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Mackenzie GA, Hossain I, Salaudeen R, Badji H, Manjang A, Usuf E, Bottomley C, Greenwood B, Hill PC. Impact of pneumococcal conjugate vaccination on pneumococcal nasopharyngeal carriage in the Gambia: Population-based cross-sectional surveys. Vaccine 2024; 42:2680-2686. [PMID: 38490820 PMCID: PMC11004668 DOI: 10.1016/j.vaccine.2024.02.066] [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: 06/01/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The introduction of pneumococcal conjugate vaccines (PCV) has reduced carriage of vaccine-type (VT) pneumococci in many settings. We determined the impact of The Gambia's national PCV programme on carriage of VT pneumococci in the population. METHODS Seven-valent PCV (PCV7) was introduced in August 2009 without catch-up and with doses scheduled at 2, 3, 4 months of age; it was replaced by PCV13 in May 2011. We did cross-sectional carriage surveys in 2009, 2015, and 2017 in age-stratified, population-based samples. Nasopharyngeal specimens were collected and processed according to WHO guidelines. We calculated observed and adjusted prevalence ratios (PR) of VT carriage before and after PCV introduction. FINDINGS We enrolled 2988, 3162, and 2709 participants in 2009, 2015, and 2017 respectively. The baseline (2009) prevalence of VT pneumococcal carriage among children aged 0-4 years was 42.6 %, which declined to 14.9 % and 17.5 % in 2015 and 2017 respectively (adjPR 0.32 [95 % CI 0.27, 0.38] and 0.38 [0.31, 0.46] respectively). VT prevalence among children aged 5-14 years was 16.6 %, 15.1 %, and 15.8 % in the three surveys (2017 vs 2009, adjPR 0.70 [0.58, 0.83]). VT prevalence among 15-44 year-olds was 6.4 %, 5.7 %, and 7.1 % in the three surveys (2017 vs 2009, adjPR 0.59 [0.46, 0.75]), while in those aged ≥ 45 years it was 4.5 %, 6.5 %, and 4.5 % respectively. Non-VT carriage increased in all age-groups. Prevalent residual serotypes were 34 and 15B (age 0-4 years), 3 and 34 (age 5-14 years), and 3 and 16F (age ≥ 15 years). CONCLUSIONS Introduction of PCV was associated with reduced VT pneumococcal carriage in young, and older children, although with substantial residual prevalence. Persisting VT, and non-VT, carriage indicate significant, persistent transmission of pneumococci in the population.
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Affiliation(s)
- Grant A Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia; Murdoch Children's Research Institute, Parkville, 3052 Melbourne, Victoria, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Department of Paediatrics, University of Melbourne, Parkville, 3052 Melbourne, Victoria, Australia.
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Ahmed Manjang
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Effua Usuf
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Christian Bottomley
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Philip C Hill
- Centre for International Health, University of Otago, McMillan Street, Dunedin 9010, New Zealand
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Apriani L, McAllister S, Sharples K, Aini IN, Nurhasanah H, Ratnaningsih DF, Indrati AR, Ruslami R, Alisjahbana B, van Crevel R, Hill PC. Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia. PLoS One 2024; 19:e0299874. [PMID: 38498488 PMCID: PMC10947906 DOI: 10.1371/journal.pone.0299874] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND No gold standard diagnostic test exists for latent tuberculosis infection (LTBI). The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk factors for test positivity, in Indonesian healthcare students. METHODS Medical and nursing students starting their clinical training were screened using IGRA and TST. Agreement between the two tests was measured using Cohen's Kappa coefficient. Logistic regression was used to identify factors associated with test positivity. RESULTS Of 266 students, 43 (16.2%) were IGRA positive and 85 (31.9%) TST positive. Agreement between the two tests was 74.7% (kappa 0.33, 95% CI 0.21-0.45, P<0.0001). Students who had direct contact with family or friends with TB were less likely to be test positive using IGRA (AOR 0.18, 95% CI 0.05-0.64) and using TST (AOR 0.51, 95% CI 0.26-0.99). CONCLUSION Test positivity for LTBI was lower when measured by IGRA than by TST, with poor agreement between the two tests. Known close TB contact was unexpectedly negatively associated with positivity by either test. Longitudinal studies may be required to help determine the best test for LTBI in healthcare students in Indonesia.
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Affiliation(s)
- Lika Apriani
- TB Working Group, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Susan McAllister
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Isni Nurul Aini
- TB Working Group, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Hanifah Nurhasanah
- TB Working Group, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Dwi Febni Ratnaningsih
- TB Working Group, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Agnes Rengga Indrati
- TB Working Group, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- TB Working Group, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Bachti Alisjahbana
- TB Working Group, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip C Hill
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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White RG, Fiore-Gartland AJ, Hanekom WA, Vekemans J, Garcia-Basteiro AL, Churchyard G, Rangaka MX, Frick M, Behr MA, Hill PC, Mave V. What is next for BCG revaccination to prevent tuberculosis? Lancet Respir Med 2024; 12:e7-e8. [PMID: 38272048 DOI: 10.1016/s2213-2600(24)00009-2] [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] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Richard G White
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | | | | | - Johan Vekemans
- International AIDS Vaccine Initiative, New York, NY, USA
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | | | - Molebogeng X Rangaka
- Institute for Global Health, Medical Research Council Clinical Trials Unit, University College London, London, UK; CIDRI-AFRICA, Institute of Infectious Disease and Molecular Medicine and School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mike Frick
- Treatment Action Group, New York, NY, USA
| | - Marcel A Behr
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | | | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India; Center for Infectious Diseases in India, Johns Hopkins India, Pune, India
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Sonder GJB, Grey C, Ryan D, Cumming J, Sporle A, Hill PC. Selective under-representation of Pacific peoples in population estimates for health indicator measurements in Aotearoa New Zealand misinforms policy making. BMC Public Health 2024; 24:564. [PMID: 38388865 PMCID: PMC10882897 DOI: 10.1186/s12889-024-17984-2] [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: 10/01/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The Census of Populations and Dwellings' is the five yearly population count of Aotearoa New Zealand. Best available populations (BAP) are subnational projections based on census data and demographic assumptions developed for healthcare planning and funding allocation but are also used as the denominator for health indicator monitoring. Pacific people are systematically undercounted, but the impact on health statistics is not well studied. For COVID-19 vaccination coverage, health service user (HSU) data were considered a more reliable denominator than BAP but introduced new biases. We aimed to understand how the choice of denominator population impacts estimates of population size and health system performance for Pacific people at a local level. METHODS We described how declining census response rates affected population data quality. We compared BAP and HSU data at district level. For the indicators 'access to primary care' and 'cervical cancer screening uptake' we replaced currently used BAP denominators with HSU and examined the impact for different ethnic groups in different geographic districts. RESULTS Overall Census 2018 response declined by 10%, but for Māori and Pacific people by 21% and 23%, respectively. This inequitably affected BAP accuracy. Census undercount was highest in the district with the largest Pacific populations, where HSU exceeded BAP most. Notably, 'access to primary care' for Pacific people in this district consistently exceeds 100%. Using BAP, both health indicators are currently estimated as highest for Pacific people compared to other ethnic groups, but when based on HSU, they dropped to lowest. Similar, but less pronounced trends occurred in other districts. Changes in trends over time for both indicators coincided mostly with adjustments in BAP, rather than changes in the numerators. CONCLUSIONS The current use of BAP denominators for health statistics does not enable reliable monitoring of key health indicators for Pacific people. HSU denominators are also unsuitable for monitoring health. Exploring the feasibility of a real-time population register is strongly recommended as a new, transparent, way of obtaining more reliable, timely population data to guide policymaking and underpin a more equitable health system under the health reforms. Meanwhile, reporting of ethnic specific outcomes need to include a clear assessment of the potential for bias due to inaccurate population estimates.
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Affiliation(s)
- Gerard J B Sonder
- Pacific Perspectives Ltd, PO Box 8010, Wellington, New Zealand.
- Department of Internal Medicine, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands.
| | - Corina Grey
- Pacific Perspectives Ltd, PO Box 8010, Wellington, New Zealand
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Debbie Ryan
- Pacific Perspectives Ltd, PO Box 8010, Wellington, New Zealand
| | | | - Andrew Sporle
- iNZight Analytics Ltd, Auckland, New Zealand
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Philip C Hill
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Hill PC, Cobelens F, Martinez L, Garcia-Basteiro AL, Behr MA, Rangaka MX, Churchyard G, Evans T, Hanekom W, White RG. Reply to McShane. J Infect Dis 2024; 229:616. [PMID: 37897697 DOI: 10.1093/infdis/jiad466] [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] [Received: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 10/30/2023] Open
Affiliation(s)
- Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Frank Cobelens
- Department of Global Health, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto de Salud Global, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | - Marcel A Behr
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Molebogeng X Rangaka
- Institute for Global Health, University College London, London, United Kingdom
- MRC Clinical Trials Unit, University College London, London, United Kingdom
- Centre for Infectious Diseases Research Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Willem Hanekom
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Richard G White
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Khadka P, Dummer J, Hill PC, Das SC. The quest to deliver high-dose rifampicin: can the inhaled approach help? Expert Opin Drug Deliv 2024; 21:31-44. [PMID: 38180078 DOI: 10.1080/17425247.2024.2301931] [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: 06/20/2023] [Accepted: 01/02/2024] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Tuberculosis (TB) is a global health problem that poses a challenge to global treatment programs. Rifampicin is a potent and highly effective drug for TB treatment; however, higher oral doses than the standard dose (10 mg/kg/day) rifampicin may offer better efficacy in TB treatment. AREAS COVERED High oral dose rifampicin is not implemented in anti-TB regimens yet and requires about a 3-fold increase in dose for increased efficacy. We discuss inhaled delivery of rifampicin as an alternative or adjunct to oral high-dose rifampicin. Clinical results of safety, tolerability, and patient compliance with antibiotic dry powder inhalers are reviewed. EXPERT OPINION Clinical trials suggest that an approximately 3-fold increase in the standard oral dose of rifampicin may be required for better clinical outcomes. On the other hand, animal studies suggest that inhaled rifampicin can deliver a high concentration of the drug to the lungs and achieve approximately double the plasma concentration than that from oral rifampicin. Clinical trials on inhaled antibiotics suggest that dry powder inhalation is a patient-friendly and well-tolerated approach in treating respiratory infections compared to conventional treatments. Rifampicin, a well-known anti-TB drug given orally, is a good candidate for clinical development as a dry powder inhaler.
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Affiliation(s)
- Prakash Khadka
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Jack Dummer
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Shyamal C Das
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Kibirige D, Andia-Biraro I, Kyazze AP, Olum R, Bongomin F, Nakavuma RM, Ssekamatte P, Emoru R, Nalubega G, Chamba N, Kilonzo K, Laizer SN, Mrema LE, Olomi W, Minja LT, Ntinginya NE, Sabi I, Hill PC, Te Brake L, van Crevel R, Sharples K, Critchley J. Burden and associated phenotypic characteristics of tuberculosis infection in adult Africans with diabetes: a systematic review. Sci Rep 2023; 13:19894. [PMID: 37963989 PMCID: PMC10645877 DOI: 10.1038/s41598-023-47285-4] [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: 05/30/2023] [Accepted: 11/11/2023] [Indexed: 11/16/2023] Open
Abstract
Diabetes mellitus (DM) increases the risk of developing tuberculosis infection (TBI). However, the evidence on the burden and phenotypic characteristics of TBI in African patients with DM is limited. This study aimed to determine the prevalence and characterisation of TBI in native African patients living with DM. We searched PubMed, EMBASE, and African Journals Online for original studies reporting information on the prevalence and characteristics of TBI in adult Africans with DM. A forest plot was used to describe the pooled prevalence estimate of TBI and the corresponding 95% confidence intervals (CI). Six studies conducted in four African countries involving 721 participants with DM were included in this systematic review. The pooled prevalence estimate of TBI was 40% (95% CI 20-60%, I2 = 98.52%, p < 0.001). Age ≥ 40 years and glycated haemoglobin levels independently predicted TBI positivity in patients with DM in three studies. Africans with DM have a high prevalence of TBI, especially those who are older or with poorly controlled diabetes. This justifies the need for studies to explore how to screen and manage TBI to avert the progression to active TB disease.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs' Hospital Lubaga, Kampala, Uganda.
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda.
| | - Irene Andia-Biraro
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Peter Kyazze
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Rose Mwanje Nakavuma
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Phillip Ssekamatte
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Reagan Emoru
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Goretti Nalubega
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Nyasatu Chamba
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajiru Kilonzo
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sweetness Naftal Laizer
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Lucy Elauteri Mrema
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Willyhelmina Olomi
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Lilian Tina Minja
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Issa Sabi
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Philip C Hill
- Centre for International Health, Otago University, Dunedin, New Zealand
| | - Lindsey Te Brake
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Katrina Sharples
- Centre for International Health, Otago University, Dunedin, New Zealand
| | - Julia Critchley
- Population Health Research Institute, St. George's University of London, London, UK
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Hill PC, Cobelens F, Martinez L, Behr MA, Churchyard G, Evans T, Fiore-Gartland AJ, Garcia-Basteiro AL, Hanekom W, Rangaka MX, Vekemans J, White RG. An Aspiration to Radically Shorten Phase 3 Tuberculosis Vaccine Trials. J Infect Dis 2023; 228:1150-1153. [PMID: 37607272 DOI: 10.1093/infdis/jiad356] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023] Open
Abstract
A new tuberculosis vaccine is a high priority. However, the classical development pathway is a major deterrent. Most tuberculosis cases arise within 2 years after Mycobacterium tuberculosis exposure, suggesting a 3-year trial period should be possible if sample size is large to maximize the number of early exposures. Increased sample size could be facilitated by working alongside optimized routine services for case ascertainment, with strategies for enhanced case detection and safety monitoring. Shortening enrolment could be achieved by simplifying screening criteria and procedures and strengthening site capacity. Together, these measures could enable radically shortened phase 3 tuberculosis vaccine trials.
