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Wen Y, Xie Q, Zhang R, Zhao J, Liu X, Wu J, Huang Y, Yu J, Liang R, Qin Z, Zeng Y, He H, Wang X, Wu Q, Wan C, Zhang B, Zhao W. Pulmonary tuberculosis screening in emigrants and travellers: A retrospective analysis of Guangzhou Port in China. Travel Med Infect Dis 2022; 49:102357. [DOI: 10.1016/j.tmaid.2022.102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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Van't Hoog A, Viney K, Biermann O, Yang B, Leeflang MM, Langendam MW. Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status. Cochrane Database Syst Rev 2022; 3:CD010890. [PMID: 35320584 PMCID: PMC9109771 DOI: 10.1002/14651858.cd010890.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Systematic screening in high-burden settings is recommended as a strategy for early detection of pulmonary tuberculosis disease, reducing mortality, morbidity and transmission, and improving equity in access to care. Questioning for symptoms and chest radiography (CXR) have historically been the most widely available tools to screen for tuberculosis disease. Their accuracy is important for the design of tuberculosis screening programmes and determines, in combination with the accuracy of confirmatory diagnostic tests, the yield of a screening programme and the burden on individuals and the health service. OBJECTIVES To assess the sensitivity and specificity of questioning for the presence of one or more tuberculosis symptoms or symptom combinations, CXR, and combinations of these as screening tools for detecting bacteriologically confirmed pulmonary tuberculosis disease in HIV-negative adults and adults with unknown HIV status who are considered eligible for systematic screening for tuberculosis disease. Second, to investigate sources of heterogeneity, especially in relation to regional, epidemiological, and demographic characteristics of the study populations. SEARCH METHODS We searched the MEDLINE, Embase, LILACS, and HTA (Health Technology Assessment) databases using pre-specified search terms and consulted experts for unpublished reports, for the period 1992 to 2018. The search date was 10 December 2018. This search was repeated on 2 July 2021. SELECTION CRITERIA Studies were eligible if participants were screened for tuberculosis disease using symptom questions, or abnormalities on CXR, or both, and were offered confirmatory testing with a reference standard. We included studies if diagnostic two-by-two tables could be generated for one or more index tests, even if not all participants were subjected to a microbacteriological reference standard. We excluded studies evaluating self-reporting of symptoms. DATA COLLECTION AND ANALYSIS We categorized symptom and CXR index tests according to commonly used definitions. We assessed the methodological quality of included studies using the QUADAS-2 instrument. We examined the forest plots and receiver operating characteristic plots visually for heterogeneity. We estimated summary sensitivities and specificities (and 95% confidence intervals (CI)) for each index test using bivariate random-effects methods. We analyzed potential sources of heterogeneity in a hierarchical mixed-model. MAIN RESULTS The electronic database search identified 9473 titles and abstracts. Through expert consultation, we identified 31 reports on national tuberculosis prevalence surveys as eligible (of which eight were already captured in the search of the electronic databases), and we identified 957 potentially relevant articles through reference checking. After removal of duplicates, we assessed 10,415 titles and abstracts, of which we identified 430 (4%) for full text review, whereafter we excluded 364 articles. In total, 66 articles provided data on 59 studies. We assessed the 2 July 2021 search results; seven studies were potentially eligible but would make no material difference to the review findings or grading of the evidence, and were not added in this edition of the review. We judged most studies at high risk of bias in one or more domains, most commonly because of incorporation bias and verification bias. We judged applicability concerns low in more than 80% of studies in all three domains. The three most common symptom index tests, cough for two or more weeks (41 studies), any cough (21 studies), and any tuberculosis symptom (29 studies), showed a summary sensitivity of 42.1% (95% CI 36.6% to 47.7%), 51.3% (95% CI 42.8% to 59.7%), and 70.6% (95% CI 61.7% to 78.2%, all very low-certainty evidence), and a specificity of 94.4% (95% CI 92.6% to 95.8%, high-certainty evidence), 87.6% (95% CI 81.6% to 91.8%, low-certainty evidence), and 65.1% (95% CI 53.3% to 75.4%, low-certainty evidence), respectively. The data on symptom index tests were more heterogenous than those for CXR. The studies on any tuberculosis symptom were the most heterogeneous, but had the lowest number of variables explaining this variation. Symptom index tests also showed regional variation. The summary sensitivity of any CXR abnormality (23 studies) was 94.7% (95% CI 92.2% to 96.4%, very low-certainty evidence) and 84.8% (95% CI 76.7% to 90.4%, low-certainty evidence) for CXR abnormalities suggestive of