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Marco MH, Ahmedov S, Castro KG. The global impact of COVID-19 on tuberculosis: A thematic scoping review, 2020-2023. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003043. [PMID: 38959278 PMCID: PMC11221697 DOI: 10.1371/journal.pgph.0003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND This thematic scoping review of publications sought to understand the global impact of COVID-19 on tuberculosis (TB), interpret the scope of resonating themes, and offer policy recommendations to stimulate TB recovery and future pandemic preparedness. DATA SOURCES Publications were captured from three search engines, PubMed, EBSCO, and Google Scholar, and applicable websites written in English from January 1, 2020, to April 30, 2023. STUDY SELECTION Our scoping review was limited to publications detailing the impact of COVID-19 on TB. Original research, reviews, letters, and editorials describing the deleterious and harmful--yet sometimes positive--impact of COVID-19 (sole exposure) on TB (sole outcome) were included. The objective was to methodically categorize the impacts into themes through a comprehensive review of selected studies to provide significant health policy guidance. DATA EXTRACTION Two authors independently screened citations and full texts, while the third arbitrated when consensus was not met. All three performed data extraction. DATA SYNTHESIS/RESULTS Of 1,755 screened publications, 176 (10%) covering 39 countries over 41 months met the inclusion criteria. By independently using a data extraction instrument, the three authors identified ten principal themes from each publication. These themes were later finalized through a consensus decision. The themes encompassed TB's care cascade, patient-centered care, psychosocial issues, and health services: 1) case-finding and notification (n = 45; 26%); 2) diagnosis and laboratory systems (n = 19; 10.7%) 3) prevention, treatment, and care (n = 22; 12.2%); 4) telemedicine/telehealth (n = 12; 6.8%); 5) social determinants of health (n = 14; 8%); 6) airborne infection prevention and control (n = 8; 4.6%); 7) health system strengthening (n = 22; 13%); 8) mental health (n = 13; 7.4%); 9) stigma (n = 11; 6.3%); and 10) health education (n = 10; 5.7%). LIMITATIONS Heterogeneity of publications within themes. CONCLUSIONS We identified ten globally generalizable themes of COVID-19's impact on TB. The impact and lessons learned from the themed analysis propelled us to draft public health policy recommendations to direct evidence-informed guidance that strengthens comprehensive global responses, recovery for TB, and future airborne pandemic preparedness.
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Affiliation(s)
- Michael H. Marco
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Global Health Technical Assistance and Mission Support, Vienna, Virginia, United States of America
| | - Sevim Ahmedov
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Kenneth G. Castro
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Rollins School of Public Health, School of Medicine, Emory/Georgia TB Research Advancement Center, Atlanta, Georgia, United States of America
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Kilinç G, Boland R, Heemskerk MT, Spaink HP, Haks MC, van der Vaart M, Ottenhoff THM, Meijer AH, Saris A. Host-directed therapy with amiodarone in preclinical models restricts mycobacterial infection and enhances autophagy. Microbiol Spectr 2024:e0016724. [PMID: 38916320 DOI: 10.1128/spectrum.00167-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/23/2024] [Indexed: 06/26/2024] Open
Abstract
Mycobacterium tuberculosis (Mtb) as well as nontuberculous mycobacteria are intracellular pathogens whose treatment is extensive and increasingly impaired due to the rise of mycobacterial drug resistance. The loss of antibiotic efficacy has raised interest in the identification of host-directed therapeutics (HDT) to develop novel treatment strategies for mycobacterial infections. In this study, we identified amiodarone as a potential HDT candidate that inhibited both intracellular Mtb and Mycobacterium avium in primary human macrophages without directly impairing bacterial growth, thereby confirming that amiodarone acts in a host-mediated manner. Moreover, amiodarone induced the formation of (auto)phagosomes and enhanced autophagic targeting of mycobacteria in macrophages. The induction of autophagy by amiodarone is likely due to enhanced transcriptional regulation, as the nuclear intensity of the transcription factor EB, the master regulator of autophagy and lysosomal biogenesis, was strongly increased. Furthermore, blocking lysosomal degradation with bafilomycin impaired the host-beneficial effect of amiodarone. Finally, amiodarone induced autophagy and reduced bacterial burden in a zebrafish embryo model of tuberculosis, thereby confirming the HDT activity of amiodarone in vivo. In conclusion, we have identified amiodarone as an autophagy-inducing antimycobacterial HDT that improves host control of mycobacterial infections. IMPORTANCE Due to the global rise in antibiotic resistance, there is a strong need for alternative treatment strategies against intracellular bacterial infections, including Mycobacterium tuberculosis (Mtb) and non-tuberculous mycobacteria. Stimulating host defense mechanisms by host-directed therapy (HDT) is a promising approach for treating mycobacterial infections. This study identified amiodarone, an antiarrhythmic agent, as a potential HDT candidate that inhibits the survival of Mtb and Mycobacterium avium in primary human macrophages. The antimycobacterial effect of amiodarone was confirmed in an in vivo tuberculosis model based on Mycobacterium marinum infection of zebrafish embryos. Furthermore, amiodarone induced autophagy and inhibition of the autophagic flux effectively impaired the host-protective effect of amiodarone, supporting that activation of the host (auto)phagolysosomal pathway is essential for the mechanism of action of amiodarone. In conclusion, we have identified amiodarone as an autophagy-inducing HDT that improves host control of a wide range of mycobacteria.
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Affiliation(s)
- Gül Kilinç
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Ralf Boland
- Institute of Biology Leiden, Leiden University, Leiden, the Netherlands
| | - Matthias T Heemskerk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Herman P Spaink
- Institute of Biology Leiden, Leiden University, Leiden, the Netherlands
| | - Mariëlle C Haks
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Anno Saris
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
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3
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Deng H, Liu Y, Lv F, Li X, Qi M, Bo Y, Qiu S, He X, Ji F, Zeng QL, Gao N. Sex disparities of the effect of the COVID-19 pandemic on mortality among patients living with tuberculosis in the United States. Front Public Health 2024; 12:1413604. [PMID: 38957204 PMCID: PMC11217309 DOI: 10.3389/fpubh.2024.1413604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Background We aimed to determine the trend of TB-related deaths during the COVID-19 pandemic. Methods TB-related mortality data of decedents aged ≥25 years from 2006 to 2021 were analyzed. Excess deaths were estimated by determining the difference between observed and projected mortality rates during the pandemic. Results A total of 18,628 TB-related deaths were documented from 2006 to 2021. TB-related age-standardized mortality rates (ASMRs) were 0.51 in 2020 and 0.52 in 2021, corresponding to an excess mortality of 10.22 and 9.19%, respectively. Female patients with TB demonstrated a higher relative increase in mortality (26.33 vs. 2.17% in 2020; 21.48 vs. 3.23% in 2021) when compared to male. Female aged 45-64 years old showed a surge in mortality, with an annual percent change (APC) of -2.2% pre-pandemic to 22.8% (95% CI: -1.7 to 68.7%) during the pandemic, corresponding to excess mortalities of 62.165 and 99.16% in 2020 and 2021, respectively; these excess mortality rates were higher than those observed in the overall female population ages 45-64 years in 2020 (17.53%) and 2021 (33.79%). Conclusion The steady decline in TB-related mortality in the United States has been reversed by COVID-19. Female with TB were disproportionately affected by the pandemic.
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Affiliation(s)
- Huan Deng
- National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yishan Liu
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fan Lv
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China
| | - Xiaofeng Li
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Center for Infectious Diseases, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Mingyan Qi
- Department of Clinical Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yajing Bo
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sikai Qiu
- Department of Clinical Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyuan He
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fanpu Ji
- National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Provincial Research Center, Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, China
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Xi'an, China
| | - Qing-Lei Zeng
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ning Gao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Chang T, Cho SI, Yoo DS, Min KD. Trends in Nationally Notifiable Infectious Diseases in Humans and Animals during COVID-19 Pandemic, South Korea. Emerg Infect Dis 2024; 30:1154-1163. [PMID: 38781924 PMCID: PMC11138988 DOI: 10.3201/eid3006.231422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
We investigated trends in notifiable infectious diseases in both humans and animals during the COVID-19 pandemic in South Korea and compared those data against expected trends had nonpharmaceutical interventions (NPIs) not been implemented. We found that human respiratory infectious diseases other than COVID-19 decreased by an average of 54.7% after NPIs were introduced. On the basis of that trend, we estimated that annual medical expenses associated with respiratory infections other than COVID-19 also decreased by 3.8% in 2020 and 18.9% in 2021. However, human gastrointestinal infectious diseases and livestock diseases exhibited similar or even higher incidence rates after NPIs were instituted. Our investigation revealed that the preventive effect of NPIs varied among diseases and that NPIs might have had limited effectiveness in reducing the spread of certain types of infectious diseases. These findings suggest the need for future, novel public health interventions to compensate for such limitations.