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Affiliation(s)
- Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Frank Cobelens
- Department of Global Health, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Marcel A Behr
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andrew J Fiore-Gartland
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto de Salud Global, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | - Willem Hanekom
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Molebogeng X Rangaka
- MRC Clinical Trials Unit, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
- Centre for Infectious Diseases Research Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Richard G White
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Baleivanualala SC, Isaia L, Devi SV, Howden B, Gorrie CL, Matanitobua S, Sharma S, Wilson D, Kumar S, Maharaj K, Beatson S, Boseiwaqa LV, Dyet K, Crump JA, Hill PC, Ussher JE. Molecular and clinical epidemiology of carbapenem resistant Acinetobacter baumannii ST2 in Oceania: a multicountry cohort study. Lancet Reg Health West Pac 2023; 40:100896. [PMID: 38116498 PMCID: PMC10730321 DOI: 10.1016/j.lanwpc.2023.100896] [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] [Received: 06/19/2023] [Accepted: 08/22/2023] [Indexed: 12/21/2023]
Abstract
Background Carbapenem resistant Acinetobacter baumannii (CRAb) is categorised by the World Health Organization (WHO) as a pathogen of critical concern. However, little is known about CRAb transmission within the Oceania region. This study addresses this knowledge gap by using molecular epidemiology to characterise the phylogenetic relationships of CRAb isolated in hospitals in Fiji, Samoa, and other countries within the Oceania region including Australia and New Zealand, and India from South Asia. Methods In this multicountry cohort study, we analysed clinical isolates of CRAb collected from the Colonial War Memorial Hospital (CWMH) in Fiji from January through December 2019 (n = 64) and Tupua Tamasese Mea'ole Hospital (TTMH) in Samoa from November 2017 through June 2021 (n = 32). All isolates were characterised using mass spectrometry, antimicrobial susceptibility testing, and whole-genome sequencing. For CWMH, data were collected on clinical and demographic characteristics of patients with CRAb, duration of hospital stay, mortality and assessing the appropriateness of meropenem use from the treated patients who had CRAb infections. To provide a broader geographical context, CRAb strains from Fiji and Samoa were compared with CRAb sequences from Australia collected in 2016-2018 (n = 22), New Zealand in 2018-2021 (n = 13), and India in 2019 (n = 58), a country which has close medical links with Fiji. Phylogenetic relationships of all these CRAb isolates were determined using differences in core genome SNPs. Findings Of CRAb isolates, 49 (77%) of 64 from Fiji and all 32 (100%) from Samoa belonged to CRAb sequence type 2 (ST2). All ST2 isolates from both countries harboured blaOXA-23, blaOXA-66 and ampC-2 genes, mediating resistance to β-lactam antimicrobials, including cephalosporins and carbapenems. The blaOXA-23 gene was associated with two copies of ISAba1 insertion element, forming the composite transposon Tn2006, on the chromosome. Two distinct clusters (group 1 and group 2) of CRAb ST2 were detected in Fiji. The first group shared common ancestral linkage to all CRAb ST2 collected from Fiji's historic outbreak in 2016/2017, Samoa, Australia and 54% of total New Zealand isolates; they formed a single cluster with a median (range) SNP difference of 13 (0-102). The second group shared common ancestral linkage to 3% of the total CRAb ST2 isolated from India. Fifty eight of the 64 patients with CRAb infections at the CWMH had their first positive CRAb sample collected 72 h or more following admission. Meropenem use was deemed inappropriate in 15 (48%) of the 31 patients that received treatment with meropenem in Fiji. Other strains of CRAb ST1, ST25, ST107, and ST1112 were also detected in Fiji. Interpretation We identified unrecognised outbreaks of CRAb ST2 in Fiji and Samoa that linked to strains in other parts of Oceania and South Asia. The existence of Tn2006, containing the blaOXA-23 and ISAba1 insertion element, within CRAb ST2 from Fiji and Samoa indicates the potential for high mobility and dissemination. This raises concerns about unmitigated prolonged outbreaks of CRAb ST2 in the two major hospitals in Fiji and Samoa. Given the magnitude of this problem, there is a need to re-evaluate the current strategies used for infection prevention and control, antimicrobial stewardship, and public health measures locally and internationally. Moreover, a collaborative approach to AMR surveillance within the Oceania region with technical, management and budgetary support systems is required to prevent introduction and control transmission of these highly problematic strains within the island nation health systems. Funding This project was funded by an Otago Global Health Institute seed grant and Maurice Wilkins Centre of Research Excellence (CoREs) grant (SC0000169653, RO0000002300).
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Affiliation(s)
- Sakiusa C. Baleivanualala
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin 9054, New Zealand
- College of Medicine, Nursing and Health Science, Fiji National University, Suva, Fiji
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland 92019, New Zealand
| | - Lupeoletalalelei Isaia
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin 9054, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland 92019, New Zealand
- Tupua Tamasese Mea'ole Hospital, Apia, Samoa
| | - Swastika V. Devi
- College of Medicine, Nursing and Health Science, Fiji National University, Suva, Fiji
| | - Benjamin Howden
- Microbiological Diagnostic Unit, Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
- Department of Microbiology & Immunology, Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Claire L. Gorrie
- Microbiological Diagnostic Unit, Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
- Department of Microbiology & Immunology, Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
| | | | | | - Donald Wilson
- College of Medicine, Nursing and Health Science, Fiji National University, Suva, Fiji
| | | | | | - Scott Beatson
- Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, Queensland 4072, Australia
| | | | - Kristin Dyet
- Institute of Environmental Science and Research Ltd., Porirua 5022, New Zealand
| | - John A. Crump
- Otago Global Health Institute, University of Otago, Dunedin 9054, New Zealand
| | - Philip C. Hill
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland 92019, New Zealand
- Otago Global Health Institute, University of Otago, Dunedin 9054, New Zealand
| | - James E. Ussher
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin 9054, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland 92019, New Zealand
- Southern Community Laboratories, Dunedin Hospital, Dunedin 9016, New Zealand
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10
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Olatunji YA, Banjo AA, Jarde A, Salaudeen R, Ndiaye M, Galega LB, Odutola A, Hossain IM, Osuorah C, Sahito MS, Muhammad BS, Ikumapayi NU, Drammeh MM, Manjang A, Adegbola RA, Greenwood BM, Hill PC, Grant MA. Invasive bacterial disease in young infants in rural Gambia: Population-based surveillance. J Glob Health 2023; 13:04106. [PMID: 37772795 PMCID: PMC10540664 DOI: 10.7189/jogh.13.04106] [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: 09/30/2023] Open
Abstract
Background Invasive bacterial diseases (IBD) cause significant mortality in young infants. There are limited population-based data on IBD in young infants in Sub-Saharan Africa. Methods We conducted population-based surveillance for IBD among infants aged 0-90 days in a demographic surveillance area in rural Gambia between 1 March 2011 and 31 December 2017. Infants admitted to health facilities within the study area had standardised clinical evaluation plus conventional microbiological investigation. We defined IBD as isolation of pathogenic bacteria from blood, cerebrospinal fluid, lung, or pleural aspirate. We determined incidence, aetiology and case-fatality of IBD. Results A total of 3794 infants were admitted and 3605 (95%) had at least one sample collected for culture. We detected 254 (8.0%) episodes of IBD (bacteraemia 241; meningitis 14; pneumonia seven). The incidence of IBD in infants aged 0-90 days was 25 episodes/1000 person-years (95% confidence interval (CI) = 22-28), the incidence in neonates was 50 episodes/1000 person-years (95% CI = 43-58) and the incidence in infants aged 29-90 days was 12 episodes/1000 person-years (95% CI = 9-15). The most common pathogens causing IBD were Staphylococcus aureus (n = 102, 40%), Escherichia coli (n = 37, 15%), Streptococcus pneumoniae (n = 24, 9%) and Klebsiella pneumoniae (n = 12, 5%). Case-fatality was 29% (95% CI = 23-37) in neonates and 19% (95% CI = 11-29) in infants aged 29-90 days. A minimum of 7.3% of all young infant deaths in the population were caused by IBD. Conclusions IBD are common in young infants in rural Gambia and have a high case-fatality. Strategies are needed to prevent IBD in young infants. Overcoming barriers to widespread implementation of existing vaccines and developing new vaccines against the most common pathogens causing IBD should be among top priorities for reducing the high mortality rate in young infants.
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Affiliation(s)
- Yekini A Olatunji
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Adeshola A Banjo
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Alexander Jarde
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Lobga B Galega
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Aderonke Odutola
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Ilias M Hossain
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Chidiebere Osuorah
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Muhammad S Sahito
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Bilquees Shah Muhammad
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Nurudeen U Ikumapayi
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Momodou M Drammeh
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Ahmad Manjang
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | | | - Brian M Greenwood
- London School of Hygiene & Tropical Medicine, Department of Disease Control, London, England, UK
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Mackenzie A Grant
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
- London School of Hygiene & Tropical Medicine, Department of Disease Control, London, England, UK
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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11
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Eckold C, van Doorn CLR, Ruslami R, Ronacher K, Riza A, van Veen S, Lee J, Kumar V, Kerry‐Barnard S, Malherbe ST, Kleynhans L, Stanley K, Joosten SA, Critchley JA, Hill PC, van Crevel R, Wijmenga C, Haks MC, Ioana M, Alisjahbana B, Walzl G, Ottenhoff THM, Dockrell HM, Vianello E, Cliff JM. Impaired resolution of blood transcriptomes through tuberculosis treatment with diabetes comorbidity. Clin Transl Med 2023; 13:e1375. [PMID: 37649224 PMCID: PMC10468587 DOI: 10.1002/ctm2.1375] [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: 11/23/2022] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND People with diabetes are more likely to develop tuberculosis (TB) and to have poor TB-treatment outcomes than those without. We previously showed that blood transcriptomes in people with TB-diabetes (TB-DM) co-morbidity have excessive inflammatory and reduced interferon responses at diagnosis. It is unknown whether this persists through treatment and contributes to the adverse outcomes. METHODS Pulmonary TB patients recruited in South Africa, Indonesia and Romania were classified as having TB-DM, TB with prediabetes, TB-related hyperglycaemia or TB-only, based on glycated haemoglobin concentration at TB diagnosis and after 6 months of TB treatment. Gene expression in blood at diagnosis and intervals throughout treatment was measured by unbiased RNA-Seq and targeted Multiplex Ligation-dependent Probe Amplification. Transcriptomic data were analysed by longitudinal mixed-model regression to identify whether genes were differentially expressed between clinical groups through time. Predictive models of TB-treatment response across groups were developed and cross-tested. RESULTS Gene expression differed between TB and TB-DM patients at diagnosis and was modulated by TB treatment in all clinical groups but to different extents, such that differences remained in TB-DM relative to TB-only throughout. Expression of some genes increased through TB treatment, whereas others decreased: some were persistently more highly expressed in TB-DM and others in TB-only patients. Genes involved in innate immune responses, anti-microbial immunity and inflammation were significantly upregulated in people with TB-DM throughout treatment. The overall pattern of change was similar across clinical groups irrespective of diabetes status, permitting models predictive of TB treatment to be developed. CONCLUSIONS Exacerbated transcriptome changes in TB-DM take longer to resolve during TB treatment, meaning they remain different from those in uncomplicated TB after treatment completion. This may indicate a prolonged inflammatory response in TB-DM, requiring prolonged treatment or host-directed therapy for complete cure. Development of transcriptome-based biomarker signatures of TB-treatment response should include people with diabetes for use across populations.
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Affiliation(s)
- Clare Eckold
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Rovina Ruslami
- Department of Biomedical SciencesFaculty of MedicineUniversitas PadjadjaranBandungIndonesia
| | - Katharina Ronacher
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
- Mater Research InstituteFaculty of MedicineTranslational Research InstituteThe University of QueenslandBrisbaneQLDAustralia
| | - Anca‐Lelia Riza
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
- Human Genomics LaboratoryDepartment of Diagnostics and TreatmentUniversity of Medicine and Pharmacy of CraiovaCraiovaRomania
- Regional Centre for Human Genetics – DoljEmergency Clinical County Hospital CraiovaCraiovaRomania
| | - Suzanne van Veen
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Ji‐Sook Lee
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
| | - Vinod Kumar
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
- Department of GeneticsUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Stephanus T. Malherbe
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Léanie Kleynhans
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Kim Stanley
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Simone A. Joosten
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Julia A Critchley
- Population Health Research InstituteSt George'sUniversity of LondonLondonUK
| | - Philip C. Hill
- Division of Health SciencesCentre for International HealthUniversity of OtagoDunedinNew Zealand
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
- Nuffield Department of MedicineCentre for Tropical Medicine and Global HealthUniversity of OxfordOxfordUK
| | - Cisca Wijmenga
- Department of GeneticsUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Mariëlle C. Haks
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Mihai Ioana
- Human Genomics LaboratoryDepartment of Diagnostics and TreatmentUniversity of Medicine and Pharmacy of CraiovaCraiovaRomania
- Regional Centre for Human Genetics – DoljEmergency Clinical County Hospital CraiovaCraiovaRomania
| | - Bachti Alisjahbana
- Internal Medicine DepartmentHasan Sadikin General HospitalBandungIndonesia
- Research Center for Care and Control of Infectious DiseasesUniversitas PadjadjaranBandungIndonesia
| | - Gerhard Walzl
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Tom H. M. Ottenhoff
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Hazel M. Dockrell
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
| | - Eleonora Vianello
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Jacqueline M. Cliff
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
- Department of Life SciencesCentre for Inflammation Research and Translational MedicineBrunel University LondonLondonUK
| | - the TANDEM Consortium$
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
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12
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van Crevel R, Hill PC. Shorter regimens for tuberculosis preventive treatment: piecing together the global implementation jigsaw. Lancet Respir Med 2023; 11:757-759. [PMID: 36966789 DOI: 10.1016/s2213-2600(23)00086-3] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, Netherlands; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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13
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Crump JA, Vakaoti P, Moore-Jones M, Tan L, Ergler CR, Fenton E, Anderson EMR, Bremer PJ, Sharples KJ, Walls T, Quiñones-Mateu ME, Kolandai K, Hadingham J, Hill PC, Knowles S. Health nationalism in Aotearoa New Zealand during COVID-19: problems for global health equity. Nat Med 2023; 29:1887-1889. [PMID: 37464060 DOI: 10.1038/s41591-023-02436-y] [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: 07/20/2023]
Affiliation(s)
- John A Crump
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand.
