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Martinez L, Seddon JA, Horsburgh CR, Lange C, Mandalakas AM. Effectiveness of preventive treatment among different age groups and Mycobacterium tuberculosis infection status: a systematic review and individual-participant data meta-analysis of contact tracing studies. Lancet Respir Med 2024:S2213-2600(24)00083-3. [PMID: 38734022 DOI: 10.1016/s2213-2600(24)00083-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Tuberculosis is a preventable disease. However, there is debate regarding which individuals would benefit most from tuberculosis preventive treatment and whether these benefits vary in settings with a high burden and low burden of tuberculosis. We aimed to compare the effectiveness of tuberculosis preventive treatment in exposed individuals of differing ages and Mycobacterium tuberculosis infection status while considering tuberculosis burden of the settings. METHODS In this systematic review and individual-participant meta-analysis, we investigated the development of incident tuberculosis in people closely exposed to individuals with tuberculosis. We searched for studies published between Jan 1, 1998, and April 6, 2018, in MEDLINE, Web of Science, BIOSIS, and Embase. We restricted our search to cohort studies; case-control studies and outbreak reports were excluded. Two reviewers evaluated titles, abstracts, and full text articles for eligibility. At each stage, two reviewers discussed discrepancies and re-evaluated articles until a consensus was reached. Individual-participant data and a pre-specified list of variables, including characteristics of the exposed contact, the index patient, and environmental characteristics, were requested from authors of all eligible studies; contacts exposed to a drug-resistant tuberculosis index patient were excluded. The primary study outcome was incident tuberculosis. We estimated adjusted hazard ratios (aHRs) for incident tuberculosis with mixed-effects Cox regression models with a study-level random effect. We estimated the number-needed-to-treat (NNT) to prevent one person developing tuberculosis. Propensity score matching procedures were used in all analyses. This study is registered with PROSPERO (CRD42018087022). FINDINGS After screening 25 358 records for eligibility, 439 644 participants from 32 cohort studies were included in the individual-participant data meta-analysis. Participants were followed for 1 396 413 person-years (median of 2·7 years [IQR 1·3-4.4]), during which 2496 people were diagnosed with incident tuberculosis. Overall, effectiveness of preventive treatment was 49% (aHR 0·51 [95% CI 0·44-0·60]). Participants with a positive tuberculin-skin-test (TST) or IFNγ release assay (IGRA) result at baseline benefitted from greater protection, regardless of age (0·09 [0·05-0·17] in children younger than 5 years, 0·20 [0·15-0·28] in individuals aged 5-17 years, and 0·17 [0·13-0·22] in adults aged 18 years and older). The effectiveness of preventive treatment was greater in high-burden (0·31 [0·23-0·40]) versus low-burden (0·58 [0·47-0·72]) settings. The NNT ranged from 9 to 34 depending on age among participants with a positive TST or IGRA in both high-burden and low-burden settings; among all contacts (regardless of TST or IGRA test result), the NNT ranged from 29 to 43 in high-burden settings and 213 to 455 in low-burden settings. INTERPRETATION Our findings suggest that a risk-targeted strategy prioritising contacts with evidence of M tuberculosis infection might be indicated in low-burden settings, and a broad approach including all contacts should be considered in high-burden settings. Preventive treatment was similarly effective among contacts of all ages. FUNDING None.
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Affiliation(s)
- Leonardo Martinez
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA.
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa; Department of Infectious Disease, Imperial College London, London, UK
| | - C Robert Horsburgh
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Christoph Lange
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Global TB and Immigrant Health Program, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
| | - Anna M Mandalakas
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Global TB and Immigrant Health Program, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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Schwalb A, Kayumba K, Houben RMGJ, Bothamley GH. Recent Travel and Tuberculosis in Migrants: Data From a Low-Incidence Country. Clin Infect Dis 2024; 78:742-745. [PMID: 37939790 PMCID: PMC10954334 DOI: 10.1093/cid/ciad672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023] Open
Abstract
Tuberculosis (TB) incidence rates among migrants are higher than those in low-incidence countries. We evaluated smear-positive, pulmonary TB notifications of foreign-born individuals, comparing time since arrival and time since last return travel to the country of origin. TB incidence suggests a time course consistent with recent infection during travel.
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Affiliation(s)
- Alvaro Schwalb
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kumvana Kayumba
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rein M G J Houben
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graham H Bothamley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Respiratory Medicine, Homerton University Hospital, London, United Kingdom
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Østergaard AA, Lillebaek T, Petersen I, Fløe A, Bøkan EHW, Hilberg O, Holden IK, Larsen L, Colic A, Wejse C, Ravn P, Nørgård BM, Bjerrum S, Johansen IS. Prevalence estimates of tuberculosis infection in adults in Denmark: a retrospective nationwide register-based cross-sectional study, 2010 to 2018. Euro Surveill 2024; 29:2300590. [PMID: 38516789 PMCID: PMC11063675 DOI: 10.2807/1560-7917.es.2024.29.12.2300590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/12/2024] [Indexed: 03/23/2024] Open
Abstract
BackgroundTuberculosis (TB) elimination requires identifying and treating persons with TB infection (TBI).AimWe estimate the prevalence of positive interferon gamma release assay (IGRA) tests (including TB) and TBI (excluding TB) in Denmark based on TBI screening data from patients with inflammatory bowel disease (IBD) or inflammatory rheumatic disease (IRD).MethodsUsing nationwide Danish registries, we included all patients with IBD or IRD with an IGRA test performed between 2010 and 2018. We estimated the prevalence of TBI and positive IGRA with 95% confidence intervals (CI) in adolescents and adults aged 15-64 years after sample weighting adjusting for distortions in the sample from the background population of Denmark for sex, age group and TB incidence rates (IR) in country of birth.ResultsIn 13,574 patients with IBD or IRD, 12,892 IGRA tests (95.0%) were negative, 461 (3.4%) were positive and 221 (1.6%) were indeterminate, resulting in a weighted TBI prevalence of 3.2% (95% CI: 2.9-3.5) and weighted positive IGRA prevalence of 3.8% (95% CI: 3.5-4.2) among adults aged 15-64 years in the background population of Denmark. Unweighted TBI prevalence increased with age and birthplace in countries with a TB IR higher than 10/100,000 population.ConclusionEstimated TBI prevalence is low in Denmark. We estimate that 200,000 persons have TBI and thus are at risk of developing TB. Screening for TBI and preventive treatment, especially in persons born in high TB incidence countries or immunosuppressed, are crucial to reduce the risk of and eliminate TB.
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Affiliation(s)
- Anne Ahrens Østergaard
- Department of Infectious Diseases and Mycobacterial Centre for Research Southern Denmark, MyCRESD, Odense University Hospital, Denmark
- Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Inge Petersen
- Department of Infectious Diseases and Mycobacterial Centre for Research Southern Denmark, MyCRESD, Odense University Hospital, Denmark
| | - Andreas Fløe
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Eliza H Worren Bøkan
- Department of Infectious Diseases and Mycobacterial Centre for Research Southern Denmark, MyCRESD, Odense University Hospital, Denmark
| | - Ole Hilberg
- Department of Medicine, Vejle Hospital, Hospital Lillebælt, Vejle, Denmark
| | - Inge K Holden
- Department of Infectious Diseases and Mycobacterial Centre for Research Southern Denmark, MyCRESD, Odense University Hospital, Denmark
- Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark
| | - Lone Larsen
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Denmark
| | - Ada Colic
- Department of Rheumatology, Zealand University Hospital, Køge, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Pernille Ravn
- Section for Infectious Diseases, Department of Medicine, Herlev and Gentofte Hospital, Copenhagen, University of Copenhagen, Gentofte, Denmark
| | - Bente Mertz Nørgård
- Center of Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Stephanie Bjerrum
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark
| | - Isik Somuncu Johansen
- Department of Infectious Diseases and Mycobacterial Centre for Research Southern Denmark, MyCRESD, Odense University Hospital, Denmark
- Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark
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van Geuns D, Arts RJ, de Vries G, Wit FW, Degtyareva SY, Brown J, Pareek M, Lipman M, van Crevel R. Screening for tuberculosis infection and effectiveness of preventive treatment among people with HIV in low-incidence settings. AIDS 2024; 38:193-205. [PMID: 37991008 PMCID: PMC10734787 DOI: 10.1097/qad.0000000000003747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To determine the yield of screening for latent tuberculosis infection (LTBI) among people with HIV (PWH) in low tuberculosis (TB) incidence countries (<10 TB cases per 100 000 persons). DESIGN A systematic review and meta-analysis were performed to assess prevalence and predictive factors of LTBI, rate of TB progression, effect of TB preventive treatment (TPT), and numbers needed to screen (NNS). METHODS PubMed and Cochrane Library were searched for studies reporting primary data, excluding studies on active or paediatric TB. We extracted LTBI cases, odds ratios, and TB incidences; pooled estimates using a random-effects model; and used the Newcastle-Ottawa scale for bias. RESULTS In 51 studies with 65 930 PWH, 12% [95% confidence interval (CI) 10-14] had a positive LTBI test, which was strongly associated with origin from a TB-endemic country [odds ratio (OR) 4.7] and exposure to TB (OR 2.9). Without TPT (10 629 PWH), TB incidence was 28/1000 person-years (PY; 95% CI 12-45) for LTBI-test positive versus 4/1000 PY (95% CI 0-7) for LTBI-test-negative individuals. Among 625 PWH (1644 PY) receiving TPT, 15 developed TB (6/1000 PY). An estimated 20 LTBI-positive individuals would need TPT to prevent one case of TB, and numbers NNS to detect LTBI or prevent active TB varied according to a-priori risk of LTBI. CONCLUSION The relatively high prevalence of LTBI among PWH and the strong correlation with origin from a TB-endemic country support risk-stratified LTBI screening strategies for PWH in low-incidence countries and treating those who test positive.