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Mihuta C, Socaci A, Hogea P, Tudorache E, Mihuta MS, Oancea C. Colliding Challenges: An Analysis of SARS-CoV-2 Infection in Patients with Pulmonary Tuberculosis versus SARS-CoV-2 Infection Alone. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:823. [PMID: 38793006 PMCID: PMC11123355 DOI: 10.3390/medicina60050823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The concurrent occurrence of tuberculosis and COVID-19 coinfection poses significant clinical complexities, warranting a nuanced approach to diagnosis, management, and patient care. Materials and Methods: A retrospective, cross-sectional study was conducted on two groups: one comprising 32 patients with pulmonary TB (PTB) and COVID-19 co-infection, and one including 100 patients with COVID-19 alone. Data was collected from medical records, including patient history, clinical parameters, laboratory, imaging results, and patient outcome. Results: A lower BMI emerges as a significant marker suggesting underlying PTB in patients with SARS-CoV-2 co-infection. Type 2 diabetes mellitus increases the risk of death in PTB-SARS-CoV-2 co-infection. Co-infected patients show lymphocytopenia and higher neutrophil levels, CRP, transaminases, and D-dimer levels. Elevated CRP and ALT levels are linked to increased co-infection likelihood. Certain parameters like SpO2, CRP, ALT, AST, and D-dimer effectively differentiate between co-infected and COVID-19 patients. Platelet-to-lymphocyte ratio is notably higher in co-infected individuals. Lesion severity on imaging is significantly associated with co-infection, highlighting imaging's diagnostic importance. Longer hospital stays are linked to co-infection but not significantly to death risk. Conclusions: Certain clinical and biological factors may serve as potential indicators of PTB co-infection in patients with SARS-CoV-2.
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Affiliation(s)
- Camil Mihuta
- Department of Doctoral Studies, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
| | - Adriana Socaci
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Department of Biology and Life Sciences, Faculty of Medicine, “Vasile Goldis” Western University of Arad, 310025 Arad, Romania
| | - Patricia Hogea
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Emanuela Tudorache
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Monica Simina Mihuta
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Cristian Oancea
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Rajotiya S, Mishra S, Singh AK, Debnath S, Raj P, Singh P, Bareth H, Nakash P, Sharma A, Singh M, Nathiya D, Joshi N, Tomar BS. Burden of COVID-19 pandemic on tuberculosis hospitalisation patterns at a tertiary care hospital in Rajasthan, India: a retrospective analysis. BMJ Open 2024; 14:e080623. [PMID: 38702079 PMCID: PMC11086464 DOI: 10.1136/bmjopen-2023-080623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/06/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the burden of the COVID-19 pandemic on tuberculosis (TB) trends, patient demographics, disease types and hospitalisation duration within the Respiratory Medicine Department over three distinct phases: pre-COVID-19, COVID-19 and post-COVID-19. DESIGN Retrospective analysis using electronic medical records of patients with TB admitted between June 2018 and June 2023 was done to explore the impact of COVID-19 on patients with TB. The study employed a meticulous segmentation into pre-COVID-19, COVID-19 and post-COVID-19 eras. SETTING National Institute of Medical Science Hospital in Jaipur, Rajasthan, India. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome includes patients admitted to the Respiratory Medicine Department of the hospital and secondary outcome involves the duration of hospital stay. RESULTS The study encompassed 1845 subjects across the three eras, revealing a reduction in TB incidence during the post-COVID-19 era compared with the pre-COVID-19 period (p<0.01). Substantial demographic shifts were observed, with 5.2% decline in TB incidence among males in the post-COVID-19 era (n=529) compared with the pre-COVID-19 era (n=606). Despite the decrease, overall TB incidence remained significantly higher in males (n=1460) than females (n=385), with consistently elevated rates in rural (65.8%) as compared with the urban areas (34.2%). Extended hospital stays were noted in the post-COVID-19 era compared with the pre-COVID-19 era (p<0.01). CONCLUSION The study underscores the influence of the COVID-19 pandemic on the TB landscape and hospitalisation dynamics. Notably, patient burden of TB declined during the COVID-19 era, with a decline in the post-COVID-19 era compared with the pre-COVID-19 era. Prolonged hospitalisation in the post-COVID-19 period indicates the need for adaptive healthcare strategies and the formulation of public health policies in a post-pandemic context. These findings contribute to a comprehensive understanding of the evolving TB scenario, emphasising the necessity for tailored healthcare approaches in the aftermath of a global health crisis.
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Affiliation(s)
- Sumit Rajotiya
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Shivang Mishra
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Anurag Kumar Singh
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Sourav Debnath
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Preeti Raj
- Department of Public health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pratima Singh
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Hemant Bareth
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Prashant Nakash
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Anupama Sharma
- Department of Biochemistry, NIMS University, Jaipur, Rajasthan, India
| | - Mahaveer Singh
- Department of Endocrinology, NIMS University, Jaipur, Rajasthan, India
| | - Deepak Nathiya
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
- Department of Clinical Studies, Fourth Hospital of Yulin (Xingyuan), Yulin, Shaanxi, China
- Department of Clinical Sciences, Shenmu Hospital, Shenmu, Shaanxi, China
| | - Nalin Joshi
- Department of Respiratory Medicine, NIMS University, Jaipur, Rajasthan, India
| | - Balvir Singh Tomar
- Department of Clinical Studies, Fourth Hospital of Yulin (Xingyuan), Yulin, Shaanxi, China
- Department of Clinical Sciences, Shenmu Hospital, Shenmu, Shaanxi, China
- Institute of Gastroenterology, Hepatology & Transplant, NIMS University, Jaipur, Rajasthan, India
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AlHamawi R, Khader Y, Abaza H, Satyanarayana S, Wilson N, Saleh Abu Rumman A, Okkah K. Tuberculosis-related knowledge, practices, perceived stigma and discrimination among patients with tuberculosis: a cross-sectional study in Jordan. Infect Dis (Lond) 2024; 56:359-375. [PMID: 38329456 DOI: 10.1080/23744235.2024.2311292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Tuberculosis knowledge, practices, and perceived stigma and discrimination among patients with tuberculosis are key factors for the management of the disease. OBJECTIVES The objectives of the study were to assess knowledge, practices, perceived stigma and discrimination, perceived family and health workers support, perceived level of satisfaction with healthcare services, delay in diagnosis/treatment and reasons for delay among patients with tuberculosis in Jordan. METHODS A cross-sectional study was conducted among patients who were under treatment for tuberculosis in Jordan in 2021. RESULTS This study included a total of 452 patients with tuberculosis. About 91.4% of patients had low to moderate overall tuberculosis-related knowledge score and 8.6% had high knowledge score. Almost two-thirds of patients (67.5%) had perceived a low level of stigma, 61 (13.5%) perceived a moderate level of stigma, and 86 (19.0%) perceived a high level of stigma. The majority (84.5%) of patients with tuberculosis thought that there was a delay in diagnosis and/or treatment of tuberculosis. CONCLUSION Our study showed gaps in tuberculosis knowledge and practices, high perceived stigma and discrimination, and perceived delay in diagnosis and treatment initiation,. Efforts within the national tuberculosis control program should be made to increase public awareness about the symptoms of tuberculosis and the importance of seeking early care.
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Affiliation(s)
- Rana AlHamawi
- Research and policy Global Health Development|Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Yousef Khader
- Professor of Epidemiology, Medical Education and Biostatistics, Department of Community Medicine, Public Health, and Family Medicine/, Jordan University of Science & Technology, Irbid, Jordan
| | - Hiba Abaza
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | - Srinath Satyanarayana
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | - Nevin Wilson
- Migration Health Division, International Organization for Migration (IOM) Amman, Jordan
| | | | - Khaled Okkah
- Department of Chest Disease and Foreigners, Jordan Ministry of health, Jordan
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Kendall EA, Kitonsa PJ, Nalutaaya A, Robsky KO, Erisa KC, Mukiibi J, Cattamanchi A, Kato-Maeda M, Katamba A, Dowdy D. Decline in prevalence of tuberculosis following an intensive case finding campaign and the COVID-19 pandemic in an urban Ugandan community. Thorax 2024; 79:325-331. [PMID: 38050134 PMCID: PMC10947924 DOI: 10.1136/thorax-2023-220047] [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: 01/31/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Systematic screening is a potential tool for reducing the prevalence of tuberculosis (TB) and counteracting COVID-19-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of TB over time. METHODS We conducted serial, cross-sectional TB case finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum for TB testing (Xpert MTB/RIF Ultra) from all adolescents and adults. We estimated the prevalence of TB among screening participants in each campaign and compared characteristics of people with TB across campaigns. We simultaneously enrolled and characterised community residents who were diagnosed with TB through routine care and assessed trends in facility-based diagnosis. RESULTS We successfully screened 12 033 community residents (35% of the estimated adult/adolescent population) in 2019 and 11 595 (33%) in 2021. In 2019, 0.94% (95% CI: 0.77% to 1.13%) of participants tested Xpert positive (including trace). This proportion fell to 0.52% (95% CI: 0.40% to 0.67%) in 2021; the prevalence ratio was 0.55 (95% CI: 0.40 to 0.75)). There was no change in the age (median 26 vs 26), sex (56% vs 59% female) or prevalence of chronic cough (49% vs 54%) among those testing positive. By contrast, the rate of routine facility-based diagnosis remained steady in the 8 months before each campaign (210 (95% CI: 155 to 279) vs 240 (95% CI: 181 to 312) per 100 000 per year). CONCLUSIONS Following an intensive initial case finding campaign in an urban Ugandan community in 2019, the burden of prevalent TB as measured by systematic screening had decreased by 45% in 2021, despite the intervening COVID-19 pandemic.