| | - Patrick Vakaoti
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- Te Tumu - School of Māori, Pacific, and Indigenous Studies, Division of Humanities, University of Otago, Dunedin, New Zealand
| | - Michael Moore-Jones
- English Literature Programme, School of English, Film, Theatre, Media and Communication, and Art History, Victoria University of Wellington, Wellington, New Zealand
| | - Lena Tan
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- Politics Programme, Division of Humanities, University of Otago, Dunedin, New Zealand
| | - Christina R Ergler
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- School of Geography, Division of Humanities, University of Otago, Dunedin, New Zealand
| | - Elizabeth Fenton
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- Bioethics Centre, Dunedin School of Medicine, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Emma M R Anderson
- Bioethics Centre, Dunedin School of Medicine, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Philip J Bremer
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- Department of Food Science, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Katrina J Sharples
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- Department of Mathematics and Statistics, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Tony Walls
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- Department of Paediatrics, Division of Health Sciences, University of Otago, Christchurch, New Zealand
| | - Miguel E Quiñones-Mateu
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- Department of Microbiology and Immunology, School of Biomedical Sciences, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Komathi Kolandai
- COMPASS Research Centre and Public Policy Institute, Faculty of Arts, University of Auckland, Auckland, New Zealand
| | - Jacqui Hadingham
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
| | - Stephen Knowles
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
- Department of Economics, Otago Business School, Division of Commerce, University of Otago, Dunedin, New Zealand
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14
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Shannon FQ, Bawo LL, Crump JA, Sharples K, Egan R, Hill PC. Evaluation of Ebola virus disease surveillance system capability to promptly detect a new outbreak in Liberia. BMJ Glob Health 2023; 8:e012369. [PMID: 37532462 PMCID: PMC10401241 DOI: 10.1136/bmjgh-2023-012369] [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: 03/22/2023] [Accepted: 07/09/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Liberia was heavily affected by the 2014-2016 Ebola virus disease (EVD) outbreak. With substantial investments in interventions to combat future outbreaks, it is hoped that Liberia is well prepared for a new incursion. We assessed the performance of the current EVD surveillance system in Liberia, focusing on its ability to promptly detect a new EVD outbreak. METHODS We integrated WHO and US Centers for Disease Control and Prevention guidelines for public health surveillance system evaluation and used standardised indicators to measure system performance. We conducted 23 key informant interviews, 150 health facility assessment surveys and a standardised patient (SP) study (19 visits) from January 2020 to January 2021. Data were summarised and a gap analysis conducted. RESULTS We found basic competencies of case detection and reporting necessary for a functional surveillance system were in place. At the higher (national, county and district) levels, we found performance gaps in 2 of 6 indicators relating to surveillance system structure, 3 of 14 indicators related to core functions, 1 of 5 quality indicators and 2 of 8 indicators related to support functions. The health facility assessment found performance gaps in 9 of 10 indicators related to core functions, 5 of 6 indicators related to support functions and 3 of 7 indicators related to quality. The SP simulations revealed large gaps between expected and actual practice in managing a patient warranting investigation for EVD. Major challenges affecting the system's operations across all levels included limited access to resources to support surveillance activities, persistent stock out of sample collection materials and attrition of trained staff. CONCLUSION The EVD surveillance system in Liberia may fail to promptly detect a new EVD outbreak. Specific improvements are required, and regular evaluations recommended. SP studies could be crucial in evaluating surveillance systems for rarely occurring diseases that are important to detect early.
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Affiliation(s)
- Fulton Quincy Shannon
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Planning Research and Development, Republic of Liberia Ministry of Health, Monrovia, Liberia
| | - Luke L Bawo
- Planning Research and Development, Republic of Liberia Ministry of Health, Monrovia, Liberia
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Richard Egan
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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15
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Nelson KN, Churchyard G, Cobelens F, Hanekom WA, Hill PC, Lopman B, Mave V, Rangaka MX, Vekemans J, White RG, Wong EB, Martinez L, García-Basteiro AL. Measuring indirect transmission-reducing effects in tuberculosis vaccine efficacy trials: why and how? Lancet Microbe 2023; 4:e651-e656. [PMID: 37329893 PMCID: PMC10393779 DOI: 10.1016/s2666-5247(23)00112-x] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/24/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
Tuberculosis is the leading bacterial cause of death globally. In 2021, 10·6 million people developed symptomatic tuberculosis and 1·6 million died. Seven promising vaccine candidates that aim to prevent tuberculosis disease in adolescents and adults are currently in late-stage clinical trials. Conventional phase 3 trials provide information on the direct protection conferred against infection or disease in vaccinated individuals, but they tell us little about possible indirect (ie, transmission-reducing) effects that afford protection to unvaccinated individuals. As a result, proposed phase 3 trial designs will not provide key information about the overall effect of introducing a vaccine programme. Information on the potential for indirect effects can be crucial for policy makers deciding whether and how to introduce tuberculosis vaccines into immunisation programmes. We describe the rationale for measuring indirect effects, in addition to direct effects, of tuberculosis vaccine candidates in pivotal trials and lay out several options for incorporating their measurement into phase 3 trial designs.
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Affiliation(s)
- Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA.
| | | | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Benjamin Lopman
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Vidya Mave
- Johns Hopkins Center for Infectious Diseases in India, Pune, India
| | - Molebogeng X Rangaka
- Institute for Global Health and MRC Clinical Trials Unit, University College London, London, UK
| | | | - Richard G White
- Tuberculosis Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu Natal, South Africa; Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Alberto L García-Basteiro
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
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16
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Rangaka MX, Frick M, Churchyard G, García-Basteiro AL, Hatherill M, Hanekom W, Hill PC, Hamada Y, Quaife M, Vekemans J, White RG, Cobelens F. Clinical trials of tuberculosis vaccines in the era of increased access to preventive antibiotic treatment. Lancet Respir Med 2023; 11:380-390. [PMID: 36966794 DOI: 10.1016/s2213-2600(23)00084-x] [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] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
Approximately 10·6 million people worldwide develop tuberculosis each year, representing a failure in epidemic control that is accentuated by the absence of effective vaccines to prevent infection or disease in adolescents and adults. Without effective vaccines, tuberculosis prevention has relied on testing for Mycobacterium tuberculosis infection and treating with antibiotics to prevent progression to tuberculosis disease, known as tuberculosis preventive treatment (TPT). Novel tuberculosis vaccines are in development and phase 3 efficacy trials are imminent. The development of effective, shorter, and safer TPT regimens has broadened the groups eligible for TPT beyond people with HIV and child contacts of people with tuberculosis; future vaccine trials will be undertaken in an era of increased TPT access. Changes in the prevention standard will have implications for tuberculosis vaccine trials of disease prevention, for which safety and sufficient accrual of cases are crucial. In this paper, we examine the urgent need for trials that allow the evaluation of new vaccines and fulfil the ethical duty of researchers to provide TPT. We observe how HIV vaccine trials have incorporated preventive treatment in the form of pre-exposure prophylaxis, propose trial designs that integrate TPT, and summarise considerations for each design in terms of trial validity, efficiency, participant safety, and ethics.
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Affiliation(s)
- Molebogeng X Rangaka
- Institute for Global Health and MRC Clinical Trials Unit, University College London, London, UK; Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, and School of Public Health, University of Cape Town, Cape Town, South Africa; Aurum Institute, Parktown, South Africa.
| | - Mike Frick
- Treatment Action Group, New York, NY, USA
| | - Gavin Churchyard
- Aurum Institute, Parktown, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Alberto L García-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, and Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Willem Hanekom
- Africa Health Research Institute, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - Yohhei Hamada
- Institute for Global Health and MRC Clinical Trials Unit, University College London, London, UK
| | - Matthew Quaife
- TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Richard G White
- TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres Location University of Amsterdam, Netherlands
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17
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Sonder GJ, Grey C, Anglemyer A, Tukuitonga C, Hill PC, Sporle A, Ryan D. The August 2020 COVID-19 outbreak in Aotearoa, New Zealand: Delayed contact tracing for Pacific people contributes to widening health disparities. IJID Reg 2023; 6:177-183. [PMID: 36741984 PMCID: PMC9890878 DOI: 10.1016/j.ijregi.2023.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
Background After COVID-19 arrived in New Zealand, a national system was developed to improve the efficiency of contact tracing. The first outbreak was followed by a period of 'COVID-19 elimination', until a community outbreak occurred in August 2020. We describe the characteristics of cases and their contacts during this outbreak, focused on the results of contact tracing. Methods COVID-19 case data from the national surveillance database were linked to contacts from the national contact tracing database. Demographic and clinical characteristics of cases, number of contacts, and timeliness of contact tracing were analysed by ethnicity. Findings Most of the 179 cases were Pacific people (59%) or Māori (25%), living in areas of high socioeconomic deprivation, who had higher rates of comorbidity and accounted for almost all (21/22) hospitalisations, all 8 ICU admissions and all 3 deaths. Only 6% belonged to the European majority ethnic group. Of 2,528 registered contacts, 46% were Pacific, 14% Māori and 19% European. Only contacts that were reached were registered. Overall, 41% of contacts were reached within 4 days of onset of disease of the case, which was significantly lower for Pacific (31%) than for other ethnic groups. Interpretation Our findings confirm the greater health burden that ethnic minorities face from COVID-19. The significant delay in the timeliness of care for Pacific people shows that the public health response was inequitable for those at highest risk. Tailored public health responses and better registration of marginalised groups are necessary to provide better access to services and to improve insights for optimal future outbreak management.
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Affiliation(s)
- Gerard Jb Sonder
- Pacific Perspectives Ltd, PO Box 8010, Wellington 6143, New Zealand.,Department of Internal Medicine, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, location Academic Medical Center, the Netherlands
| | - Corina Grey
- Pacific Perspectives Ltd, PO Box 8010, Wellington 6143, New Zealand.,Department of General Practice and Primary Health Care, School of Population Health, University of Auckland
| | - Andrew Anglemyer
- Department of Preventive and Social Medicine, Division of Health Sciences, University of Otago, Dunedin, New Zealand.,Health Intelligence Team, Institute for Environmental Science and Research, Wellington, New Zealand
| | - Collin Tukuitonga
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Philip C Hill
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Andrew Sporle
- iNZight Analytics Ltd.,Department of Statistics, The University of Auckland
| | - Debbie Ryan
- Pacific Perspectives Ltd, PO Box 8010, Wellington 6143, New Zealand
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18
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Green EW, Ndiaye M, Hossain IM, Olatunji YA, Sahito SM, Salaudeen R, Badji H, Manjang A, Ceesay L, Hill PC, Greenwood B, Mackenzie GA. Pneumonia, Meningitis, and Septicemia in Adults and Older Children in Rural Gambia: 8 Years of Population-Based Surveillance. Clin Infect Dis 2023; 76:694-703. [PMID: 35903006 PMCID: PMC9938739 DOI: 10.1093/cid/ciac603] [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: 02/09/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Representative data describing serious infections in children aged ≥5 years and adults in Africa are limited. METHODS We conducted population-based surveillance for pneumonia, meningitis, and septicemia in a demographic surveillance area in The Gambia between 12 May 2008 and 31 December 2015. We used standardized criteria to identify, diagnose, and investigate patients aged ≥5 years using conventional microbiology and radiology. RESULTS We enrolled 1638 of 1657 eligible patients and investigated 1618. Suspected pneumonia, septicemia, or meningitis was diagnosed in 1392, 135, and 111 patients, respectively. Bacterial pathogens from sterile sites were isolated from 105 (7.5%) patients with suspected pneumonia, 11 (8.1%) with suspected septicemia, and 28 (25.2%) with suspected meningitis. Streptococcus pneumoniae (n = 84), Neisseria meningitidis (n = 16), and Staphylococcus aureus (n = 15) were the most common pathogens. Twenty-eight (1.7%) patients died in hospital and 40 (4.1%) died during the 4 months after discharge. Thirty postdischarge deaths occurred in patients aged ≥10 years with suspected pneumonia. The minimum annual incidence was 133 cases per 100 000 person-years for suspected pneumonia, 13 for meningitis, 11 for septicemia, 14 for culture-positive disease, and 46 for radiological pneumonia. At least 2.7% of all deaths in the surveillance area were due to suspected pneumonia, meningitis, or septicemia. CONCLUSIONS Pneumonia, meningitis, and septicemia in children aged ≥5 years and adults in The Gambia are responsible for significant morbidity and mortality. Many deaths occur after hospital discharge and most cases are culture negative. Improvements in prevention, diagnosis, inpatient, and follow-up management are urgently needed.
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Affiliation(s)
- Edward W Green
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Malick Ndiaye
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ilias M Hossain
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Yekini A Olatunji
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Shah M Sahito
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Grant A Mackenzie
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Murdoch Children's Research Institute, Melbourne, Australia
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19
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Koesoemadinata RC, McAllister SM, Soetedjo NNM, Santoso P, Dewi NF, Permana H, Ruslami R, Alisjahbana B, Critchley JA, Dockrell HM, Hill PC, van Crevel R. Diabetes characteristics and long-term management needs in diabetic TB patients. Int J Tuberc Lung Dis 2023; 27:113-120. [PMID: 36853103 DOI: 10.5588/ijtld.22.0367] [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: 01/26/2023] Open
Abstract
BACKGROUND: Diabetes mellitus (DM) is common among patients with TB. We assessed DM characteristics and long-term needs of DM-TB patients after completing TB treatment.METHODS: Newly diagnosed TB patients with DM were recruited for screening in a randomised clinical trial evaluating a simple algorithm to improve glycaemic control during TB treatment. DM characteristics, lifestyle and medication were compared before and after TB treatment and 6 months later. Risk of cardiovascular disease (CVD), albuminuria and neuropathy were assessed after TB treatment.RESULTS: Of 218 TB-DM patients identified, 170 (78%) were followed up. Half were males, the mean age was 53 years, 26.5% were newly diagnosed DM. High glycated haemoglobin at TB diagnosis (median 11.2%) decreased during TB treatment (to 7.4% with intensified management and 8.4% with standard care), but this effect was lost 6 months later (9.3%). Hypertension and dyslipidemia contributed to a high 10-year CVD risk (32.9% at month 6 and 35.5% at month 12). Neuropathy (33.8%) and albuminuria (61.3%) were common. After TB treatment, few patients used CVD-mitigating drugs.CONCLUSION: DM in TB-DM patients is characterised by poor glycaemic control, high CVD risk, and nephropathy. TB treatment provides opportunities for better DM management, but effort is needed to improve long-term care.