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Affiliation(s)
- Dorine van Geuns
- Julius Centre for Health Sciences and Primary Care Medicine, University Medical Centre Utrecht, Utrecht
| | - Rob J.W. Arts
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen
| | - Gerard de Vries
- National Institute for Public Health and the Environment (RIVM), Bilthoven
| | - Ferdinand W.N.M. Wit
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Svetlana Y. Degtyareva
- Department of Infectious Diseases, Epidemiology and Phthisiology, RUDN University, Moscow, Russia
| | - James Brown
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester
- Department of Infection and HIV medicine, Leicester Royal Infirmary, Leicester
| | - Marc Lipman
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London
- UCL Respiratory, University College London, London
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Jordan AE, Nsengiyumva NP, Houben RMGJ, Dodd PJ, Dale KD, Trauer JM, Denholm JT, Johnston JC, Khan FA, Campbell JR, Schwartzman K. The prevalence of tuberculosis infection among foreign-born Canadians: a modelling study. CMAJ 2023; 195:E1651-E1659. [PMID: 38081633 PMCID: PMC10718277 DOI: 10.1503/cmaj.230228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The prevalence of tuberculosis infection is critical to the design of tuberculosis prevention strategies, yet is unknown in Canada. We estimated the prevalence of tuberculosis infection among Canadian residents born abroad. METHODS We estimated the prevalence of tuberculosis infection by age and year of migration to Canada for people from each of 168 countries by constructing country-specific and calendar year-specific trends for annual risk of infection using a previously developed model. We combined country-specific prevalence estimates with Canadian Census data from 2001, 2006, 2011, 2016 and 2021 to estimate the overall prevalence of tuberculosis infection among foreign-born Canadian residents. RESULTS The estimated overall prevalence of tuberculosis infection among foreign-born people in Canada was 25% (95% uncertainty interval [UI] 20%-35%) for census year 2001, 24% (95% UI 20%-33%) for 2006, 23% (95% UI 19%-30%) for 2011, 22% (95% UI 19%-28%) for 2016 and 22% (95% UI 19%-27%) for 2021. The prevalence increased with age at migration and incidence of tuberculosis in the country of origin. In 2021, the estimated prevalence of infection among foreign-born residents was lowest in Quebec (19%, 95% UI 16%-24%) and highest in Alberta (24%, 95% UI 21%-28%) and British Columbia (24%, 95% UI 20%-30%). Among all foreign-born Canadian residents with tuberculosis infection in 2021, we estimated that only 1 in 488 (95% UI 185-1039) had become infected within the 2 preceding years. INTERPRETATION About 1 in 4 foreign-born Canadian residents has tuberculosis infection, but very few were infected within the 2 preceding years (the highest risk period for progression to tuberculosis disease). These data may inform future tuberculosis infection screening policies.
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Affiliation(s)
- Aria Ed Jordan
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - Ntwali Placide Nsengiyumva
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - Rein M G J Houben
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - Peter J Dodd
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - Katie D Dale
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - James M Trauer
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - Justin T Denholm
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - James C Johnston
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - Faiz Ahmad Khan
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que
| | - Jonathon R Campbell
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que.
| | - Kevin Schwartzman
- Department of Epidemiology, Biostatistics, and Occupational Health (Jordan), McGill University; McGill International Tuberculosis Centre (Jordan, Nsengiyumva, Ahmad Khan, Campbell, Schwartzman); Respiratory Epidemiology and Clinical Research Unit (Nsengiyumva, Ahmad Khan, Campbell, Schwartzman), Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Infectious Disease Epidemiology and Tuberculosis Centre (Houben), Tuberculosis Modelling Group, London School of Hygiene and Tropical Medicine, London, UK; School of Health and Related Research (Dodd), University of Sheffield, Sheffield, UK; Victorian Tuberculosis Program (Dale, Denholm), Melbourne Health, at the Peter Doherty Institute for Infection and Immunity; School of Public Health and Preventive Medicine (Trauer), Monash University; Department of Infectious Diseases (Denholm), University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; British Columbia Centre for Disease Control (Johnston); Department of Medicine (Johnston), University of British Columbia, Vancouver, BC; Departments of Medicine and of Global and Public Health (Campbell), McGill University, Montréal, Que.
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Vasiliu A, Martinez L, Gupta RK, Hamada Y, Ness T, Kay A, Bonnet M, Sester M, Kaufmann SHE, Lange C, Mandalakas AM. Tuberculosis prevention: current strategies and future directions. Clin Microbiol Infect 2023:S1198-743X(23)00533-5. [PMID: 37918510 DOI: 10.1016/j.cmi.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND An estimated one fourth of the world's population is infected with Mycobacterium tuberculosis, and 5-10% of those infected develop tuberculosis in their lifetime. Preventing tuberculosis is one of the most underutilized but essential components of curtailing the tuberculosis epidemic. Moreover, current evidence illustrates that tuberculosis manifestations occur along a dynamic spectrum from infection to disease rather than a binary state as historically conceptualized. Elucidating determinants of transition between these states is crucial to decreasing the tuberculosis burden and reaching the END-TB Strategy goals as defined by the WHO. Vaccination, detection of infection, and provision of preventive treatment are key elements of tuberculosis prevention. OBJECTIVES This review provides a comprehensive summary of recent evidence and state-of-the-art updates on advancements to prevent tuberculosis in various settings and high-risk populations. SOURCES We identified relevant studies in the literature and synthesized the findings to provide an overview of the current state of tuberculosis prevention strategies and latest research developments. CONTENT We present the current knowledge and recommendations regarding tuberculosis prevention, with a focus on M. bovis Bacille-Calmette-Guérin vaccination and novel vaccine candidates, tests for latent infection with M. tuberculosis, regimens available for tuberculosis preventive treatment and recommendations in low- and high-burden settings. IMPLICATIONS Effective tuberculosis prevention worldwide requires a multipronged approach that addresses social determinants, and improves access to tuberculosis detection and to new short tuberculosis preventive treatment regimens. Robust collaboration and innovative research are needed to reduce the global burden of tuberculosis and develop new detection tools, vaccines, and preventive treatments that serve all populations and ages.
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Affiliation(s)
- Anca Vasiliu
- Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA.
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Rishi K Gupta
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, United Kingdom
| | - Tara Ness
- Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA
| | - Alexander Kay
- Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA
| | - Maryline Bonnet
- University of Montpellier, TransVIHMI, IRD, INSERM, Montpellier, France
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Stefan H E Kaufmann
- Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany; Systems Immunology (Emeritus Group), Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany; Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA
| | - Christoph Lange
- Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - Anna M Mandalakas
- Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
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7
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Gasser N, Fritschi N, Egger JM, Ritz N, Schoch OD, Zellweger JP. Tuberculosis Case Detection and Guideline Adherence among Child Contacts in Switzerland: A Retrospective Observational Study. Respiration 2023; 102:934-943. [PMID: 37899038 PMCID: PMC10664337 DOI: 10.1159/000534362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Children exposed to a tuberculosis (TB) index case are at risk of TB infection and disease. OBJECTIVES The aim of this study was to describe the proportion of child contacts who developed TB infection or disease after exposure and to assess the diagnostic pathways and adherence to current guidelines. METHODS Retrospective observational study including children ≤16 years of age who had contact to a TB index case between January 2019 and July 2021. Analysis was stratified by age groups 0-4, 5-11, and 12-16 years. RESULTS Of 401 TB-exposed children, data were available for 380 (95%). Of those, 7 (2%) were diagnosed with TB disease and 35 (9%) with TB infection. We identified several deviations in the management compared to recommendations in national Swiss guidelines: In the children aged 0-4 years, only 82% were examined with an immunodiagnostic test or a chest radiography within 2 weeks after last contact. Recommended prophylactic treatment was prescribed in 66% of the children only. In the children aged 5-11 years, 64% were tested with an immunodiagnostic test in a first examination and 75% in a second examination, 2 weeks and 2 months after last contact, respectively. CONCLUSIONS Contact investigations of children exposed to a TB index case identified a significant proportion of children with TB infection and disease in a low TB incidence setting. We observed significant deviations from the guidelines in the contact investigations suggesting the need for improved implementation.
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Affiliation(s)
- Nathalie Gasser
- TB Competence Center, Swiss Lung Association, Bern, Switzerland
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children’s Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
- University of Basel Children’s Hospital Basel, Basel, Switzerland
| | | | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children’s Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
- University of Basel Children’s Hospital Basel, Basel, Switzerland
- Department of Pediatrics and Pediatric Infectious Diseases, Children’s Hospital Lucerne and Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Otto D. Schoch
- TB Competence Center, Swiss Lung Association, Bern, Switzerland
- Department of Pneumology and Sleep Medicine, St. Gallen Hospital, St. Gallen, Switzerland
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Zenner D, Brals D, Nederby-Öhd J, Menezes D, Aldridge R, Anderson SR, de Vries G, Erkens C, Marchese V, Matteelli A, Muzyamba M, van Rest J, Spruijt I, Were J, Migliori GB, Lönnroth K, Cobelens F, Abubakar I. Drivers determining tuberculosis disease screening yield in four European screening programmes: a comparative analysis. Eur Respir J 2023; 62:2202396. [PMID: 37230498 PMCID: PMC10568038 DOI: 10.1183/13993003.02396-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The World Health Organization End TB Strategy emphasises screening for early diagnosis of tuberculosis (TB) in high-risk groups, including migrants. We analysed key drivers of TB yield differences in four large migrant TB screening programmes to inform TB control planning and feasibility of a European approach. METHODS We pooled individual TB screening episode data from Italy, the Netherlands, Sweden and the UK, and analysed predictors and interactions for TB case yield using multivariable logistic regression models. RESULTS Between 2005 and 2018 in 2 302 260 screening episodes among 2 107 016 migrants to four countries, the programmes identified 1658 TB cases (yield 72.0 (95% CI 68.6-75.6) per 100 000). In logistic regression analysis, we found associations between TB screening yield and age (≥55 years: OR 2.91 (95% CI 2.24-3.78)), being an asylum seeker (OR 3.19 (95% CI 1.03-9.83)) or on a settlement visa (OR 1.78 (95% CI 1.57-2.01)), close TB contact (OR 12.25 (95% CI 11.73-12.79)) and higher TB incidence in the country of origin. We demonstrated interactions between migrant typology and age, as well as country of origin. For asylum seekers, the elevated TB risk remained similar above country of origin incidence thresholds of 100 per 100 000. CONCLUSIONS Key determinants of TB yield included close contact, increasing age, incidence in country of origin and specific migrant groups, including asylum seekers and refugees. For most migrants such as UK students and workers, TB yield significantly increased with levels of incidence in the country of origin. The high, country of origin-independent TB risk in asylum seekers above a 100 per 100 000 threshold could reflect higher transmission and re-activation risk of migration routes, with implications for selecting populations for TB screening.