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Affiliation(s)
- Emily A Kendall
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter J Kitonsa
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Annet Nalutaaya
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - Katherine O Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kamoga Caleb Erisa
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - James Mukiibi
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - Adithya Cattamanchi
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Orange, California, USA
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Midori Kato-Maeda
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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9
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Tovar M, Sanz J, Moreno Y. Model-based impact evaluation of new tuberculosis vaccines in aging populations under different modeling scenarios: the case of China. Front Public Health 2024; 12:1302688. [PMID: 38463158 PMCID: PMC10920235 DOI: 10.3389/fpubh.2024.1302688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction The slow descent in TB burden, the COVID-19 pandemic, along with the rise of multidrug-resistant strains of Mycobacterium tuberculosis, seriously threaten TB control and the goals of the End TB strategy. To fight back, several vaccine candidates are under development, with some of them undergoing the phases 2B and 3 of the development pipeline. The impact of these vaccines on the general population needs to be addressed using disease-transmission models, and, in a country like China, which last year ranked third in number of cases worldwide, and where the population is aging at a fast pace, the impact of TB vaccination campaigns may depend heavily upon the age of targeted populations, the mechanistic descriptions of the TB vaccines and the coupling between TB dynamics and demographic evolution. Methods In this work, we studied the potential impact of a new TB vaccine in China targeting adolescents (15-19 y.o.) or older adults (60-64 y.o.), according to varying vaccine descriptions that represent reasonable mechanisms of action leading to prevention of disease, or prevention of recurrence, each of them targetting specific routes to TB disease. To measure the influence of the description of the coupling between transmission dynamics and aging in TB transmission models, we explored two different approaches to compute the evolution of the contact matrices, which relate to the spreading among different age strata. Results Our findings highlight the dependence of model-based impact estimates on vaccine profiles and the chosen modeling approach for describing the evolution of contact matrices. Our results also show, in line with previous modeling works, that older adult vaccination is a suitable option in China to reduce the incidence of TB as long as the vaccine is able to protect already exposed individuals. Discussion This study underscores the importance of considering vaccine characteristics and demographic dynamics in shaping TB control strategies. In this sense, older adult vaccination emerges as a promising avenue for mitigating TB transmission in China but also remarks the need for tailored intervention strategies aligned with demographic trends.
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Affiliation(s)
- Mario Tovar
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Spain
- Department of Theoretical Physics, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Sanz
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Spain
- Department of Theoretical Physics, University of Zaragoza, Zaragoza, Spain
| | - Yamir Moreno
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Spain
- Department of Theoretical Physics, University of Zaragoza, Zaragoza, Spain
- CENTAI Institute, Turin, Italy
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Dinh LV, Vo LNQ, Wiemers AMC, Nguyen HB, Vu HQ, Mo HTL, Nguyen LP, Nguyen NTT, Dong TTT, Tran KT, Dang TMH, Nguyen LH, Pham AT, Codlin AJ, Forse RJ. Ensuring Continuity of Tuberculosis Care during Social Distancing through Integrated Active Case Finding at COVID-19 Vaccination Events in Vietnam: A Cohort Study. Trop Med Infect Dis 2024; 9:26. [PMID: 38276637 PMCID: PMC10819868 DOI: 10.3390/tropicalmed9010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
COVID-19 significantly disrupted tuberculosis (TB) services in Vietnam. In response, the National TB Program (NTP) integrated TB screening using mobile chest X-rays into COVID-19 vaccination events. This prospective cohort study evaluated the integrated model's yield, treatment outcomes, and costs. We further fitted regressions to identify risk factors and conduct interrupted time-series analyses in the study area, Vietnam's eight economic regions, and at the national level. At 115 events, we conducted 48,758 X-ray screens and detected 174 individuals with TB. We linked 89.7% to care, while 92.9% successfully completed treatment. The mean costs per person diagnosed with TB was $547. TB risk factors included male sex (aOR = 6.44, p < 0.001), age of 45-59 years (aOR = 1.81, p = 0.006) and ≥60 years (aOR = 1.99, p = 0.002), a history of TB (aOR = 7.96, p < 0.001), prior exposure to TB (aOR = 3.90, p = 0.001), and symptomatic presentation (aOR = 2.75, p < 0.001). There was a significant decline in TB notifications during the Delta wave and significant increases immediately after lockdowns were lifted (IRR(γ1) = 5.00; 95%CI: (2.86, 8.73); p < 0.001) with a continuous upward trend thereafter (IRR(γ2) = 1.39; 95%CI: (1.22, 1.38); p < 0.001). Similar patterns were observed at the national level and in all regions but the northeast region. The NTP's swift actions and policy decisions ensured continuity of care and led to the rapid recovery of TB notifications, which may serve as blueprint for future pandemics.
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Affiliation(s)
- Luong Van Dinh
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Luan Nguyen Quang Vo
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anja Maria Christine Wiemers
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Hoa Binh Nguyen
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Hoa Quynh Vu
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Huong Thi Lan Mo
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Lan Phuong Nguyen
- IRD VN Social Enterprise Company Limited, Ho Chi Minh City 700000, Vietnam;
| | - Nga Thi Thuy Nguyen
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Thuy Thi Thu Dong
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Khoa Tu Tran
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Thi Minh Ha Dang
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700000, Vietnam; (T.M.H.D.); (L.H.N.)
| | - Lan Huu Nguyen
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700000, Vietnam; (T.M.H.D.); (L.H.N.)
| | | | - Andrew James Codlin
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Rachel Jeanette Forse
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
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11
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Jinyi W, Zhang Y, Wang K, Peng P. Global, regional, and national mortality of tuberculosis attributable to alcohol and tobacco from 1990 to 2019: A modelling study based on the Global Burden of Disease study 2019. J Glob Health 2024; 14:04023. [PMID: 38175959 PMCID: PMC10767425 DOI: 10.7189/jogh.14.04023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
Background Tuberculosis (TB) is expected to become the second leading single cause of death with several risk factors, but the related disease burden is currently unknown. We aimed to analyse the pre-coronavirus disease 2019 (COVID-19) changes in mortality of TB attributable to alcohol and tobacco worldwide from 1990 to 2019. Methods We obtained data of TB deaths and age-standardised death rates attributed to alcohol and cigarette in 204 countries and territories from the Global Burden of Disease 2019 public database. We performed a spatial-temporal analysis of age-standardised death rate and the average annual per cent change (AAPC), after which we analysed the effects of gender and socio-demographic index on age-standardised death rate using an age-period-cohort model. Finally, we built machine learning models to predict the TB age-standardised death rate in 2035. Results We found that the global age-standardised death rate of TB attributable to alcohol consumption declined from 5.35 (95% uncertainty interval (UI) = 3.51, 7.00) in 1990 to 2.54 (95% UI = 1.65, 3.33) in 2019, with significant declines in Andean Latin America (AAPC = -7.59; 95% confidence interval (CI) = -8, -7.16, P < 0.05), East Asia (AAPC = -7.32; 95% CI = -8.00, -6.62, P < 0.05), and Central Latin America (AAPC = -7.31; 95% CI = -7.63, -6.99, P < 0.05). However, there was an increase in a few regions, especially in parts of Central Asia. The age-standardised death rate for TB attributable to cigarette smoking declined more rapidly than that for TB attributable to alcohol, from 7.45 (95% UI = 6.17, 8.72) to 2.21 (95% UI = 1.78, 2.64), especially in East Asia (AAPC = -6.64; 95% CI = -7.07, -6.2, P < 0.05), North Africa and Middle East (AAPC = -6.47; 95% CI = -6.67, -6.28, P < 0.05), and Andean Latin America (AAPC = -6.31; 95% CI = -6.87, -5.75, P < 0.05). However, TB attributable to cigarette smoking increased in parts of Eastern Europe. In both TB attributable to alcohol consumption and to cigarette smoking, the age-standardised death rate was much higher in men than in women. The age-period-cohort model results showed that TB attributable to alcohol consumption was the highest in older adults aged 60-80 years, while TB attributable to cigarette smoking was the highest in adults aged 40-60 years. Machine learning models projected that by 2035, the age-standardised death rate for TB attributable to alcohol consumption would be 1.29 (per 100 000 population), while the age-standardised death rate for TB attributable to cigarette consumption would be 0.37 (per 100 000 population), which might not achieve the 2035 global target for eliminating TB. Conclusions Globally, the age-standardised death rate for TB attributable to alcohol consumption declined slower than that attributable to cigarette smoking. Controlling these two factors would help achieve the global goal of TB elimination, especially for the elderly who are at high risk.
