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Tafess K, Beyen TK, Girma S, Girma A, Siu G. Spatial clustering and genetic diversity of Mycobacterium tuberculosis isolate among pulmonary tuberculosis suspected patients, Arsi Zone, Ethiopia. BMC Pulm Med 2021; 21:206. [PMID: 34193091 PMCID: PMC8244181 DOI: 10.1186/s12890-021-01567-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/10/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Tuberculosis remains a serious public health concern globally. The enormous social, economic, and health impacts of the diseases are attributed to the lack of updated data on the prevalence, geospatial distribution, population structures, and genotypic variants of the circulating M. tuberculosis. METHODS Structured questionnaire, mycobacterial culture, and standard 24-Mycobacterial Interspersed Repeated Units-Variable Number Tandem Repeats (MIRU-VNTR) were employed to collect sociodemographic characters, residence linked information, and genotype the isolates. The retrospective discrete Bernoulli model was used to identify the hot spot districts of sputum smear positivity, and Web-based Miru-VNTRPlus were used for the identification of lineages and sublineages. RESULTS Out of 832 presumptive pulmonary tuberculosis (PTB) suspects, 119 (14.3%) were smear-positive. In the multivariate binary logistic model, PTB suspected patients in the age groups of 7-25 and 25-34 and those from rural residents were 4.53 (AOR = 4.53; 95% CI 2.25-9.13), 3.00 (AOR = 3.00; 95% CI 1.41-6.35) and 1.65 (AOR = 1.65; 95% CI 1.01-2.70) times at higher risk of turning smear-positive. Eleven (47.8%) districts of Arsi Zone were shown to have a high rate of clustering (RR = 2.27; 95% CI 1.62-3.2) of smear-positive PTB. Of 72 isolates queried for the lineage assignment, 59 (81.9%) were classified into the previously known lineages and 13 (18.1%) were not assigned to any known lineages. Overall, 42 (58.3%) belong to M. tuberculosis lineage 4 (Euro-American), 16 (22.2%) M. tuberculosis lineage 3 (Delhi/CAS), and 1 (1.4%) M. tuberculosis Lineage 1 (Indo-Oceanic/ East Africa Indian). Further classification to the sublineage indicates that the predominant lineage was Delhi/CAS comprising 16 (22.2%) isolates followed by 15 (20.8%) isolates belonging to Haarlem. The remaining isolates were distributed as 13 (18.1%) TUR, 6 (8.3%) LAM, 4 (5.5%) URAL, 4 (4.5%) NEW-1 and 1 (1.4%) EAI. CONCLUSION Our study showed higher smear-positive results among PTB suspected patients and remarkable spatial variation across districts of Arsi Zone in smear-positive PTB. This information together with the genotypic features could be used as input for the efforts of designing control strategies.
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Affiliation(s)
- Ketema Tafess
- Institute of Pharmaceutical Science, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia
| | - Teresa Kisi Beyen
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Sisay Girma
- Department of Clinical Study, College of Veterinary Medicine and Agriculture, Addis Ababa University, P. O. Box 34, Bishoftu, Ethiopia
| | - Asnakech Girma
- Disease Prevention, Training and Research Division, Federal Prison General Hospital, Addis Ababa, Ethiopia
| | - Gilman Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Aduh U, Ewa AU, Sam-Agudu NA, Urhioke O, Kusimo O, Ugwu C, Fadare OA, Anyaike C. Addressing gaps in adolescent tuberculosis programming and policy in Nigeria from a public health perspective. Int J Adolesc Med Health 2021; 33:41-51. [PMID: 33913304 DOI: 10.1515/ijamh-2020-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15-24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10-19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. CONTENT All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. SUMMARY AND OUTLOOK Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.
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Affiliation(s)
- Ufuoma Aduh
- World Health Organisation, Abuja, Nigeria
- Texila American University, Georgetown, Guyana
| | - Atana Uket Ewa
- Department of Paediatrics, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
| | - Ochuko Urhioke
- National TB and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - Chukwuma Anyaike
- National TB and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
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Osman M, du Preez K, Seddon JA, Claassens MM, Dunbar R, Dlamini SS, Welte A, Naidoo P, Hesseling AC. Mortality in South African Children and Adolescents Routinely Treated for Tuberculosis. Pediatrics 2021; 147:peds.2020-032490. [PMID: 33692161 PMCID: PMC8405866 DOI: 10.1542/peds.2020-032490] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In South Africa, tuberculosis (TB) is a leading cause of death among those <20 years of age. We describe changes in TB mortality among children and adolescents in South Africa over a 13-year period, identify risk factors for mortality, and estimate excess TB-related mortality. METHODS Retrospective analysis of all patients <20 years of age routinely recorded in the national electronic drug-susceptible TB treatment register (2004-2016). We developed a multivariable Cox regression model for predictors of mortality and used estimates of mortality among the general population to calculate standardized mortality ratios (SMRs). RESULTS Between 2004 and 2016, 729 463 children and adolescents were recorded on TB treatment; 84.0% had treatment outcomes and 2.5% (18 539) died during TB treatment. The case fatality ratio decreased from 3.3% in 2007 to 1.9% in 2016. In the multivariable Cox regression model, ages 0 to 4, 10 to 14, and 15 to 19 years (compared with ages 5 to 9 years) were associated with increased risk of mortality, as was HIV infection, previous TB treatment, and extrapulmonary involvement. The SMR of 15 to 19-year-old female patients was more than double that of male patients the same age (55.3 vs 26.2). Among 10 to 14-year-olds and those who were HIV-positive, SMRs increased over time. CONCLUSIONS Mortality in South African children and adolescents treated for TB is declining but remains considerable, with 2% dying during 2016. Adolescents (10 to 19 years) and those people living with HIV have the highest risk of mortality and the greatest SMRs. Interventions to reduce mortality during TB treatment, specifically targeting those at highest risk, are urgently needed.
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Affiliation(s)
- Muhammad Osman
- Desmond Tutu Tuberculosis Centre, Departments of Paediatrics and Child Health and
| | - Karen du Preez
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - James A. Seddon
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa,Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Mareli M. Claassens
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa,Department of Biochemistry and Microbiology, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Rory Dunbar
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Sicelo S. Dlamini
- Research Information Monitoring, Evaluation, and Surveillance, National Tuberculosis Control and Management Cluster, National Department of Health, Pretoria, South Africa
| | - Alex Welte
- Department of Science and Innovation – National Research Foundation South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Pren Naidoo
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Anneke C. Hesseling
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
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Frigati LJ, Wilkinson KA, le Roux S, Brown K, Ruzive S, Githinji L, Petersen W, Belard S, Cotton MF, Myer L, Zar HJ. Tuberculosis infection and disease in South African adolescents with perinatally acquired HIV on antiretroviral therapy: a cohort study. J Int AIDS Soc 2021; 24:e25671. [PMID: 33719199 PMCID: PMC7957181 DOI: 10.1002/jia2.25671] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/22/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There are limited data on Tuberculosis (TB) in adolescents with perinatally acquired HIV (APHIV). We examined the incidence and determinants of TB infection and disease in the Cape Town Adolescent Antiretroviral Cohort (CTAAC). METHODS Youth between nine and fourteen years on antiretroviral therapy (ART) for more than six months in public sector care, and age-matched HIV-negative adolescents, were enrolled between July 2013 through March 2015 and followed six-monthly. Data were censored on 31 October 2018. Symptom screening, chest radiograph, viral load, CD4 count, QuantiFERON (QFT) and sputum for Xpert MTB/RIF, microscopy, culture and sensitivity were performed annually. TB infection was defined by a QFT of >0.35 IU/mL. TB diagnosis was defined as confirmed (culture or Xpert MTB/RIF positive) or unconfirmed (clinical diagnosis and started on TB treatment). Analyses examined the incidence and determinants of TB infection and disease. RESULTS Overall 496 HIV+ and 103 HIV-negative participants (median age at enrolment 12 years (interquartile range, IQR 10.6 to 13.3) were followed for a median of 3.1 years (IQR 3.0 to 3.4); 50% (298/599) were male. APHIV initiated ART at median age 4.4 years (IQR 2.1 to 7.6). At enrolment, 376/496 (76%) had HIV viral load <40 copies/mL, median CD4 count was 713 cells/mm3 and 179/559 (32%) were QFT+, with no difference by HIV status (APHIV 154/468, 33%; HIV negative 25/91, 27%; p = 0.31). The cumulative QFT+ prevalence was similar (APHIV 225/492, 46%; 95%CI 41% to 50%; HIV negative 44/98, 45%; 95% CI 35% to 55%; p = 0.88). APHIV had a higher incidence of all TB disease than HIV-negative adolescents (2.2/100PY, 95% CI 1.6 to 3.1 vs. 0.3/100PY, 95% CI 0.04 to 2.2; IRR 7.36, 95% CI 1.01 to 53.55). The rate of bacteriologically confirmed TB in APHIV was 1.3/100 PY compared to 0.3/100PY for HIV-negative adolescents, suggesting a fourfold increased risk of developing TB disease in APHIV despite access to ART. In addition, a positive QFT at enrolment was not predictive of TB in this population. CONCLUSIONS High incidence rates of TB disease occur in APHIV despite similar QFT conversion rates to HIV-negative adolescents. Strategies to prevent TB in this vulnerable group must be strengthened.