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Affiliation(s)
- Dominik Zenner
- Faculty of Population Health Sciences, University College London, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Amsterdam University Medical Centers, location University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, The Netherlands
| | - Daniella Brals
- Amsterdam University Medical Centers, location University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, The Netherlands
| | - Joanna Nederby-Öhd
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dee Menezes
- Institute of Health Informatics Research, University College London, London, UK
| | - Robert Aldridge
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Gerard de Vries
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Valentina Marchese
- WHO Collaborating Center for TB/HIV and the TB Elimination Strategy, University of Brescia, Brescia, Italy
| | - Alberto Matteelli
- WHO Collaborating Center for TB/HIV and the TB Elimination Strategy, University of Brescia, Brescia, Italy
| | | | - Job van Rest
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Ineke Spruijt
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - John Were
- Faculty of Population Health Sciences, University College London, London, UK
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Frank Cobelens
- Amsterdam University Medical Centers, location University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, The Netherlands
| | - Ibrahim Abubakar
- Faculty of Population Health Sciences, University College London, London, UK
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9
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Yan M, Campbell JR, Marras TK, Brode SK. Tests cutanés à la tuberculine et tests de libération de l’interféron γ pour le diagnostic de l’infection tuberculeuse. CMAJ 2023; 195:E1196-E1197. [PMID: 37696555 PMCID: PMC10495176 DOI: 10.1503/cmaj.221570-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Affiliation(s)
- Marie Yan
- Département de médecine (Yan, Marras, Brode), Université de Toronto, Toronto, Ont.; Programme de cliniciens-chercheurs (Yan), Université de la Colombie-Britannique, Vancouver, C.-B.; Départements de médecine et de santé des populations et de santé mondiale (Campbell), Faculté de médecine et des sciences de la santé, Université McGill; Centre international de TB de McGill (Campbell), Montréal, Qc; Division de pneumologie (Marras, Brode), Réseau universitaire de santé, Toronto, Ont.; Division de pneumologie (Brode), Centre de santé West Park, Toronto, Ont
| | - Jonathon R Campbell
- Département de médecine (Yan, Marras, Brode), Université de Toronto, Toronto, Ont.; Programme de cliniciens-chercheurs (Yan), Université de la Colombie-Britannique, Vancouver, C.-B.; Départements de médecine et de santé des populations et de santé mondiale (Campbell), Faculté de médecine et des sciences de la santé, Université McGill; Centre international de TB de McGill (Campbell), Montréal, Qc; Division de pneumologie (Marras, Brode), Réseau universitaire de santé, Toronto, Ont.; Division de pneumologie (Brode), Centre de santé West Park, Toronto, Ont
| | - Theodore K Marras
- Département de médecine (Yan, Marras, Brode), Université de Toronto, Toronto, Ont.; Programme de cliniciens-chercheurs (Yan), Université de la Colombie-Britannique, Vancouver, C.-B.; Départements de médecine et de santé des populations et de santé mondiale (Campbell), Faculté de médecine et des sciences de la santé, Université McGill; Centre international de TB de McGill (Campbell), Montréal, Qc; Division de pneumologie (Marras, Brode), Réseau universitaire de santé, Toronto, Ont.; Division de pneumologie (Brode), Centre de santé West Park, Toronto, Ont
| | - Sarah K Brode
- Département de médecine (Yan, Marras, Brode), Université de Toronto, Toronto, Ont.; Programme de cliniciens-chercheurs (Yan), Université de la Colombie-Britannique, Vancouver, C.-B.; Départements de médecine et de santé des populations et de santé mondiale (Campbell), Faculté de médecine et des sciences de la santé, Université McGill; Centre international de TB de McGill (Campbell), Montréal, Qc; Division de pneumologie (Marras, Brode), Réseau universitaire de santé, Toronto, Ont.; Division de pneumologie (Brode), Centre de santé West Park, Toronto, Ont.
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10
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Kontsevaya I, Cabibbe AM, Cirillo DM, DiNardo AR, Frahm N, Gillespie SH, Holtzman D, Meiwes L, Petruccioli E, Reimann M, Ruhwald M, Sabiiti W, Saluzzo F, Tagliani E, Goletti D. Update on the diagnosis of tuberculosis. Clin Microbiol Infect 2023:S1198-743X(23)00340-3. [PMID: 37490968 DOI: 10.1016/j.cmi.2023.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Tuberculosis (TB) remains a global public health threat, and the development of rapid and precise diagnostic tools is the key to enabling the early start of treatment, monitoring response to treatment, and preventing the spread of the disease. OBJECTIVES An overview of recent progress in host- and pathogen-based TB diagnostics. SOURCES We conducted a PubMed search of recent relevant articles and guidelines on TB screening and diagnosis. CONTENT An overview of currently used methods and perspectives in the following areas of TB diagnostics is provided: immune-based diagnostics, X-ray, clinical symptoms and scores, cough detection, culture of Mycobacterium tuberculosis and identifying its resistance profile using phenotypic and genotypic methods, including next-generation sequencing, sputum- and non-sputum-based molecular diagnosis of TB and monitoring of response to treatment. IMPLICATIONS A brief overview of the most relevant advances and changes in international guidelines regarding screening and diagnosing TB is provided in this review. It aims at reviewing all relevant areas of diagnostics, including both pathogen- and host-based methods.
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Affiliation(s)
- Irina Kontsevaya
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany; Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom.
| | | | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrew R DiNardo
- Global TB Program, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA; Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Frahm
- Clinical Development, Bill & Melinda Gates Medical Research Institute, Cambridge, MA, USA
| | | | - David Holtzman
- Clinical Development, Bill & Melinda Gates Medical Research Institute, Cambridge, MA, USA; Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lennard Meiwes
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
| | - Elisa Petruccioli
- Translational Research Unit, National Institute for Infectious Diseases (INMI) "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Maja Reimann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
| | | | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Francesca Saluzzo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Tagliani
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases (INMI) "Lazzaro Spallanzani" - IRCCS, Rome, Italy
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Brehm TT, Köhler N, Schmiedel S, Terhalle E, Martensen J, Kalsdorf B, Kandulla J, Heyckendorf J, Kuhns M, Friesen I, Lange C. [Treatment of tuberculosis: what is new?]. Inn Med (Heidelb) 2023:10.1007/s00108-023-01523-z. [PMID: 37316702 DOI: 10.1007/s00108-023-01523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/16/2023]
Abstract
Never before have so many people around the world been simultaneously affected by tuberculosis. Tuberculosis is the leading cause of death from a bacterial infectious disease worldwide. The World Health Organization's ambitious goal from 2014 of achieving global elimination of tuberculosis does not seem realistic, but on current trends, tuberculosis could be eliminated in the European Union by 2040. Since the beginning of 2022, there have been more innovations for the treatment of tuberculosis than in no other comparable time period before. One month of rifapentine and isoniazid is effective in treating latent tuberculosis infection. However, rifapentine is licensed in the USA but not in the EU and must be imported for individual cases. The duration of the standard treatment for tuberculosis can be shortened to four months but this treatment regimen is also based on rifapentine, in addition to isoniazid, pyrazinamide, and moxifloxacin. The approval of rifapentine in Europe is a much-needed step towards shortening the treatment of tuberculosis. With new drugs an even shorter standard treatment of only 2 months is possible. The treatment of multidrug-resistant/rifampicin-resistant tuberculosis (MDR-/RR-TB) has been shortened to six months, the same length as the standard treatment available in Germany. The combination of bedaquiline, pretomanid, linezolid ± moxifloxacin, cured around 90% of affected patients were cured in studies with a treatment duration of six months. With 19 drugs in clinical trials, the treatment of tuberculosis is expected to continue to improve rapidly in the coming years.
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Affiliation(s)
- Thomas Theo Brehm
- Sektion Infektiologie, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Braunschweig, Deutschland
| | - Niklas Köhler
- Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 35, 23845, Borstel, Deutschland
| | - Stefan Schmiedel
- Sektion Infektiologie, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Braunschweig, Deutschland
| | | | | | - Barbara Kalsdorf
- Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 35, 23845, Borstel, Deutschland
| | | | - Jan Heyckendorf
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Christian Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Martin Kuhns
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Borstel, Deutschland
| | - Inna Friesen
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Borstel, Deutschland
| | - Christoph Lange
- Deutsches Zentrum für Infektionsforschung (DZIF), Braunschweig, Deutschland.
- Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 35, 23845, Borstel, Deutschland.
- Respiratory Medicine & International Health, Universität zu Lübeck, Lübeck, Deutschland.
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
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12
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Barker E, Moss J, Holmes H, Bowe C, Suryaprakash V, Alagna R, Nikolayevskyy V, Destito M, Manissero D. A cost-effectiveness evaluation of latent tuberculosis infection screening of a migrant population in Malaysia. Sci Rep 2023; 13:2390. [PMID: 36765258 DOI: 10.1038/s41598-023-29648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
To estimate the costs and benefits of screening for latent tuberculosis infection (LTBI) in a migrant population in Malaysia. An economic model was developed from a Malaysian healthcare perspective to compare QuantiFERON-TB Gold Plus (QuantiFERON) with the tuberculin skin test (TST). A decision tree was used to capture outcomes relating to LTBI screening followed by a Markov model that simulated the lifetime costs and benefits of the patient cohort. The Markov model did not capture the impact of secondary infections. The model included an R shiny interactive interface to allow adaptation to other scenarios and settings. QuantiFERON is both more effective and less costly than TST (dominant). Compared with QuantiFERON, the lifetime risk of developing active TB increases by approximately 40% for TST due to missed LTBI cases during screening (i.e. a higher number of false negative cases for TST). For a migrant population in Malaysia, QuantiFERON is cost-effective when compared with TST. Further research should consider targeted LTBI screening for migrants in Malaysia based on common risk factors.