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Affiliation(s)
- R C Koesoemadinata
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S M McAllister
- Centre for International Health, Division of Health Sciences, University of Otago Medical School, Dunedin, New Zealand
| | - N N M Soetedjo
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P Santoso
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - N F Dewi
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - H Permana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R Ruslami
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - B Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - J A Critchley
- Population Health Research Institute, St George´s University of London, London, UK
| | - H M Dockrell
- Faculty of Infectious and Tropical Diseases and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - P C Hill
- Centre for International Health, Division of Health Sciences, University of Otago Medical School, Dunedin, New Zealand
| | - R van Crevel
- Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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20
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Curtis SJ, Shah AW, Ratu A, Wilson DJ, Hill PC, Hulcome P, Gaylard C, Faktaufon D, Cabemaiwai T, Rabukawaqa I, Qoriniasi T, Narayan A, Nakalevu S, Romakin P, Tudravu J, Fong J, Walsh N. Rapid SARS-CoV-2 Seroprevalence Survey in Central and Western Divisions of Fiji, 2021. Emerg Infect Dis 2023; 29:226-228. [PMID: 36573643 PMCID: PMC9796197 DOI: 10.3201/eid2901.221514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
During November-December 2021, we performed a SARS-CoV-2 seroprevalence survey in Central and Western Divisions of Fiji. A total of 539 participants 8-70 years of age were 95.5% (95% CI 93.4%-97.1%) seropositive, indicating high community levels of immunity. Seroprevalence studies can inform public health responses to emerging SARS-CoV-2 variants.
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21
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Nartey Y, Amo-Antwi K, Hill PC, Dassah ET, Asmah RH, Nyarko KM, Agambire R, Konney TO, Yarney J, Damale N, Cox B. Human papillomavirus genotype distribution among women with and without cervical cancer: Implication for vaccination and screening in Ghana. PLoS One 2023; 18:e0280437. [PMID: 36656844 PMCID: PMC9851533 DOI: 10.1371/journal.pone.0280437] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Determining the high-risk human papillomavirus (HR-HPV) genotypes burden in women with and without cervical cancer afford a direct comparison of their relative distributions. This quest is fundamental to implementing a future population-based cervical cancer prevention strategy in Ghana. We estimated the cervical cancer risk by HPV genotypes, and the HPV vaccine-preventable proportion of cervical cancer diagnosed in Ghana. MATERIALS AND METHODS An unmatched case-control study was conducted at the two largest cervical cancer treatment centres in Ghana from 1st October 2014 to 31st May 2015. Cases were women diagnosed with cervical cancer and controls were women without cervical cancer who were seeking care at the two hospitals. Nested multiplex polymerase chain reaction (NM-PCR) was used to detect HPV infection in cervical samples. Logistic regression was used to determine the association between the risk of cervical cancer and identified HPV infection. P ≤0.05 was considered statistically significant. RESULTS HPV deoxyribonucleic acid (DNA) data were analysed for 177 women with cervical cancer (cases) and 201 without cancer (controls). Cervical cancer was diagnosed at older ages compared to the age at which controls were recruited (median ages, 57 years vs 34 years; p < 0.001). Most women with cervical cancer were more likely to be single with no formal education, unemployed and less likely to live in metropolitan areas compared to women without cervical cancer (all p-value <0.001). HPV DNA was detected in more women with cervical cancer compared to those without cervical cancer (84.8% vs 45.8%). HR-HPV genotypes 16, 18, 45, 35 and 52 were the most common among women with cervical cancer, while 66, 52, 35, 43 and 31 were frequently detected in those without cancer. HPV 66 and 35 were the most dominant non-vaccine genotypes; HPV 66 was more prevalent among women with cervical cancer and HPV 35 in those without cervical cancer. Cervical cancer risk was associated with a positive HPV test (Adjusted OR (AOR): 5.78; 95% CI: 2.92-11.42), infection with any of the HR-HPV genotypes (AOR: 5.56; 95% CI: 3.27-13.16) or multiple HPV infections (AOR: 9.57 95% CI 4.06-22.56). CONCLUSION Women with cervical cancer in Ghana have HPV infection with multiple genotypes, including some non-vaccine genotypes, with an estimated cervical cancer risk of about six- to ten-fold in the presence of a positive HPV test. HPV DNA tests and multivalent vaccine targeted at HPV 16, 18, 45 and 35 genotypes will be essential in Ghana's cervical cancer control programme. Large population-based studies are required in countries where cervical cancer is most prevalent to determine non-vaccine HPV genotypes which should be considered for the next-generation HPV vaccines.
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Affiliation(s)
- Yvonne Nartey
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - Kwabena Amo-Antwi
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Philip C. Hill
- Centre for International Health, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Edward T. Dassah
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Richard H. Asmah
- Department of Biomedical Sciences, University of Health & Allied Sciences, School of Basic and Biomedical Sciences, Ho, Volta region, Ghana
| | - Kofi M. Nyarko
- Disease Control and Prevention Department, Ghana Health Service, Accra, Ghana
| | - Ramatu Agambire
- Department of Nursing, Garden City University College, Kumasi-Ghana, Ghana
| | - Thomas O. Konney
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Nelson Damale
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Brian Cox
- Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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22
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Khadka P, Dummer J, Hill PC, Katare R, Das SC. A review of formulations and preclinical studies of inhaled rifampicin for its clinical translation. Drug Deliv Transl Res 2022; 13:1246-1271. [PMID: 36131190 PMCID: PMC9491662 DOI: 10.1007/s13346-022-01238-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/15/2022]
Abstract
Inhaled drug delivery is a promising approach to achieving high lung drug concentrations to facilitate efficient treatment of tuberculosis (TB) and to reduce the overall duration of treatment. Rifampicin is a good candidate for delivery via the pulmonary route. There have been no clinical studies yet at relevant inhaled doses despite the numerous studies investigating its formulation and preclinical properties for pulmonary delivery. This review discusses the clinical implications of pulmonary drug delivery in TB treatment, the drug delivery systems reported for pulmonary delivery of rifampicin, animal models, and the animal studies on inhaled rifampicin formulations, and the research gaps hindering the transition from preclinical development to clinical investigation. A review of reports in the literature suggested there have been minimal attempts to test inhaled formulations of rifampicin in laboratory animals at relevant high doses and there is a lack of appropriate studies in animal models. Published studies have reported testing only low doses (≤ 20 mg/kg) of rifampicin, and none of the studies has investigated the safety of inhaled rifampicin after repeated administration. Preclinical evaluations of inhaled anti-TB drugs, such as rifampicin, should include high-dose formulations in preclinical models, determined based on allometric conversions, for relevant high-dose anti-TB therapy in humans.
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Affiliation(s)
- Prakash Khadka
- School of Pharmacy, University of Otago, Dunedin, 9054, New Zealand
| | - Jack Dummer
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand
| | - Rajesh Katare
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, 9054, New Zealand
| | - Shyamal C Das
- School of Pharmacy, University of Otago, Dunedin, 9054, New Zealand.
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23
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Martinez L, Cords O, Liu Q, Acuna-Villaorduna C, Bonnet M, Fox GJ, Carvalho ACC, Chan PC, Croda J, Hill PC, Lopez-Varela E, Donkor S, Fielding K, Graham SM, Espinal MA, Kampmann B, Reingold A, Huerga H, Villalba JA, Grandjean L, Sotgiu G, Egere U, Singh S, Zhu L, Lienhardt C, Denholm JT, Seddon JA, Whalen CC, García-Basteiro AL, Triasih R, Chen C, Singh J, Huang LM, Sharma S, Hannoun D, Del Corral H, Mandalakas AM, Malone LL, Ling DL, Kritski A, Stein CM, Vashishtha R, Boulahbal F, Fang CT, Boom WH, Netto EM, Lemos AC, Hesseling AC, Kay A, Jones-López EC, Horsburgh CR, Lange C, Andrews JR. Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis. Lancet Glob Health 2022; 10:e1307-e1316. [PMID: 35961354 PMCID: PMC10406427 DOI: 10.1016/s2214-109x(22)00283-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [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: 04/04/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND BCG vaccines are given to more than 100 million children every year, but there is considerable debate regarding the effectiveness of BCG vaccination in preventing tuberculosis and death, particularly among older children and adults. We therefore aimed to investigate the age-specific impact of infant BCG vaccination on tuberculosis (pulmonary and extrapulmonary) development and mortality. METHODS In this systematic review and individual participant data meta-analysis, we searched MEDLINE, Web of Science, BIOSIS, and Embase without language restrictions for case-contact cohort studies of tuberculosis contacts published between Jan 1, 1998, and April 7, 2018. Search terms included "mycobacterium tuberculosis", "TB", "tuberculosis", and "contact". We excluded cohort studies that did not provide information on BCG vaccination or were done in countries that did not recommend BCG vaccination at birth. Individual-level participant data for a prespecified list of variables, including the characteristics of the exposed participant (contact), the index case, and the environment, were requested from authors of all eligible studies. Our primary outcome was a composite of prevalent (diagnosed at or within 90 days of baseline) and incident (diagnosed more than 90 days after baseline) tuberculosis in contacts exposed to tuberculosis. Secondary outcomes were pulmonary tuberculosis, extrapulmonary tuberculosis, and mortality. We derived adjusted odds ratios (aORs) using mixed-effects, binary, multivariable logistic regression analyses with study-level random effects, adjusting for the variable of interest, baseline age, sex, previous tuberculosis, and whether data were collected prospectively or retrospectively. We stratified our results by contact age and Mycobacterium tuberculosis infection status. This study is registered with PROSPERO, CRD42020180512. FINDINGS We identified 14 927 original records from our database searches. We included participant-level data from 26 cohort studies done in 17 countries in our meta-analysis. Among 68 552 participants, 1782 (2·6%) developed tuberculosis (1309 [2·6%] of 49 686 BCG-vaccinated participants vs 473 [2·5%] of 18 866 unvaccinated participants). The overall effectiveness of BCG vaccination against all tuberculosis was 18% (aOR 0·82, 95% CI 0·74-0·91). When stratified by age, BCG vaccination only significantly protected against all tuberculosis in children younger than 5 years (aOR 0·63, 95% CI 0·49-0·81). Among contacts with a positive tuberculin skin test or IFNγ release assay, BCG vaccination significantly protected against tuberculosis among all participants (aOR 0·81, 95% CI 0·69-0·96), participants younger than 5 years (0·68, 0·47-0·97), and participants aged 5-9 years (0·62, 0·38-0·99). There was no protective effect among those with negative tests, unless they were younger than 5 years (0·54, 0·32-0·90). 14 cohorts reported on whether tuberculosis was pulmonary or extrapulmonary (n=57 421). BCG vaccination significantly protected against pulmonary tuberculosis among all participants (916 [2·2%] in 41 119 vaccinated participants vs 334 [2·1%] in 16 161 unvaccinated participants; aOR 0·81, 0·70-0·94) but not against extrapulmonary tuberculosis (106 [0·3%] in 40 318 vaccinated participants vs 38 [0·2%] in 15 865 unvaccinated participants; 0·96, 0·65-1·41). In the four studies with mortality data, BCG vaccination was significantly protective against death (0·25, 0·13-0·49). INTERPRETATION Our results suggest that BCG vaccination at birth is effective at preventing tuberculosis in young children but is ineffective in adolescents and adults. Immunoprotection therefore needs to be boosted in older populations. FUNDING National Institutes of Health.
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Affiliation(s)
- Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA.
| | - Olivia Cords
- Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Carlos Acuna-Villaorduna
- Section of Infectious Diseases, Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Maryline Bonnet
- Université de Montpellier, IRD, INSERM, TransVIHMI, Montpellier, France
| | - Greg J Fox
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Anna Cristina C Carvalho
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Pei-Chun Chan
- Division of Chronic Infectious Disease, Taiwan Centers for Disease Control, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Julio Croda
- Oswaldo Cruz Foundation Mato Grosso do Sul, Campo Grande, Brazil; Federal University of Mato Grosso do Sul, Campo Grande, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Philip C Hill
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Simon Donkor
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen M Graham
- Centre for International Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Marcos A Espinal
- Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, USA
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Arthur Reingold
- Division of Epidemiology, University of California, Berkeley, Berkeley, CA, USA
| | | | - Julian A Villalba
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Louis Grandjean
- Department of Infection, Inflammation and Immunity, Institute of Child Health, University College London, London, UK
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Uzochukwu Egere
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarman Singh
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India; Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India; Medical Science and Engineering Research Centre, Indian Institute of Science Education and Research, Bhopal, India
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Christian Lienhardt
- Université de Montpellier, IRD, INSERM, TransVIHMI, Montpellier, France; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Justin T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia; Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC, Australia
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; Department of Infectious Disease, Imperial College London, London, UK
| | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA; Global Health Institute, University of Georgia, Athens, GA, USA
| | - Alberto L García-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | - Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada and Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Cheng Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Jitendra Singh
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India; Translational Medicine Centre, All India Institute of Medical Sciences, Bhopal, India; Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Surendra Sharma
- Department of Molecular Medicine, Jamia Hamdard Institute of Molecular Medicine, New Delhi, India; Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India; Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Djohar Hannoun
- Department of Information, National Institute of Public Health, Algiers, Algeria
| | - Helena Del Corral
- Grupo de Inmunología Celulare Inmunogenética, Facultad de Medicina, Sede de Investigación Universitaria, Universidad de Antioquia, Medellin, Colombia; Grupo de Epidemiologıa, Universidad de Antioquia, Medellin, Colombia
| | - Anna M Mandalakas
- The Global TB Program, Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Clinical Infectious Diseases, Medical Clinic, Research Center Borstel, Borstel, Germany; Tuberculosis Unit, German Center for Infection Research, Borstel, Germany
| | - LaShaunda L Malone
- Uganda-CWRU Research Collaboration, Kampala, Uganda; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Du-Lin Ling
- Taichung Regional Center, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Afrânio Kritski
- Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Catherine M Stein
- Uganda-CWRU Research Collaboration, Kampala, Uganda; Tuberculosis Research Unit, Case Western Reserve University, Cleveland, OH, USA; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Richa Vashishtha
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Fadila Boulahbal
- Groupe de recherche sur la tuberculose latente, Laboratoire National de Référence pour la Tuberculose, Institut Pasteur d'Algérie, Algiers, Algeria
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - W Henry Boom
- Uganda-CWRU Research Collaboration, Kampala, Uganda; Tuberculosis Research Unit, Case Western Reserve University, Cleveland, OH, USA; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Eduardo Martins Netto
- Medicine Department, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Antonio Carlos Lemos
- Medicine Department, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Alexander Kay
- The Global TB Program, Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Edward C Jones-López
- Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - C Robert Horsburgh
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Christoph Lange
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Clinical Infectious Diseases, Medical Clinic, Research Center Borstel, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Tuberculosis Unit, German Center for Infection Research, Borstel, Germany
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Ikumapayi UN, Hill PC, Hossain I, Olatunji Y, Ndiaye M, Badji H, Manjang A, Salaudeen R, Ceesay L, Adegbola RA, Greenwood BM, Mackenzie GA. Childhood meningitis in rural Gambia: 10 years of population-based surveillance. PLoS One 2022; 17:e0265299. [PMID: 35947593 PMCID: PMC9365145 DOI: 10.1371/journal.pone.0265299] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. Methods Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. Results We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2–23-month age group, but lower at 5 per 100,000 in the 5–14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. Conclusions Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.