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Affiliation(s)
- Wu Jinyi
- Wuhan Fourth Hospital, Wuhan, China
| | - Yue Zhang
- Shanxi Medical University, Taiyuan, China
| | - Kai Wang
- Wuhan Fourth Hospital, Wuhan, China
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12
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Muniyandi M, Nagarajan K, Mathiyazhagan K, Giridharan P, Thiruvengadam K, Krishnan R. The Predicted Potential Impact of COVID-19 Pandemic on Tuberculosis Epidemic in Tamil Nadu, South India. Trop Med Infect Dis 2024; 9:12. [PMID: 38251209 PMCID: PMC10821053 DOI: 10.3390/tropicalmed9010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE To estimate the prevalence and incidence of TB before and during the COVID-19 pandemic in Tamil Nadu, south India. METHODS In the present study, the effect of COVID-19 epidemiology on the TB epidemic was assessed by the SEIR (Susceptible-Exposed-Infected-Recovered), a compartmental epidemiological model. The model input parameters on compartments of TB and incidence of COVID-19 were collected from the published literature. Based on the data collected, point prevalence and incidence of TB per 100,000 population is calculated with and without COVID-19. A prediction was conducted up to 2025, trend analysis was performed, and a trend chi-square test and chi-square test of independence were used to test the difference between the prevalence with and without COVID-19. R software 2000 (R 4.0.0) was used for analysis. RESULTS The TB prevalence without and with COVID-19 decreases from 289 in 2020 to 271 in 2025 and from 289 in 2020 to 269 in 2025, respectively. Similarly, the incidence of TB was decreasing from 144 in 2020 to 135 in 2025 without COVID-19 and 143 in 2020 to 134 in 2025 with COVID-19. Though the TB burden is decreasing over the years, the trend was not statistically significant (p > 0.05). With respect to the district level, the prevalence and incidence of TB with and without COVID-19 is also found to be decreasing over the years. It was also found that the difference in the prevalence and incidence of TB with and without COVID-19 was not statically significant. CONCLUSION The results of our study shows that there was an annual decline of around 2% from 2020 to 2025 in the trend of the prevalence and incidence of TB with and without COVID-19. Overall, there is a reduction, but it was not significant, and there is no significant effect of COVID-19 on TB in Tamil Nadu.
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Bai W, Ameyaw EK. Global, regional and national trends in tuberculosis incidence and main risk factors: a study using data from 2000 to 2021. BMC Public Health 2024; 24:12. [PMID: 38166735 PMCID: PMC10759569 DOI: 10.1186/s12889-023-17495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Despite the significant progress over the years, Tuberculosis remains a major public health concern and a danger to global health. This study aimed to analyze the spatial and temporal characteristics of the incidence of tuberculosis and its risk factors and to predict future trends in the incidence of Tuberculosis. METHODS This study used secondary data on tuberculosis incidence and tuberculosis risk factor data from 209 countries and regions worldwide between 2000 and 2021 for analysis. Specifically, this study analyses the spatial autocorrelation of Tuberculosis incidence from 2000 to 2021 by calculating Moran's I and identified risk factors for Tuberculosis incidence by multiple stepwise linear regression analysis. We also used the Autoregressive Integrated Moving Average model to predict the trend of Tuberculosis incidence to 2030. This study used ArcGIS Pro, Geoda and R studio 4.2.2 for analysis. RESULTS The study found the global incidence of Tuberculosis and its spatial autocorrelation trends from 2000 to 2021 showed a general downward trend, but its spatial autocorrelation trends remained significant (Moran's I = 0.465, P < 0.001). The risk factors for Tuberculosis incidence are also geographically specific. Low literacy rate was identified as the most pervasive and profound risk factor for Tuberculosis. CONCLUSIONS This study shows the global spatial and temporal status of Tuberculosis incidence and risk factors. Although the incidence of Tuberculosis and Moran's Index of Tuberculosis are both declining, there are still differences in Tuberculosis risk factors across countries and regions. Even though literacy rate is the leading risk factor affecting the largest number of countries and regions, there are still many countries and regions where gender (male) is the leading risk factor. In addition, at the current rate of decline in Tuberculosis incidence, the World Health Organization's goal of ending the Tuberculosis pandemic by 2030 will be difficult to achieve. Targeted preventive interventions, such as health education and regular screening of Tuberculosis-prone populations are needed if we are to achieve the goal. The results of this study will help policymakers to identify high-risk groups based on differences in TB risk factors in different areas, rationalize the allocation of healthcare resources, and provide timely health education, so as to formulate more effective Tuberculosis prevention and control policies.
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Affiliation(s)
- Wentao Bai
- School of Graduate Studies, Lingnan University, Tuen Mun, New Territories, Hong Kong.
| | - Edward Kwabena Ameyaw
- School of Graduate Studies, Lingnan University, Tuen Mun, New Territories, Hong Kong
- L & E Research Consult Ltd, Upper West Region, Ghana
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14
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Gupta P, Sandhu D, Gupta V, Singhal L. Triple Burden: The Incorrigible Threat of Tuberculosis, HIV, and COVID-19. Infect Disord Drug Targets 2024; 24:1-7. [PMID: 37937570 DOI: 10.2174/0118715265259959231031104820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 11/09/2023]
Abstract
The Coronavirus-19 (COVID-19) hasn't seen the dawn since its emergence, however waxing and waning has resulted in the emergence of deadly variants. The effects of pandemic have not been limited to its virulence, but have rather conferred multiple collateral effects, especially in developing countries; thereby, designating it as a SYNDEMIC. The same culminated in neglect of non-COVID-19 conditions like tuberculosis (TB) and human immunodeficiency virus-acquired immunodeficiency syndrome (HIV/AIDS). Besides being the prognostic factor for severe COVID-19, these infections in hidden pockets served as reservoir for emergence of the deadly Omicron. Another significant impact of this juxtaposition was on the delivery of healthcare services for TB and HIV. The unanticipated COVID-19 pandemic turned the path of ongoing progress of elimination programs. Direct consequences of the COVID-19 pandemic were pronounced on diagnosis, treatment, and services for patients with TB and HIV. Essential TB services were reallocated to the COVID-19 rapid response task force. However, despite escalating the tribulations, this triple burden has simultaneously taught lessons to escalate the progress of halted programs. The pandemic has catalyzed an unusual level of collaboration among scientists, which can be exploited for TB and HIV. Fast-track diagnostics, digitalization, contact tracing, and vaccine development have enabled world to envision the same for TB/HIV. .
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Affiliation(s)
| | - Diljot Sandhu
- Department of Microbiology, GMCH-32, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, GMCH-32, Chandigarh, India
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15
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Cottam A, Manneh IL, Gindeh A, Sillah AK, Cham O, Mendy J, Barry A, Coker EG, Daffeh GK, Badjie S, Barry S, Owolabi O, Winter J, Walzl G, Sutherland JS. The impact of prior SARS-CoV-2 infection on host inflammatory cytokine profiles in patients with TB or other respiratory diseases. Front Immunol 2023; 14:1292486. [PMID: 38179046 PMCID: PMC10764540 DOI: 10.3389/fimmu.2023.1292486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
Background Tuberculosis (TB) and COVID-19 are the two leading causes of infectious disease mortality worldwide, and their overlap is likely frequent and inevitable. Previous research has shown increased mortality in TB/COVID-coinfected individuals, and emerging evidence suggests that COVID-19 may increase susceptibility to TB. However, the immunological mechanisms underlying these interactions remain unclear. In this study, we aimed to elucidate the impact of prior or concurrent COVID-19 infection on immune profiles of TB patients and those with other respiratory diseases (ORD). Methods Serum and nasopharyngeal samples were collected from 161 Gambian adolescents and adults with either TB or an ORD. Concurrent COVID-19 infection was determined by PCR, while prior COVID-19 was defined by antibody seropositivity. Multiplex cytokine immunoassays were used to quantify 27 cytokines and chemokines in patient serum samples at baseline, and throughout treatment in TB patients. Results Strikingly, TB and ORD patients with prior COVID-19 infection were found to have significantly reduced expression of several cytokines, including IL-1β, TNF-α and IL-7, compared to those without (p<0.035). Moreover, at month-six of anti-TB treatment, seropositive patients had lower serum Basic FGF (p=0.0115), IL-1β (p=0.0326) and IL-8 (p=0.0021) than seronegative. TB patients with acute COVID-19 coinfection had lower levels of IL-8, IL-13, TNF-α and IP-10 than TB-only patients, though these trends did not reach significance (p>0.035). Conclusions Our findings demonstrate that COVID-19 infection alters the subsequent response to TB and ORDs, potentially contributing to pathogenesis. Further work is necessary to determine whether COVID-19 infection accelerates TB disease progression, though our results experimentally support this hypothesis.