tuberculosis (19 studies), and specificity was 89.1% (95% CI 85.6% to 91.8%, low-certainty evidence) and 95.6% (95% CI 92.6% to 97.4%, high-certainty evidence), respectively. Sensitivity was more heterogenous than specificity, and could be explained by regional variation. The addition of cough for two or more weeks, whether to any (pulmonary) CXR abnormality or to CXR abnormalities suggestive of tuberculosis, resulted in a summary sensitivity and specificity of 99.2% (95% CI 96.8% to 99.8%) and 84.9% (95% CI 81.2% to 88.1%) (15 studies; certainty of evidence not assessed). AUTHORS' CONCLUSIONS The summary estimates of the symptom and CXR index tests may inform the choice of screening and diagnostic algorithms in any given setting or country where screening for tuberculosis is being implemented. The high sensitivity of CXR index tests, with or without symptom questions in parallel, suggests a high yield of persons with tuberculosis disease. However, additional considerations will determine the design of screening and diagnostic algorithms, such as the availability and accessibility of CXR facilities or the resources to fund them, and the need for more or fewer diagnostic tests to confirm the diagnosis (depending on screening test specificity), which also has resource implications. These review findings should be interpreted with caution due to methodological limitations in the included studies and regional variation in sensitivity and specificity. The sensitivity and specificity of an index test in a specific setting cannot be predicted with great precision due to heterogeneity. This should be borne in mind when planning for and implementing tuberculosis screening programmes.
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Affiliation(s)
- Anja Van't Hoog
- Anja van't Hoog, Health Research & Training Consultancy, Utrecht, Netherlands
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- School of Public Health, The University of Sydney, Sydney, Australia
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Bada Yang
- Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Miranda W Langendam
- Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Koegelenberg CFN, Schoch OD, Lange C. Tuberculosis: The Past, the Present and the Future. Respiration 2021; 100:553-556. [PMID: 34034257 DOI: 10.1159/000516509] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Otto D Schoch
- Department of Pneumology and Sleep Medicine, Kantonsspital St. Gallen and University of Zurich, Zurich, Switzerland.,Tuberculosis Competence Center, Swiss Lung League, Berne, Switzerland
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Borstel, Germany.,Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.,Global TB Program, Baylor College of Medicine, Houston, Texas, USA
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Liang S, Zhang J, Hu L, Chen J, Wu J, Huang Y, Zeng Y, Zhu Y, Li Z, Wen Y, Liang W, Zhuo J, He H. USA's expanded overseas tuberculosis screening program: a retrospective study in China. BMC Public Health 2015; 15:231. [PMID: 25886508 PMCID: PMC4364631 DOI: 10.1186/s12889-015-1558-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To address increasing tuberculosis (TB) incidence in foreign-born populations, immigrant TB screening programs have been implemented in the USA. These programs are modified periodically, the effectiveness of which have been disputed. The aim of this retrospective study was to assess the value of the 2009 Technical Instructions for Tuberculosis Screening and Treatment Using Cultures and Directly Observed Therapy (CDOT TB TI) in a cohort of the USA permanent-resident applicants from China. METHODS Standardized forms were used to collect demographic, clinical, and laboratory data of Chinese individuals screened at the Guangdong International Travel Healthcare Center for permanent residence in the USA between October 08, 2009 and December 31, 2012. Applicants' data were further retrospectively evaluated by three experienced panel physicians and radiologists according to the 1991 Technical Instructions for Tuberculosis Screening and Treatment (TI). TB cases and characteristics identified by the 1991 and expanded 2009 programs were compared. RESULTS The CDOT TB TI identified more than twice as many TB cases that required treatment completion before clearance for travel than the 1991 TI (270 vs. 131). In addition, the expanded screening program identified more cases of negative sputum smear but positive culture (181 vs. 44), and more cases of radiography suggestive of inactive (22 vs. 3) and active (248 vs. 128) TB. Specifically, the 1991 TI screening program failed to identify 25/38 (65.79%) cases carrying drug-resistant isolates, and 13/131 (9.92%) would have been inappropriately treated. Moreover, 220/270 (81.48%) of the cases were asymptomatic, which were identified by screening and subsequently treated. Improved chest radiograph and sputum negative conversion occurred in all treated cases. CONCLUSION CDOT TB TI, a screening program that includes sputum culture and drug susceptibility tests, identifies a greater number of TB cases, likely contributing to the overall decrease in TB prevalence in host (USA) and origin (China) countries.