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Affiliation(s)
- Usman N. Ikumapayi
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- * E-mail:
| | - Philip C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Ilias Hossain
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Ministry of Health, Gambia Government, Banjul, The Gambia
| | - Richard A. Adegbola
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- RAMBICON, Immunisation & Global Health Consulting, Lekki, Lagos, Nigeria
| | | | - Grant A. Mackenzie
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Murdoch Children’s Research Institute, Parkville, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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van Doorn CLR, Eckold C, Ronacher K, Ruslami R, van Veen S, Lee JS, Kumar V, Kerry-Barnard S, Malherbe ST, Kleynhans L, Stanley K, Hill PC, Joosten SA, van Crevel R, Wijmenga C, Critchley JA, Walzl G, Alisjahbana B, Haks MC, Dockrell HM, Ottenhoff THM, Vianello E, Cliff JM. Transcriptional profiles predict treatment outcome in patients with tuberculosis and diabetes at diagnosis and at two weeks after initiation of anti-tuberculosis treatment. EBioMedicine 2022; 82:104173. [PMID: 35841871 PMCID: PMC9297076 DOI: 10.1016/j.ebiom.2022.104173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Globally, the tuberculosis (TB) treatment success rate is approximately 85%, with treatment failure, relapse and death occurring in a significant proportion of pulmonary TB patients. Treatment success is lower among people with diabetes mellitus (DM). Predicting treatment outcome early after diagnosis, especially in TB-DM patients, would allow early treatment adaptation for individuals and may improve global TB control. METHODS Samples were collected in a longitudinal cohort study of adult TB patients from South Africa (n = 94) and Indonesia (n = 81), who had concomitant DM (n = 59), intermediate hyperglycaemia (n = 79) or normal glycaemia/no DM (n = 37). Treatment outcome was monitored, and patients were categorized as having a good (cured) or poor (failed, recurrence, died) outcome during treatment and 12 months follow-up. Whole blood transcriptional profiles before, during and at the end of TB treatment were characterized using unbiased RNA-Seq and targeted gene dcRT-MLPA. FINDINGS We report differences in whole blood transcriptome profiles, which were observed before initiation of treatment and throughout treatment, between patients with a good versus poor TB treatment outcome. An eight-gene and a 22-gene blood transcriptional signature distinguished patients with a good TB treatment outcome from patients with a poor TB treatment outcome at diagnosis (AUC = 0·815) or two weeks (AUC = 0·834) after initiation of TB treatment, respectively. High accuracy was obtained by cross-validating this signature in an external cohort (AUC = 0·749). INTERPRETATION These findings suggest that transcriptional profiles can be used as a prognostic biomarker for treatment failure and success, even in patients with concomitant DM. FUNDING The research leading to these results, as part of the TANDEM Consortium, received funding from the European Community's Seventh Framework Programme (FP7/2007-2013 Grant Agreement No. 305279) and the Netherlands Organization for Scientific Research (NWO-TOP Grant Agreement No. 91214038). The research leading to the results presented in the Indian validation cohort was supported by Research Council of Norway Global Health and Vaccination Research (GLOBVAC) projects: RCN 179342, 192534, and 248042, the University of Bergen (Norway).
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Affiliation(s)
- Cassandra L R van Doorn
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Clare Eckold
- Dept of Infection Biology and TB Centre, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Katharina Ronacher
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa; Mater Research Institute - The University of Queensland, Translational Research Institute, Brisbane, QLD, Australia
| | - Rovina Ruslami
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Suzanne van Veen
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Ji-Sook Lee
- Dept of Infection Biology and TB Centre, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Vinod Kumar
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sarah Kerry-Barnard
- Population Health Research Institute, St George's Hospital Medical School, University of London
| | - Stephanus T Malherbe
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Léanie Kleynhans
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kim Stanley
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip C Hill
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Simone A Joosten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Cisca Wijmenga
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St George's Hospital Medical School, University of London
| | - Gerhard Walzl
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bachti Alisjahbana
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Mariëlle C Haks
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Hazel M Dockrell
- Dept of Infection Biology and TB Centre, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora Vianello
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.
| | - Jacqueline M Cliff
- Dept of Infection Biology and TB Centre, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, United Kingdom; Department of Life Sciences, Brunel University London, United Kingdom
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Apriani L, McAllister S, Sharples K, Nurul Aini I, Nurhasanah H, Ruslami R, Menzies D, Hill PC, Alisjahbana B. Mycobacterium tuberculosis infection and disease in healthcare workers in a tertiary referral hospital in Bandung, Indonesia. J Infect Prev 2022; 23:155-166. [PMID: 37256158 PMCID: PMC10226060 DOI: 10.1177/17571774211046887] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Indexed: 09/20/2023] Open
Abstract
Background Healthcare workers (HCWs), especially in high tuberculosis (TB) incidence countries, are at risk of Mycobacterium tuberculosis infection and TB disease, likely due to greater exposure to TB cases and variable implementation of infection control measures. Aim We aimed to estimate the prevalence of tuberculin skin test (TST) positivity, history of TB and to identify associated risk factors in HCWs employed at a tertiary referral hospital in Bandung, Indonesia. Methods A cross-sectional study was conducted from April to August 2018. A stratified sample of the HCWs were recruited, screened by TST, assessed for TB symptoms, history of TB disease and possible risk factors. Prevalence of positive TST included diagnosis with TB after starting work. HCWs with TB disease diagnosed earlier were excluded. Survey weights were used for all analyses. Possible risk factors were examined using logistic regression; adjusted odds ratios and 95% confidence intervals (CI) are presented. Results Of 455 HCWs recruited, 42 reported a history of TB disease (25 after starting work) and 395 had a TST result. The prevalence of positive TST was 76.9% (95% CI 72.6-80.8%). The odds increased by 7% per year at work (95% CI 3-11%) on average, with a rapid rise in TST positivity up to 10 years of work and then a plateau with around 80% positive. Discussion A high proportion of HCWs had a history of TB or were TST positive, increasing with longer duration of work. A package of TB infection control measures is needed to protect HCWs from Mycobacterium tuberculosis infection.
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Affiliation(s)
- Lika Apriani
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Susan McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Isni Nurul Aini
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Hanifah Nurhasanah
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dick Menzies
- Montreal Chest Institute, McGill University Montreal, Canada
| | - Philip C Hill
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Bachti Alisjahbana
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Garcia-Basteiro AL, White RG, Tait D, Schmidt AC, Rangaka MX, Quaife M, Nemes E, Mogg R, Hill PC, Harris RC, Hanekom WA, Frick M, Fiore-Gartland A, Evans T, Dagnew AF, Churchyard G, Cobelens F, Behr MA, Hatherill M. End-point definition and trial design to advance tuberculosis vaccine development. Eur Respir Rev 2022; 31:220044. [PMID: 35675923 PMCID: PMC9488660 DOI: 10.1183/16000617.0044-2022] [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: 03/02/2022] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
Tuberculosis (TB) remains a leading infectious cause of death worldwide and the coronavirus disease 2019 pandemic has negatively impacted the global TB burden of disease indicators. If the targets of TB mortality and incidence reduction set by the international community are to be met, new more effective adult and adolescent TB vaccines are urgently needed. There are several new vaccine candidates at different stages of clinical development. Given the limited funding for vaccine development, it is crucial that trial designs are as efficient as possible. Prevention of infection (POI) approaches offer an attractive opportunity to accelerate new candidate vaccines to advance into large and expensive prevention of disease (POD) efficacy trials. However, POI approaches are limited by imperfect current tools to measure Mycobacterium tuberculosis infection end-points. POD trials need to carefully consider the type and number of microbiological tests that define TB disease and, if efficacy against subclinical (asymptomatic) TB disease is to be tested, POD trials need to explore how best to define and measure this form of TB. Prevention of recurrence trials are an alternative approach to generate proof of concept for efficacy, but optimal timing of vaccination relative to treatment must still be explored. Novel and efficient approaches to efficacy trial design, in addition to an increasing number of candidates entering phase 2-3 trials, would accelerate the long-standing quest for a new TB vaccine.
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Affiliation(s)
- Alberto L Garcia-Basteiro
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECT), Barcelona, Spain
| | | | - Dereck Tait
- International AIDS Vaccine Initiative (IAVI) NPC, Cape Town, South Africa
| | | | - Molebogeng X Rangaka
- Institute for Global Health and MRC Clinical Trials Unit at University College London, London, UK
- CIDRI-AFRICA, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Matthew Quaife
- London School of Hygiene and Tropical Medicine, London, UK
| | - Elisa Nemes
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Dept of Pathology, University of Cape Town, Cape Town, South Africa
| | - Robin Mogg
- Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Rebecca C Harris
- London School of Hygiene and Tropical Medicine, London, UK
- Sanofi Pasteur, Singapore
| | - Willem A Hanekom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Mike Frick
- Treatment Action Group, New York, NY, USA
| | - Andrew Fiore-Gartland
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Alemnew F Dagnew
- Bill and Melinda Gates Medical Research Institute, Cambridge, MA, USA
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa
- Vanderbilt University, Nashville, TN, USA
- University of the Witwatersrand, Johannesburg, South Africa
| | - Frank Cobelens
- Dept of Global Health and Amsterdam Institute for Global health and development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Marcel A Behr
- Dept of Medicine, McGill University; McGill International TB Centre, Montreal, QC, Canada
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Dept of Pathology, University of Cape Town, Cape Town, South Africa
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28
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Uruamo S, McAllister S, Scott N, Hancox RJ, Hayudini R, Baxter J, Hill PC. Feasibility study of the prevalence of latent tuberculosis infection for Māori in the Waikato region, Aotearoa New Zealand. Aust N Z J Public Health 2022; 46:872-877. [PMID: 35735941 DOI: 10.1111/1753-6405.13274] [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: 10/01/2021] [Revised: 03/01/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to assess the feasibility of conducting a representative tuberculin skin test (TST) survey for Māori in Aotearoa New Zealand and to estimate the prevalence of latent tuberculosis (TB) infection. METHODS Participants were Māori in the Waikato region, recruited by a Māori nurse, through: 1) random household selection from the Electoral Roll; 2) randomly selected prison inmates; and 3) community and health settings. A TB history and symptoms questionnaire was completed, TST performed and investigation of those with TST induration ≥10mm. RESULTS Random household selection was resource intensive and only contributed 14 participants. Repeated random selection of prison lists were required to recruit 207 participants and there were no positive TST cases. Community and health settings yielded the highest participation (n=370) and the three people (0.5%) with TST ≥10mm. Age ≥45 years and history of contact with a TB case were associated with TST induration ≥5mm (n=39; 6.6%). CONCLUSIONS The community and health settings were the only feasible options for recruitment. The overall prevalence of a positive TST in the study population was low. A 5mm cut-off may be best to maximise sensitivity for future studies. IMPLICATIONS FOR PUBLIC HEALTH A mixture of sample selection processes that are more targeted are needed to identify Māori with latent TB infection.
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Affiliation(s)
- Siobhan Uruamo
- Respiratory Department, Waikato District Health Board, Hamilton, New Zealand
| | - Susan McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Nina Scott
- Waikato District Health Board, Te Puna Oranga, Hamilton, New Zealand
| | - Robert J Hancox
- Respiratory Department, Waikato District Health Board, Hamilton, New Zealand.,Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Ron Hayudini
- Respiratory Department, Waikato District Health Board, Hamilton, New Zealand
| | - Joanne Baxter
- Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Ntinginya NE, Te Brake L, Sabi I, Chamba N, Kilonzo K, Laizer S, Andia-Biraro I, Kibirige D, Kyazze AP, Ninsiima S, Critchley JA, Romeo R, van de Maat J, Olomi W, Mrema L, Magombola D, Mwayula IH, Sharples K, Hill PC, van Crevel R. Rifapentine and isoniazid for prevention of tuberculosis in people with diabetes (PROTID): protocol for a randomised controlled trial. Trials 2022; 23:480. [PMID: 35689272 PMCID: PMC9186476 DOI: 10.1186/s13063-022-06296-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Diabetes mellitus (DM) increases the risk of tuberculosis (TB) and will hamper global TB control due to the dramatic rise in type 2 DM in TB-endemic settings. In this trial, we will examine the efficacy and safety of TB preventive therapy against the development of TB disease in people with DM who have latent TB infection (LTBI), with a 12-week course of rifapentine and isoniazid (3HP). Methods The ‘Prevention of tuberculosis in diabetes mellitus’ (PROTID) consortium will randomise 3000 HIV-negative eligible adults with DM and LTBI, as evidenced by a positive tuberculin skin test or interferon gamma release assay, to 12 weeks of 3HP or placebo. Participants will be recruited through screening adult patients attending DM clinics at referral hospitals in Tanzania and Uganda. Patients with previous TB disease or treatment with a rifamycin medication or isoniazid (INH) in the previous 2 years will be excluded. The primary outcome is the occurrence of definite or probable TB disease; secondary outcome measures include adverse events, all-cause mortality and treatment completion. The primary efficacy analysis will be intention-to-treat; per-protocol analyses will also be carried out. We will estimate the ratio of TB incidence rates in intervention and control groups, adjusting for the study site using Poisson regression. Results will be reported as efficacy estimates (1-rate ratio). Cumulative incidence rates allowing for death as a competing risk will also be reported. Approximately 1000 LTBI-negative, HIV-negative participants will be enrolled consecutively into a parallel cohort study to compare the incidence of TB in people with DM who are LTBI negative vs positive. A number of sub-studies will be conducted among others to examine the prevalence of LTBI and active TB, estimate the population impact and cost-effectiveness of LTBI treatment in people living with DM in these African countries and address gaps in the prevention and therapeutic management of combined TB-DM. Discussion PROTID is anticipated to generate key evidence to guide decisions over the use of TB preventive treatment among people with DM as an important target group for better global TB control. Trial registration ClinicalTrials.govNCT04600167. Registered on 23 October 2020
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Affiliation(s)
- Nyanda Elias Ntinginya
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre, Mbeya, Tanzania.
| | - Lindsey Te Brake
- Departmentt of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands
| | - Issa Sabi
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Nyasatu Chamba
- The Good Samaritan Foundation (Kilimanjaro Christian Medical Centre GSF KCMC), Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajiru Kilonzo
- The Good Samaritan Foundation (Kilimanjaro Christian Medical Centre GSF KCMC), Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sweetness Laizer
- The Good Samaritan Foundation (Kilimanjaro Christian Medical Centre GSF KCMC), Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Irene Andia-Biraro
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Andrew Peter Kyazze
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sandra Ninsiima
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Josephine van de Maat
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willyhelmina Olomi
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Lucy Mrema
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre, Mbeya, Tanzania
| | - David Magombola
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Katrina Sharples
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Hamijoyo L, Sahiratmadja E, Ghassani NG, Darmawan G, Susandi E, van Crevel R, Hill PC, Alisjahbana B. Tuberculosis among Patients with Systemic Lupus Erythematosus in Indonesia: a Cohort study. Open Forum Infect Dis 2022; 9:ofac201. [PMID: 35794932 PMCID: PMC9251660 DOI: 10.1093/ofid/ofac201] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/10/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Previous studies have identified systemic lupus erythematosus (SLE) as a risk factor for tuberculosis (TB), but data from TB endemic countries are still relatively scarce. We examined TB in a large cohort of SLE patients in Indonesia.