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Affiliation(s)
- Lisa J Frigati
- Department of Paediatrics and Child HealthUniversity of Cape TownCapeSouth Africa
- Family Center for Research with Ubuntu (FAMCRU)Department of Paediatrics and Child HealthStellenbosch UniversityCape TownSouth Africa
| | - Katalin A Wilkinson
- Wellcome Centre for Infectious Disease Research in AfricaInstitute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
- The Francis Crick InstituteLondonUnited Kingdom
| | - Stanzi le Roux
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Karryn Brown
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Sheena Ruzive
- Wellcome Centre for Infectious Disease Research in AfricaInstitute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Leah Githinji
- Department of Paediatrics and Child HealthUniversity of Cape TownCapeSouth Africa
| | - Wonita Petersen
- Department of Paediatrics and Child HealthUniversity of Cape TownCapeSouth Africa
| | - Sabine Belard
- Department of Pediatric Pulmonology, Immunology and Intensive Care MedicineCharité ‐ Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of HealthBerlinGermany
| | - Mark F Cotton
- Family Center for Research with Ubuntu (FAMCRU)Department of Paediatrics and Child HealthStellenbosch UniversityCape TownSouth Africa
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Heather J Zar
- Department of Paediatrics and Child HealthUniversity of Cape TownCapeSouth Africa
- SAMRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
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Dorjee K, Topgyal S, Tsewang T, Tsundue T, Namdon T, Bonomo E, Kensler C, Lhadon D, Choetso T, Nangsel T, Dolkar T, Tsekyi T, Dorjee C, Phunkyi D, Sadutshang TD, Paster Z, Chaisson RE. Risk of developing active tuberculosis following tuberculosis screening and preventive therapy for Tibetan refugee children and adolescents in India: An impact assessment. PLoS Med 2021; 18:e1003502. [PMID: 33465063 PMCID: PMC7853467 DOI: 10.1371/journal.pmed.1003502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/02/2021] [Accepted: 12/29/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) rates among Tibetan refugee children and adolescents attending boarding schools in India are extremely high. We undertook a comprehensive case finding and TB preventive treatment (TPT) program in 7 schools in the Zero TB Kids project. We aimed to measure the TB infection and disease burden and investigate the risk of TB disease in children and adults who did and did not receive TPT in the schools. METHODS AND FINDINGS A mobile team annually screened children and staff for TB at the 7 boarding schools in Himachal Pradesh, India, using symptom criteria, radiography, molecular diagnostics, and tuberculin skin tests. TB infection (TBI) was treated with short-course regimens of isoniazid and rifampin or rifampin. TB disease was treated according to Tibetan and Indian guidelines. Between April 2017 and December 2019, 6,582 schoolchildren (median age 14 [IQR 11-16] years) and 807 staff (median age 40 [IQR 33-48] years) were enrolled. Fifty-one percent of the students and 58% of the staff were females. Over 13,161 person-years of follow-up in schoolchildren (median follow-up 2.3 years) and 1,800 person-years of follow-up in staff (median follow-up 2.5 years), 69 TB episodes occurred in schoolchildren and 4 TB episodes occurred in staff, yielding annual incidence rates of 524/100,000 (95% CI 414-663/100,000) person-years and 256/100,000 (95% CI 96-683/100,000) person-years, respectively. Of 1,412 schoolchildren diagnosed with TBI, 1,192 received TPT. Schoolchildren who received TPT had 79% lower risk of TB disease (adjusted hazard ratio [aHR] 0.21; 95% CI 0.07-0.69; p = 0.010) compared to non-recipients, the primary study outcome. Protection was greater in recent contacts (aHR 0.07; 95% CI 0.01-0.42; p = 0.004), the secondary study outcome. The prevalence of recent contacts was 28% (1,843/6,582). Two different TPT regimens were used (3HR and 4R), and both were apparently effective. No staff receiving TPT developed TB. Overall, between 2017 and 2019, TB disease incidence decreased by 87%, from 837/100,000 (95% CI 604-1,129/100,000) person-years to 110/100,000 (95% CI 36-255/100,000) person-years (p < 0.001), and TBI prevalence decreased by 42% from 19% (95% CI 18%-20%) to 11% (95% CI 10%-12%) (p < 0.001). A limitation of our study is that TB incidence could be influenced by secular trends during the study period. CONCLUSIONS In this study, following implementation of a school-wide TB screening and preventive treatment program, we observed a significant reduction in the burden of TB disease and TBI in children and adolescents. The benefit of TPT was particularly marked for recent TB contacts. This initiative may serve as a model for TB detection and prevention in children and adolescents in other communities affected by TB.
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Affiliation(s)
- Kunchok Dorjee
- Center for TB Research, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Sonam Topgyal
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tenzin Tsewang
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tenzin Tsundue
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tenzin Namdon
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Elizabeth Bonomo
- Center for TB Research, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Caroline Kensler
- Center for TB Research, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Dekyi Lhadon
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tsering Choetso
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tenzin Nangsel
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tsering Dolkar
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Thupten Tsekyi
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | | | - Dawa Phunkyi
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Tsetan D. Sadutshang
- Division of Tuberculosis, Delek Hospital, Department of Health, Central Tibetan Administration, Dharamsala, India
| | - Zorba Paster
- Department of Family Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Richard E. Chaisson
- Center for TB Research, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
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Farsida, Hatta M, Patellongi I, Prihantono, Shabariyah R, Larasati Laras RA, Islam AA, Natzir R, Massi MN, Hamid F, Bahagia AD. The correlation of Foxp3 + gene and regulatory T cells with scar BCG formation among children with Tuberculosis. J Clin Tuberc Other Mycobact Dis 2020; 21:100202. [PMID: 33319069 PMCID: PMC7725952 DOI: 10.1016/j.jctube.2020.100202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tuberculosis infection causes a complex immunological response, where interactions between the pathogen and the host are unique, making it difficult to treat and control this disease. According to WHO, an estimated 1 million children became ill with TB, and 233,000 children died of TB in 2017. Bacillus Calmette-Guérin (BCG) vaccines continue to be the only vaccines to prevent Tuberculosis (TB). Studies suggesting the association of BCG scar with decreased childhood mortality in developing countries have rekindled the interest in BCG scar. However, the direct effect of the BCG scar remains unknown. We examined 76 cases in this study. All Subjects were diagnosed with Tuberculosis. BCG scars were examined directly when physical examination at the BCG vaccination site was performed. Tuberculin Skin Test was performed with 0.1 ml purified protein derivative (PPD) solution (5TU PPD/0.1 ml) injected intradermally. We examined the FOXP3 gene by real-time PCR and the level of Treg byELISA. The comparison of the mean Treg gene expression and the Treg protein content was higher in the positive scar group than in the negative scar group. It shows that Treg plays a role in the Tuberculosis during its active phase development. Treg protein levels were higher in the combination of positive TST and scar. It shows that BCG scarring is an essential marker of a well-functioning immune system. Cheap and straightforward initiatives like early BCG vaccinations, monitoring BCG scarring, and revaccinating scar-negative children could have an enormous immediate impact on global child survival.
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Affiliation(s)
- Farsida
- Faculty of Medicine, Universitas Muhammadiyah Jakarta, Indonesia
| | - Mochammad Hatta
- Faculty of Medicine, Universitas Hasanuddin Makassar, Indonesia
| | | | - Prihantono
- Faculty of Medicine, Universitas Hasanuddin Makassar, Indonesia
| | | | | | | | - Rosdiana Natzir
- Faculty of Medicine, Universitas Hasanuddin Makassar, Indonesia
| | | | - Firdaus Hamid
- Faculty of Medicine, Universitas Hasanuddin Makassar, Indonesia
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Reuter A, Seddon JA, Marais BJ, Furin J. Preventing tuberculosis in children: A global health emergency. Paediatr Respir Rev 2020; 36:44-51. [PMID: 32253128 DOI: 10.1016/j.prrv.2020.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022]
Abstract
It is estimated that 20 million children are exposed to tuberculosis (TB) each year, making TB a global paediatric health emergency. TB preventative efforts have long been overlooked. With the view of achieving "TB elimination" in "our lifetime", this paper explores challenges and potential solutions in the TB prevention cascade, including identifying children who have been exposed to TB; detecting TB infection in these children; identifying those at highest risk of progressing to disease; implementing treatment of TB infection; and mobilizing multiple stakeholders support to successfully prevent TB.
