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Mzembe T, Lessells R, Karat AS, Randera-Rees S, Edwards A, Khan P, Tomita A, Tanser F, Baisley K, Grant AD. Prevalence and Risk Factors for Mycobacterium tuberculosis Infection Among Adolescents in Rural South Africa. Open Forum Infect Dis 2021; 8:ofaa520. [PMID: 33511219 PMCID: PMC7814392 DOI: 10.1093/ofid/ofaa520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We aimed to estimate the prevalence of and explore risk factors for Mycobacterium tuberculosis infection among adolescents in a high tuberculosis (TB) and human immunodeficiency virus (HIV) prevalence setting. METHODS A cross-sectional study of adolescents (10-19 years) randomly selected from a demographic surveillance area (DSA) in rural KwaZulu-Natal, South Africa. We determined M tuberculosis infection status using the QuantiFERON-TB Gold-plus assay. We used HIV data from the DSA to estimate community-level adult HIV prevalence and random-effects logistic regression to identify risk factors for TB infection. RESULTS We enrolled 1094 adolescents (548 [50.1%] female); M tuberculosis infection prevalence (weighted for nonresponse by age, sex, and urban/rural residence) was 23.0% (95% confidence interval [CI], 20.6-25.6%). Mycobacterium tuberculosis infection was associated with older age (adjusted odds ratio [aOR], 1.37; 95% CI, 1.10-1.71, for increasing age-group [12-14, 15-17, and 18-19 vs 10-11 years]), ever (vs never) having a household TB contact (aOR, 2.13; 95% CI, 1.25-3.64), and increasing community-level HIV prevalence (aOR, 1.43 and 95% CI, 1.07-1.92, for increasing HIV prevalence category [25%-34.9%, 35%-44.9%, ≥45% vs <25%]). CONCLUSIONS Our data support prioritizing TB prevention and care activities in TB-affected households and high HIV prevalence communities.
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Affiliation(s)
- Themba Mzembe
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Richard Lessells
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- KwaZulu-Natal Research Innovation and Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), UKZN, Durban, South Africa
| | - Aaron S Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Anita Edwards
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Palwasha Khan
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Interactive Research and Development, Karachi, Pakistan
| | - Andrew Tomita
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), UKZN, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Lincoln Institute for Health, University of Lincoln, Lincoln, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathy Baisley
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Martinez L, Lo NC, Cords O, Hill PC, Khan P, Hatherill M, Mandalakas A, Kay A, Croda J, Horsburgh CR, Zar HJ, Andrews JR. Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies. THE LANCET RESPIRATORY MEDICINE 2019; 7:544-552. [PMID: 31078497 DOI: 10.1016/s2213-2600(19)30137-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Tuberculosis is a major cause of death and disability among children globally, yet children have been neglected in global tuberculosis control efforts. Historically, tuberculosis in children has been thought of as a family disease, and because of this, household contact tracing of children after identification of an adult tuberculosis case has been emphasised as the principal public health intervention. However, the population-level effect of household contact tracing is predicated on the assumption that most paediatric tuberculosis infections are acquired within the household. In this Personal View, we focus on accumulating scientific evidence indicating that the majority of Mycobacterium tuberculosis transmission to children in high-burden settings occurs in the community, outside of households in which a person has tuberculosis. We estimate the population-attributable fraction of M tuberculosis transmission to children due to household exposures to be between 10% and 30%. M tuberculosis transmission from the household was low (<30%) even in children younger than age 5 years. We propose that an effective public health response to childhood tuberculosis requires comprehensive, community-based interventions, such as active surveillance in select settings, rather than contact tracing alone. Importantly, the historical paradigm that most paediatric transmission occurs in households should be reconsidered on the basis of the scientific knowledge presented.