Methods
All patients registered in a lupus registry of the top-referral hospital for West-Java between 2008 and 2020 were included. Data on SLE characteristics and treatment were retrieved from the registry, and data on TB diagnosis, localization and outcome were extracted from medical records. Cox-proportional hazard model was used to examine risk factors for development of TB.
Results
Among 1278 SLE patients followed over a total of 4804 patient years, 131 patients experienced 138 episodes of TB, a median 2 years (IQR 0.6–5.4) after diagnosis of SLE. A total of 113 patients (81.9%) had pulmonary and 61 (44.2%) had extra-pulmonary involvement, with disseminated disease in 26 of 138 episodes (18.8%), and 13 of 131 patients (9.9%) died from TB. The estimated TB incidence was 2,873 cases per 100,000 person years. In multivariate cox regression analysis, development of TB was associated with household TB contact (HR 7.20; 95%CI 4.05-12.80), pulse methylprednisolone therapy (HR 1.64; 95%CI 1.01-2.67) and age ≤ 25 years old at SLE diagnosis (HR 1.54; 95%CI 1.00-2.35).
Conclusion
There is a high burden of TB in SLE patients in this TB endemic setting, underlining the need for evaluation or implementation of TB preventive strategies.
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Affiliation(s)
- Laniyati Hamijoyo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
- Study Center of Immunology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Edhyana Sahiratmadja
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia
| | - Nadia G. Ghassani
- Study Center of Immunology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Guntur Darmawan
- Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, Indonesia
| | - Evan Susandi
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia
- Division of Tropical Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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31
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Skegg DCG, Brewerton M, Hill PC, Iosua E, Murdoch DR, Turner N. Vaccine mandates in the time of Omicron. N Z Med J 2022; 135:11-15. [PMID: 35728180] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- David C G Skegg
- Emeritus Professor, Department of Preventive and Social Medicine, University of Otago, Dunedin
| | - Maia Brewerton
- Clinical Immunologist, Department of Clinical Immunology and Allergy, Auckland City Hospital, Auckland
| | - Philip C Hill
- Professor of International Health, Centre for International Health, University of Otago, Dunedin
| | - Ella Iosua
- Senior Research Fellow, Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin
| | | | - Nikki Turner
- Immunisation Advisory Centre, Department of General Practice and Primary Health Care, University of Auckland, Auckland
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32
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Hadisoemarto PF, Lestari BW, Sharples K, Afifah N, Chaidir L, Huang CC, McAllister S, van Crevel R, Murray M, Alisjahbana B, Hill PC. A public health intervention package for increasing tuberculosis notifications from private practitioners in Bandung, Indonesia (INSTEP2): A cluster-randomised controlled trial protocol. F1000Res 2022; 10:327. [PMID: 35528962 PMCID: PMC9039369 DOI: 10.12688/f1000research.52089.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background. A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public–private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public–private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. Methods. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. Discussion. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.
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Affiliation(s)
- Panji Fortuna Hadisoemarto
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago, Dunedin, 9016, New Zealand
| | - Bony Wiem Lestari
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands
| | - Katrina Sharples
- Department of Mathematics and Statistics, University of Otago, Dunedin, 9016, New Zealand
| | - Nur Afifah
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Lidya Chaidir
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Microbiology, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Chuan-Chin Huang
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Susan McAllister
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago, Dunedin, 9016, New Zealand
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands
| | - Megan Murray
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Bachti Alisjahbana
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Internal Medicine, Dr Hasan Sadikin General Hospital, Bandung, West Java, 40161, Indonesia
| | - Philip C Hill
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago, Dunedin, 9016, New Zealand
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33
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Apriani L, McAllister S, Sharples K, Nurhasanah H, Aini IN, Susilawati N, Ruslami R, Alisjahbana B, Menzies D, Hill PC. Tuberculosis infection control measures and knowledge in primary health centres in Bandung, Indonesia. J Infect Prev 2022; 23:49-58. [PMID: 35340927 PMCID: PMC8941593 DOI: 10.1177/17571774211046880] [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: 10/18/2020] [Accepted: 08/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Health care workers (HCWs) in low- and middle-income countries (LMICs) continue to have an unacceptably high prevalence and incidence of Mycobacterium tuberculosis infection due to high exposure to tuberculosis (TB) cases at health care facilities and often inadequate infection control measures. This can contribute to an increased risk of transmission not only to HCWs themselves but also to patients and the general population. Aim We assessed implementation of TB infection control measures in primary health centres (PHCs) in Bandung, Indonesia, and TB knowledge among HCWs. Methods A cross-sectional study was conducted between May and November 2017 amongst a stratified sample of the PHCs, and their HCWs, that manage TB patients in Bandung. Questionnaires were used to assess TB infection control measures plus HCW knowledge. Summary statistics, linear regression and the Kruskal-Wallis test were used for analysis. Results The median number of TB infection control measures implemented in 24 PHCs was 21 of 41 assessed. Only one of five management controls was implemented, 15 of 24 administrative controls, three of nine environmental controls and one of three personal respiratory protection controls. PHCs with TB laboratory facilities and high TB case numbers were more likely to implement TB infection control measures than other PHCs (p=0.003). In 398 HCWs, the median number of correct responses for knowledge was 10 (IQR 9-11) out of 11. Discussion HCWs had good TB knowledge. TB infection control measures were generally not implemented and need to be strengthened in PHCs to reduce M. tuberculosis transmission to HCWs, patients and visitors.
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Affiliation(s)
- Lika Apriani
- TB-HIV Research Centre, Faculty of
Medicine, Universitas Padjadjaran, Bandung, Indonesia,Department of Public Health,
Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia,Centre for International Health,
Department of Preventive and Social Medicine, University of Otago, Bandung, Indonesia
| | - Susan McAllister
- Centre for International Health,
Department of Preventive and Social Medicine, University of Otago, Bandung, Indonesia,Sue McAllister, Department of Preventive
and Social Medicine, Centre for International Health, University of Otago, PO
Box 56, Dunedin 9054, New Zealand.
| | - Katrina Sharples
- Centre for International Health,
Department of Preventive and Social Medicine, University of Otago, Bandung, Indonesia,Department of Mathematics and
Statistics, University of Otago, New Zealand
| | - Hanifah Nurhasanah
- TB-HIV Research Centre, Faculty of
Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Isni Nurul Aini
- TB-HIV Research Centre, Faculty of
Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Nopi Susilawati
- TB-HIV Research Centre, Faculty of
Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- TB-HIV Research Centre, Faculty of
Medicine, Universitas Padjadjaran, Bandung, Indonesia,Department of Biomedical Sciences,
Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Bachti Alisjahbana
- TB-HIV Research Centre, Faculty of
Medicine, Universitas Padjadjaran, Bandung, Indonesia,Department of Internal Medicine,
Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Philip C Hill
- Centre for International Health,
Department of Preventive and Social Medicine, University of Otago, Bandung, Indonesia
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Apriani L, Koesoemadinata RC, Bastos ML, Wulandari DA, Santoso P, Alisjahbana B, Rutherford ME, Hill PC, Benedetti A, Menzies D, Ruslami R. Implementing the 4R and 9H regimens for TB preventive treatment in Indonesia. Int J Tuberc Lung Dis 2022; 26:103-110. [PMID: 35086621 PMCID: PMC8802562 DOI: 10.5588/ijtld.21.0318] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACK GROUND: The implementation of tuberculosis preventive treatment (TPT) is challenging especially in resource-limited settings. As part of a Phase 3 trial on TPT, we described our experience with the use of rifampicin for 4 months (4R) and isoniazid for 9 months (9H) in Indonesia. METHODS: In 2011–2017, children and adults with latent TB infection were randomised to either 4R or 9H and followed until 16 months after randomisation for children and 28 months for adults. The primary outcome was the treatment completion rate. Secondary outcomes were Grade 3–5 adverse events (AEs), active TB occurrence, and health costs. RESULTS: A total of 157 children and 860 adults were enrolled. The 4R treatment completion rate was significantly higher than that of 9H (78.7% vs. 65.5%), for a rate difference of 13.2% (95% CI 7.1–19.2). No Grade 3–5 AEs were reported in children; in adults, it was lower in 4R (0.4%) compared to 9H (2.8%). The incidence of active TB was lower with 4R than with 9H (0.09/100 person-year vs. 0.36/100 person-year) (rate difference: −0.36/100 person-year). The total cost per patient was lower for the 4R regimen than for the 9H regimen (USD151.9 vs. USD179.4 in adults and USD152.9 vs. USD206.5 in children) CONCLUSIONS: Completion and efficacy rates for 4R were better than for 9H. Compared to 9H, 4R was cheaper in all age groups, safer in adults and equally safe in children. The Indonesian TB program could benefit from these benefits of the 4R regimen.
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Affiliation(s)
- L Apriani
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - R C Koesoemadinata
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - M L Bastos
- Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - D A Wulandari
- Department of Child Health, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P Santoso
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - B Alisjahbana
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - M E Rutherford
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Otago, New Zealand
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Otago, New Zealand
| | - A Benedetti
- Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, Departments of Epidemiology, Biostatistics and Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - D Menzies
- Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, Departments of Epidemiology, Biostatistics and Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - R Ruslami
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Setiabudiawan TP, Reurink RK, Hill PC, Netea MG, van Crevel R, Koeken VACM. Protection against tuberculosis by Bacillus Calmette-Guérin (BCG) vaccination: A historical perspective. Med (N Y) 2022; 3:6-24. [PMID: 35590145 DOI: 10.1016/j.medj.2021.11.006] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 01/23/2023]
Abstract
Bacillus Calmette-Guérin (BCG) was developed exactly 100 years ago, and it is still the only licensed tuberculosis (TB) vaccine and the most frequently administered of all vaccines worldwide. Despite universal vaccination policies in TB-endemic settings, the burden of TB remains high. Although BCG protects against Mycobacterium tuberculosis infection and TB disease, the level of protection varies greatly between age groups and settings. In this review, we present a historical perspective and describe the evidence for BCG's ability to protect against TB as well as the factors that influence protection. We also present the immunological mechanisms through which BCG vaccination induces protection, focusing on T cell, B cell, and innate immunity. Finally, we discuss several possibilities to boost BCG's efficacy, including alternative vaccination routes, BCG revaccination, and use of recombinant BCG vaccines, and describe the knowledge gaps that exist with respect to BCG's protection against TB.
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Affiliation(s)
- Todia P Setiabudiawan
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Gelderland 6525 GA, the Netherlands
| | - Remi K Reurink
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Gelderland 6525 GA, the Netherlands
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, North Dunedin 9016, New Zealand
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Gelderland 6525 GA, the Netherlands; Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, Județul Dolj 200349, Romania
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Gelderland 6525 GA, the Netherlands; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Valerie A C M Koeken
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Gelderland 6525 GA, the Netherlands; Department of Computational Biology for Individualised Infection Medicine, Centre for Individualised Infection Medicine (CiiM), a joint venture between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover 30625, Germany; TWINCORE, a joint venture between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover 30625, Germany.
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36
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Koesoemadinata RC, McAllister SM, Soetedjo NNM, Santoso P, Ruslami R, Damayanti H, Rahmadika N, Alisjahbana B, van Crevel R, Hill PC. Educational counselling of patients with combined TB and diabetes mellitus: a randomised trial. Public Health Action 2021; 11:202-208. [PMID: 34956849 DOI: 10.5588/pha.21.0064] [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: 07/08/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Newly diagnosed pulmonary TB with diabetes mellitus (DM) comorbidity attending clinics in Bandung City, Indonesia. OBJECTIVE To describe the effect of educational counselling on patients' knowledge about TB (transmission, treatment, risk factors) and DM (symptoms, treatment, complications, healthy lifestyle), adherence to medication, and to assess characteristics associated with knowledge. DESIGN All patients received counselling and were then randomised to either structured education on TB-DM, combined with clinical monitoring and medication adjustment (intervention arm), or routine care (control arm). Knowledge and adherence were assessed using a questionnaire. RESULTS Baseline and 6-month questionnaires were available for 108 of 150 patients randomised (60/76 in the intervention arm and 48/74 in the control arm). Patients knew less about DM than about TB. There was no significant difference in the proportion with knowledge improvement at 6 months, both for TB (difference of differences 14%; P = 0.20) or for DM (10%; P = 0.39) between arms. Intervention arm patients were more likely to adhere to taking DM medication, with fewer patients reporting ever missing oral DM drugs than those in the control arm (23% vs. 48%; P = 0.03). Higher education level was associated with good knowledge of both TB and DM. CONCLUSIONS Structured education did not clearly improve patients' knowledge. It was associated with better adherence to DM medication, but this could not be attributed to education alone. More efforts are needed to improve patients' knowledge, especially regarding DM.
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Affiliation(s)
- R C Koesoemadinata
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S M McAllister
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - N N M Soetedjo
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P Santoso
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R Ruslami
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - H Damayanti
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - N Rahmadika
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - B Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R van Crevel
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P C Hill
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
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Aung HL, Nyunt WW, Fong Y, Biggs PJ, Winkworth RC, Lockhart PJ, Yeo TW, Hill PC, Cook GM, Aung ST. Genomic Profiling of Mycobacterium tuberculosis Strains, Myanmar. Emerg Infect Dis 2021; 27:2847-2855. [PMID: 34670644 PMCID: PMC8544997 DOI: 10.3201/eid2711.210726] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Multidrug resistance is a major threat to global elimination of tuberculosis (TB). We performed phenotypic drug-susceptibility testing and whole-genome sequencing for 309 isolates from 342 consecutive patients who were given a diagnosis of TB in Yangon, Myanmar, during July 2016‒June 2018. We identified isolates by using the GeneXpert platform to evaluate drug-resistance profiles. A total of 191 (62%) of 309 isolates had rifampin resistance; 168 (88%) of these rifampin-resistant isolates were not genomically related, indicating the repeated emergence of resistance in the population, rather than extensive local transmission. We did not detect resistance mutations to new oral drugs, including bedaquiline and pretomanid. The current GeneXpert MTB/RIF system needs to be modified by using the newly launched Xpert MTB/XDR cartridge or line-probe assay. Introducing new oral drugs to replace those currently used in treatment regimens for multidrug-resistant TB will also be useful for treating TB in Myanmar.