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Affiliation(s)
- Anja Reuter
- Medecins Sans Frontieres, Khayelitsha, South Africa.
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Ben J Marais
- The University of Sydney and the Children's Hospital at Westmead, Sydney, Australia
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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58
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Gafar F, Ochi T, Van't Boveneind-Vrubleuskaya N, Akkerman OW, Erkens C, van den Hof S, van der Werf TS, Alffenaar JWC, Wilffert B. Towards elimination of childhood and adolescent tuberculosis in the Netherlands: an epidemiological time-series analysis of national surveillance data. Eur Respir J 2020; 56:13993003.01086-2020. [PMID: 32471938 DOI: 10.1183/13993003.01086-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/22/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Tuberculosis (TB) in children and adolescents is a sentinel event for ongoing transmission. In the Netherlands, epidemiological characteristics of childhood and adolescent TB have not been fully evaluated. Therefore, we aimed to assess TB epidemiology within this population to provide guidance for TB elimination. METHODS A retrospective time-series analysis using national surveillance data from 1993-2018 was performed in children (aged <15 years) and adolescents (aged 15-19 years) with TB. Poisson regression models offset with log-population size were used to estimate notification rates and rate ratios. Trends in notification rates were estimated using average annual percentage changes (AAPC) based on the segmented linear regression analysis. RESULTS Among 3899 children and adolescents with TB notified during 1993-2018, 2418 (62%) were foreign-born (725 (41.3%) out of 1755 children and 1693 (78.9%) out of 2144 adolescents). The overall notification rate in children was 2.3 per 100 000 person-years, declining steadily during the study period (AAPC -10.9%, 95% CI -12.6--9.1). In adolescents, the overall notification rate was 8.4 per 100 000 person-years, strongly increasing during 1993-2001 and 2012-2018. Compared to Dutch-born children and adolescents, substantially higher notification rates were observed among African-born children and adolescents (116.8 and 316.6 per 100 000 person-years, respectively). Additionally, an increasing trend was observed in African-born adolescents (AAPC 18.5%, 95% CI 11.9-25.5). Among the foreign-born population, those from countries in the horn of Africa contributed most to the TB caseload. CONCLUSION TB notification rate among children was low and constantly declining across different demographic groups. However, heterogeneities were shown in adolescents, with an increasing trend in the foreign-born, particularly those from Africa.
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Affiliation(s)
- Fajri Gafar
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen, The Netherlands
| | - Taichi Ochi
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen, The Netherlands
| | - Natasha Van't Boveneind-Vrubleuskaya
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.,Dept of Public Health TB Control, Metropolitan Public Health Services, The Hague, The Netherlands
| | - Onno W Akkerman
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Susan van den Hof
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Tjip S van der Werf
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Internal Medicine, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.,University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia.,Westmead Hospital, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - Bob Wilffert
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
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Seddon JA, Johnson S, Palmer M, van der Zalm MM, Lopez-Varela E, Hughes J, Schaaf HS. Multidrug-resistant tuberculosis in children and adolescents: current strategies for prevention and treatment. Expert Rev Respir Med 2020; 15:221-237. [PMID: 32965141 DOI: 10.1080/17476348.2021.1828069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION An estimated 30,000 children develop multidrug-resistant (MDR) tuberculosis (TB) each year, with only a small proportion diagnosed and treated. This field has historically been neglected due to the perception that children with MDR-TB are challenging to diagnose and treat. Diagnostic and therapeutic developments in adults have improved pediatric management, yet further pediatric-specific research and wider implementation of evidence-based practices are required. AREAS COVERED This review combines the most recent data with expert opinion to highlight best practice in the evaluation, diagnosis, treatment, and support of children and adolescents with MDR-TB disease. A literature search of PubMed was carried out on topics related to MDR-TB in children. This review provides practical advice on MDR-TB prevention and gives updates on new regimens and novel treatments. The review also addresses host-directed therapy, comorbid conditions, special populations, psychosocial support, and post-TB morbidity, as well as identifying outstanding research questions. EXPERT OPINION Increased availability of molecular diagnostics has the potential to aid with the diagnosis of MDR-TB in children. Shorter MDR-TB disease treatment regimens have made therapy safer and shorter and further developments with novel agents and repurposed drugs should lead to additional improvements. The evidence base for MDR-TB preventive therapy is increasing.
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Affiliation(s)
- James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK
| | - Sarah Johnson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Elisa Lopez-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat De Barcelona , Barcelona, Spain
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
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Chiang SS, Dolynska M, Rybak NR, Cruz AT, Aibana O, Sheremeta Y, Petrenko V, Mamotenko A, Terleieva I, Horsburgh CR, Jenkins HE. Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine. ERJ Open Res 2020; 6:00308-2020. [PMID: 32964003 PMCID: PMC7487357 DOI: 10.1183/23120541.00308-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background During adolescence, childhood and adult forms of tuberculosis (TB) overlap, resulting in diverse disease manifestations. Knowing which patient characteristics are associated with which manifestations may facilitate diagnosis and enhance understanding of TB pathophysiology. Methods In this cross-sectional study, we included 10–19-year-olds in Ukraine's national TB registry who started TB treatment between 2015 and 2018. Using multivariable regression, we estimated associations between patient characteristics and four presentations of TB: pleural, extrathoracic, cavitary and rifampicin-resistant (RR). We also described the epidemiology of adolescent TB in Ukraine. Results Among 2491 adolescent TB cases, 88.4% were microbiologically confirmed. RR-TB was confirmed in 16.9% of new and 29.7% of recurrent cases. Of 88 HIV-infected adolescents, 59.1% were not on antiretroviral therapy at TB diagnosis. Among 10–14-year-olds, boys had more pleural disease (adjusted OR (aOR) 2.12, 95% CI: 1.08–4.37). Extrathoracic TB was associated with age 15–19 years (aOR 0.26, 95% CI: 0.18–0.37) and HIV (aOR 3.25, 95% CI: 1.55–6.61 in 10–14-year-olds; aOR 8.18, 95% CI: 3.58–17.31 in 15–19-year-olds). Cavitary TB was more common in migrants (aOR 3.53, 95% CI: 1.66–7.61) and 15–19-year-olds (aOR 4.10, 95% CI: 3.00–5.73); among 15–19-year-olds, it was inversely associated with HIV (aOR 0.32, 95% CI: 0.13–0.70). RR-TB was associated with recurrent disease (aOR 1.87, 95% CI: 1.08–3.13), urban residence (aOR 1.27, 95% CI: 1.01–1.62) and cavitation (aOR 2.98, 95% CI: 2.35–3.78). Conclusions Age, sex, HIV and social factors impact the presentation of adolescent TB. Preventive, diagnostic and treatment activities should take these factors into consideration. Analysing 2491 cases of adolescent tuberculosis in Ukraine, associations were observed between four clinical presentations – cavitary, pleural, extrathoracic and rifampicin-resistant TB – and age, sex, HIV status, prior treatment and social factors.https://bit.ly/2XplZFt
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Affiliation(s)
- Silvia S Chiang
- Dept of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA.,Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - Maria Dolynska
- Dept of Tuberculosis and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natasha R Rybak
- Dept of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Dept of Medicine, The Miriam Hospital, Providence, RI, USA
| | - Andrea T Cruz
- Dept of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Omowunmi Aibana
- Dept of Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Yana Sheremeta
- All-Ukrainian Network of People Living with HIV/AIDS, Kyiv, Ukraine
| | - Vasyl Petrenko
- Dept of Tuberculosis and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | | | - Iana Terleieva
- Public Health Center of the Ministry of Health, Kyiv, Ukraine
| | - C Robert Horsburgh
- Dept of Medicine, Boston University School of Medicine, Boston, MA, USA.,Dept of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Helen E Jenkins
- Dept of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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de Oliveira MCB, Sant'Anna CC, Raggio Luiz R, Kritski AL. Unfavorable Outcomes in Tuberculosis: Multidimensional Factors among Adolescents in Rio de Janeiro, Brazil. Am J Trop Med Hyg 2020; 103:2492-2500. [PMID: 32959763 DOI: 10.4269/ajtmh.20-0209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Since 2018, adolescents have been included as a target group for tuberculosis (TB) surveillance by the WHO. However, they are considered a neglected population, as there are considerable gaps in information about them. We aimed to analyze the risk factors for unfavorable TB treatment outcomes among adolescents in Rio de Janeiro, a Brazilian city with a high burden of TB. This is a retrospective study of adolescents (10-18 years) with TB notified in Rio de Janeiro, from four national database systems, covering 2014-2016. "Extreme vulnerability" was defined as adolescents who presented one of the following characteristics: homelessness, incarceration, tobacco use, illicit drug use, or alcohol abuse. Logistic regression analysis was used to identify factors associated with favorable (cure/completed treatment) and unfavorable outcomes (lost to follow-up, death, and treatment failure). A total of 725 adolescents with TB were included: 610 (84.1%) were cured, 94 (13%) were lost to follow-up, six (0.8%) died because of TB, 13 (1.8%) died because of other causes, and two (0.3%) failed treatment. Unfavorable outcomes were associated with retreatment (adjusted odds ratio [aOR]: 4.51; 95% CI: 2.23-9.17), TB-HIV coinfection (aOR: 10.15; 95% CI: 4.15-25.34), extreme vulnerability (aOR: 3.01; 95% CI: 1.70-5.33), and living in the two districts (3.1 and 3.3) with worst conditions: large population and rates of homicides and shantytowns (aOR: 4.11; 95% CI: 1.79-9.46 and aOR: 5.35; 95% CI: 2.20-13.03, respectively). Our findings underscore the need for strengthening early identification and interventions for adolescents at high risk of unfavorable outcomes, especially those living in shantytowns.