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Affiliation(s)
- Annabelle Cottam
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ismaila L. Manneh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Awa Gindeh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Abdou K. Sillah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Ousainou Cham
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Joseph Mendy
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Amadou Barry
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Edward G. Coker
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Georgetta K. Daffeh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Simon Badjie
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Salieu Barry
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Olumuyiwa Owolabi
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Jill Winter
- Catalysis Foundation for Health, Emeryville, CA, United States
| | - Gerhard Walzl
- Department of Molecular Biology and Human Genetics, University of Stellenbosch, Tygerberg, South Africa
| | - Jayne S. Sutherland
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
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Liu Y, Sun R, Zhang H, Huang J, Chen M, Zhan Y, Xiang J, Yuan J, Zou H, Martinez L, Yang C. Trends and predictions of tuberculosis notification in mainland China during and after the COVID-19 pandemic. J Infect 2023; 87:e100-e103. [PMID: 38251471 DOI: 10.1016/j.jinf.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Yueting Liu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China; Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Ruoyao Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Hongyin Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jinrong Huang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China; Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Meiru Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China; Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Yiqiang Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jianbang Xiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jianhui Yuan
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China.
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Chongguang Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China; Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China.
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Sentís A, Prats-Uribe A, Peixoto VR, Caylà JA, Gomes MD, Sousa S, Duarte R, Carvalho I, Carvalho C. Decline of tuberculosis notification rate in different populations and regions in Portugal, 2010-2017. Pulmonology 2023; 29 Suppl 4:S36-S43. [PMID: 34544672 DOI: 10.1016/j.pulmoe.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes. METHODS We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010-2017, disaggregated by region, age group, nationality and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models. RESULTS The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive). CONCLUSIONS The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.
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Affiliation(s)
- A Sentís
- Epiconcept, Epidemiology Department, Paris, France; Pompeu Fabra University (UPF), Barcelona, Spain
| | - A Prats-Uribe
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - V R Peixoto
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal; Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
| | - J A Caylà
- Foundation of Tuberculosis Research Unit of Barcelona, Spain
| | - M D Gomes
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal; National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal
| | - S Sousa
- National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - R Duarte
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal; Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal; Pulmonology Department, Hospital Centre of Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
| | - I Carvalho
- National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal; Pediatric Department, Hospital Centre of Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
| | - C Carvalho
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.
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Muneeb Hassan M, Ameeq M, Jamal F, Tahir MH, Mendy JT. Prevalence of covid-19 among patients with chronic obstructive pulmonary disease and tuberculosis. Ann Med 2023; 55:285-291. [PMID: 36594409 PMCID: PMC9815254 DOI: 10.1080/07853890.2022.2160491] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The exhaustive information about non-communicable diseases associated with COVID-19 and severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) are getting easier to find in the literature. However, there is a lack of knowledge regarding tuberculosis (TB) and chronic obstructed pulmonary disease (COPD), with numerous infections in COVID-19 patients. OBJECTIVES Priority is placed on determining the patient's prognosis based on the presence or absence of TB and COPD. Additionally, a comparison is made between the risk of death and the likelihood of recovery in terms of time in COVID-19 patients who have either COPD or TB. METHODOLOGY At the DHQ Hospital in Muzaffargarh, Punjab, Pakistan, 498 COVID-19 patients with TB and COPD were studied retrospectively. The duration of study started in February 2022 and concluded in August 2022. The Kaplan-Meier curves described time-to-death and time-to-recovery stratified by TB and COPD status. The Wilcoxon test compared the survival rates of people with TB and COPD in two matched paired groups and their status differences with their standard of living. RESULTS The risk of death in COVID-19 patients with TB was 1.476 times higher than in those without (95% CI: 0.949-2.295). The recovery risk in COVID-19 patients with TB was 0.677 times lower than in those without (95% CI: 0.436-1.054). Similarly, patients with TB had a significantly shorter time to death (p=.001) and longer time to recovery (p=.001). CONCLUSIONS According to the findings, the most significant contributor to an increased risk of morbidity and mortality in TB and COPD patients was the COVID-19.KEY MESSAGESSARS-Cov-19 is a new challenge for the universe in terms of prevention and treatment for people with tuberculosis and chronic obstructive pulmonary disease, among other diseases.Propensity score matching to control for potential biases.Compared to hospitalized patients with and without (TB and COPD) had an equivalently higher mortality rate.
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Affiliation(s)
| | - Muhammad Ameeq
- Department of Statistics, The Islamia University, Bahawalpur, Pakistan
| | - Farrukh Jamal
- Department of Statistics, The Islamia University, Bahawalpur, Pakistan
| | - Muhammad H Tahir
- Department of Statistics, The Islamia University, Bahawalpur, Pakistan
| | - John T Mendy
- Department of Mathematics, School of Arts and Science, University of The Gambia, Serekunda, The Gambia
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19
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Morena D, Campos C, Castillo M, Alonso M, Benavent M, Izquierdo JL. Impact of the COVID-19 Pandemic on the Epidemiological Situation of Pulmonary Tuberculosis-Using Natural Language Processing. J Pers Med 2023; 13:1629. [PMID: 38138856 PMCID: PMC10744898 DOI: 10.3390/jpm13121629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We aimed to analyze the impact of the COVID-19 pandemic on pulmonary tuberculosis (TB) using artificial intelligence. To do so, we compared the real-life situation during the pandemic with the pre-2020 situation. METHODS This non-interventional, retrospective, observational study applied natural language processing to the electronic health records of the Castilla-La Mancha region of Spain. The analysis was conducted from January 2015 to December 2020. RESULTS A total of 2592 patients were diagnosed with pulmonary tuberculosis; 64.6% were males, and the mean age was 53.5 years (95%CI 53.0-54.0). In 2020, pulmonary tuberculosis diagnoses dropped by 28% compared to 2019. In total, 62 (14.2%) patients were diagnosed with COVID-19 and pulmonary tuberculosis coinfection in 2020, with a mean age of 52.3 years (95%CI 48.3-56.2). The main symptoms in these patients were dyspnea (27.4%) and cough (35.5%), although their comorbidities were no greater than patients with isolated TB. The female sex was more frequently affected, representing 53.4% of this patient subgroup. CONCLUSIONS During the first year of the COVID-19 pandemic, a decrease was observed in the incidence of pulmonary tuberculosis. Women presented a significantly higher risk for pulmonary tuberculosis and COVID-19 coinfection, although the symptoms were not more severe than patients diagnosed with pulmonary tuberculosis alone.
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Affiliation(s)
- Diego Morena
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
- Programa de Doctorado en Ciencias de la Salud, Universidad de Alcalá, 28801 Madrid, Spain
| | - Carolina Campos
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
| | - María Castillo
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
| | - Miguel Alonso
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
| | | | - José Luis Izquierdo
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, 28801 Madrid, Spain
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20
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Mui WL, Parekh FK, Tseng AS, Toro J, Craig T, Ndugga M, Schmidt AC, Dagnew AF, Penz C, Belai G. Data-driven epidemiologic approach to conducting site feasibility for a global phase III tuberculosis vaccine clinical trial. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002544. [PMID: 37939024 PMCID: PMC10631637 DOI: 10.1371/journal.pgph.0002544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
An efficacious tuberculosis (TB) vaccine is critical to reducing the global burden of TB. TB vaccine trials require the identification of multiple sites globally that have both a high incidence of TB and the capacity to conduct a clinical trial. To expand the diversity of potential phase III TB vaccine trial sites to be considered for inclusion, we describe a novel epidemiologic method that incorporates approaches from a variety of public health practices. Our approach incorporates analytic methodology to enable quantification and validation of qualitative information from disparate data sources, and epidemiologic analysis to systematically assess site-specific TB epidemiology. The integration of robust data-driven practices, and more quantitatively focused analysis, allowed for the objective evaluation of sites, which resulted in the identification of sites and catchment areas with high TB burden that may not have been previously considered. This suggests that an integrated epidemiologic methodology, not traditionally utilized for clinical trial site evaluations, could be integrated into site feasibility assessments as it results in more rapid site identification and reduces unintended bias.