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Olomi W, Biraro IA, Kilonzo K, Te Brake L, Kibirige D, Chamba N, Ntinginya NE, Sabi I, Critchley J, Sharples K, Hill PC, Van Crevel R. Tuberculosis preventive therapy for people with diabetes mellitus. Clin Infect Dis 2021; 74:1506-1507. [PMID: 34505132 DOI: 10.1093/cid/ciab755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Willyhelmina Olomi
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Irene Andia Biraro
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kajiru Kilonzo
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Lindsey Te Brake
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Davis Kibirige
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | | | - Nyanda Elias Ntinginya
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Issa Sabi
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Katrina Sharples
- Centre for International Health, Otago University, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, Otago University, Dunedin, New Zealand
| | - Reinout Van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Mackenzie GA, Hill PC, Jeffries DJ, Ndiaye M, Sahito SM, Hossain I, Uchendu U, Ameh D, Adeyemi O, Pathirana J, Olatunji Y, Abatan B, Muhammad BS, Ahameefula E, Fombah AE, Adeshola B, Lobga BG, Saha D, Mackenzie R, Odutola A, Plumb ID, Akano A, Ebruke BE, Ideh RC, Kuti B, Githua P, Olutunde E, Ofordile O, Green E, Usuf E, Badji H, Ikumapayi UN, Manjang A, Salaudeen R, Nsekpong ED, Jarju S, Antonio M, Sambou S, Ceesay L, Lowe-Jallow Y, Fofana S, Jasseh M, Mulholland K, Knoll M, Levine OS, Howie SR, Adegbola RA, Greenwood BM, Corrah T. Impact of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease and pneumonia in The Gambia: 10 years of population-based surveillance. Lancet Infect Dis 2021; 21:1293-1302. [PMID: 34280357 PMCID: PMC8384632 DOI: 10.1016/s1473-3099(20)30880-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 10/01/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022]
Abstract
Background The Gambia introduced seven-valent pneumococcal conjugate vaccine (PCV7) in August 2009, followed by PCV13 in May, 2011, using a schedule of three primary doses without a booster dose or catch-up immunisation. We aimed to assess the long-term impact of PCV on disease incidence. Methods We did 10 years of population-based surveillance for invasive pneumococcal disease (IPD) and WHO defined radiological pneumonia with consolidation in rural Gambia. The surveillance population included all Basse Health and Demographic Surveillance System residents aged 2 months or older. Nurses screened all outpatients and inpatients at all health facilities using standardised criteria for referral. Clinicians then applied criteria for patient investigation. We defined IPD as a compatible illness with isolation of Streptococcus pneumoniae from a normally sterile site (cerebrospinal fluid, blood, or pleural fluid). We compared disease incidence between baseline (May 12, 2008–May 11, 2010) and post-vaccine years (2016–2017), in children aged 2 months to 14 years, adjusting for changes in case ascertainment over time. Findings We identified 22 728 patients for investigation and detected 342 cases of IPD and 2623 cases of radiological pneumonia. Among children aged 2–59 months, IPD incidence declined from 184 cases per 100 000 person-years to 38 cases per 100 000 person-years, an 80% reduction (95% CI 69–87). Non-pneumococcal bacteraemia incidence did not change significantly over time (incidence rate ratio 0·88; 95% CI, 0·64–1·21). We detected zero cases of vaccine-type IPD in the 2–11 month age group in 2016–17. Incidence of radiological pneumonia decreased by 33% (95% CI 24–40), from 10·5 to 7·0 per 1000 person-years in the 2–59 month age group, while pneumonia hospitalisations declined by 27% (95% CI 22–31). In the 5–14 year age group, IPD incidence declined by 69% (95% CI −28 to 91) and radiological pneumonia by 27% (95% CI −5 to 49). Interpretation Routine introduction of PCV13 substantially reduced the incidence of childhood IPD and pneumonia in rural Gambia, including elimination of vaccine-type IPD in infants. Other low-income countries can expect substantial impact from the introduction of PCV13 using a schedule of three primary doses. Funding Gavi, The Vaccine Alliance; Bill & Melinda Gates Foundation; UK Medical Research Council; Pfizer Ltd.
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Affiliation(s)
| | - Grant A Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia; London School of Hygiene & Tropical Medicine, London, UK; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australi.
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - David J Jeffries
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Shah M Sahito
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Uchendu Uchendu
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - David Ameh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Oyedeji Adeyemi
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Jayani Pathirana
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Baderinwa Abatan
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Bilquees S Muhammad
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ebirim Ahameefula
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Augustin E Fombah
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Banjo Adeshola
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Babila G Lobga
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Debasish Saha
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Roslyn Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Aderonke Odutola
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ian D Plumb
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Aliu Akano
- The National Hospital, Garki, Abuja, Nigeria
| | - Bernard E Ebruke
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Readon C Ideh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Bankole Kuti
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Peter Githua
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Emmanuel Olutunde
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ogochukwu Ofordile
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Edward Green
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Effua Usuf
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Usman Na Ikumapayi
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - E David Nsekpong
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sheikh Jarju
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Martin Antonio
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; London School of Hygiene & Tropical Medicine, London, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Sana Sambou
- Ministry of Health, Gambia Government, The Gambia
| | - Lamin Ceesay
- Ministry of Health, Gambia Government, The Gambia
| | | | - Sidat Fofana
- Ministry of Health, Gambia Government, The Gambia
| | - Momodou Jasseh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kim Mulholland
- Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia; London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Knoll
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Orin S Levine
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen R Howie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | | | | | - Tumani Corrah
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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Affiliation(s)
- David Cg Skegg
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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McAllister S, Thorn L, Boladuadua S, Gil M, Audas R, Edmonds T, Rafai E, Hill PC, Howie SRC. Cost analysis and critical success factors of the use of oxygen concentrators versus cylinders in sub-divisional hospitals in Fiji. BMC Health Serv Res 2021; 21:636. [PMID: 34215232 PMCID: PMC8249838 DOI: 10.1186/s12913-021-06687-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background Oxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings. Oxygen concentrators (OCs) can increase access to oxygen, compared to conventional oxygen cylinders. We investigated the costs and critical success factors of OCs in three hospitals in Fiji, and extrapolated these to estimate the oxygen delivery cost to all Sub-Divisional hospitals (SDH) nationwide. Methods Data sources included key personnel interviews, and data from SDH records, Ministry of Health and Medical Services, and a non-governmental organisation. We used Investment Logic Mapping (ILM) to define key issues. An economic case was developed to identify the investment option that optimised value while incorporating critical success factors identified through ILM. A fit-for-purpose analysis was conducted using cost analysis of four short-listed options. Sensitivity analyses were performed by altering variables to show the best or worst case scenario. All costs are presented in Fijian dollars. Results Critical success factors identifed included oxygen availability, safety, ease of use, feasibility, and affordability. Compared to the status quo of having only oxygen cylinders, an option of having a minimum number of concentrators with cylinder backup would cost $434,032 (range: $327,940 to $506,920) over 5 years which would be 55% (range: 41 to 64%) of the status quo cost. Conclusion Introducing OCs into all SDHs in Fiji would reduce overall costs, while ensuring identified critical success factors are maintained. This study provides evidence for the benefits of OCs in this and similar settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06687-8.
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Affiliation(s)
- Susan McAllister
- Centre for International Health, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Louise Thorn
- Centre for International Health, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Sainimere Boladuadua
- Cure Kids Fiji, Suva, Fiji.,Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, New Zealand
| | | | - Rick Audas
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
| | | | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Stephen R C Howie
- Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, New Zealand
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Alisjahbana B, McAllister SM, Ugarte-Gil C, Panduru NM, Ronacher K, Koesoemadinata RC, Zubiate C, Riza AL, Malherbe ST, Kleynhans L, Lopez S, Dockrell HM, Ruslami R, Ioana M, Walzl G, Pearson F, Critchley JA, Moore DAJ, van Crevel R, Hill PC. Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa. Trans R Soc Trop Med Hyg 2021; 115:634-643. [PMID: 33118039 DOI: 10.1093/trstmh/traa100] [Citation(s) in RCA: 3] [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: 12/17/2019] [Revised: 02/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. METHODS DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. RESULTS A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. CONCLUSIONS These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.
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Affiliation(s)
- Bachti Alisjahbana
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran - Hasan Sadikin Hospital, Bandung, Indonesia
| | - Susan M McAllister
- Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Cesar Ugarte-Gil
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicolae Mircea Panduru
- 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Katharina Ronacher
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Translational Research Institute, Mater Research Institute - University of Queensland, Brisbane, Australia
| | - Raspati C Koesoemadinata
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlos Zubiate
- Servicio de Endocrinologia, Hospital Maria Auxiliadora, Lima, Peru
| | - Anca Lelia Riza
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Romania.,Regional Centre for Human Genetics - Dolj, Emergency Clinical County Hospital Craiova, Romania.,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stephanus T Malherbe
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leanie Kleynhans
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sonia Lopez
- Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hazel M Dockrell
- Faculty of Infectious and Tropical Diseases and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rovina Ruslami
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Mihai Ioana
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Romania.,Regional Centre for Human Genetics - Dolj, Emergency Clinical County Hospital Craiova, Romania.,University of Medicine and Pharmacy of Craiova, Human Genomics Laboratory, Clinical County Emergency Hospital Craiova, Romania
| | - Gerhard Walzl
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Fiona Pearson
- Population Health Research Institute, St George's University of London, London, UK
| | - Julia A Critchley
- Population Health Research Institute, St George's University of London, London, UK
| | - David A J Moore
- Faculty of Infectious and Tropical Diseases and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand
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McAllister SM, Koesoemadinata RC, Santoso P, Soetedjo NNM, Kamil A, Permana H, Ruslami R, Critchley JA, van Crevel R, Hill PC, Alisjahbana B. High tuberculosis incidence among people living with diabetes in Indonesia. Trans R Soc Trop Med Hyg 2021; 114:79-85. [PMID: 31711230 DOI: 10.1093/trstmh/trz100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/17/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Data regarding the incidence of tuberculosis (TB) among people living with diabetes (PLWD) in TB-endemic settings are scarce. We examined TB incidence among PLWD in Indonesia who had previously been screened for latent TB infection (LTBI) and TB disease. METHODS PLWD (≥18 y of age) in an urban setting were examined a mean 3.4 y after they had been screened for active TB and LTBI. Data on subsequent TB diagnosis were collected by interview and with chest X-ray, sputum smear and Mycobacterium tuberculosis culture. TB incidence rates were stratified for baseline LTBI status, as determined by the QuantiFERON interferon-gamma release assay (IGRA). RESULTS Of 590 PLWD, 101 had died and 163 could not be contacted or refused. Among the 326 who were re-examined, 6 (1.8%; 95% confidence interval [CI] 0.7 to 4.0) reported being diagnosed already and a further 5 were diagnosed with active TB (1.5%; 95% CI 0.50 to 3.5). The TB incidence rate was 9.85 (95% CI 4.03 to 15.68) per 1000 person-years. TB incidence was higher among PLWD with baseline LTBI (17.13; 95% CI 5.25 to 29.00/1000 person-years) compared with those without LTBI (4.79; 95% CI -0.63 to 10.21), with an incidence rate ratio of 3.57 (95% CI 0.86 to 20.92; p=0.054). CONCLUSIONS PLWD with LTBI in Indonesia and similar settings are likely to benefit from TB preventive therapy.
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Affiliation(s)
- Susan M McAllister
- Centre for International Health, University of Otago Medical School, University of Otago, P.O. Box 56, Dunedin, New Zealand
| | - Raspati C Koesoemadinata
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Internal Medicine, Nijmegen, The Netherlands
| | - Prayudi Santoso
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Nanny N M Soetedjo
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Abdul Kamil
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Hikmat Permana
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Rovina Ruslami
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Julia A Critchley
- Population Health Research Institute, St Georges, University of London, London, SW 17 ORE, UK
| | - Reinout van Crevel
- Radboud University Medical Centre, Department of Internal Medicine and Radboud Centre of Infectious Diseases, 6500 HB Nijmegen, The Netherlands
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, University of Otago, P.O. Box 56, Dunedin, New Zealand
| | - Bachti Alisjahbana
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, Indonesia
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Foster M, Hill PC, Setiabudiawan TP, Koeken VACM, Alisjahbana B, van Crevel R. BCG-induced protection against Mycobacterium tuberculosis infection: Evidence, mechanisms, and implications for next-generation vaccines. Immunol Rev 2021; 301:122-144. [PMID: 33709421 PMCID: PMC8252066 DOI: 10.1111/imr.12965] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022]
Abstract
The tuberculosis (TB) vaccine Bacillus Calmette-Guérin (BCG) was introduced 100 years ago, but as it provides insufficient protection against TB disease, especially in adults, new vaccines are being developed and evaluated. The discovery that BCG protects humans from becoming infected with Mycobacterium tuberculosis (Mtb) and not just from progressing to TB disease provides justification for considering Mtb infection as an endpoint in vaccine trials. Such trials would require fewer participants than those with disease as an endpoint. In this review, we first define Mtb infection and disease phenotypes that can be used for mechanistic studies and/or endpoints for vaccine trials. Secondly, we review the evidence for BCG-induced protection against Mtb infection from observational and BCG re-vaccination studies, and discuss limitations and variation of this protection. Thirdly, we review possible underlying mechanisms for BCG efficacy against Mtb infection, including alternative T cell responses, antibody-mediated protection, and innate immune mechanisms, with a specific focus on BCG-induced trained immunity, which involves epigenetic and metabolic reprogramming of innate immune cells. Finally, we discuss the implications for further studies of BCG efficacy against Mtb infection, including for mechanistic research, and their relevance to the design and evaluation of new TB vaccines.