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Affiliation(s)
- Marcia C B de Oliveira
- Post Graduation Program in Medical Clinics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clemax C Sant'Anna
- Pediatrics Department, Faculty of Medicine, Instituto de Puericultura e Pediatria Martagão Gesteira, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Afrânio L Kritski
- Academic Program of Tuberculosis, School of Medicine, Institute of Torax Disease, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Eddabra R, Neffa M. Epidemiological profile among pulmonary and extrapulmonary tuberculosis patients in Laayoune, Morocco. Pan Afr Med J 2020; 37:56. [PMID: 33209183 PMCID: PMC7648485 DOI: 10.11604/pamj.2020.37.56.21111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/31/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction despite major strides in the prevention, diagnosis and management of tuberculosis, the disease continues to be one of the most pressing global health problems, particularly in developing countries. The purpose of the present study was to describe the epidemiological profile among tuberculosis patients in Laayoune, Morocco. Methods a retrospective study was conducted among tuberculosis patients (having extrapulmonary tuberculosis and pulmonary tuberculosis), registered in the diagnosis of tuberculosis and respiratory diseases reference center of Laayoune, between January 2017 and May 2018. Demographic characteristics, clinical presentation of TB and apparent risk factors of the disease were obtained from the medical case records of all patients. Results during the study period, a total of 211 patients (125 males and 86 females) with tuberculosis were enrolled. The majority of cases (93.40%) were newly diagnosed and the segment with the pulmonary tuberculosis was 63.50%. The highest disease burden was found in the ≥15 year age group (92.40%; p=0.022). Men were more frequently affected by pulmonary tuberculosis (70.90%), while extrapulmonary tuberculosis was more commonly detected in women (61%) (p<0.0001). The most common sites of extrapulmonary disease were lymphatic (32.47%), pleural (16.88%) and spinal tuberculosis (15.58%). HIV infection and smoking seem to be the most important risk factors that affect host defense against TB infection. Conclusion the results obtained in tuberculosis patients in Laayoune, Morocco, showed that active tuberculosis was associated with risk factors such as sex, age and smoking.
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Affiliation(s)
- Rkia Eddabra
- Higher Institute of Nurses Professions and Health Techniques of Laayoune, Ministry of Health, Avenue Colonel Major Habbouha Oueld Laâbid, Madinat Al Wahda I, Laayoune, Morocco
| | - Mounsef Neffa
- Laboratory of Bioresources, Biotechnology, Ethnopharmacology and Health, Applied Biochemistry to the Valorization of Bioresources, Faculty of Sciences, Mohamed 1st University, Oujda, Morocco
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63
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Chai Q, Lu Z, Liu CH. Host defense mechanisms against Mycobacterium tuberculosis. Cell Mol Life Sci 2020; 77:1859-1878. [PMID: 31720742 PMCID: PMC11104961 DOI: 10.1007/s00018-019-03353-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022]
Abstract
Tuberculosis (TB), which is caused by Mycobacterium tuberculosis (Mtb), remains the leading cause of death worldwide from a single infectious pathogen. Mtb is a paradigmatic intracellular pathogen that primarily invades the lungs after host inhalation of bacteria-containing droplets via the airway. However, the majority of Mtb-exposed individuals can spontaneously control the infection by virtue of a robust immune defense system. The mucosal barriers of the respiratory tract shape the first-line defense against Mtb through various mucosal immune responses. After arriving at the alveoli, the surviving mycobacteria further encounter a set of host innate immune cells that exert multiple cellular bactericidal functions. Adaptive immunity, predominantly mediated by a range of different T cell and B cell subsets, is subsequently activated and participates in host anti-mycobacterial defense. During Mtb infection, host bactericidal immune responses are exquisitely adjusted and balanced by multifaceted mechanisms, including genetic and epigenetic regulation, metabolic regulation and neuroendocrine regulation, which are indispensable for maintaining host immune efficiency and avoiding excessive tissue injury. A better understanding of the integrated and equilibrated host immune defense system against Mtb will contribute to the development of rational TB treatment regimens especially novel host-directed therapeutics.
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Affiliation(s)
- Qiyao Chai
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China.
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Zhe Lu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Cui Hua Liu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China.
- Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China.
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, 100049, China.
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Dong Y, Wang L, Burgner DP, Miller JE, Song Y, Ren X, Li Z, Xing Y, Ma J, Sawyer SM, Patton GC. Infectious diseases in children and adolescents in China: analysis of national surveillance data from 2008 to 2017. BMJ 2020; 369:m1043. [PMID: 32241761 PMCID: PMC7114954 DOI: 10.1136/bmj.m1043] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To outline which infectious diseases in the pre-covid-19 era persist in children and adolescents in China and to describe recent trends and variations by age, sex, season, and province. DESIGN National surveillance studies, 2008-17. SETTING 31 provinces in mainland China. PARTICIPANTS 4 959 790 Chinese students aged 6 to 22 years with a diagnosis of any of 44 notifiable infectious diseases. The diseases were categorised into seven groups: quarantinable; vaccine preventable; gastrointestinal and enteroviral; vectorborne; zoonotic; bacterial; and sexually transmitted and bloodborne. MAIN OUTCOME MEASURES Diagnosis of, and deaths from, 44 notifiable infectious diseases. RESULTS From 2008 to 2017, 44 notifiable infectious diseases were diagnosed in 4 959 790 participants (3 045 905 males, 1 913 885 females) and there were 2532 deaths (1663 males, 869 females). The leading causes of death among infectious diseases shifted from rabies and tuberculosis to HIV/AIDS, particularly in males. Mortality from infectious diseases decreased steadily from 0.21 per 100 000 population in 2008 to 0.07 per 100 000 in 2017. Quarantinable conditions with high mortality have effectively disappeared. The incidence of notifiable infectious diseases in children and adolescents decreased from 280 per 100 000 in 2008 to 162 per 100 000 in 2015, but rose again to 242 per 100 000 in 2017, largely related to mumps and seasonal influenza. Excluding mumps and influenza, the incidence of vaccine preventable diseases fell from 96 per 100 000 in 2008 to 7 per 100 000 in 2017. The incidence of gastrointestinal and enterovirus diseases remained constant, but typhoid, paratyphoid, and dysentery continued to decline. Vectorborne diseases all declined, with a particularly noticeable reduction in malaria. Zoonotic infections remained at low incidence, but there were still unpredictable outbreaks, such as pandemic A/H1N1 2009 influenza. Tuberculosis remained the most common bacterial infection, although cases of scarlet fever doubled between 2008 and 2017. Sexually transmitted diseases and bloodborne infections increased significantly, particularly from 2011 to 2017, among which HIV/AIDS increased fivefold, particularly in males. Difference was noticeable between regions, with children and adolescents in western China continuing to carry a disproportionate burden from infectious diseases. CONCLUSIONS China's success in infectious disease control in the pre-covid-19 era was notable, with deaths due to infectious diseases in children and adolescents aged 6-22 years becoming rare. Many challenges remain around reducing regional inequalities, scaling-up of vaccination, prevention of further escalation of HIV/AIDS, renewed efforts for persisting diseases, and undertaking early and effective response to highly transmissible seasonal and unpredictable diseases such as that caused by the novel SARS-CoV-2 virus.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Haidian District, Beijing 100191, China
| | - Liping Wang
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia
| | - Jessica E Miller
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Haidian District, Beijing 100191, China
| | - Xiang Ren
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Zhongjie Li
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yi Xing
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Haidian District, Beijing 100191, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Haidian District, Beijing 100191, China
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
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65