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13
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Hamada Y, Gupta RK, Quartagno M, Izzard A, Acuna-Villaorduna C, Altet N, Diel R, Dominguez J, Floyd S, Gupta A, Huerga H, Jones-López EC, Kinikar A, Lange C, van Leth F, Liu Q, Lu W, Lu P, Rueda IL, Martinez L, Mbandi SK, Muñoz L, Padilla ES, Paradkar M, Scriba T, Sester M, Shanaube K, Sharma SK, Sloot R, Sotgiu G, Thiruvengadam K, Vashishtha R, Abubakar I, Rangaka MX. Predictive performance of interferon-gamma release assays and the tuberculin skin test for incident tuberculosis: an individual participant data meta-analysis. EClinicalMedicine 2023; 56:101815. [PMID: 36636295 PMCID: PMC9829704 DOI: 10.1016/j.eclinm.2022.101815] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Evidence on the comparative performance of purified protein derivative tuberculin skin tests (TST) and interferon-gamma release assays (IGRA) for predicting incident active tuberculosis (TB) remains conflicting. We conducted an individual participant data meta-analysis to directly compare the predictive performance for incident TB disease between TST and IGRA to inform policy. METHODS We searched Medline and Embase from 1 January 2002 to 4 September 2020, and studies that were included in previous systematic reviews. We included prospective longitudinal studies in which participants received both TST and IGRA and estimated performance as hazard ratios (HR) for the development of all diagnoses of TB in participants with dichotomised positive test results compared to negative results, using different thresholds of positivity for TST. Secondary analyses included an evaluation of the impact of background TB incidence. We also estimated the sensitivity and specificity for predicting TB. We explored heterogeneity through pre-defined sub-group analyses (e.g. country-level TB incidence). Publication bias was assessed using funnel plots and Egger's test. This review is registered with PROSPERO, CRD42020205667. FINDINGS We obtained data from 13 studies out of 40 that were considered eligible (N = 32,034 participants: 36% from countries with TB incidence rate ≥100 per 100,000 population). All reported data on TST and QuantiFERON Gold in-Tube (QFT-GIT). The point estimate for the TST was highest with higher cut-offs for positivity and particularly when stratified by bacillus Calmette-Guérin vaccine (BCG) status (15 mm if BCG vaccinated and 5 mm if not [TST5/15 mm]) at 2.88 (95% CI 1.69-4.90). The pooled HR for QFT-GIT was higher than for TST at 4.15 (95% CI 1.97-8.75). The difference was large in countries with TB incidence rate <100 per 100,000 population (HR 10.38, 95% CI 4.17-25.87 for QFT-GIT VS. HR 5.36, 95% CI 3.82-7.51 for TST5/15 mm) but much of this difference was driven by a single study (HR 5.13, 95% CI 3.58-7.35 for TST5/15 mm VS. 7.18, 95% CI 4.48-11.51 for QFT-GIT, when excluding the study, in which all 19 TB cases had positive QFT-GIT results). The comparative performance was similar in the higher burden countries (HR 1.61, 95% CI 1.23-2.10 for QFT-GIT VS. HR 1.72, 95% CI 0.98-3.01 for TST5/15 mm). The predictive performance of both tests was higher in countries with TB incidence rate <100 per 100,000 population. In the lower TB incidence countries, the specificity of TST (76% for TST5/15 mm) and QFT-GIT (74%) for predicting active TB approached the minimum World Health Organization target (≥75%), but the sensitivity was below the target of ≥75% (63% for TST5/15 mm and 65% for QFT-GIT). The absolute differences in positive and negative predictive values between TST15 mm and QFT-GIT were small (positive predictive values 2.74% VS. 2.46%; negative predictive values 99.42% VS. 99.52% in low-incidence countries). Egger's test did not show evidence of publication bias (0.74 for TST15 mm and p = 0.68 for QFT-GIT). INTERPRETATION IGRA appears to have higher predictive performance than the TST in low TB incidence countries, but the difference was driven by a single study. Any advantage in clinical performance may be small, given the numerically similar positive and negative predictive values. Both IGRA and TST had lower performance in countries with high TB incidence. Test choice should be contextual and made considering operational and likely clinical impact of test results. FUNDING YH, IA, and MXR were supported by the National Institute for Health and Care Research (NIHR), United Kingdom (RP-PG-0217-20009). MQ was supported by the Medical Research Council [MC_UU_00004/07].
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Affiliation(s)
- Yohhei Hamada
- Institute for Global Health, University College London, London, United Kingdom
- Corresponding author.
| | - Rishi K. Gupta
- Institute for Global Health, University College London, London, United Kingdom
| | - Matteo Quartagno
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Abbie Izzard
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Neus Altet
- Unitat de Tuberculosis, Hospital Universitari Vall d’Hebron-Drassanes, Barcelona, Spain
- Unitat de TDO de la Tuberculosis ‘Servicios Clínicos’, Barcelona, Spain
| | - Roland Diel
- Institute for Epidemiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jose Dominguez
- Institut d'Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Edward C. Jones-López
- Division of Infectious Diseases, Department of Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
| | - Frank van Leth
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
- Department of Health Sciences, VU University, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
| | - Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
| | - Irene Latorre Rueda
- Institut d'Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Stanley Kimbung Mbandi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, and Division of Immunology, Department of Pathology, University of Cape Town, South Africa, Western Cape, South Africa
| | - Laura Muñoz
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | | | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins India, Pune, Maharashtra, India
| | - Thomas Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, and Division of Immunology, Department of Pathology, University of Cape Town, South Africa, Western Cape, South Africa
| | - Martina Sester
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | | | - Surendra K. Sharma
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
- Department of Molecular Medicine, Jamia Hamdard Institute of Molecular Medicine, Hamdard University, Delhi, India
- Departments of General Medicine & Pulmonary Medicine, JNMC, Datta Meghe Institute of Medical Sciences, Maharashtra, India
| | - Rosa Sloot
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Giovanni Sotgiu
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Kannan Thiruvengadam
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Richa Vashishtha
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, United Kingdom
| | - Molebogeng X. Rangaka
- Institute for Global Health, University College London, London, United Kingdom
- School of Public Health, and Clinical Infectious Disease Research Institute-Africa, University of Cape Town, Cape Town, South Africa
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14
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Lin Y, Zheng B, Chen J, Huang Q, Ye Y, Yang Y, Chen Y, Chen B, You M, Wang Q, Xu Y. Development of a prognostic nomogram and risk stratification system for upper thoracic esophageal squamous cell carcinoma. Front Oncol 2023; 13:1059539. [PMID: 37124485 PMCID: PMC10130360 DOI: 10.3389/fonc.2023.1059539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Background The study aimed to develop a nomogram model to predict overall survival (OS) and construct a risk stratification system of upper thoracic esophageal squamous cell carcinoma (ESCC). Methods Newly diagnosed 568 patients with upper ESCC at Fujian Medical University Cancer Hospital were taken as a training cohort, and additional 155 patients with upper ESCC from Sichuan Cancer Hospital Institute were used as a validation cohort. A nomogram was established using Cox proportional hazard regression to identify prognostic factors for OS. The predictive power of nomogram model was evaluated by using 4 indices: concordance statistics (C-index), time-dependent ROC (ROCt) curve, net reclassification index (NRI) and integrated discrimination improvement (IDI). Results In this study, multivariate analysis revealed that gender, clinical T stage, clinical N stage and primary gross tumor volume were independent prognostic factors for OS in the training cohort. The nomogram based on these factors presented favorable prognostic efficacy in the both training and validation cohorts, with concordance statistics (C-index) of 0.622, 0.713, and area under the curve (AUC) value of 0.709, 0.739, respectively, which appeared superior to those of the American Joint Committee on Cancer (AJCC) staging system. Additionally, net reclassification index (NRI) and integrated discrimination improvement (IDI) of the nomogram presented better discrimination ability to predict survival than those of AJCC staging. Furthermore, decision curve analysis (DCA) of the nomogram exhibited greater clinical performance than that of AJCC staging. Finally, the nomogram fairly distinguished the OS rates among low, moderate, and high risk groups, whereas the OS curves of clinical stage could not be well separated among clinical AJCC stage. Conclusion We built an effective nomogram model for predicting OS of upper ESCC, which may improve clinicians' abilities to predict individualized survival and facilitate to further stratify the management of patients at risk.
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Affiliation(s)
- Yu Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Binglin Zheng
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Junqiang Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Qiuyuan Huang
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yuling Ye
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yong Yang
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuanmei Chen
- Department of Thoracic Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Bijuan Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Mengxing You
- Department of Medical Oncology, The First Hosptial of Putian, Fujian Medical University Teaching Hospital, Putian, China
| | - Qifeng Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Yuanji Xu, ; Qifeng Wang,
| | - Yuanji Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- *Correspondence: Yuanji Xu, ; Qifeng Wang,
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15
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Boutilier JJ, Yoeli E, Rathauser J, Owiti P, Subbaraman R, Jónasson JO. Can digital adherence technologies reduce inequity in tuberculosis treatment success? Evidence from a randomised controlled trial. BMJ Glob Health 2022; 7:bmjgh-2022-010512. [PMID: 36455988 PMCID: PMC9716804 DOI: 10.1136/bmjgh-2022-010512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/07/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) is a global health emergency and low treatment adherence among patients is a major barrier to ending the TB epidemic. The WHO promotes digital adherence technologies (DATs) as facilitators for improving treatment adherence in resource-limited settings. However, limited research has investigated whether DATs improve outcomes for high-risk patients (ie, those with a high probability of an unsuccessful outcome), leading to concerns that DATs may cause intervention-generated inequality. METHODS We conducted secondary analyses of data from a completed individual-level randomised controlled trial in Nairobi, Kenya during 2016-2017, which evaluated the average intervention effect of a novel DAT-based behavioural support programme. We trained a causal forest model to answer three research questions: (1) Was the effect of the intervention heterogeneous across individuals? (2) Was the intervention less effective for high-risk patients? nd (3) Can differentiated care improve programme effectiveness and equity in treatment outcomes? RESULTS We found that individual intervention effects-the percentage point reduction in the likelihood of an unsuccessful treatment outcome-ranged from 4.2 to 12.4, with an average of 8.2. The intervention was beneficial for 76% of patients, and most beneficial for high-risk patients. Differentiated enrolment policies, targeted at high-risk patients, have the potential to (1) increase the average intervention effect of DAT services by up to 28.5% and (2) decrease the population average and standard deviation (across patients) of the probability of an unsuccessful treatment outcome by up to 8.5% and 31.5%, respectively. CONCLUSION This DAT-based intervention can improve outcomes among high-risk patients, reducing inequity in the likelihood of an unsuccessful treatment outcome. In resource-limited settings where universal provision of the intervention is infeasible, targeting high-risk patients for DAT enrolment is a worthwhile strategy for programmes that involve human support sponsors, enabling them to achieve the highest possible impact for high-risk patients at a substantially improved cost-effectiveness ratio.