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Affiliation(s)
- Mitchell Foster
- Department of Microbiology and ImmunologyUniversity of OtagoDunedinNew Zealand
| | - Philip C. Hill
- Centre for International HealthUniversity of OtagoDunedinNew Zealand
| | - Todia Pediatama Setiabudiawan
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI)Radboud University Medical CenterNijmegenThe Netherlands
| | - Valerie A. C. M. Koeken
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI)Radboud University Medical CenterNijmegenThe Netherlands
- Department of Computational Biology for Individualised Infection MedicineCentre for Individualised Infection Medicine (CiiM) & TWINCOREJoint Ventures between The Helmholtz‐Centre for Infection Research (HZI) and The Hannover Medical School (MHH)HannoverGermany
| | - Bachti Alisjahbana
- Tuberculosis Working GroupFaculty of MedicineUniversitas PadjadjaranBandungIndonesia
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI)Radboud University Medical CenterNijmegenThe Netherlands
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Bastos ML, Oxlade O, Benedetti A, Fregonese F, Valiquette C, Lira SCC, Carvalho-Cordeiro D, Cavalcante JR, Faerstein E, Albuquerque MFM, Cordeiro-Santos M, Hill PC, Menzies D, Trajman A. A public health approach to increase treatment of latent TB among household contacts in Brazil. Int J Tuberc Lung Dis 2021; 24:1000-1008. [PMID: 33126931 DOI: 10.5588/ijtld.19.0728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities.METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician.RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI - 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial.DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.
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Affiliation(s)
- M L Bastos
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Respiratory Epidemiology & Clinical Research Unit
| | | | - A Benedetti
- Respiratory Epidemiology & Clinical Research Unit, Departments of Epidemiology, Biostatistics & Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - F Fregonese
- Respiratory Epidemiology & Clinical Research Unit
| | - C Valiquette
- Respiratory Epidemiology & Clinical Research Unit
| | - S C C Lira
- Recife Municipal Health Secretariat, Recife, PE, Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Pernambuco, Recife, PE
| | - D Carvalho-Cordeiro
- Manaus Municipal Health Secretariat, Manaus, AM, Programa de Pós-gradução em Enfermagem, Universidade Federal do Amazonas, Manaus, AM
| | - J R Cavalcante
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - E Faerstein
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - M Cordeiro-Santos
- Tropical Medicine Post-Graduation Program, Amazonas State University, Manaus, AM, Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, AM, Brazil
| | - P C Hill
- Centre for International Health, Otago Medical School, University of Otago, Otago, New Zealand
| | - D Menzies
- Respiratory Epidemiology & Clinical Research Unit, McGill International TB Centre, Departments of Epidemiology, Biostatistics & Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - A Trajman
- McGill International TB Centre, Internal Medicine Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Primary Health Care Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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46
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Hadisoemarto PF, Lestari BW, Sharples K, Afifah N, Chaidir L, Huang CC, McAllister S, van Crevel R, Murray M, Alisjahbana B, Hill PC. A public health intervention package for increasing tuberculosis notifications from private practitioners in Bandung, Indonesia (INSTEP2): A cluster-randomised controlled trial protocol. F1000Res 2021; 10:327. [PMID: 35528962 PMCID: PMC9039369 DOI: 10.12688/f1000research.52089.1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 02/13/2024] Open
Abstract
Background. A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public-private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public-private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. Methods. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. Discussion. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.
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Affiliation(s)
- Panji Fortuna Hadisoemarto
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago, Dunedin, 9016, New Zealand
| | - Bony Wiem Lestari
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands
| | - Katrina Sharples
- Department of Mathematics and Statistics, University of Otago, Dunedin, 9016, New Zealand
| | - Nur Afifah
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Lidya Chaidir
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Microbiology, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Chuan-Chin Huang
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Susan McAllister
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago, Dunedin, 9016, New Zealand
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands
| | - Megan Murray
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Bachti Alisjahbana
- Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
- Department of Internal Medicine, Dr Hasan Sadikin General Hospital, Bandung, West Java, 40161, Indonesia
| | - Philip C Hill
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago, Dunedin, 9016, New Zealand
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47
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Oxlade O, Benedetti A, Adjobimey M, Alsdurf H, Anagonou S, Cook VJ, Fisher D, Fox GJ, Fregonese F, Hadisoemarto P, Hill PC, Johnston J, Khan FA, Long R, Nguyen NV, Nguyen TA, Obeng J, Ruslami R, Schwartzman K, Trajman A, Valiquette C, Menzies D. Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial. Lancet Public Health 2021; 6:e272-e282. [PMID: 33765453 DOI: 10.1016/s2468-2667(20)30261-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Reaching the UN General Assembly High-Level Meeting on Tuberculosis target of providing tuberculosis preventive treatment to at least 30 million people by 2022, including 4 million children under the age of 5 years and 20 million other household contacts, will require major efforts to strengthen health systems. The aim of this study was to evaluate the effectiveness and cost-effectiveness of a health systems intervention to strengthen management for latent tuberculosis infection (LTBI) in household contacts of confirmed tuberculosis cases. METHODS ACT4 was a cluster-randomised, open-label trial involving 24 health facilities in Benin, Canada, Ghana, Indonesia, and Vietnam randomly assigned to either a three-phase intervention (LTBI programme evaluation, local decision making, and strengthening activities) or control (standard LTBI care). Tuberculin and isoniazid were provided to control and intervention sites if not routinely available. Randomisation was stratified by country and restricted to ensure balance of index patients with tuberculosis by arm and country. The primary outcome was the number of household contacts who initiated tuberculosis preventive treatment at each health facility within 4 months of the diagnosis of the index case, recorded in the first or last 6 months of our 20-month study. To ease interpretation, this number was standardised per 100 newly diagnosed index patients with tuberculosis. Analysis was by intention to treat. Masking of staff at the coordinating centre and sites was not possible; however, those analysing data were masked to assignment of intervention or control. An economic analysis of the intervention was done in parallel with the trial. ACT4 is registered at ClinicalTrials.gov, NCT02810678. FINDINGS The study was done between Aug 1, 2016, and March 31, 2019. During the first 6 months of the study the crude overall proportion of household contacts initiating tuberculosis preventive treatment out of those eligible at intervention sites was 0·21. After the implementation of programme strengthening activities, the proportion initiating tuberculosis preventive treatment increased to 0·35. Overall, the number of household contacts initiating tuberculosis preventive treatment per 100 index patients with tuberculosis increased between study phases in intervention sites (adjusted rate difference 60, 95% CI 4 to 116), while control sites showed no statistically significant change (-12, -33 to 10). There was a difference in rate differences of 72 (95% CI 10 to 134) contacts per 100 index patients with tuberculosis initiating preventive treatment associated with the intervention. The total cost for the intervention, plus LTBI clinical care per additional contact initiating treatment was estimated to be CA$1348 (range 724 to 9708). INTERPRETATION A strategy of standardised evaluation, local decision making, and implementation of health systems strengthening activities can provide a mechanism for scale-up of tuberculosis prevention, particularly in low-income and middle-income countries. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Olivia Oxlade
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Andrea Benedetti
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Mênonli Adjobimey
- Centre National Hospitalier Universitaire de Pneumo-Pthisiologie de Cotonou, Cotonou, Benin
| | - Hannah Alsdurf
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | | | - Victoria J Cook
- Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Greg J Fox
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Federica Fregonese
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Panji Hadisoemarto
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Centre for International Health, Faculty of Medicine, University of Otago, Otago, New Zealand
| | - James Johnston
- Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Faiz Ahmad Khan
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Richard Long
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Thu Anh Nguyen
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research in Vietnam, Hanoi, Vietnam
| | | | - Rovina Ruslami
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Kevin Schwartzman
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Anete Trajman
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Chantal Valiquette
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Dick Menzies
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
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48
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Khadka P, Sinha S, Tucker IG, Dummer J, Hill PC, Katare R, Das SC. Studies on the safety and the tissue distribution of inhaled high-dose amorphous and crystalline rifampicin in a rat model. Int J Pharm 2021; 597:120345. [PMID: 33545287 DOI: 10.1016/j.ijpharm.2021.120345] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 12/17/2022]
Abstract
Inhaled delivery of rifampicin has the potential to achieve high drug concentrations in the lung and the blood for efficient treatment of tuberculosis (TB). Due to its existence as polymorphs, in vivo evaluation of the respiratory tract safety of inhalable amorphous and crystalline rifampicin particles, at clinically relevant high-dose, is necessary. This study investigates the lung and liver safety and the tissue distribution of rifampicin after intra-tracheal administration of high (≥25 mg/kg) doses of amorphous and crystalline powder formulations to Sprague Dawley rats. Powder formulations were administered by intra-tracheal insufflation to rats. Lung and liver safety were evaluated by histopathology. Serum alanine transaminase (ALT) and aspartate aminotransferase (AST) assays were performed to study the hepatic effects. Rifampicin was quantified in the tissues using LC-MS/MS. Intra-tracheal administration of rifampicin decreased the drug burden on the liver compared to oral administration based on its lower serum ALT activity. Repeated-dose intra-tracheal rifampicin was well tolerated by rats, confirmed by the absence of drug or delivery induced complexities. The histopathological evaluation of rat lungs, after both single and repeated drug administration for seven days, suggested the absence of drug-induced toxicity. Following single intra-tracheal delivery of 50 mg/kg doses, comparable rifampicin concentrations to that from same oral dose were observed in lung, liver, heart and brain. Inhaled delivery of high-dose rifampicin was safe to rat lungs and liver suggesting its potential for localized as well as systemic drug delivery without toxicity concerns.
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Affiliation(s)
- Prakash Khadka
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Shubhra Sinha
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, 270 Great King Street, P.O. Box 913, Dunedin 9054, New Zealand
| | - Ian G Tucker
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Jack Dummer
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rajesh Katare
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, 270 Great King Street, P.O. Box 913, Dunedin 9054, New Zealand
| | - Shyamal C Das
- School of Pharmacy, University of Otago, Dunedin, New Zealand.
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49
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Apriani L, McAllister S, Sharples K, Aini IN, Nurhasanah H, Ratnaningsih DF, Indrati AR, Ruslami R, Alisjahbana B, van Crevel R, Hill PC. High risk of Mycobacterium tuberculosis infection among medical and nursing students in Indonesia: a 1-year prospective study. Trans R Soc Trop Med Hyg 2021; 116:10-18. [PMID: 33721022 DOI: 10.1093/trstmh/trab038] [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: 11/30/2020] [Revised: 02/03/2021] [Accepted: 02/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Medical and nursing students entering their clinical programmes are at increased risk for tuberculosis (TB) in TB-endemic settings. Relatively little is known about Mycobacterium tuberculosis infection among such students in high-endemic countries. METHODS We examined M. tuberculosis infection among medical and nursing students starting clinical training in Bandung, Indonesia using interferon-γ release assay (IGRA) QuantiFERON-TB Gold Plus. IGRA-negative students had a repeat test after 1 y and logistic regression was used to identify factors associated with IGRA positivity or conversion. RESULTS There were 379 students included in this study: 248 (65.4%) were medical students and 131 (34.6%) were nursing students. Of 379 students, 70 (18.5%) were IGRA positive at baseline. Of 293 IGRA-negative students with 1-y results, 26 (8.9%) underwent IGRA conversion. Being a medical student (adjusted relative risk [ARR] 5.15 [95% confidence interval {CI} 1.82 to 14.59], p=0.002) and participation in sputum collection or bronchoscopy were associated with IGRA conversion (ARR 2.74 [95% CI 1.29 to 5.79], p=0.008). CONCLUSIONS Medical and nursing students entering clinical training are at high risk of M. tuberculosis infection and need improved infection prevention and control strategies.
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Affiliation(s)
- Lika Apriani
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
| | - Susan McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
| | - Katrina Sharples
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand.,Department of Mathematics and Statistics, University of Otago, 730 Cumberland Street, North Dunedin, Dunedin 9016, New Zealand
| | - Isni Nurul Aini
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Hanifah Nurhasanah
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Dwi Febni Ratnaningsih
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Agnes Rengga Indrati
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Jl Pasteur No. 38 Bandung 40161, Indonesia
| | - Rovina Ruslami
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman No. 38 Bandung 40161, Indonesia
| | - Bachti Alisjahbana
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Jl Pasteur No. 38 Bandung 40161, Indonesia
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
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50
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Weiner J, Domaszewska T, Donkor S, Kaufmann SHE, Hill PC, Sutherland JS. Changes in Transcript, Metabolite, and Antibody Reactivity During the Early Protective Immune Response in Humans to Mycobacterium tuberculosis Infection. Clin Infect Dis 2021; 71:30-40. [PMID: 31412355 PMCID: PMC7312225 DOI: 10.1093/cid/ciz785] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/14/2019] [Accepted: 08/09/2019] [Indexed: 01/09/2023] Open
Abstract
Background Strategies to prevent Mycobacterium tuberculosis (Mtb) infection are urgently required. In this study, we aimed to identify correlates of protection against Mtb infection. Methods Two groups of Mtb-exposed contacts of tuberculosis (TB) patients were recruited and classified according to their Mtb infection status using the tuberculin skin test (TST; cohort 1) or QuantiFERON (QFT; cohort 2). A negative reading at baseline with a positive reading at follow-up classified TST or QFT converters and a negative reading at both time points classified TST or QFT nonconverters. Ribonucleic acid sequencing, Mtb proteome arrays, and metabolic profiling were performed. Results Several genes were found to be differentially expressed at baseline between converters and nonconverters. Gene set enrichment analysis revealed a distinct B-cell gene signature in TST nonconverters compared to converters. When infection status was defined by QFT, enrichment of type I interferon was observed. A remarkable area under the curve (AUC) of 1.0 was observed for IgA reactivity to Rv0134 and an AUC of 0.98 for IgA reactivity to both Rv0629c and Rv2188c. IgG reactivity to Rv3223c resulted in an AUC of 0.96 and was markedly higher compared to TST nonconverters. We also identified several differences in metabolite profiles, including changes in biomarkers of inflammation, fatty acid metabolism, and bile acids. Pantothenate (vitamin B5) was significantly increased in TST nonconverters compared to converters at baseline (q = 0.0060). Conclusions These data provide new insights into the early protective response to Mtb infection and possible avenues to interfere with Mtb infection, including vitamin B5 supplementation. Analysis of blood from highly exposed household contacts from The Gambia who never develop latent Mycobacterium tuberculosis infection shows distinct transcriptomic, antibody, and metabolomic profiles compared to those who develop latent tuberculosis infection but prior to any signs of infection.
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Affiliation(s)
- January Weiner
- Max Planck Institute for Infection Biology, Berlin, Germany
| | | | - Simon Donkor
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany.,Hagler Institute for Advanced Study, Texas A&M University, College Station, USA
| | - Philip C Hill
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.,Otago University, Otago, New Zealand
| | - Jayne S Sutherland
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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