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Affiliation(s)
- Wai-Ling Mui
- EpiPointe, Cary, North Carolina, United States of America
| | | | | | - Joy Toro
- FHI Clinical, Durham, North Carolina, United States of America
| | - Taylor Craig
- FHI Clinical, Durham, North Carolina, United States of America
| | - Maggwa Ndugga
- FHI Clinical, Durham, North Carolina, United States of America
| | - Alexander C. Schmidt
- Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts, United States of America
| | - Alemnew F. Dagnew
- Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts, United States of America
| | - Craig Penz
- Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts, United States of America
| | - Ghiorghis Belai
- FHI Clinical, Durham, North Carolina, United States of America
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21
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Arinaminpathy N, Mukadi YD, Bloom A, Vincent C, Ahmedov S. Meeting the 2030 END TB goals in the wake of COVID-19: A modelling study of countries in the USAID TB portfolio. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001271. [PMID: 37870997 PMCID: PMC10593207 DOI: 10.1371/journal.pgph.0001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/10/2023] [Indexed: 10/25/2023]
Abstract
Progress towards the 2030 End TB goals has seen severe setbacks due to disruptions arising from the COVID-19 pandemic. For governments and international partner organizations supporting the global TB response, there is a need to assess what level of effort is now needed to reach these goals. Using mathematical modelling, we addressed this question for the countries being supported by the United States Agency for International Development (USAID). We aggregated the 24 countries in the USAID portfolio into three geographical country groups: South Asia; sub-Saharan Africa; and Central Asian Republics/Europe (CAR/EU). From 2023 onwards we modelled a combination of interventions acting at different stages of the care cascade, including improved diagnostics; reducing the patient care seeking delay; and the rollout of a disease-preventing vaccine from 2025 onwards. We found that in all three country groups, meeting the End TB goals by 2030 will require a combination of interventions acting at stages of the TB care cascade. Specific priorities may depend on country settings, for example with public-private mix playing an important role in countries in South Asia and elsewhere. When a vaccine becomes available, its required coverage to meet the 2030 goals will vary by setting, depending on the amount of preventive therapy that has already been implemented. Monitoring the number-needed-to-test to identify 1 person with TB in community settings can provide a useful measure of progress towards the End TB goals.
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Affiliation(s)
- Nimalan Arinaminpathy
- MRC Centre for Global Infectious Disease Analysis, Imperial College, London, United Kingdom
| | - Ya Diul Mukadi
- United States Agency for International Development, Washington, DC, United States of America
| | - Amy Bloom
- United States Agency for International Development, Washington, DC, United States of America
| | - Cheri Vincent
- United States Agency for International Development, Washington, DC, United States of America
| | - Sevim Ahmedov
- United States Agency for International Development, Washington, DC, United States of America
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22
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Reid M, Agbassi YJP, Arinaminpathy N, Bercasio A, Bhargava A, Bhargava M, Bloom A, Cattamanchi A, Chaisson R, Chin D, Churchyard G, Cox H, Denkinger CM, Ditiu L, Dowdy D, Dybul M, Fauci A, Fedaku E, Gidado M, Harrington M, Hauser J, Heitkamp P, Herbert N, Herna Sari A, Hopewell P, Kendall E, Khan A, Kim A, Koek I, Kondratyuk S, Krishnan N, Ku CC, Lessem E, McConnell EV, Nahid P, Oliver M, Pai M, Raviglione M, Ryckman T, Schäferhoff M, Silva S, Small P, Stallworthy G, Temesgen Z, van Weezenbeek K, Vassall A, Velásquez GE, Venkatesan N, Yamey G, Zimmerman A, Jamison D, Swaminathan S, Goosby E. Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis. Lancet 2023; 402:1473-1498. [PMID: 37716363 DOI: 10.1016/s0140-6736(23)01379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/14/2023] [Accepted: 06/29/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Michael Reid
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Yvan Jean Patrick Agbassi
- Global TB Community Advisory Board, Abidjan, Côte d'Ivoire, Yenepoya Medical College, Mangalore, India
| | | | - Alyssa Bercasio
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Anurag Bhargava
- Department of General Medicine, Yenepoya Medical College, Mangalore, India
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, India
| | - Amy Bloom
- Division of Tuberculosis, Bureau of Global Health, USAID, Washington, DC, USA
| | | | - Richard Chaisson
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Chin
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | | | - Helen Cox
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Claudia M Denkinger
- Heidelberg University Hospital, German Center of Infection Research, Heidelberg, Germany
| | | | - David Dowdy
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Dybul
- Department of Medicine, Center for Global Health Practice and Impact, Georgetown University, Washington, DC, USA
| | - Anthony Fauci
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Petra Heitkamp
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Nick Herbert
- Global TB Caucus, Houses of Parliament, London, UK
| | | | - Philip Hopewell
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Emily Kendall
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aamir Khan
- Interactive Research & Development, Karachi, Pakistan
| | - Andrew Kim
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Nalini Krishnan
- Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India
| | - Chu-Chang Ku
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Erica Lessem
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Payam Nahid
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Mario Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Theresa Ryckman
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sachin Silva
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | | | | | | | | | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Gustavo E Velásquez
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Dean Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Eric Goosby
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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23
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Zhang Y, Zhang L, Gao W, Li M, Luo Q, Xiang Y, Bao K. The impact of COVID-19 pandemic on reported tuberculosis incidence and mortality in China: An interrupted time series analysis. J Glob Health 2023; 13:06043. [PMID: 37824176 PMCID: PMC10569365 DOI: 10.7189/jogh.13.06043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Background The reported number of cases and deaths from common infectious diseases can change during major public health crises. We explored whether the coronavirus disease 2019 (COVID-19) had an impact on tuberculosis (TB) incidence and mortality in China based on routinely reported TB data. Methods We used TB data used from the monthly national notifiable infectious disease reports in China from January 2015 to January 2023. Based on an interrupted time series (ITS) design, we applied Poisson and negative binomial regression models to assess the changes of reported TB incidence and mortality before and during the COVID-19 pandemic. Results We found a significant and immediate decrease in the levels of both reported TB incidence (relative risk (RR) = 0.887; 95% confidence interval (CI) = 0.810-0.973) and mortality (RR = 0.448; 95% CI = 0.351-0.572) at the start of COVID-19 outbreak. During the pandemic, the slope of reported incidence decreased significantly (RR = 0.994; 95% CI = 0.989-0.999), while the slope of reported mortality increased sharply (RR = 1.032; 95% CI = 1.022-1.041) owing to an abrupt rise in reported mortality after January 2022. Conclusions Both TB incidence and mortality decreased immediately at the start of the COVID-19 pandemic. Over a longer period, the COVID-19 pandemic had contributed to a sustained and more significant decrease in reported incidence, and a delayed but sharp increase in reported mortality.
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Affiliation(s)
- Yuqi Zhang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Li Zhang
- TB Prevention and Control Institute, Lanzhou Municipal Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Wenlong Gao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ming Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Qiuxia Luo
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yuanyuan Xiang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Kai Bao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
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24
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Allué-Guardia A, Garcia-Vilanova A, Schami AM, Olmo-Fontánez AM, Hicks A, Peters J, Maselli DJ, Wewers MD, Wang Y, Torrelles JB. Exposure of Mycobacterium tuberculosis to human alveolar lining fluid shows temporal and strain-specific adaptation to the lung environment. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.27.559381. [PMID: 37808780 PMCID: PMC10557635 DOI: 10.1101/2023.09.27.559381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Upon infection, Mycobacterium tuberculosis ( M.tb ) reaches the alveolar space and comes in close contact with human alveolar lining fluid (ALF) for an uncertain period of time prior to its encounter with alveolar cells. We showed that homeostatic ALF hydrolytic enzymes modify the M.tb cell envelope, driving M.tb -host cell interactions. Still, the contribution of ALF during M.tb infection is poorly understood. Here, we exposed 4 M.tb strains with different levels of virulence, transmissibility, and drug resistance (DR) to physiological concentrations of human ALF for 15-min and 12-h, and performed RNA sequencing. Gene expression analysis showed a temporal and strain-specific adaptation to human ALF. Differential expression (DE) of ALF-exposed vs. unexposed M.tb revealed a total of 397 DE genes associated with lipid metabolism, cell envelope and processes, intermediary metabolism and respiration, and regulatory proteins, among others. Most DE genes were detected at 12-h post-ALF exposure, with DR- M.tb strain W-7642 having the highest number of DE genes. Interestingly, genes from the KstR2 regulon, which controls the degradation of cholesterol C and D rings, were significantly upregulated in all strains post-ALF exposure. These results indicate that M.tb -ALF contact drives initial metabolic and physiologic changes in M.tb , with potential implications in infection outcome. IMPORTANCE Tuberculosis, caused by airborne pathogen Mycobacterium tuberculosis ( M.tb ), is one of the leading causes of mortality worldwide. Upon infection, M.tb reaches the alveoli and gets in contact with human alveolar lining fluid (ALF), where ALF hydrolases modify the M.tb cell envelope driving subsequent M.tb -host cell interactions. Still, the contributions of ALF during infection are poorly understood. We exposed 4 M.tb strains to ALF for 15-min and 12-h and performed RNA sequencing, demonstrating a temporal and strain-specific adaptation of M.tb to ALF. Interestingly, genes associated with cholesterol degradation were highly upregulated in all strains. This study shows for the first time that ALF drives global metabolic changes in M.tb during the initial stages of the infection, with potential implications in disease outcome. Biologically relevant networks and common and strain-specific bacterial determinants derived from this study could be further investigated as potential therapeutic candidates.