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Affiliation(s)
- Justin J Boutilier
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erez Yoeli
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | | | - Ramnath Subbaraman
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jónas Oddur Jónasson
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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16
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Schaberg T, Brinkmann F, Feiterna-Sperling C, Geerdes-Fenge H, Hartmann P, Häcker B, Hauer B, Haas W, Heyckendorf J, Lange C, Maurer FP, Nienhaus A, Otto-Knapp R, Priwitzer M, Richter E, Salzer HJ, Schoch O, Schönfeld N, Stahlmann R, Bauer T. Tuberkulose im Erwachsenenalter. Pneumologie 2022; 76:727-819. [DOI: 10.1055/a-1934-8303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungDie Tuberkulose ist in Deutschland eine seltene, überwiegend gut behandelbare Erkrankung. Weltweit ist sie eine der häufigsten Infektionserkrankungen mit ca. 10 Millionen Neuerkrankungen/Jahr. Auch bei einer niedrigen Inzidenz in Deutschland bleibt Tuberkulose insbesondere aufgrund der internationalen Entwicklungen und Migrationsbewegungen eine wichtige Differenzialdiagnose. In Deutschland besteht, aufgrund der niedrigen Prävalenz der Erkrankung und der damit verbundenen abnehmenden klinischen Erfahrung, ein Informationsbedarf zu allen Aspekten der Tuberkulose und ihrer Kontrolle. Diese Leitlinie umfasst die mikrobiologische Diagnostik, die Grundprinzipien der Standardtherapie, die Behandlung verschiedener Organmanifestationen, den Umgang mit typischen unerwünschten Arzneimittelwirkungen, die Besonderheiten in der Diagnostik und Therapie resistenter Tuberkulose sowie die Behandlung bei TB-HIV-Koinfektion. Sie geht darüber hinaus auf Versorgungsaspekte und gesetzliche Regelungen wie auch auf die Diagnosestellung und präventive Therapie einer latenten tuberkulösen Infektion ein. Es wird ausgeführt, wann es der Behandlung durch spezialisierte Zentren bedarf.Die Aktualisierung der S2k-Leitlinie „Tuberkulose im Erwachsenenalter“ soll allen in der Tuberkuloseversorgung Tätigen als Richtschnur für die Prävention, die Diagnose und die Therapie der Tuberkulose dienen und helfen, den heutigen Herausforderungen im Umgang mit Tuberkulose in Deutschland gewachsen zu sein.
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Affiliation(s)
- Tom Schaberg
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | - Folke Brinkmann
- Abteilung für pädiatrische Pneumologie/CF-Zentrum, Universitätskinderklinik der Ruhr-Universität Bochum, Bochum
| | - Cornelia Feiterna-Sperling
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin
| | | | - Pia Hartmann
- Labor Dr. Wisplinghoff Köln, Klinische Infektiologie, Köln
- Department für Klinische Infektiologie, St. Vinzenz-Hospital, Köln
| | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | - Jan Heyckendorf
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Christoph Lange
- Klinische Infektiologie, Forschungszentrum Borstel
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Hamburg-Lübeck-Borstel-Riems
- Respiratory Medicine and International Health, Universität zu Lübeck, Lübeck
- Baylor College of Medicine and Texas Childrenʼs Hospital, Global TB Program, Houston, TX, USA
| | - Florian P. Maurer
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Borstel
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Albert Nienhaus
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg
| | - Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | | | | | | | - Ralf Stahlmann
- Institut für klinische Pharmakologie und Toxikologie, Charité Universitätsmedizin, Berlin
| | - Torsten Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
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Ortiz-Brizuela E, Menzies D, Behr MA. Testing and Treating Mycobacterium tuberculosis Infection. Med Clin North Am 2022; 106:929-947. [PMID: 36280337 DOI: 10.1016/j.mcna.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After infection with Mycobacterium tuberculosis, a minority of individuals will progress to tuberculosis disease (TB). The risk is higher among persons with well-established risk factors and within the first year after infection. Testing and treating individuals at high risk of progression maximizes the benefits of TB preventive therapy; avoiding testing of low-risk persons will limit potential harms. Several treatment options are available; rifamycin-based regimens offer the best efficacy-safety balance. In this review, we present an overview of the diagnosis and treatment of TB infection, and summarize common clinical scenarios.
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Affiliation(s)
- Edgar Ortiz-Brizuela
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue, West Montreal, H3A 1A2, Canada; McGill International TB Centre, Research Institute of the McGill University Health Centre, 5252 boul.de Maisonneuve, West Montreal, Quebec, H4A 3S5, Canada; Department of Medicine, Insituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, Mexico City, 14000, Mexico
| | - Dick Menzies
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue, West Montreal, H3A 1A2, Canada; McGill International TB Centre, Research Institute of the McGill University Health Centre, 5252 boul.de Maisonneuve, West Montreal, Quebec, H4A 3S5, Canada; Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada
| | - Marcel A Behr
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue, West Montreal, H3A 1A2, Canada; McGill International TB Centre, Research Institute of the McGill University Health Centre, 5252 boul.de Maisonneuve, West Montreal, Quebec, H4A 3S5, Canada; Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada.
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18
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Dahl VN, Tiberi S, Goletti D, Wejse C. Armed conflict and human displacement may lead to an increase in the burden of tuberculosis in Europe. Int J Infect Dis 2022; 124 Suppl 1:S104-S106. [PMID: 35364284 DOI: 10.1016/j.ijid.2022.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Victor Naestholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Delia Goletti
- Epidemiology and Preclinical research, National Institute for Infectious diseases, L. Spallanazani-IRCCS, Roma, Italy
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark
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Abstract
Tuberculosis (TB) preventive therapy (TPT) is increasingly recognized as the key to eliminating tuberculosis globally and is particularly critical for children with TB infection or who are in close contact with individuals with infectious TB. But many barriers currently impede successful scale-up to provide TPT to those at high risk of TB disease. The cascade of care in TB infection (and the related contact management cascade) is a conceptual framework to evaluate and improve the care of persons who are potential candidates for TPT. This review summarizes recent literature on barriers and solutions in the TB infection care cascade, focusing on children in both high- and low-burden settings, and drawing from studies on children and adults. Identifying and closing gaps in the care cascade will require the implementation of tools that are new (e.g. computer-assisted radiography) and old (e.g. efficient contact tracing), and will be aided by innovative implementation study designs, quality improvement methods, and shared clinical practice with primary care providers.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dick Menzies
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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20
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Tran-Dinh A, Laurent Q, Even G, Tanaka S, Lortat-Jacob B, Castier Y, Mal H, Messika J, Mordant P, Nicoletti A, Montravers P, Caligiuri G, Morilla I. Personalized risk predictor for acute cellular rejection in lung transplant using soluble CD31. Sci Rep 2022; 12:17628. [PMID: 36271122 DOI: 10.1038/s41598-022-21070-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
We evaluated the contribution of artificial intelligence in predicting the risk of acute cellular rejection (ACR) using early plasma levels of soluble CD31 (sCD31) in combination with recipient haematosis, which was measured by the ratio of arterial oxygen partial pressure to fractional oxygen inspired (PaO2/FiO2) and respiratory SOFA (Sequential Organ Failure Assessment) within 3 days of lung transplantation (LTx). CD31 is expressed on endothelial cells, leukocytes and platelets and acts as a "peace-maker" at the blood/vessel interface. Upon nonspecific activation, CD31 can be cleaved, released, and detected in the plasma (sCD31). The study included 40 lung transplant recipients, seven (17.5%) of whom experienced ACR. We modelled the plasma levels of sCD31 as a nonlinear dependent variable of the PaO2/FiO2 and respiratory SOFA over time using multivariate and multimodal models. A deep convolutional network classified the time series models of each individual associated with the risk of ACR to each individual in the cohort.
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21
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Giardini M, Arcolin I, Godi M, Guglielmetti S, Maretti A, Capelli A, Corna S. The Coronavirus Footprint on Dual-Task Performance in Post-Acute Patients after Severe COVID-19: A Future Challenge for Rehabilitation. Int J Environ Res Public Health 2022; 19:10644. [PMID: 36078366 PMCID: PMC9518102 DOI: 10.3390/ijerph191710644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Recent studies suggest that also the non-critical form of COVID-19 infection may be associated with executive function impairments. However, it is not clear if they result from cognitive impairments or by COVID-19 infection per se. We aimed to investigate if patients in the post-acute stage of severe COVID-19 (PwCOVID), without manifest cognitive deficits, reveal impairments in performing dual-task (DT) activities compared to healthy controls (HS). We assessed balance in 31 PwCOVID vs. 30 age-matched HS by stabilometry and the Timed Up and Go (TUG) test with/without a cognitive DT. The DT cost (DTC), TUG test time and sway oscillations were recorded; correct cognitive responses (CCR) were calculated to evaluate cognitive performance. Results show a significant difference in overall DT performance between PwCOVID and HS in both stabilometry (p < 0.01) and the TUG test (p < 0.0005), although with similar DTCs. The main difference in the DTs between groups emerged in the CCR (effect size > 0.8). Substantially, PwCOVID gave priority to the motor task, leaving out the cognitive one, while HS performed both tasks simultaneously. Our findings suggest that PwCOVID, even without a manifest cognitive impairment, may present a deficit in executive function during DTs. These results encourage the use of DTs and CCR in PwCOVID.
