County Public Health
CDC Minneapolis Quarantine Station
MN Department of Human Services
Members not present: Osman Ahmed, Timothy Aksamit, Lori Groven, Lisa Fink, Jill HeinsNesvold, Jerry Hoistad, Neal Holtan, Noreen Kleinfehn-Wald, Joanne Larson, Karen Marienau,
Christine Reller, Chuck Sieber, Amanda Smith, and Dean Tsukayama.
Minnesota Department of Health (MDH) staff present:
Cynthia Hickman
Metro District Epidemiologist
Marge Higgins
TB Program Refugee and Immigrant Coordinator
Beth Kingdon
TB Program Education Coordinator
Nadya Sabuwala
TB Nurse Case Manager
Ann Sittig
TB Nurse Case Manager
Deb Sodt
TB Program Manager
Sarah Solarz
TB Program Epidemiologist
Substitute Committee Chair Carol Klitz called the meeting to order at 6:10 P.M.
Welcome and introductions
Chair welcomed all present, announced membership changes, introduced new Committee members,
and invited everyone to introduce him or herself.
Dr. Ed Ehlinger, who represented College Health Services, was appointed by Gov. Dayton to
serve as Commissioner of Health – congratulations to him! However, this means he will no
longer be serving on the Committee.
Dave Golden, Director of Public Health and Communications at Boynton Health Services at the
U of M, is taking Ed’s place on the Committee.
Dr. Ann Settgast, from HealthPartners Center for International Health is replacing Bill Stauffer
on the Committee, representing International Health. Bill was not able to make these meetings
due to his schedule, but will be presenting to the Committee in the future about his international
and domestic health screening work.
1
Will Wilson from DHS is taking Chris Reisdorf’s place on the Committee.
Betty Hanna will be retiring before our next meeting, so we are looking for a replacement from
the Community Clinic sector. Chair and MDH staff thanked Betty for her service and wished her
well in retirement.
Arnold Vang, from the CDC MSP Quarantine Station, attended the meeting in place of
Committee member Karen Marienau.
Marge Higgins, MDH TB Advisory Committee Coordinator, called members’ attention to the
handout listing current Committee membership and the sectors represented. She invited Committee
members to suggest new membership categories or individuals who play an important role in TB
prevention and control in the state, as potential additions to the Committee. No suggestions were
made at the meeting, but committee members can email Marge with their ideas.
Updates and announcements
Beth Kingdon, MDH TB Education Coordinator, enthusiastically promoted an updated CDC
resource, the “Blue Booklet”, Latent Tuberculosis Infection: A Guide for Primary Health Care
Providers. The revisions include the use of IGRAs. Beth provided members with a copy of the
booklet and directed them to CDC’s web site to order additional (free) copies.
Kevin McCoy, Olmsted County PHN, informed the Committee of an arrangement made by
Olmsted County Public Health Clinic with surrounding counties. The clinic has signed contracts
to see TB suspects or cases from neighboring counties. Winona, Houston, and Steele counties
have signed contracts, and Wabasha, Fillmore, and Dodge counties are considering it. Olmstead
County may consider expanding this arrangement in the future to include LTBI referrals.
Kevin also shared that Hawthorne Education Center, which primarily offers English classes to
new arrivals, is doing targeted testing and treatment for TB on a quarterly basis. A retired Mayo
Clinic physician is implementing the program. Persons diagnosed with LTBI are referred to
Olmsted County Public Health Clinic for treatment. Currently they have a treatment completion
rate of 70%. Marge Higgins offered to share with Kevin the ESL teaching materials she
developed for classes in the Twin Cities.
Marge Higgins provided an update on some of the Refugee Health Program activities. The MDH
Refugee Health program has developed screening tools, a web-based surveillance tool, and
systems for successful and comprehensive domestic refugee screenings that are seen as national
standards. For the past several years, Minnesota’s refugee screening rate has consistently been
over 95%. Ann O’Fallon, the Refugee Health Program Manager, is currently on leave from
MDH and has taken a six-month position with the Association of State and Territorial Health
Officers to develop national Refugee Health Program recommendations.