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25
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Veettil SK, Schwerer L, Kategeaw W, Toth D, Samore MH, Hutubessy R, Chaiyakunapruk N. Scoping review of modelling studies assessing the impact of disruptions to essential health services during COVID-19. BMJ Open 2023; 13:e071799. [PMID: 37751952 PMCID: PMC10533712 DOI: 10.1136/bmjopen-2023-071799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Studies assessing the indirect impact of COVID-19 using mathematical models have increased in recent years. This scoping review aims to identify modelling studies assessing the potential impact of disruptions to essential health services caused by COVID-19 and to summarise the characteristics of disruption and the models used to assess the disruptions. METHODS Eligible studies were included if they used any models to assess the impact of COVID-19 disruptions on any health services. Articles published from January 2020 to December 2022 were identified from PubMed, Embase and CINAHL, using detailed searches with key concepts including COVID-19, modelling and healthcare disruptions. Two reviewers independently extracted the data in four domains. A descriptive analysis of the included studies was performed under the format of a narrative report. RESULTS This scoping review has identified a total of 52 modelling studies that employed several models (n=116) to assess the potential impact of disruptions to essential health services. The majority of the models were simulation models (n=86; 74.1%). Studies covered a wide range of health conditions from infectious diseases to non-communicable diseases. COVID-19 has been reported to disrupt supply of health services, demand for health services and social change affecting factors that influence health. The most common outcomes reported in the studies were clinical outcomes such as mortality and morbidity. Twenty-five studies modelled various mitigation strategies; maintaining critical services by ensuring resources and access to services are found to be a priority for reducing the overall impact. CONCLUSION A number of models were used to assess the potential impact of disruptions to essential health services on various outcomes. There is a need for collaboration among stakeholders to enhance the usefulness of any modelling. Future studies should consider disparity issues for more comprehensive findings that could ultimately facilitate policy decision-making to maximise benefits to all.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- School of Medicine, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia
| | - Luke Schwerer
- USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Warittakorn Kategeaw
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Damon Toth
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Mathematics, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Matthew H Samore
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals (IVB) Department, World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
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26
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Gabdullina M, Maes EF, Horth RZ, Dzhazybekova P, Amanova GN, Zikriyarova S, Nabirova DA. COVID-19 pandemic and other factors associated with unfavorable tuberculosis treatment outcomes-Almaty, Kazakhstan, 2018-2021. Front Public Health 2023; 11:1247661. [PMID: 37808989 PMCID: PMC10552263 DOI: 10.3389/fpubh.2023.1247661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction The COVID-19 pandemic negatively influenced the availability of tuberculosis (TB) services, such as detection, diagnosis and treatment, around the world, including Kazakhstan. We set out to estimate the COVID-19 pandemic influence on TB treatment outcomes by comparing outcomes among people starting treatment before the pandemic (2018-2019) and during the pandemic (2020-2021) and to determine risk factors associated with unfavorable outcomes. Methods We conducted a retrospective cohort study among all people newly diagnosed with drug-sensitive pulmonary or extrapulmonary TB at least 18 years old who initiated treatment from 2018 to 2021 in Almaty. We abstracted data from the national electronic TB register. Unfavorable treatment outcomes were ineffective treatment, death, loss to follow-up, results not evaluated, and transferred. We used multivariable Poisson regression to calculate adjusted relative risk (aRR) and 95% confidence intervals (95%CI). Results Among 1548 people newly diagnosed with TB during the study period, average age was 43 years (range 18-93) and 52% were male. The number of people initiating treatment was higher before than the pandemic (935 vs. 613, respectively). There was significantly different proportions before compared to during the pandemic for people diagnosed through routine screening (39% vs. 31%, p < 0.001), 60 years and older (16% vs. 22%, p = 0.005), and with diabetes (5% vs. 8%, p = 0.017). There was no difference in the proportion of HIV (8% in both periods). Unfavorable outcomes increased from 11 to 20% during the pandemic (aRR = 1.83; 95% CI: 1.44-2.31). Case fatality rose from 6 to 9% (p = 0.038). Risk factors for unfavorable TB treatment outcomes among all participants were being male (aRR = 1.44, 95%CI = 1.12-1.85), having HIV (aRR = 2.72, 95%CI = 1.99-3.72), having alcohol use disorder (aRR = 2.58, 95%CI = 1.83-3.62) and experiencing homelessness (aRR = 2.94, 95%CI = 1.80-4.80). Protective factors were being 18-39 years old (aRR = 0.33, 95%CI = 0.24-0.44) and 40-59 years old (aRR = 0.56, 95%CI = 0.41-0.75) compared to 60 years old and up. Conclusion COVID-19 pandemic was associated with unfavorable treatment outcomes for people newly diagnosed with drug-sensitive TB in Almaty, Kazakhstan. People with fewer comorbidities were at increased risk. Results point to the need to maintain continuity of care for persons on TB treatment, especially those at higher risk for poor outcomes during periods of healthcare service disruption.
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Affiliation(s)
- Malika Gabdullina
- Central Asia Field Epidemiology Training Program, Almaty, Kazakhstan
- Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- National Scientific Center of Phthisiopulmonology, Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan
| | - Edmond F. Maes
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Roberta Z. Horth
- Central Asia Field Epidemiology Training Program, Almaty, Kazakhstan
- Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- United States Centers for Disease Control and Prevention, Central Asia Office, Almaty, Kazakhstan
| | - Panagul Dzhazybekova
- Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring, Almaty, Kazakhstan
| | - Gulzhan N. Amanova
- Central Asia Field Epidemiology Training Program, Almaty, Kazakhstan
- Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring, Almaty, Kazakhstan
| | - Sanam Zikriyarova
- Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Dilyara A. Nabirova
- Central Asia Field Epidemiology Training Program, Almaty, Kazakhstan
- Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- United States Centers for Disease Control and Prevention, Central Asia Office, Almaty, Kazakhstan
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Osei E, Amu H, Kye-Duodu G, Kwabla MP, Danso E, Binka FN, Kim SY. Impact of COVID-19 pandemic on Tuberculosis and HIV services in Ghana: An interrupted time series analysis. PLoS One 2023; 18:e0291808. [PMID: 37729176 PMCID: PMC10511085 DOI: 10.1371/journal.pone.0291808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION The Coronavirus disease 2019 (COVID-19) burden, coupled with unprecedented control measures including physical distancing, travel bans, and lockdowns of cities, implemented to stop the spread of the virus, have undoubtedly far-reaching aftereffects on other diseases. In low and middle-income countries (LMICs), a particular worry is the potential impact on Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), as a consequence of possible disruption to health services and limiting access to needed life-saving health care. In Ghana, there is a paucity of information regarding the impact of COVID-19 on disease control, particularly TB and HIV control. This study sought to contribute to bridging this knowledge gap. METHOD The study involved the analysis of secondary data obtained from the District Health Information Management System-2 (DHIMS-2) database of Ghana Health Service, from 2016 to 2020. Data were analysed using an interrupted time-series regression approach to estimate the impact of COVID-19 on TB case notification, HIV testing, and Antiretroviral Therapy (ART) initiations, using March 2020 as the event period. RESULTS The study showed that during the COVID-19 pandemic period, there was an abrupt decline of 20.5% (955CI: 16.0%, 24.5%) in TB case notifications in April and 32.7% (95%CI: 28.8%, 39.1%) in May 2020, with a median monthly decline of 21.4% from April-December 2020. A cumulative loss of 2,128 (20%; 95%CI: 13.3%, 26.7%) TB cases was observed nationwide as of December 2020. There was also a 40.3% decrease in people presenting for HIV tests in the first month of COVID-19 (April 2020) and a cumulative loss of 262620 (26.5%) HIV tests as of December 2020 attributable to the COVID-19 pandemic. ART initiations increased by 39.2% in the first month and thereafter decreased by an average of 10% per month from May to September 2020. Cumulatively, 443 (1.9%) more of the people living with HIV initiated ART during the pandemic period, however, this was not statistically significant. CONCLUSION This study demonstrated that the COVID-19 pandemic negatively impacted TB case notifications and HIV testing and counselling services, However, ART initiation was generally not impacted during the first year of the pandemic. Proactive approaches aimed at actively finding the thousands of individuals with TB who were missed in 2020 and increasing HIV testing and counselling and subsequent treatment initiations should be prioritised.