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Martinez L, Cords O, Horsburgh CR, Andrews JR. The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis. Lancet 2020; 395:973-984. [PMID: 32199484 PMCID: PMC7289654 DOI: 10.1016/s0140-6736(20)30166-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tens of millions of children are exposed to Mycobacterium tuberculosis globally every year; however, there are no contemporary estimates of the risk of developing tuberculosis in exposed children. The effectiveness of contact investigations and preventive therapy remains poorly understood. METHODS In this systematic review and meta-analysis, we investigated the development of tuberculosis in children closely exposed to a tuberculosis case and followed for incident disease. We restricted our search to cohort studies published between Jan 1, 1998, and April 6, 2018, in MEDLINE, Web of Science, BIOSIS, and Embase electronic databases. Individual-participant data and a pre-specified list of variables were requested from authors of all eligible studies. These included characteristics of the exposed child, the index case, and environmental characteristics. To be eligible for inclusion in the final analysis, a dataset needed to include: (1) individuals below 19 years of age; (2) follow-up for tuberculosis for a minimum of 6 months; (3) individuals with household or close exposure to an individual with tuberculosis; (4) information on the age and sex of the child; and (5) start and end follow-up dates. Studies assessing incident tuberculosis but without dates or time of follow-up were excluded. Our analysis had two primary aims: (1) estimating the risk of developing tuberculosis by time-period of follow-up, demographics (age, region), and clinical attributes (HIV, tuberculosis infection status, previous tuberculosis); and (2) estimating the effectiveness of preventive therapy and BCG vaccination on the risk of developing tuberculosis. We estimated the odds of prevalent tuberculosis with mixed-effects logistic models and estimated adjusted hazard ratios (HRs) for incident tuberculosis with mixed-effects Poisson regression models. The effectiveness of preventive therapy against incident tuberculosis was estimated through propensity score matching. The study protocol is registered with PROSPERO (CRD42018087022). FINDINGS In total, study groups from 46 cohort studies in 34 countries-29 (63%) prospective studies and 17 (37%) retrospective-agreed to share their data and were included in the final analysis. 137 647 tuberculosis-exposed children were evaluated at baseline and 130 512 children were followed for 429 538 person-years, during which 1299 prevalent and 999 incident tuberculosis cases were diagnosed. Children not receiving preventive therapy with a positive result for tuberculosis infection had significantly higher 2-year cumulative tuberculosis incidence than children with a negative result for tuberculosis infection, and this incidence was greatest among children below 5 years of age (19·0% [95% CI 8·4-37·4]). The effectiveness of preventive therapy was 63% (adjusted HR 0·37 [95% CI 0·30-0·47]) among all exposed children, and 91% (adjusted HR 0·09 [0·05-0·15]) among those with a positive result for tuberculosis infection. Among all children <5 years of age who developed tuberculosis, 83% were diagnosed within 90 days of the baseline visit. INTERPRETATION The risk of developing tuberculosis among exposed infants and young children is very high. Most cases occurred within weeks of contact investigation initiation and might not be preventable through prophylaxis. This suggests that alternative strategies for prevention are needed, such as earlier initiation of preventive therapy through rapid diagnosis of adult cases or community-wide screening approaches. FUNDING National Institutes of Health.
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Affiliation(s)
- Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Olivia Cords
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - C Robert Horsburgh
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Departments of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Al Abri S, Kasaeva T, Migliori GB, Goletti D, Zenner D, Denholm J, Al Maani A, Cirillo DM, Schön T, Lillebæk T, Al-Jardani A, Go UY, Dias HM, Tiberi S, Al Yaquobi F, Khamis FA, Kurup P, Wilson M, Memish Z, Al Maqbali A, Akhtar M, Wejse C, Petersen E. Tools to implement the World Health Organization End TB Strategy: Addressing common challenges in high and low endemic countries. Int J Infect Dis 2020; 92S:S60-S68. [PMID: 32114195 DOI: 10.1016/j.ijid.2020.02.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
AIM The purpose of this viewpoint is to summarize the advantages and constraints of the tools and strategies available for reducing the annual incidence of tuberculosis (TB) by implementing the World Health Organization (WHO) End TB Strategy and the linked WHO TB Elimination Framework, with special reference to Oman. METHODS The case-study was built based on the presentations and discussions at an international workshop on TB elimination in low incidence countries organized by the Ministry of Health, Oman, which took place from September 5 to September 7, 2019, and supported by the WHO and European Society of Clinical Microbiology and Infectious Diseases (ESCMID). RESULTS Existing tools were reviewed, including the screening of migrants for latent TB infection (LTBI) with interferon-gamma release assays, clinical examination for active pulmonary TB (APTB) including chest X-rays, organization of laboratory services, and the existing centres for mandatory health examination of pre-arrival or arriving migrants, including examination for APTB. The need for public-private partnerships to handle the burden of screening arriving migrants for active TB was discussed at length and different models for financing were reviewed. CONCLUSIONS In a country with a high proportion of migrants from high endemic countries, screening for LTBI is of high priority. Molecular typing and the development of public-private partnerships are needed.
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Affiliation(s)
- Seif Al Abri
- Directorate General for Diseases Surveillance and Control, Ministry of Health, Muscat, Oman.
| | | | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy; ESCMID Study Group on Mycobacteria, Basel, Switzerland
| | - Dominik Zenner
- Regional Office of the European Economic Area, EU and NATO and International Organization for Migration, IOM, Brussels, Belgium
| | - Justin Denholm
- Department of Infectious Diseases, Royal Melbourne Hospital and Victorian TB Programme, Melbourne, Australia
| | - Amal Al Maani
- Paediatric Infectious Diseases, The Royal Hospital and Central Department of Infection Prevention and Control, Directorate General for Diseases Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogen Research Unit, Italian Reference Centre for Molecular Typing of Mycobacteria, San Rafaele Scientific Institute, Milan, Italy
| | - Thomas Schön
- Department of Clinical Microbiology and Infectious Diseases, Kalmar Hospital and University of Linköping, Sweden
| | - Troels Lillebæk
- International Reference Laboratory of Mycobacteriology, WHO TB Supranational Reference Laboratory Copenhagen, Infectious Disease Preparedness Area, Statens Serum Institute and Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amina Al-Jardani
- Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Un-Yeong Go
- International Tuberculosis Research Centre, Seoul, Republic of Korea
| | - Hannah Monica Dias
- WHO Global TB Programme Unit on Policy, Strategy and Innovations, Geneva, Switzerland
| | - Simon Tiberi
- Infectious Diseases, Barts Health NHS Trust, London, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - Fatma Al Yaquobi
- Tuberculosis and Acute Respiratory Diseases Surveillance, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Faryal Ali Khamis
- Department of Infectious Diseases, The Royal Hospital, Ministry of Health, Muscat, Oman
| | - Padmamohan Kurup
- Department of Disease Surveillance and Control, Muscat Governorate, Muscat, Oman
| | | | - Ziad Memish
- Prince Mohammed bin Abdulaziz Hospital, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Rollings School of Public Health, Emory University, Atlanta, GA, USA
| | - Ali Al Maqbali
- Disease Surveillance and Control, North Bathinah Governorate, Sohar, Oman
| | | | - Christian Wejse
- Department of Infectious Disease, Aarhus University Hospital and School of Public Health, Faculty of Health Sciences, University of Aarhus, Denmark; ESCMID Study Group for Travel and Migration, Basel, Switzerland
| | - Eskild Petersen
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman; Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark; ESCMID Emerging Infections Task Force, Basel, Switzerland
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Arango-Slingsby C, Vinasco-Sánchez LG, Orozco-Hernández JP, Enríquez-Calvache A, Rodríguez-Ballesteros MF, Franco-Herrera D, Marín-Rincón HA. Tuberculosis diseminada en una adolescente con diabetes mellitus tipo 1: un caso inusual que imita una enfermedad autoinmune. IATREIA 2020. [DOI: 10.17533/udea.iatreia.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
La tuberculosis es una de las principales causas de mortalidad en el mundo, a pesar de los múltiples controles y estrategias del tratamiento. La forma diseminada corresponde al 5 % de las presentaciones. Reportamos el primer caso en la literatura de una paciente adolescente con diabetes mellitus tipo 1 y tuberculosis diseminada quien presentó síntomas constitucionales asociados con un dolor lumbar, inicialmente interpretado como sacroileítis no infecciosa y una probable enfermedad inflamatoria intestinal.