Marge also informed Committee members of a recent national slow-down in refugee arrivals due
to increased security measures overseas. However, we should expect to meet the national ceiling
of number of arrivals this year. This means we may have a surge in refugee arrivals toward the
end of the federal fiscal year, which is September 30, 2011.
Will Wilson, Department of Human Services, informed Committee members of a special fund
that may be used for medical care of uninsured and uninsurable TB patients. The MDH TB nurse
case managers work with local public health nurses and Will to determine eligibility and to
obtain these funds for patients who qualify. This is an invaluable resource for TB patients
statewide.
Arnold Vang, CDC MSP Quarantine Station, mentioned a TB-related issue he encounters
regarding secondary migration of immigrants and refugees. He raised some good questions about
2
how to ensure universal and timely screening. He stated that some other quarantine stations
schedule medical appointments for new arrivals. These issues can be explored further with those
involved in the refugee and immigrant screening processes.
Dave Golden and Carol Klitz raised their concerns about appropriate screening of international
or traveling students and military personnel as other high-risk groups where appropriate TB
screening could be addressed.
World TB Day
Beth Kingdon shared MDH TB Program activities for World TB Day 2011 including:
o sending a letter to local public health and community partners encouraging them to
sponsor activities to raise awareness of TB,
o writing and distributing an article on TB for ethnic media outlets,
o giving educational presentations at two ESL classes in Minneapolis,
o highlighting World TB Day on the MDH web page, and
o hosting an event at MDH for the Laboratory, Refugee Health, and TB Program staff
to network and build relationships.
Beth asked for suggestions from Committee members for World TB Day next year. She
acknowledged that we have to be sensitive to the social and political climate, as TB is declining
and it disproportionately affects our immigrant and refugee population. Education and
awareness-raising activities need to be focused and appropriate for the audience. Committee
members were encouraged to send ideas for future activities to Beth.
2010 TB Surveillance Data
Sarah Solarz, TB Program Epidemiologist, presented a summary and highlights of MN TB data
through 2010, including:
o Being born outside the U.S. continues to be the highest risk factor for TB (80%).
o The number of foreign-born and U.S. born cases has decreased dramatically in the
last 2-3 years.
o TB cases historically have occurred in approximately 30 of MN’s counties, but in
2010, only 15 counties reported TB cases.
o We are seeing an increase in the number of TB cases with diabetes.
o Drug resistance has decreases slightly
o Very few of our cases are being found though active cases finding methods such as
refugee screening, class B follow-up, and contact investigations. The majority of TB
cases are identified when presenting for illness-related medical care.
Slides from this presentation are in the meeting attachments. Additional surveillance data and slides
are on the MDH TB Program website at: www.health.state.mn.us/tb.
MDH TB Program Activities and Current Issues: Group Discussion
Deb Sodt gave a presentation and lead a discussion on what the MDH TB Program is doing well,
what needs improvement, and some of the future challenges. Slides from this presentation are in
the meeting attachments.
Committee members engaged in discussion and raised questions clarifying some of the
challenges or barriers particularly regarding TB screening and follow-up of immigrants, and
utilizing community health workers in TB follow-up.
3
Wrap-up – Final thoughts or comments from Committee members and future agenda items
Chair Klitz solicited final comments from each Committee member. These included:
Losing funding for health care for TB patients is very concerning
While it might be good to revisit whether international students should be tested for TB, it is true
that schools that require TB testing reap other health benefits like improved immunization rates.
Some larger health care facilities in MN are using IGRAs for employee screening.
There are more opportunities for collaboration with the CDC MSP Quarantine Station in TB
prevention and control.
MDH TB surveillance data is impressive.
Community health workers could be used to fill some gaps in the system, perhaps to serve a
liaison role between clinics and local public health agencies.
Next Meeting Date
September or October 2011
Chair Klitz thanked everyone for participating and adjourned the meeting at 8:05 p.m.
4