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Affiliation(s)
- Marica Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Ilaria Arcolin
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Marco Godi
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Simone Guglielmetti
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Alessandro Maretti
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Armando Capelli
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Pulmonary Rehabilitation of Veruno Institute, 28013 Gattico, Italy
| | - Stefano Corna
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Physical Medicine and Rehabilitation of Veruno Institute, 28013 Gattico, Italy
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22
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Abstract
BACKGROUND: Protection against infection by the bacille Calmette-Guérin vaccine against Mycobacterium tuberculosis remains a subject of controversy. We investigated the association between BCG vaccination at birth and infection by M. tuberculosis. MATERIAL AND METHODS: This was a secondary analysis of data from tuberculin skin test (TST) surveys in Vietnamese schoolchildren between 1988 and 2001. We investigated whether a BCG scar was associated with a lower prevalence of TST positivity, adjusting for BCG-induced variation by varying cut-off values for a positive TST. RESULTS: We found a positive association between BCG scar and TST positivity. The strength of the association decreased with increasing TST cut-off values; however, it never inverted significantly, irrespective of geographic region and survey year. CONCLUSION: In Vietnam, BCG vaccination was not associated with reduced M. tuberculosis infection prevalence as measured using TST. This in contrary to a similar study conducted in Tanzania. These contradictory findings may be explained by geographical differences and the relatively high prevalence in Vietnam of the M. tuberculosis Beijing genotype, which is reported to be capable of circumventing BCG-induced immunity.
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Affiliation(s)
- P T Pelzer
- KNCV Tuberculosis foundation, Technical division, The Hague, The Netherlands, Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Y Smit
- KNCV Tuberculosis foundation, Technical division, The Hague, The Netherlands
| | - E W Tiemersma
- KNCV Tuberculosis foundation, Technical division, The Hague, The Netherlands
| | - N T Huong
- NTP Vietnam, National Lung Hospital, Hanoi, Viet Nam
| | - N V Nhung
- KNCV Tuberculosis Foundation, Country office in Vietnam, Hanoi, Viet Nam
| | - F Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Pépin J, Desjardins F, Carignan A, Lambert M, Vaillancourt I, Labrie C, Mercier D, Bourque R, LeBlanc L. Impact and benefit-cost ratio of a program for the management of latent tuberculosis infection among refugees in a region of Canada. PLoS One 2022; 17:e0267781. [PMID: 35587499 PMCID: PMC9119458 DOI: 10.1371/journal.pone.0267781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
The identification and treatment of latent tuberculosis infection (LTBI) among immigrants from high-incidence regions who move to low-incidence countries is generally considered an ineffective strategy because only ≈14% of them comply with the multiple steps of the ‘cascade of care’ and complete treatment. In the Estrie region of Canada, a refugee clinic was opened in 2009. One of its goals is LTBI management.
Methods
Key components of this intervention included: close collaboration with community organizations, integration within a comprehensive package of medical care for the whole family, timely delivery following arrival, shorter treatment through preferential use of rifampin, and risk-based selection of patients to be treated. Between 2009–2020, 5131 refugees were evaluated. To determine the efficacy and benefit-cost ratio of this intervention, records of refugees seen in 2010–14 (n = 1906) and 2018–19 (n = 1638) were reviewed. Cases of tuberculosis (TB) among our foreign-born population occurring before (1997–2008) and after (2009–2020) setting up the clinic were identified. All costs associated with TB or LTBI were measured.
Results
Out of 441 patients offered LTBI treatment, 374 (85%) were compliant. Adding other losses, overall compliance was 69%. To prevent one case of TB, 95.1 individuals had to be screened and 11.9 treated, at a cost of $16,056. After discounting, each case of TB averted represented $32,631, for a benefit-cost ratio of 2.03. Among nationals of the 20 countries where refugees came from, incidence of TB decreased from 68.2 (1997–2008) to 26.3 per 100,000 person-years (2009–2020). Incidence among foreign-born persons from all other countries not targeted by the intervention did not change.
Conclusions
Among refugees settling in our region, 69% completed the LTBI cascade of care, leading to a 61% reduction in TB incidence. This intervention was cost-beneficial. Current defeatism towards LTBI management among immigrants and refugees is misguided. Compliance can be enhanced through simple measures.
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Affiliation(s)
- Jacques Pépin
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
- * E-mail:
| | - France Desjardins
- Clinique des Réfugiés, Centre Local de Services Communautaires, Sherbrooke, Québec, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Michel Lambert
- Clinique des Réfugiés, Centre Local de Services Communautaires, Sherbrooke, Québec, Canada
| | - Isabelle Vaillancourt
- Clinique des Réfugiés, Centre Local de Services Communautaires, Sherbrooke, Québec, Canada
| | - Christiane Labrie
- Clinique des Réfugiés, Centre Local de Services Communautaires, Sherbrooke, Québec, Canada
| | - Dominique Mercier
- Clinique des Réfugiés, Centre Local de Services Communautaires, Sherbrooke, Québec, Canada
| | - Rachel Bourque
- Clinique des Réfugiés, Centre Local de Services Communautaires, Sherbrooke, Québec, Canada
| | - Louiselle LeBlanc
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
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24
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Mulenga H, Fiore-Gartland A, Mendelsohn SC, Penn-Nicholson A, Mbandi SK, Borate B, Musvosvi M, Tameris M, Walzl G, Naidoo K, Churchyard G, Scriba TJ, Hatherill M. The effect of host factors on discriminatory performance of a transcriptomic signature of tuberculosis risk. EBioMedicine 2022; 77:103886. [PMID: 35183869 PMCID: PMC8861653 DOI: 10.1016/j.ebiom.2022.103886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 01/28/2023] Open
Abstract
Background We aimed to understand host factors that affect discriminatory performance of a transcriptomic signature of tuberculosis risk (RISK11). Methods HIV-negative adults aged 18–60 years were evaluated in a prospective study of RISK11 and surveilled for tuberculosis through 15 months. Generalised linear models and receiver-operating characteristic (ROC) regression were used to estimate effect of host factors on RISK11 score (%marginal effect) and on discriminatory performance for tuberculosis disease (area under the curve, AUC), respectively. Findings Among 2923 participants including 74 prevalent and 56 incident tuberculosis cases, percentage marginal effects on RISK11 score were increased among those with prevalent tuberculosis (+18·90%, 95%CI 12·66−25·13), night sweats (+14·65%, 95%CI 5·39−23·91), incident tuberculosis (+7·29%, 95%CI 1·46−13·11), flu-like symptoms (+5·13%, 95%CI 1·58−8·68), and smoking history (+2·41%, 95%CI 0·89−3·93) than those without; and reduced in males (−6·68%, 95%CI −8·31−5·04) and with every unit increase in BMI (−0·13%, −95%CI −0·25−0·01). Adjustment for host factors affecting controls did not change RISK11 discriminatory performance. Cough was associated with 72·55% higher RISK11 score in prevalent tuberculosis cases. Stratification by cough improved diagnostic performance from AUC = 0·74 (95%CI 0·67−0·82) overall, to 0·97 (95%CI 0·90−1·00, p < 0·001) in cough-positive participants. Combining host factors with RISK11 improved prognostic performance, compared to RISK11 alone, (AUC = 0·76, 95%CI 0·69−0·83 versus 0·56, 95%CI 0·46−0·68, p < 0·001) over a 15-month predictive horizon. Interpretation Several host factors affected RISK11 score, but only adjustment for cough affected diagnostic performance. Combining host factors with RISK11 should be considered to improve prognostic performance. Funding Bill and Melinda Gates Foundation, South African Medical Research Council.
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Affiliation(s)
- Humphrey Mulenga
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - Andrew Fiore-Gartland
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Fairview Ave. N., Seattle, WA 98109-1024, USA
| | - Simon C Mendelsohn
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - Adam Penn-Nicholson
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - Stanley Kimbung Mbandi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - Bhavesh Borate
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Fairview Ave. N., Seattle, WA 98109-1024, USA
| | - Munyaradzi Musvosvi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - Michèle Tameris
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - Gerhard Walzl
- DST/NRF Centre of Excellence for Biomedical TB Research and SAMRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Dr, Parow, 7505, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, Doris Duke Medical Research Institute, University of KwaZulu-Natal, 719 Umbilo Road, Durban 4001, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, 719 Umbilo Road, Durban 4001, South Africa
| | - Gavin Churchyard
- The Aurum Institute, 29 Queens Rd, Parktown, Johannesburg, Gauteng 2194, South Africa; School of Public Health, University of Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg 2193, South Africa; Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
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25
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Mendelsohn SC, Fiore-Gartland A, Awany D, Mulenga H, Mbandi SK, Tameris M, Walzl G, Naidoo K, Churchyard G, Scriba TJ, Hatherill M. Clinical predictors of pulmonary tuberculosis among South African adults with HIV. EClinicalMedicine 2022; 45:101328. [PMID: 35274090 PMCID: PMC8902614 DOI: 10.1016/j.eclinm.2022.101328] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) clinical prediction rules rely on presence of symptoms, however many undiagnosed cases in the community are asymptomatic. This study aimed to explore the utility of clinical factors in predicting TB among people with HIV not seeking care. METHODS Baseline data were analysed from an observational cohort of ambulant adults with HIV in South Africa. Participants were tested for Mycobacterium tuberculosis (Mtb) sensitisation (interferon-γ release assay, IGRA) and microbiologically-confirmed prevalent pulmonary TB disease at baseline, and actively surveilled for incident TB through 15 months. Multivariable LASSO regression with post-selection inference was used to test associations with Mtb sensitisation and TB disease. FINDINGS Between March 22, 2017, and May 15, 2018, 861 participants were enrolled; Among 851 participants included in the analysis, 94·5% were asymptomatic and 45·9% sensitised to Mtb. TB prevalence was 2·0% at baseline and incidence 2·3/100 person-years through 15 months follow-up. Study site was associated with baseline Mtb sensitisation (p < 0·001), prevalent (p < 0·001), and incident TB disease (p = 0·037). Independent of site, higher CD4 counts (per 50 cells/mm3, aOR 1·48, 95%CI 1·12-1·77, p = 0·006) were associated with increased IGRA positivity, and participants without TB disease (aOR 0·80, 95%CI 0·69-0·94, p = 0·006) had reduced IGRA positivity; no variables were independently associated with prevalent TB. Mixed ancestry (aHR 1·49, 95%CI 1·30->1000, p = 0·005) and antiretroviral initiation (aHR 1·48, 95%CI 1·01-929·93, p = 0·023) were independently associated with incident TB. Models incorporating clinical features alone performed poorly in diagnosing prevalent (AUC 0·65, 95%CI 0·44-0·85) or predicting progression to incident (0·67, 0·46-0·88) TB. INTERPRETATION CD4 count and antiretroviral initiation, proxies for immune status and HIV stage, were associated with Mtb sensitisation and TB disease. Inadequate performance of clinical prediction models may reflect predominantly subclinical disease diagnosed in this setting and unmeasured local site factors affecting transmission and progression. FUNDING The CORTIS-HR study was funded by the Bill & Melinda Gates Foundation (OPP1151915) and by the Strategic Health Innovation Partnerships Unit of the South African Medical Research Council with funds received from the South African Department of Science and Technology. The regulatory sponsor was the University of Cape Town.