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Enane LA, Eby J, Arscott-Mills T, Argabright S, Caiphus C, Kgwaadira B, Steenhoff AP, Lowenthal ED. TB and TB-HIV care for adolescents and young adults. Int J Tuberc Lung Dis 2020; 24:240-249. [PMID: 32127110 PMCID: PMC7307717 DOI: 10.5588/ijtld.19.0416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Nine high-burden public tuberculosis (TB) clinics in Gaborone, Botswana.OBJECTIVE: To evaluate the challenges encountered, healthcare worker (HCW) approaches, and supported interventions in TB and TB-HIV (human immunodeficiency virus) care for adolescents and young adults (AYA, aged 10-24 years).DESIGN: Semi-structured interviews with HCW in TB clinics, analyzed using thematic analysis.RESULTS: Sixteen HCWs were interviewed. AYA developmental needs included reliance on family support for care, increasing autonomy, attending school or work, building trust in HCWs, and intensive TB education and adherence support. Stigma strongly influenced care engagement, including clinic attendance and HIV testing. Health system barriers to optimal AYA TB care included limited staffing and resources to follow-up or support. HCWs utilized intensive education and counseling, and transitioned AYA to community-based directly observed therapy whenever feasible. HCWs supported implementation of youth-friendly services, such as AYA-friendly spaces or clinic days, training in AYA care, use of mobile applications, and peer support interventions, in addition to health system strengthening.CONCLUSION: HCWs utilize dedicated approaches for AYA with TB, but have limited time and resources for optimal care. They identified several strategies likely to improve care and better retain AYAs in TB treatment. Further work is needed to study interventions to improve AYA TB care and outcomes.
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Affiliation(s)
- L A Enane
- Division of Infectious Diseases, Botswana-UPenn Partnership, Gaborone, Botswana
| | - J Eby
- Department of Pediatrics, Boston Children's Hospital and Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - T Arscott-Mills
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, University of Pennsylvania Perelman School of Medicine
| | - S Argabright
- University of Pennsylvania, Philadelphia, PA, USA
| | - C Caiphus
- Botswana National TB Programme, Ministry of Health, Gaborone, Botswana
| | - B Kgwaadira
- Botswana National TB Programme, Ministry of Health, Gaborone, Botswana
| | - A P Steenhoff
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, University of Pennsylvania Perelman School of Medicine
| | - E D Lowenthal
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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69
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Marquez C, Atukunda M, Balzer LB, Chamie G, Kironde J, Ssemmondo E, Ruel TD, Mwangwa F, Tram KH, Clark TD, Kwarisiima D, Petersen M, Kamya MR, Charlebois ED, Havlir DV. The age-specific burden and household and school-based predictors of child and adolescent tuberculosis infection in rural Uganda. PLoS One 2020; 15:e0228102. [PMID: 31995631 PMCID: PMC6988961 DOI: 10.1371/journal.pone.0228102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The age-specific epidemiology of child and adolescent tuberculosis (TB) is poorly understood, especially in rural areas of East Africa. We sought to characterize the age-specific prevalence and predictors of TB infection among children and adolescents living in rural Uganda, and to explore the contribution of household TB exposure on TB infection. METHODS From 2015-2016 we placed and read 3,121 tuberculin skin tests (TST) in children (5-11 years old) and adolescents (12-19 years old) participating in a nested household survey in 9 rural Eastern Ugandan communities. TB infection was defined as a positive TST (induration ≥10mm or ≥5mm if living with HIV). Age-specific prevalence was estimated using inverse probability weighting to adjust for incomplete measurement. Generalized estimating equations were used to assess the association between TB infection and multi-level predictors. RESULTS The adjusted prevalence of TB infection was 8.5% (95%CI: 6.9-10.4) in children and 16.7% (95% CI:14.0-19.7) in adolescents. Nine percent of children and adolescents with a prevalent TB infection had a household TB contact. Among children, having a household TB contact was strongly associated with TB infection (aOR 5.5, 95% CI: 1.7-16.9), but the strength of this association declined among adolescents and did not meet significance (aOR 2.3, 95% CI: 0.8-7.0). The population attributable faction of TB infection due to a household TB contact was 8% for children and 4% among adolescents. Mobile children and adolescents who travel outside of their community for school had a 1.7 (95% CI 1.0-2.9) fold higher odds of TB infection than those who attended school in the community. CONCLUSION Children and adolescents in this area of rural eastern Uganda suffer a significant burden of TB. The majority of TB infections are not explained by a known household TB contact. Our findings underscore the need for community-based TB prevention interventions, especially among mobile youth.
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Affiliation(s)
- Carina Marquez
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, United States of America
| | | | - Laura B. Balzer
- University of Massachusetts, Amherst, Department of Biostatistics and Epidemiology, Amherst, Massachusetts, United States of America
| | - Gabriel Chamie
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, United States of America
| | - Joel Kironde
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Theodore D. Ruel
- University of California, San Francisco, Department of Pediatrics, San Francisco, California, United States of America
| | | | - Khai Hoan Tram
- Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Tamara D. Clark
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, United States of America
| | - Dalsone Kwarisiima
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Maya Petersen
- University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Edwin D. Charlebois
- Center for AIDS Prevention (CAPS), University of California, San Francisco, San Francisco, California United States of America
| | - Diane V. Havlir
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, United States of America
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70
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Snow KJ, Cruz AT, Seddon JA, Ferrand RA, Chiang SS, Hughes JA, Kampmann B, Graham SM, Dodd PJ, Houben RM, Denholm JT, Sawyer SM, Kranzer K. Adolescent tuberculosis. THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:68-79. [PMID: 31753806 PMCID: PMC7291359 DOI: 10.1016/s2352-4642(19)30337-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/20/2019] [Accepted: 09/23/2019] [Indexed: 02/08/2023]
Abstract
Adolescence is characterised by a substantial increase in the incidence of tuberculosis, a known fact since the early 20th century. Most of the world's adolescents live in low-income and middle-income countries where tuberculosis remains common, and where they comprise a quarter of the population. Despite this, adolescents have not yet been addressed as a distinct population in tuberculosis policy or within tuberculosis treatment services, and emerging evidence suggests that current models of care do not meet their needs. This Review discusses up-to-date information about tuberculosis in adolescence, with a focus on the management of infection and disease, including HIV co-infection and rifampicin-resistant tuberculosis. We outline the progress in vaccine development and highlight important directions for future research.
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Affiliation(s)
- Kathryn J Snow
- Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - James A Seddon
- Department of Infectious Diseases, Imperial College London, London, UK; Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Rashida A Ferrand
- Clinical Research Department, Medical Research Centre Unit, The Gambia; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Silvia S Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA; Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - Jennifer A Hughes
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Beate Kampmann
- The Vaccine Centre, Medical Research Centre Unit, The Gambia; Vaccines & Immunity Research, Medical Research Centre Unit, The Gambia
| | - Steve M Graham
- Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; The Burnet Institute, Melbourne, VIC, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rein M Houben
- Tuberculosis Modelling Group, Tuberculosis Centre, London School of Hygiene and Tropical Medicine, London, UK; Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Justin T Denholm
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity University of Melbourne, University of Melbourne, Melbourne, VIC, Australia; Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia
| | - Susan M Sawyer
- Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Katharina Kranzer
- Clinical Research Department, Medical Research Centre Unit, The Gambia; Biomedical Research and Training Institute, Harare, Zimbabwe.
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71
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Gafar F, Van't Boveneind-Vrubleuskaya N, Akkerman OW, Wilffert B, Alffenaar JWC. Nationwide analysis of treatment outcomes in children and adolescents routinely treated for tuberculosis in the Netherlands. Eur Respir J 2019; 54:13993003.01402-2019. [PMID: 31515410 DOI: 10.1183/13993003.01402-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND As a vulnerable population, children and adolescents with tuberculosis (TB) are faced with many challenges, even those who live in low TB incidence countries. We aimed to evaluate factors associated with TB treatment outcomes allowing more focused interventions to support this population once diagnosed. METHODS A retrospective cohort study using a nationwide surveillance database was performed in children and adolescents (aged 0-18 years) treated for TB in the Netherlands from 1993 to 2018. Logistic regression analyses were used to estimate adjusted odds ratios (aOR) for associated factors of mortality and loss to follow-up (LTFU). RESULTS Among 3253 eligible patients with known outcomes, 94.4% (95.9% children and 92.8% adolescents) were cured or completed treatment, 0.7% died during treatment and 4.9% were LTFU. There were no reported treatment failures. Risk factors of death included children aged 2-4 years (aOR 10.42), central nervous system TB (aOR 5.14), miliary TB (aOR 10.25), HIV co-infection (aOR 8.60), re-treated TB cases (aOR 10.12) and drug-induced liver injury (aOR 6.50). Active case-finding was a protective factor of death (aOR 0.13). Risk factors of LTFU were adolescents aged 15-18 years (aOR 1.91), illegal immigrants (aOR 4.28), urban domicile (aOR 1.59), unknown history of TB contact (aOR 1.99), drug-resistant TB (aOR 2.31), single adverse drug reaction (aOR 2.12), multiple adverse drug reactions (aOR 7.84) and treatment interruption >14 days (aOR 6.93). Treatment in recent years (aOR 0.94) and supervision by public health nurses (aOR 0.14) were protective factors of LTFU. CONCLUSION Highly successful treatment outcomes were demonstrated in children and adolescents routinely treated for TB. Special attention should be given to specific risk groups to improve treatment outcomes.