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Affiliation(s)
- Shaojun Liang
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Jianming Zhang
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Longfei Hu
- Shenzhen Entery-exit Inspection and Quarantine Bureau, 1101 Fuqiang Road, Futian District, Shenzhen, Guangdong, 518045, PR China.
| | - Jiandong Chen
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Jian Wu
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Yongxin Huang
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Yan Zeng
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Yufeng Zhu
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Zhaohui Li
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Ying Wen
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Wuyi Liang
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Jinxue Zhuo
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Hongtao He
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
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Zohar M, Moshe L, Daniel C, Noa C, Itamar G. HIV prevalence in the Israeli tuberculosis cohort, 1999-2011. BMC Public Health 2014; 14:1090. [PMID: 25335562 PMCID: PMC4221682 DOI: 10.1186/1471-2458-14-1090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/16/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) patients who are co-infected with HIV are at greater risk of mortality. Nevertheless, not all countries achieved sustainable and TB and HIV collaboration to describe the burden of both diseases at a national scale. This study aims to describe HIV prevalence among TB-patients in Israel and identify variable associated with TB/HIV co-infection. METHODS This retrospective study was conducted by cross-matching the National HIV and TB Registries to describe TB/HIV epidemiology during the last 13-years and define variables predicting TB/HIV co-infection. RESULTS Between 1999 and 2011, 5,502 TB-patients were reported: 779 (14.2%) were Israeli-born and 4,723 (85.8%) non-Israeli born. Of all TB patients, 254 (4.6%) were HIV-infected. The trend of HIV/TB co-infection among non-Israeli born has generally decreased since 2003 (trend analysis p < 0.001).TB/HIV co-infected patients were mostly males, their TB diagnosis had been performed relatively in shorter time following their arrival in Israel, more likely to be in the 35-44 and 25-34 age groups, non-Israeli born (mostly Africa born), more likely to be culture positive, have multi-drug resistant strains, had worse treatment outcomes and more likely to die treatment than HIV-negative tuberculosis patient. In a multivariate analysis, short time after arrival in Israel, older age, being born in Ethiopia, having positive sputum, positive culture and multi-drug resistant TB predicted TB/HIV co-infection.TB/HIV co-infected patients with extra-pulmonary TB had a higher proportion of infection in lymphatic, miliary and abdominal sites than those with extra-pulmonary TB who were HIV-negative. CONCLUSIONS Most TB/HIV co-infected patients were migrants originating in high-burden countries. Despite the moderate 4.6% TB/HIV co-infection rate in Israel, these patients had worse treatment outcomes and higher mortality rates. This study illustrates the importance of integrating TB with HIV in surveillance and treatment components, which should be employed in other countries, as it has a positive impact on disease control.
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Affiliation(s)
- Mor Zohar
- />Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
- />Ramla Department of Public Health, Ministry of Health, 3 Danny Mass St, Ramla, 72100 Israel
| | - Lidji Moshe
- />Tel-Aviv Tuberculosis Clinic, League against Tuberculosis and Lung Diseases, Tel Aviv, Israel
| | - Chemtob Daniel
- />Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - Cedar Noa
- />Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - Grotto Itamar
- />Public Health Services, Ministry of Health, Jerusalem, Israel
- />Faculty of Medicine, Ben Gurion University in the Negev, Beer Sheva, Israel
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Leung CC, Porcel JM, Takahashi K, Restrepo MI, Lee P, Wainwright C. Year in review 2013: Lung cancer, respiratory infections, tuberculosis, cystic fibrosis, pleural diseases, bronchoscopic intervention and imaging. Respirology 2014; 19:448-60. [PMID: 24708034 DOI: 10.1111/resp.12250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Chi Chiu Leung
- Tuberculosis and Chest Service, Department of Health, Hong Kong, China
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