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Affiliation(s)
- Simon C. Mendelsohn
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Andrew Fiore-Gartland
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Denis Awany
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Humphrey Mulenga
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Stanley Kimbung Mbandi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Michèle Tameris
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Gerhard Walzl
- DST/NRF Centre of Excellence for Biomedical TB Research, South African Medical Research Council Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban 4001, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Gavin Churchyard
- The Aurum Institute, Johannesburg 2194, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg 2193, South Africa
- Department of Medicine, Vanderbilt University, Nashville, TN 37232, USA
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - 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, Anzio Road, Observatory, Cape Town 7925, South Africa
- Corresponding author.
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Campbell JR, Schwartzman K. Invited Commentary: The Role of Tuberculosis Screening Among Migrants to Low-Incidence Settings in (Not) Achieving Elimination. Am J Epidemiol 2022; 191:271-274. [PMID: 34216207 DOI: 10.1093/aje/kwab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023] Open
Abstract
The cost-effectiveness of migrant tuberculosis prevention programs is highly relevant to many countries with low tuberculosis incidence as they attempt to eliminate the disease. Dale et al. (Am J Epidemiol. 2022;191(2):255-270) evaluated strategies for tuberculosis infection screening and treatment among new migrants to Australia. Screening for infection before migration, and then administering preventive treatment after arrival, was more cost-effective than performing both screening and treatment after arrival. From the Australian health payer perspective, the improved cost-effectiveness of premigration screening partly reflected the shift of screening costs to migrants, which may raise ethical concerns. Key sensitivity analyses highlighted the influence of health disutility associated with tuberculosis preventive treatment, and of posttreatment sequelae of tuberculosis disease. Both considerations warrant greater attention in future research. For all strategies, the impact on tuberculosis incidence among migrants was modest (<15%), suggesting enhanced migrant screening will not achieve tuberculosis elimination in low-incidence settings. This emphasizes the need to increase investment and effort in global tuberculosis prevention and care, which will ultimately reduce the prevalence of tuberculosis infection and therefore the risk of tuberculosis disease among migrants. Such efforts will benefit high and low tuberculosis incidence countries alike, and advance all countries further toward tuberculosis elimination.
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27
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Bastos ML, Oxlade O, Campbell JR, Faerstein E, Menzies D, Trajman A. Scaling up investigation and treatment of household contacts of tuberculosis patients in Brazil: a cost-effectiveness and budget impact analysis. Lancet Reg Health Am 2022; 8:100166. [PMID: 36778732 PMCID: PMC9903685 DOI: 10.1016/j.lana.2021.100166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background In Brazil, investigation and treatment of tuberculosis infection (TBI) in households contacts (HHC) of TB patients is not a priority. We estimated the cost-effectiveness and budget-impact of scaling-up an enhanced HHC management in Brazil. Methods We conceptualized a cascade-of-care that captures how HHC of tuberculosis patients are investigated in Brazil (status quo) and two enhanced strategies for management of HHC focusing on: (1) only tuberculosis disease (TBD) detection and, (2) TBD and TBI detection and treatment. Effectiveness was the number of HHC diagnosed with TBD and completing TBI treatment. Proportions in the cascades-of-care were derived from a meta-analysis. Health-system costs (2019 US$) were based on literature and official data from Brazil. The impact of enhanced strategies was extrapolated using reported data from 2019. Findings With the status quo, 0 (95% uncertainty interval: 0-1) HHC are diagnosed with TBD and 2 (0-16) complete TBI treatment. With strategy(1), an additional 15 (3-45) HHC would be diagnosed with TBD at a cost of US$346 each. With strategy(2), 81 (19-226) additional HHC would complete TBI treatment at a cost of US$84 each. A combined strategy, implemented nationally to enhance TBD detection and TBI treatment would result in an additional 9,711 (845-28,693) TBD being detected, and 51,277 (12,028-143,495) more HHC completing TBI treatment each year, utilizing 10.9% and 11.6% of the annual national tuberculosis program budget, respectively. Interpretation Enhanced detection and treatment of TBD and TBI among HHC in Brazil can be achieved at a national level using current tools at reasonable cost. Funding None.
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Key Words
- Brazil
- CI, confidence interval
- Cascade-of-care
- HHC, household contact
- LMIC, low and middle-income countries
- Latent tuberculosis
- MoH, Ministry of Health
- TBD, tuberculosis disease
- TBI, tuberculosis infection
- TST, tuberculin skin testing
- Tuberculosis
- UI, uncertainty interval
- US$, United States Dollar
- WHO, World Health Organization
- budget impact
- cost-effectiveness
- tuberculosis preventive therapy
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Affiliation(s)
- Mayara Lisboa Bastos
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil,Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada,McGill International TB Centre, McGill University, Montreal, Canada
| | - Olivia Oxlade
- McGill International TB Centre, McGill University, Montreal, Canada
| | - Jonathon R. Campbell
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada,McGill International TB Centre, McGill University, Montreal, Canada
| | - Eduardo Faerstein
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada,McGill International TB Centre, McGill University, Montreal, Canada
| | - Anete Trajman
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil,McGill International TB Centre, McGill University, Montreal, Canada,Federal University of Rio de Janeiro, RJ, Brazil,Corresponding author: Anete Trajman, Rua Macedo Sobrinho 74/203, Humaitá, 22271-080, Rio de Janeiro, Brazil
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28
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Noursadeghi M, Gupta RK. New Insights into the Limitations of Host Transcriptional Biomarkers of Tuberculosis. Am J Respir Crit Care Med 2021; 204:1363-1365. [PMID: 34705613 PMCID: PMC8865719 DOI: 10.1164/rccm.202109-2146ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mahdad Noursadeghi
- Division of Infection and Immunity University College London London, United Kingdom
| | - Rishi K Gupta
- Institute for Global Health University College London London, United Kingdom
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29
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Yu S, Jeong D, Choi H. The burden and predictors of latent tuberculosis infection among immigrants in South Korea: a retrospective cross-sectional study. BMC Infect Dis 2021; 21:1206. [PMID: 34861855 PMCID: PMC8641149 DOI: 10.1186/s12879-021-06922-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately one-fourth of the global population is latently infected with Mycobacterium tuberculosis. An understanding of the burden of latent tuberculosis infection (LTBI) among immigrants compared with the general Korean population should be the first step in identifying priority groups for LTBI diagnosis and treatment. The study aimed to compute the age-standardized LTBI prevalence and predictors among immigrants with LTBI in South Korea. METHODS In 2018, the Korea Disease Control and Prevention Agency implemented a pilot LTBI screening project for immigrants using a chest radiography and the QuantiFERON Gold In-Tube assay. A standardized prevalence ratio (SPR) was computed to compare the LTBI burden in immigrants and the general Korean population. RESULTS During the duration of the project, a total of 8108 immigrants (5134 males and 2974 females) underwent LTBI screening. The SPR of 1.547 (95% confidence interval [CI] 1.468-1.629) in males and 1.261 (95% CI 1.177-1.349) in females were both higher than the Korean reference population. Furthermore, among the immigrants, those aged < 40 years and Korean diaspora visa holders had a higher SPR. CONCLUSION This study found a higher LTBI prevalence among immigrant population in South Korea compared to that in the general Korean population, and the SPR was higher among those aged < 40 years and the Korean diaspora. The findings can be used as baseline evidence for including immigrants in South Korea in the at-risk group with a priority need for LTBI screening and treatment.
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Affiliation(s)
- Sarah Yu
- Division of Health Policy, Research Center, The Korean Institute of Tuberculosis, Cheongju, Republic of Korea.,School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.,Transdiciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul, Republic of Korea
| | - Dawoon Jeong
- Division of Health Policy, Research Center, The Korean Institute of Tuberculosis, Cheongju, Republic of Korea
| | - Hongjo Choi
- Division of Health Policy, Research Center, The Korean Institute of Tuberculosis, Cheongju, Republic of Korea. .,Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea.
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30
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Chandna A, Osborn J, Bassat Q, Bell D, Burza S, D'Acremont V, Fernandez-Carballo BL, Kain KC, Mayxay M, Wiens M, Dittrich S. Anticipating the future: prognostic tools as a complementary strategy to improve care for patients with febrile illnesses in resource-limited settings. BMJ Glob Health 2021; 6:bmjgh-2021-006057. [PMID: 34330761 PMCID: PMC8327814 DOI: 10.1136/bmjgh-2021-006057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/25/2021] [Indexed: 12/17/2022] Open
Abstract
In low-income and middle-income countries, most patients with febrile illnesses present to peripheral levels of the health system where diagnostic capacity is very limited. In these contexts, accurate risk stratification can be particularly impactful, helping to guide allocation of scarce resources to ensure timely and tailored care. However, reporting of prognostic research is often imprecise and few prognostic tests or algorithms are translated into clinical practice. Here, we review the often-conflated concepts of prognosis and diagnosis, with a focus on patients with febrile illnesses. Drawing on a recent global stakeholder consultation, we apply these concepts to propose three use-cases for prognostic tools in the management of febrile illnesses in resource-limited settings: (1) guiding referrals from the community to higher-level care; (2) informing resource allocation for patients admitted to hospital and (3) identifying patients who may benefit from closer follow-up post-hospital discharge. We explore the practical implications for new technologies and reflect on the challenges and knowledge gaps that must be addressed before this approach could be incorporated into routine care settings. Our intention is that these use-cases, alongside other recent initiatives, will help to promote a harmonised yet contextualised approach for prognostic research in febrile illness. We argue that this is especially important given the heterogeneous settings in which care is often provided for patients with febrile illnesses living in low-income and middle-income countries.