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Affiliation(s)
- Fajri Gafar
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology, and -Economics, Groningen, The Netherlands .,Both authors contributed equally
| | - Natasha Van't Boveneind-Vrubleuskaya
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.,Dept of Public Health TB Control, Metropolitan Public Health Services, The Hague, The Netherlands.,Both authors contributed equally
| | - Onno W Akkerman
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands
| | - Bob Wilffert
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology, and -Economics, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.,University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia.,Westmead Hospital, Sydney, Australia
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72
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Abstract
Adolescents have been largely neglected from tuberculosis control efforts. In low- to medium burden settings much of the tuberculosis burden in this age group occurs from school outbreaks. We report on a large tuberculosis outbreak in adolescents from a boarding high school in Jiangsu Province, China. From March to June 2018, a tuberculosis outbreak occurred in a boarding high school. We conducted an outbreak investigation involving clinical diagnostic tests and molecular analysis to determine the outbreak origin. Cases were detected through symptom screening, tuberculin skin testing (TST), chest radiography, sputum smear, solid sputum culture and GeneXpert MTB/RIF. Mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) genotyping and spoligotyping methods were performed on Mycobacterium tuberculosis (M. tuberculosis) isolates to identify the outbreak origin. A total of 845 students and 131 teachers/staff attended a TST screening for tuberculosis infection. The prevalence of elevated tuberculin reactions at ≥5, ≥10 and ≥15 mm was 12.19% (119/976), 6.35% (62/976) and 3.28% (32/976), respectively. Radiographic abnormalities were present in 5.73% (56 of 976) individuals, 40 students and 16 teachers/staff. Of these, 12 students were diagnosed with confirmed tuberculosis. In total, 14 students (two index cases and 12 confirmed cases) were diagnosed and reported in the tuberculosis outbreak, an attack rate of 1.7% (14/847) among students (two index cases and 845 screened students). Results from MIRU-VNTR typing and spoligotyping analyses demonstrated that three M. tuberculosis strains belong to the Beijing family with corresponding MIRU-VNTR alleles. This school-based tuberculosis outbreak among adolescents demonstrates that transmission among individuals in this age group is common and must be prioritised. It suggests that identifying and timely diagnosis of smear-positive cases, especially in the early phase of outbreaks, is the key to preventing further spread among close contacts.
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73
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Devlin S, MacLaren D, Massey PD, Widders R, Judd JA. The missing voices of Indigenous Australians in the social, cultural and historical experiences of tuberculosis: a systematic and integrative review. BMJ Glob Health 2019; 4:e001794. [PMID: 31798989 PMCID: PMC6861081 DOI: 10.1136/bmjgh-2019-001794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/08/2019] [Accepted: 10/12/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Disparities in tuberculosis (TB) rates exist between Indigenous and non-Indigenous populations in many countries, including Australia. The social determinants of health are central to health inequities including disparities in TB rates. There are limitations in the dominant biomedical and epidemiological approaches to representing, understanding and addressing the unequal burden of TB for Indigenous peoples represented in the literature. This paper applies a social determinants of health approach and examines the structural, programmatic and historical causes of inequities for TB in Indigenous Australia. Methods Aboriginal Australians’ families in northern New South Wales who are affected by TB initiated this investigation. A systematic search of published literature was conducted using PubMed, PsycINFO, Scopus and Informit ATSIhealth databases, the Australian Indigenous Health, InfoNet and Google. Ninety-five records published between 1885 and 2019 were categorised and graphed over time, inductively coded and thematically analysed. Results Indigenous Australians’ voices are scarce in the TB literature and absent in the development of TB policies and programmes. Epidemiological reports are descriptive and technical and avoid analysis of social processes involved in the perpetuation of TB. For Indigenous Australians, TB is more than a biomedical diagnosis and treatment; it is a consequence of European invasion and a contributor to dispossession and the ongoing fight for justice. The introduction and spread of TB has resulted in the stealing of lives, family, community and cultures for Indigenous Australians. Racist policies and practices predominate in the experiences of individuals and families as consequences of, and resulting in, ongoing structural and systematic exclusion. Conclusion Development of TB policies and programmes requires reconfiguration. Space must be given for Indigenous Australians to lead, be partners and to have ownership of decisions about how to eliminate TB. Shared knowledge between Indigenous Australians, policy makers and service managers of the social practices and structures that generate TB disparity for Indigenous Australians is essential. A social determinant of health approach will shift the focus to the social structures that cause TB. Collaboration with Indigenous partners in research is critical, and use of methods that amplify Indigenous peoples' voices and reconfigure power relations in favour of Indigenous Australians in the process is required.
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Affiliation(s)
- Sue Devlin
- Public Health Unit, Mid North Coast Local Health District, Lismore, New South Wales, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Peter D Massey
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Richard Widders
- Public Health Unit, Mid North Coast Local Health District, Lismore, New South Wales, Australia
| | - Jenni A Judd
- School of Health Medical and Applied Sciences/Division Higher Education, Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg Campus, Branyan, Queensland, Australia
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74
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Investigating Outcomes of Adolescents and Young Adults (10-24 Years of Age) Lost to Follow-up from Tuberculosis Treatment in Gaborone, Botswana. Pediatr Infect Dis J 2019; 38:e271-e274. [PMID: 31220045 PMCID: PMC6768719 DOI: 10.1097/inf.0000000000002369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This retrospective study investigated outcomes among lost to follow-up (LTFU) adolescents and young adults (AYAs: 10-24 years of age) with tuberculosis (TB) registered from 2008 to 2014 in Gaborone, using surveillance data. Of 68 LTFU AYAs, 16 repeated treatment; 8 completed and 6 were again LTFU. Of 4 confirmed deaths, 3 had TB/HIV coinfection. Approaches to improve AYA retention in TB care are needed.
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75
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Reuter A, Hughes J, Furin J. Challenges and controversies in childhood tuberculosis. Lancet 2019; 394:967-978. [PMID: 31526740 DOI: 10.1016/s0140-6736(19)32045-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
Children bear a substantial burden of suffering when it comes to tuberculosis. Ironically, they are often left out of the scientific and public health advances that have led to important improvements in tuberculosis diagnosis, treatment, and prevention over the past decade. This Series paper describes some of the challenges and controversies in paediatric tuberculosis, including the epidemiology and treatment of tuberculosis in children. Two areas in which substantial challenges and controversies exist (ie, diagnosis and prevention) are explored in more detail. This Series paper also offers possible solutions for including children in all efforts to end tuberculosis, with a focus on ensuring that the proper financial and human resources are in place to best serve children exposed to, infected with, and sick from all forms of tuberculosis.
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Affiliation(s)
- Anja Reuter
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Jennifer Hughes
- Desmond Tutu Tuberculosis Center, Stellenbosch University, Stellenbosch, South Africa
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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76
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Melsew YA, Cheng AC, McBryde ES, Denholm JT, Tay E, Ragonnet R, Trauer JM. Profiles of tuberculosis disease activation among contacts of patients with tuberculosis. Eur Respir J 2019; 54:13993003.00353-2019. [DOI: 10.1183/13993003.00353-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/25/2019] [Indexed: 11/05/2022]
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77
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Daulay RS, Majeda A, Nataprawira HM. Unrecognized and delayed to diagnose of adolescence tuberculosis case in a boarding school in West Java, Indonesia. Int J Mycobacteriol 2019; 7:387-389. [PMID: 30531040 DOI: 10.4103/ijmy.ijmy_149_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adolescent is a high-risk population for developing tuberculosis (TB) disease, unfortunately adolescence TB remains to be neglected. Clinical manifestations of TB are usually chronic and nonspecific that could be mimicking other disease. Unrecognized TB disease will lead to misdiagnosis, delayed, and inappropriate management. A 15-year-old female adolescent, admitted to the hospital due to severe anemia, loss of body weight accompanied with recurrent fever and tend to be easily tired. She was through investigation for hematology disorder with normal results. She was studying in a Muslim boarding school with overcrowded environment. History of contact with TB patient was unclear. Tuberculosis diagnosed based on positive genXpert result, detected sensitive to rifampicin Mycobacterium tuberculosis although acid-fast bacilli sputum smear and culture yielded results were negative. Worsening of the chest X-ray were obtained, initially showed infiltrate of the lung and then revealed bronchogenic spread. Lymph nodes enlargement of the neck-proven TB from fine-needle aspiration biopsy. Anti-TB drugs were started, and after the treatment, there were clinical improvement. TB among adolescents against many unique challenges such as difficulty in case detection, wider potential transmissions and problem on adherence; hence, this age group should be identified as a primary issue in the community.