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Affiliation(s)
- Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Epidemiology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Olivia Cords
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - Palwasha Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Anna Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Alexander Kay
- The Global Tuberculosis Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; The Baylor Children's Foundation, Mbabane, Swaziland
| | - Julio Croda
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Campo Grande, Mato Grosso do Sul, Brazil; Fundação Oswaldo Cruz, Campo Grande, Mato Grosso do Sul, Brazil
| | - C Robert Horsburgh
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South Africa Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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Transmission of drug-resistant tuberculosis in HIV-endemic settings. THE LANCET. INFECTIOUS DISEASES 2018; 19:e77-e88. [PMID: 30554996 DOI: 10.1016/s1473-3099(18)30537-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 12/17/2022]
Abstract
The emergence and expansion of the multidrug-resistant tuberculosis epidemic is a threat to the global control of tuberculosis. Multidrug-resistant tuberculosis is the result of the selection of resistance-conferring mutations during inadequate antituberculosis treatment. However, HIV has a profound effect on the natural history of tuberculosis, manifesting in an increased rate of disease progression, leading to increased transmission and amplification of multidrug-resistant tuberculosis. Interventions specific to HIV-endemic areas are urgently needed to block tuberculosis transmission. These interventions should include a combination of rapid molecular diagnostics and improved chemotherapy to shorten the duration of infectiousness, implementation of infection control measures, and active screening of multidrug-resistant tuberculosis contacts, with prophylactic regimens for individuals without evidence of disease. Development and improvement of the efficacy of interventions will require a greater understanding of the factors affecting the transmission of multidrug-resistant tuberculosis in HIV-endemic settings, including population-based molecular epidemiology studies. In this Series article, we review what we know about the transmission of multidrug-resistant tuberculosis in settings with high burdens of HIV and define the research priorities required to develop more effective interventions, to diminish ongoing transmission and the amplification of drug resistance.
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Sankoh O. Why population-based data are crucial to achieving the Sustainable Development Goals. Int J Epidemiol 2018; 46:4-7. [PMID: 28204483 DOI: 10.1093/ije/dyx010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Osman Sankoh
- INDEPTH Network, Accra, Ghana.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,Department of Mathematics and Statistics, Njala University, Njala, Sierra Leone
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Khan PY, Crampin AC, Mzembe T, Koole O, Fielding KL, Kranzer K, Glynn JR. Does antiretroviral treatment increase the infectiousness of smear-positive pulmonary tuberculosis? Int J Tuberc Lung Dis 2018; 21:1147-1154. [PMID: 29037295 PMCID: PMC5644739 DOI: 10.5588/ijtld.17.0162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding of the effects of human immunodeficiency virus (HIV) infection and antiretroviral treatment (ART) on Mycobacterium tuberculosis transmission dynamics remains limited. We undertook a cross-sectional study among household contacts of smear-positive pulmonary tuberculosis (TB) cases to assess the effect of established ART on the infectiousness of TB. METHOD Prevalence of tuberculin skin test (TST) positivity was compared between contacts of index cases aged 2-10 years who were HIV-negative, HIV-positive but not on ART, on ART for <1 year and on ART for 1 year. Random-effects logistic regression was used to take into account clustering within households. RESULTS Prevalence of M. tuberculosis infection in contacts of HIV-negative patients, HIV-positive patients on ART 1 year and HIV-positive patients not on ART/on ART <1 year index cases was respectively 44%, 21% and 22%. Compared to contacts of HIV-positive index cases not on ART or recently started on ART, the odds of TST positivity was similar in contacts of HIV-positive index cases on ART 1 year (adjusted OR [aOR] 1.0, 95%CI 0.3-3.7). The odds were 2.9 times higher in child contacts of HIV-negative index cases (aOR 2.9, 95%CI 1.0-8.2). CONCLUSIONS We found no evidence that established ART increased the infectiousness of smear-positive, HIV-positive index cases.
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Affiliation(s)
- P Y Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, Karonga Prevention Study, Chilumba, Malawi
| | - A C Crampin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, Karonga Prevention Study, Chilumba, Malawi
| | - T Mzembe
- Karonga Prevention Study, Chilumba, Malawi
| | - O Koole
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - K L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - K Kranzer
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, National and Supranational Mycobacterium Reference Laboratory, Forschungszentrum Borstel, Germany
| | - J R Glynn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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