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Bishara H, Weiler-Ravell D, Saffouri A, Green M. The Challenges of Tuberculosis Management beyond Professional Competence: Insights from Tuberculosis Outbreaks among Ethiopian Immigrants in Israel. Trop Med Infect Dis 2024; 9:29. [PMID: 38393118 PMCID: PMC10892168 DOI: 10.3390/tropicalmed9020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Controlling tuberculosis (TB) among immigrants from high-incidence countries presents a public health concern as well as a medical challenge. In this article, we investigate a TB outbreak in a community of people of Jewish descent who emigrated from Ethiopia to Israel (Israeli Ethiopians) that started in June 2022. The index case was a 20-year-old female who had recently immigrated to Israel with her family. Her pre-immigration tuberculin skin test was positive. After excluding active TB, treatment with daily isoniazid for latent TB (LTB) was started shortly after her arrival. A year later, she was diagnosed with smear-positive, culture-positive, pulmonary TB. Investigation of 83 contacts revealed five additional patients with active TB, and three of whom were members were of her household. In this article, we report the current TB outbreak, review previously published TB outbreaks involving Israeli Ethiopians, analyze the factors that triggered each of these outbreaks, and discuss the challenges that face the Israeli TB control program in an era of declining TB incidence and diminishing resources available for TB control.
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Affiliation(s)
- Hashem Bishara
- Tuberculosis Clinic and Pulmonary Division, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel
| | - Daniel Weiler-Ravell
- Pulmonary Division and Tuberculosis Clinic, Carmel Medical Center, Haifa 3498838, Israel;
| | - Amer Saffouri
- Tuberculosis Clinic and Internal Medicine, Nazareth Hospital, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel;
| | - Manfred Green
- School of Public Health, Faculty of Social Welfare and Health Science, University of Haifa, Haifa 3498838, Israel;
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Torres Ortiz A, Fenn Torrente F, Twigg A, Hatcher J, Saso A, Lam T, Johnson M, Wagstaffe H, Dhillon R, Mai AL, Goldblatt D, Still R, Buckland M, Gilmour K, Grandjean L. The influence of time on the sensitivity of SARS-CoV-2 serological testing. Sci Rep 2022; 12:10517. [PMID: 35732870 PMCID: PMC9214469 DOI: 10.1038/s41598-022-14351-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022] Open
Abstract
Sensitive serological testing is essential to estimate the proportion of the population exposed or infected with SARS-CoV-2, to guide booster vaccination and to select patients for treatment with anti-SARS-CoV-2 antibodies. The performance of serological tests is usually evaluated at 14–21 days post infection. This approach fails to take account of the important effect of time on test performance after infection or exposure has occurred. We performed parallel serological testing using 4 widely used assays (a multiplexed SARS-CoV-2 Nucleoprotein (N), Spike (S) and Receptor Binding Domain assay from Meso Scale Discovery (MSD), the Roche Elecsys-Nucleoprotein (Roche-N) and Spike (Roche-S) assays and the Abbott Nucleoprotein assay (Abbott-N) on serial positive monthly samples collected as part of the Co-STARs study (www.clinicaltrials.gov, NCT04380896) up to 200 days following infection. Our findings demonstrate the considerable effect of time since symptom onset on the diagnostic sensitivity of different assays. Using a time-to-event analysis, we demonstrated that 50% of the Abbott nucleoprotein assays will give a negative result after 175 days (median survival time 95% CI 168–185 days), compared to the better performance over time of the Roche Elecsys nucleoprotein assay (93% survival probability at 200 days, 95% CI 88–97%). Assays targeting the spike protein showed a lower decline over the follow-up period, both for the MSD spike assay (97% survival probability at 200 days, 95% CI 95–99%) and the Roche Elecsys spike assay (95% survival probability at 200 days, 95% CI 93–97%). The best performing quantitative Roche Elecsys Spike assay showed no evidence of waning Spike antibody titers over the 200-day time course of the study. We have shown that compared to other assays evaluated, the Abbott-N assay fails to detect SARS-CoV-2 antibodies as time passes since infection. In contrast the Roche Elecsys Spike Assay and the MSD assay maintained a high sensitivity for the 200-day duration of the study. These limitations of the Abbott assay should be considered when quantifying the immune correlates of protection or the need for SARS-CoV-2 antibody therapy. The high levels of maintained detectable neutralizing spike antibody titers identified by the quantitative Roche Elecsys assay is encouraging and provides further evidence in support of long-lasting SARS-CoV-2 protection following natural infection.
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Affiliation(s)
- Arturo Torres Ortiz
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.,Department of Infectious Diseases, Imperial College London, Paddington, London, W2 1NY, UK
| | - Fernanda Fenn Torrente
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.,UCL Medical School, University College London, 74 Huntley Street, London, WC1E 6DE, UK
| | - Adam Twigg
- Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.,School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Anja Saso
- Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.,Department of Tropical and Infectious Diseases, LSHTM, Keppel St, Bloomsbury, London, WC1E 7HT, UK.,MRC Gambia at LSHTM, PO Box 273, Fajara, The Gambia
| | - Tanya Lam
- Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Marina Johnson
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Helen Wagstaffe
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Rishi Dhillon
- Public Health Wales Microbiology, University Hospital of Wales, Heath Park Way, Cardiff, CF14 4XW, UK
| | - Anabelle Lea Mai
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - David Goldblatt
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Rachel Still
- Laboratory Medicine Service Swansea, Bay University Health Board Morriston Hospital, Swansea, SA6 6NL, UK
| | - Matthew Buckland
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Kimberly Gilmour
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Louis Grandjean
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. .,Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
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