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Affiliation(s)
- Arjun Chandna
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia .,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Jennifer Osborn
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Dé, Universitat de Barcelona, Esplugues, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - David Bell
- Independent Consultant, Issaquah, Washington, USA
| | | | - Valérie D'Acremont
- Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Kevin C Kain
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Mayfong Mayxay
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK.,Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic.,Institute of Research and Education Development (IRED), University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Matthew Wiens
- Center for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada.,Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.,Walimu, Kampala, Uganda
| | - Sabine Dittrich
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK.,Foundation for Innovative New Diagnostics, Geneva, Switzerland
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31
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Laycock KM, Enane LA, Steenhoff AP. Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People. Trop Med Infect Dis 2021; 6:148. [PMID: 34449722 PMCID: PMC8396328 DOI: 10.3390/tropicalmed6030148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023] Open
Abstract
Adolescents and young adults (AYA, ages 10-24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care strategies often overlook AYA by grouping them with either children or adults, AYA have particular physiologic, developmental, and social characteristics that require dedicated approaches. This review describes current evidence on the prevention and control of TB among AYA, including approaches to TB screening, dynamics of TB transmission among AYA, and management challenges within the context of unique developmental needs. Challenges are considered for vulnerable groups of AYA such as migrants and refugees; AYA experiencing homelessness, incarceration, or substance use; and AYA living with HIV. We outline areas for needed research and implementation strategies to address TB among AYA globally.
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Affiliation(s)
- Katherine M. Laycock
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Andrew P. Steenhoff
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
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Avsar K. Tuberkulose - Wann daran denken, wie diagnostizieren? CME (Berl) 2021; 18:9-19. [PMID: 34127916 PMCID: PMC8190733 DOI: 10.1007/s11298-021-2038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Obwohl die Tuberkulose mithilfe von Antibiotika gut heilbar ist und die Zahlen in Deutschland wieder stetig rückläufig sind, stirbt rechnerisch alle 22 Sekunden auf der Welt ein Mensch an Tuberkulose, 95% davon in Entwicklungs- und Schwellenländern. Die WHO hat in ihrer End-Tuberkulose-Strategie das Ziel formuliert, im Vergleich zu 2015 die Zahl der Tuberkuloseerkrankungen pro 100.000 Einwohner bis 2035 weltweit um 90% und die Zahl der Todesfälle um 95% zu senken. Die Coronakrise hat hier zu großen Rückschritten geführt, fast zwei Drittel der Tuberkuloseprogramme weltweit sind unterbrochen worden. Damit ist in vielen Teilen der Welt die Erreichung dieser Ziele gefährdet und es wird sogar mit zunehmenden Fallzahlen in den nächsten Jahren gerechnet. Aber gerade die Tatsache, dass die Erkrankung bei uns seltener wird führt zu einer Zunahme der Dauer vom ersten Symptom bis zur Tuberkulosediagnose. Der vorliegende Artikel soll Ihnen eine Hilfestellung geben, wann die Tuberkulose in die Differenzialdiagnostik einzubeziehen ist und wie das Krankheitsbild diagnostiziert werden kann. Die Therapie, ihre häufigsten Nebenwirkungen und die Problematik resistenter Tuberkuloseformen werden ebenfalls kurz dargestellt.
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Affiliation(s)
- Korkut Avsar
- Asklepios Fachkliniken München-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
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Kumar Gupta R, Noursadeghi M. Blood transcriptomic biomarkers for tuberculosis screening: time to redefine our target populations? Lancet Glob Health 2021; 9:e736-e737. [PMID: 33862011 DOI: 10.1016/s2214-109x(21)00088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Rishi Kumar Gupta
- Institute for Global Health, University College London, London WC1E 6JB, UK.
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London WC1E 6JB, UK
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von Both U, Gerlach P, Ritz N, Bogyi M, Brinkmann F, Thee S. Management of childhood and adolescent latent tuberculous infection (LTBI) in Germany, Austria and Switzerland. PLoS One 2021; 16:e0250387. [PMID: 33970930 PMCID: PMC8109774 DOI: 10.1371/journal.pone.0250387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Majority of active tuberculosis (TB) cases in children in low-incidence countries are due to rapid progression of infection (latent TB infection (LTBI)) to disease. We aimed to assess common practice for managing paediatric LTBI in Austria, Germany and Switzerland prior to the publication of the first joint national guideline for paediatric TB in 2017. Methods Online-based survey amongst pediatricians, practitioners and staff working in the public health sector between July and November 2017. Data analysis was conducted using IBM SPSS. Results A total of 191 individuals participated in the survey with 173 questionnaires included for final analysis. Twelve percent of respondents were from Austria, 60% from Germany and 28% from Switzerland. Proportion of children with LTBI and migrant background was estimated by the respondents to be >50% by 58%. Tuberculin skin test (TST) and interferon-γ-release-assay (IGRA), particularly Quantiferon-gold-test, were reported to be used in 86% and 88%, respectively. In children > 5 years with a positive TST or IGRA a chest x-ray was commonly reported to be performed (28%). Fifty-three percent reported to take a different diagnostic approach in children ≤ 5 years, mainly combining TST, IGRA and chest x-ray for initial testing (31%). Sixty-eight percent reported to prescribe isoniazid-monotherapy: for 9 (62%), or 6 months (6%), 31% reported to prescribe combination therapy of isoniazid and rifampicin. Dosing of isoniazid and rifampicin below current recommendations was reported by up to 22% of respondents. Blood-sampling before/during LTBI treatment was reported in >90% of respondents, performing a chest-X-ray at the end of treatment by 51%. Conclusion This survey showed reported heterogeneity in the management of paediatric LTBI. Thus, regular and easily accessible educational activities and national up-to-date guidelines are key to ensure awareness and quality of care for children and adolescents with LTBI in low-incidence countries.
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Affiliation(s)
- Ulrich von Both
- Division of Pediatric Infectious Diseases, Dr von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
- German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - Philipp Gerlach
- Division of Pediatric Infectious Diseases, Dr von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Nicole Ritz
- Pediatric Infectious Diseases Unit, University Children’s Hospital Basel, The University of Basel, Basel, Switzerland
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, Australia
| | - Matthias Bogyi
- Department of Paediatrics, Wilhelminenspital, Vienna, Austria
| | - Folke Brinkmann
- Department of Paediatric Pulmonology, Ruhr University Bochum, Bochum, Germany
| | - Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité –Universitätsmedizin, Berlin, Germany
- * E-mail:
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Affiliation(s)
- Marcel A Behr
- Department of Medicine.,McGill International Tuberculosis Centre, and
| | - Eva Kaufmann
- Department of Medicine.,Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
| | - Jacalyn Duffin
- Hannah Professor Emerita of the History of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Paul H Edelstein
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.,Molecular Immunity Unit MRC, Laboratory of Molecular Biology and Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Lalita Ramakrishnan
- Molecular Immunity Unit MRC, Laboratory of Molecular Biology and Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Sachsenweger J, Scheu KM, Lange C, Terhalle E. [24/f-Chronic cough : Preparation for the medical specialist examination: part 45]. Internist (Berl) 2021; 62:315-321. [PMID: 33751138 DOI: 10.1007/s00108-021-01005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Sachsenweger
- Medizinische Klinik, Forschungszentrum Borstel, Parkallee 35, 23843, Borstel, Deutschland
| | - K Miriam Scheu
- Medizinische Klinik, Forschungszentrum Borstel, Parkallee 35, 23843, Borstel, Deutschland
| | - C Lange
- Medizinische Klinik, Forschungszentrum Borstel, Parkallee 35, 23843, Borstel, Deutschland
| | - E Terhalle
- Medizinische Klinik, Forschungszentrum Borstel, Parkallee 35, 23843, Borstel, Deutschland.
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Fox GJ, Nguyen TA, Coleman M, Trajman A, Velen K, Marais BJ. Implementing tuberculosis preventive treatment in high-prevalence settings. Int J Infect Dis 2021:S1201-9712(21)00180-6. [PMID: 33716196 DOI: 10.1016/j.ijid.2021.02.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022] Open
Abstract
Latent tuberculosis infection affects one quarter of the world's population, and effective therapies are available. However, scale-up of tuberculosis preventive treatment (TPT) remains limited. We describe strategies to support scale-up of TPT in high-prevalence settings, where the potential benefit for affected individuals is considerable. Patients must be at the centre of policies to scale-up TPT. Addressing the health system requirements for scale-up will ensure that programs can deliver treatment safely, efficiently and sustainably. Further research is required to adapt TPT to local contexts, and develop new shorter treatments that will be suitable for wide-scale deployment.
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Mitteilungsseiten des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose (DZK). Pneumologie 2021; 75:156-158. [DOI: 10.1055/a-1351-9176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Steffen RE, Pinto M, Kritski A, Trajman A. Cost-effectiveness of newer technologies for the diagnosis of Mycobacterium tuberculosis infection in Brazilian people living with HIV. Sci Rep 2020; 10:21823. [PMID: 33311520 DOI: 10.1038/s41598-020-78737-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis is the leading cause of death among people living with HIV (PLH). Preventive tuberculosis therapy reduces mortality in PLH, especially in those with a positive tuberculin skin test (TST). New, more specific technologies for detecting latent tuberculosis infection (LTBI) are now commercially available. We sought to analyse the cost-effectiveness of four different strategies for the diagnosis of LTBI in PLH in Brazil, from the Brazilian public health care system perspective. We developed a Markov state-transition model comparing four strategies for the diagnosis of LTBI over 20 years. The strategies consisted of TST with the currently used protein purified derivative (PPD RT 23), two novel skin tests using recombinant allergens (Diaskintest [Generium Pharmaceutical, Moscow, Russia] and EC [Zhifei Longcom Biologic Pharmacy Co., Anhui, China]), and the QuantiFERON-TB-Gold-Plus (Qiagen, Hilden, Germany). The main outcome was cost (in 2020 US dollars) per quality-adjusted life years (QALY). For the base case scenario, the Diaskintest was dominant over all other examined strategies. The cost saving estimate per QALY was US $1375. In sensitivity analyses, the Diaskintest and other newer tests remained cost-saving compared to TST. For PLH, TST could be replaced by more specific tests in Brazil, considering the current national recommendations.
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