In 2010, there were 8.8 million new cases of tuberculosis (TB) disease reported worldwide, with over 1 million TB deaths [1
]. In the United States, 11,182 people were newly diagnosed with TB disease [2
]. The mission of the Division of Tuberculosis Elimination (DTBE), Centers for Disease Control and Prevention (CDC) is to promote health and quality of life by preventing, controlling, and eventually eliminating TB from the United States, and by collaborating with other countries and international partners in controlling TB globally [3
Tuberculosis surveillance is a core public health function. Ongoing and systematic collection, analysis, interpretation, and dissemination of surveillance data allow programs to target control interventions that provide the most impact in eliminating TB [4
]. These surveillance data are essential in describing morbidity and mortality, monitoring trends in TB incidence and prevalence, detecting potential outbreaks, and defining high-risk groups. In addition, TB data are needed to evaluate TB control programs, identify deficiencies, and allocate resources. In order to perform these important functions, it is essential that surveillance data are collected and reported in an accurate, complete, and timely manner.
The CDC's National Tuberculosis Surveillance System (NTSS) is the national repository of TB surveillance data in the United States. CDC receives data on TB cases from reporting jurisdictions through a standardized data collection form, the Report of Verified Case of Tuberculosis (RVCT). NTSS has 60 reporting jurisdictions: all 50 US states, the District of Columbia, New York City, American Samoa, Federated States of Micronesia, Guam, Republic of the Marshall Islands, Commonwealth of the Northern Mariana Islands, Puerto Rico, Republic of Palau, and US Virgin Islands.
The RVCT was revised by a group of TB experts in 2009 and transitioned into a new web-based reporting system. An interdisciplinary CDC DTBE team collaborated with key national partners, state-based medical or health officers, and other local healthcare professionals to launch a national training program on the new RVCT [5
]. Extensive reviews of training materials enabled partners to provide feedback for improvements on the instructions for each of the 49 RVCT items [7
]. The team also developed a self-study manual for participants that was used during facilitator-led trainings [8
]. The manual can also be used as self-study for new TB staff and as a reference guide. In addition, a facilitator manual was developed and used during training-of-trainers courses to build RVCT training capacity throughout the reporting jurisdictions [9
Quality assurance (QA) is a critical part of any successful surveillance system and is a continuous cycle of monitoring, evaluating, and improving data quality [10
]. Prior to 2009, jurisdictions depended on a CDC disk operating system (DOS) used for surveillance of TB data. This system provided a series of validation reports to jurisdictions for managing data. When CDC transitioned to a web-based system in 2009, there was a need for a standardized QA process that jurisdictions could adapt to their setting.
The team determined that a logical followup to the RVCT trainings was to enhance the QA knowledge and skills of TB surveillance staff. Furthermore, the RVCT training participants expressed concerns regarding the lack of data validation of some state systems and the inability of reporting areas to transmit all data electronically. DTBE staff began working individually with state public health partners to develop QA strategies. This paper describes these strategies to ensure the quality of TB data reported to the CDC's NTSS through the new web-based system.