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Affiliation(s)
- Rini Savitri Daulay
- Department of Child Health, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia
| | - Allisa Majeda
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Heda Melinda Nataprawira
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
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78
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Snow KJ, Sawyer SM, Denholm JT, Graham SM. Explaining variation in the burden of child and adolescent tuberculosis. Eur Respir J 2019; 53:53/6/1901007. [DOI: 10.1183/13993003.01007-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 11/05/2022]
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79
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Chen YY, Pan SW, Shen HS, Chuang FY, Feng JY, Su WJ. Declining trend in incidence of tuberculosis in adolescents and young adults in Taiwan. Eur Respir J 2019; 53:53/5/1801305. [DOI: 10.1183/13993003.01305-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/01/2019] [Indexed: 11/05/2022]
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80
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Pan D, Lan R, Graviss EA, Lin D, Liang D, McNeil E, Lin M, Chongsuvivatwong V. Adolescent tuberculosis associated with tuberculosis exposure in classrooms and dorm rooms in Guangxi, China. Int J Infect Dis 2019; 78:8-14. [PMID: 30267940 PMCID: PMC6301067 DOI: 10.1016/j.ijid.2018.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Quantify tuberculosis (TB) risk attributable to dorm room exposure in addition to classroom exposure. METHODS Adolescent school contact investigations were conducted for every reported index TB case, and similar contact investigations were conducted in selected community-control classes from November 2016 to October 2017 in Guangxi, China. RESULTS A total of 6263 contacts of 112 index TB cases and 6130 classmates of 112 controls were investigated. There were 14, 12, and 2 new active TB cases detected among classmates/non-roommates of index cases, classmates/roommates of index cases, and control classmates, respectively. Compared with control contacts, the adjusted relative risk (95% confidence interval (CI)) and population attributable fraction (PAF) for being a classmate/non-roommate of the index case increased the risk of active TB diagnosis to 8.44 (95% CI: 1.31-54.48) and 44.1%. The adjusted RR and PAF for being a classmate/roommate of the index case was 29.37 (95% CI: 3.80, 227.11) and 41.4%. Being classmates/roommates significantly increased the risk of TB compared to a classmate/non-roommate of the index case (RR=3.48, 95% CI: 1.64, 7.40). CONCLUSION The additional risk of TB due to exposure in the dorm room should be taken into account in planning of TB prevention and control in boarding schools.
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Affiliation(s)
- Dongxiang Pan
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China; Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Rushu Lan
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, The Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Dingwen Lin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China
| | - Dabin Liang
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Mei Lin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China.
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81
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Shafiei M, Ghasemian A, Eslami M, Nojoomi F, Rajabi-Vardanjani H. Risk factors and control strategies for silicotuberculosis as an occupational disease. New Microbes New Infect 2019; 27:75-77. [PMID: 30622714 PMCID: PMC6319297 DOI: 10.1016/j.nmni.2018.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 12/12/2022] Open
Abstract
Silicotuberculosis is critical in community settings among workers and employees exposed to silica dust. Older age of entry (>30 years), male sex, infection with human immunodeficiency virus (HIV), exposure duration, smoking, chronic obstructive pulmonary disease, migration, the severity of the silicosis and the intensity of the exposure are potential risk factors. Lack of timely diagnosis and treatment for tuberculosis (TB) may also raise the rate of infection; previous treatment of TB is possibly associated with the development of silicotuberculosis in more than half of patients, increasing with age (>40 years). Identification of risk factors benefits not only the academic research community, but also the workers or employees and policy making. Some strategies can be implemented, such as controlling or reducing exposure to silica dust, ensuring continuity of treatment of TB or extended anti-TB treatment, management of the situation by occupational health professionals, prevention of oscillating migration, providing workers with compensation, training and education in occupational health, improving the quality of life of miners and workers, intensive medical surveillance and TB screening in routine health check ups, and policy making for higher immunity to inhibit inhalation of dust by workers or employees.
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Affiliation(s)
- M. Shafiei
- )Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - A. Ghasemian
- )Department of Microbiology, Fasa University of Medical Sciences, Fasa, Iran
| | - M. Eslami
- )Department of Microbiology and Virology, Semnan University of Medical Sciences, Semnan, Iran
| | - F. Nojoomi
- )Microbiology Department, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
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Černá P, O'Halloran C, SjatkovskaJ O, Gunn-Moore DA. Outbreak of tuberculosis caused by Mycobacterium bovis in a cattery of Abyssinian cats in Italy. Transbound Emerg Dis 2018; 66:250-258. [PMID: 30179308 DOI: 10.1111/tbed.13010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 12/16/2022]
Abstract
Mycobacterium bovis is a re-emerging zoonosis; it was diagnosed in five Abyssinian cats in a breeding cattery in Italy. The infection entered the cattery with an imported kitten (cat A); it had a suspected bite wound on its leg that had been treated at a veterinary clinic in Kiev, Ukraine, which is probably where it became infected with M. bovis. When the kitten arrived in Italy, there were four cats in the cattery; an adult female, her two kittens and a kitten imported from Russia. These were all healthy, and had no outdoor access. All five cats developed tuberculous interstitial pneumonia; in cat A this occurred 6 weeks after importation, the others were diagnosed 4-6 weeks later. Three cats were euthanised with deteriorating pneumonia while two cats remained clinically well on antibiotic therapy (marbofloxacin, doxycycline and azithromycin). The latter cases were euthanised after 5 weeks, as required by Italian law once M. bovis infection was suspected. Changes consistent with tuberculosis on gross post-mortem examination included mesenteric and mediastinal lymphadenopathy, splenomegaly and hepatomegaly, and the presence of disseminated focal white lesions on the cut surface of the spleen, liver and lungs. Visible acid-fast bacteria (cats A, B and C) were confirmed as Mycobacterium tuberculosis complex by PCR (cats A, B, C, D and E), refined to M. bovis (cats A, B and D), spoligotype SB0950 (cats A and D).
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Affiliation(s)
- Petra Černá
- University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Conor O'Halloran
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, UK
| | | | - Danièlle A Gunn-Moore
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, UK
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Tuberculosis Elimination in the Asia-Pacific Region and the WHO Ethics Guidance. Trop Med Infect Dis 2018; 3:tropicalmed3040115. [PMID: 30384409 PMCID: PMC6306794 DOI: 10.3390/tropicalmed3040115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022] Open
Abstract
The World Health Organization has produced ethical guidance on implementation of the End TB strategy, which must be considered in local context. The Asia-Pacific Region has important distinctive characteristics relevant to tuberculosis, and engagement with the ethical implications raised is essential. This paper highlights key ethical considerations for the tuberculosis elimination agenda in the Asia-Pacific Regions and suggests that further programmatic work is required to ensure such challenges are addressed in clinical and public health programs.
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Khan PY. The adolescent tuberculosis care cascade: an urgent need to address high rates of loss to follow-up from diagnosis to cure. Public Health Action 2018; 8:101-102. [PMID: 30271724 PMCID: PMC6147067 DOI: 10.5588/pha.18.0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Palwasha Y Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Interactive Research and Development, Karachi, Pakistan
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Incidence and prevalence of bacteriologically confirmed pulmonary tuberculosis among adolescents and young adults: a systematic review. Epidemiol Infect 2018; 146:946-953. [PMID: 29655391 DOI: 10.1017/s0950268818000821] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The burden of tuberculosis (TB) among adolescents and young adults in endemic settings is poorly characterised. This study aimed to review published and unpublished estimates of the incidence and prevalence of bacteriologically confirmed TB among young people aged 10-24 years. We searched PubMed and World Health Organization archives for publications and unpublished data from population-based epidemiologic studies reporting confirmed pulmonary TB among young people, conducted from January 2000 onwards. We identified 27 publications and unpublished data from two national surveys, representing a total of 26 studies in 19 countries. The prevalence of bacteriologically confirmed TB ranged from 45 to 799 per 100 000 in the Asia-Pacific region and from 160 to 462 per 100 000 in African settings. We did not identify any epidemiologic studies of confirmed TB among adolescents living with human immunodeficiency virus (HIV). Many studies were excluded due to absent or inadequately reported age-specific data. Adolescents and young adults living in many endemic settings appear to be at substantial risk of developing active TB. There is a pressing need to improve the routine reporting of age in epidemiologic studies of TB, and to generate high-quality epidemiologic data regarding TB among adolescents living with HIV.
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García-Basteiro AL, Schaaf HS, Diel R, Migliori G. Adolescents and young adults: a neglected population group for tuberculosis surveillance. Eur Respir J 2018; 51:51/2/1800176. [DOI: 10.1183/13993003.00176-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/01/2018] [Indexed: 12/20/2022]
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