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Affiliation(s)
- Eric Osei
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Hubert Amu
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Gideon Kye-Duodu
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Mavis Pearl Kwabla
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Evans Danso
- Department of Policy Planning Monitoring and Evaluation, Mental Health Authority, Accra, Ghana
| | - Fred N. Binka
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - So Yoon Kim
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
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Scheunemann A, Moolla A, Mongwenyana C, Mkize N, Rassool M, Jezile V, Evans D. The lived experiences of tuberculosis survivors during the COVID-19 pandemic and government lockdown in South Africa: a qualitative analysis. BMC Public Health 2023; 23:1729. [PMID: 37670253 PMCID: PMC10481461 DOI: 10.1186/s12889-023-16657-w] [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: 04/25/2023] [Accepted: 08/30/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major health concern in South Africa, where prior to COVID-19 it was associated with more deaths than any other infectious disease. The COVID-19 pandemic disrupted gains made in the global response to TB, having a serious impact on the most vulnerable. COVID-19 and TB are both severe respiratory infections, where infection with one places individuals at increased risk for negative health outcomes for the other. Even after completing TB treatment, TB survivors remain economically vulnerable and continue to be negatively affected by TB. METHODS This cross-sectional qualitative study, which was part of a larger longitudinal study in South Africa, explored how TB survivors' experienced the COVID-19 pandemic and government restrictions. Participants were identified through purposive sampling and were recruited and interviewed at a large public hospital in Gauteng. Data were analyzed thematically, using a constructivist research paradigm and both inductive and deductive codebook development. RESULTS Participants (n = 11) were adults (24-74 years of age; more than half male or foreign nationals) who had successfully completed treatment for pulmonary TB in the past two years. Participants were generally found to be physically, socioeconomically, and emotionally vulnerable, with the COVID-19 pandemic exacerbating or causing a recurrence of many of the same stressors they had faced with TB. Coping strategies during COVID similarly mirrored those used during TB diagnosis and treatment, including social support, financial resources, distraction, spirituality, and inner strength. CONCLUSIONS Implications and suggestions for future directions include fostering and maintaining a strong network of social support for TB survivors.
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Affiliation(s)
- Ann Scheunemann
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
- TH Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Aneesa Moolla
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Constance Mongwenyana
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neliswe Mkize
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed Rassool
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg, South Africa
| | - Vuyokazi Jezile
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Tovar M, Moreno Y, Sanz J. Addressing mechanism bias in model-based impact forecasts of new tuberculosis vaccines. Nat Commun 2023; 14:5312. [PMID: 37658078 PMCID: PMC10474143 DOI: 10.1038/s41467-023-40976-6] [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: 11/04/2022] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
In tuberculosis (TB) vaccine development, multiple factors hinder the design and interpretation of the clinical trials used to estimate vaccine efficacy. The complex transmission chain of TB includes multiple routes to disease, making it hard to link the vaccine efficacy observed in a trial to specific protective mechanisms. Here, we present a Bayesian framework to evaluate the compatibility of different vaccine descriptions with clinical trial outcomes, unlocking impact forecasting from vaccines whose specific mechanisms of action are unknown. Applying our method to the analysis of the M72/AS01E vaccine trial -conducted on IGRA+ individuals- as a case study, we found that most plausible models for this vaccine needed to include protection against, at least, two over the three possible routes to active TB classically considered in the literature: namely, primary TB, latent TB reactivation and TB upon re-infection. Gathering new data regarding the impact of TB vaccines in various epidemiological settings would be instrumental to improve our model estimates of the underlying mechanisms.
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Affiliation(s)
- M Tovar
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, 50009, Spain
- Department of Theoretical Physics, University of Zaragoza, Zaragoza, 50009, Spain
| | - Y Moreno
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, 50009, Spain
- Department of Theoretical Physics, University of Zaragoza, Zaragoza, 50009, Spain
- Centai Institute S.p.A, 10138, Torino, Italy
| | - J Sanz
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, 50009, Spain.
- Department of Theoretical Physics, University of Zaragoza, Zaragoza, 50009, Spain.
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Falzon D, Zignol M, Bastard M, Floyd K, Kasaeva T. The impact of the COVID-19 pandemic on the global tuberculosis epidemic. Front Immunol 2023; 14:1234785. [PMID: 37795102 PMCID: PMC10546619 DOI: 10.3389/fimmu.2023.1234785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/07/2023] [Indexed: 10/06/2023] Open
Abstract
Tuberculosis (TB) is a major cause of ill health worldwide. Until the coronavirus (COVID-19) pandemic, TB was the leading cause of death from a single infectious agent. COVID-19 has caused enormous health, social and economic upheavals since 2020, impairing access to essential TB services. In marked contrast to the steady global increase in TB detection between 2017 and 2019, TB notifications dropped substantially in 2020 compared with 2019 (-18%), with only a partial recovery in 2021. TB epidemiology worsened during the pandemic: the estimated 10.6 million people who fell ill with TB worldwide in 2021 is an increase of 4.5% from the previous year, reversing many years of slow decline. The annual number of TB deaths worldwide fell steadily between 2005 and 2019, reaching 1.4 million in 2019, but this trend was reversed in 2020 (1.5 million), and by 2021 global TB deaths were back to the level of 2017 (1.6 million). Intensified efforts backed by increased funding are urgently required to reverse the negative impacts of COVID-19 on TB worldwide, made more pressing by ongoing conflicts, a global energy crisis and uncertainties in food security that are likely to worsen the broader determinants of TB.
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Affiliation(s)
- Dennis Falzon
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
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Cioboata R, Biciusca V, Olteanu M, Vasile CM. COVID-19 and Tuberculosis: Unveiling the Dual Threat and Shared Solutions Perspective. J Clin Med 2023; 12:4784. [PMID: 37510899 PMCID: PMC10381217 DOI: 10.3390/jcm12144784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The year 2020 will likely be remembered as the year dominated by COVID-19, or coronavirus disease. The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for this pandemic, can be traced back to late 2019 in China. The COVID-19 pandemic has significantly impacted the tuberculosis (TB) care system, reducing TB testing and reporting. This can be attributed to the disruption of TB services and restrictions on patient movement, consequently increasing TB-related deaths. This perspective review aims to highlight the intersection between COVID-19 and TB, highlighting their dual threat and identifying shared solutions to address these two infectious diseases effectively. There are several shared commonalities between COVID-19 and tuberculosis, particularly the transmission of their causative agents, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Mycobacterium tuberculosis. Both pathogens are transmitted via respiratory tract secretions. TB and COVID-19 are diseases that can be transmitted through droplets and airborne particles, and their primary target is typically the lungs. Regarding COVID-19 diagnostics, several methods are available for rapid and accurate detection. These include RT-PCR, which can provide results within two hours, and rapid antigen test kits that offer results in just a few minutes. The availability of point-of-care self-testing further enhances convenience. On the other hand, various approaches are employed for TB diagnostics to swiftly identify active TB. These include sputum microscopy, sputum for reverse transcription polymerase chain reaction (RT-PCR), and chest X-rays. These methods enable the rapid detection of active TB on the same day, while culture-based testing may take significantly longer, ranging from 2 to 8 weeks. The utilization of diverse diagnostic tools helps ensure the timely identification and management of COVID-19 and TB cases. The quality of life of patients affected by COVID-19 and tuberculosis (TB) can be significantly impacted due to the nature of these diseases and their associated challenges. In conclusion, it is crucial to emphasize the urgent need to address the dual threat of COVID-19 and TB. Both diseases have devastated global health, and their convergence poses an even greater challenge. Collaborative efforts, research investments, and policy reforms are essential to tackle this dual threat effectively.
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Affiliation(s)
- Ramona Cioboata
- Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania
- Department of Pneumology, Victor Babes Clinical Hospital, 030303 Craiova, Romania
| | - Viorel Biciusca
- Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania
- Department of Internal Medicine, Filantropia Hospital, 050474 Craiova, Romania
| | - Mihai Olteanu
- Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania
- Department of Pneumology, Victor Babes Clinical Hospital, 030303 Craiova, Romania
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33600 Pessac, France
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Vadlamudi NK, Basham CA, Johnston JC, Ahmad Khan F, Battista Migliori G, Centis R, D'Ambrosio L, Jassat W, Davies MA, Schwartzman K, Campbell JR. The association of SARS-CoV-2 infection and tuberculosis disease with unfavorable treatment outcomes: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002163. [PMID: 37467225 DOI: 10.1371/journal.pgph.0002163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/28/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Whether SARS-CoV-2 infection and its management influence tuberculosis (TB) treatment outcomes is uncertain. We synthesized evidence on the association of SARS-CoV-2 coinfection (Coinfection Review) and its management (Clinical Management Review) on treatment outcomes among people with tuberculosis (TB) disease. METHODS We systematically searched the literature from 1 January 2020 to 6 February 2022. Primary outcomes included: unfavorable (death, treatment failure, loss-to-follow-up) TB treatment outcomes (Coinfection and Clinical Management Review) and/or severe or critical COVID-19 or death (Clinical Management Review). Study quality was assessed with an adapted Newcastle Ottawa Scale. Data were heterogeneous and a narrative review was performed. An updated search was performed on April 3, 2023. FINDINGS From 9,529 records, we included 11 studies and 7305 unique participants. No study reported data relevant to our review in their primary publication and data had to be contributed by study authors after contact. Evidence from all studies was low quality. Eight studies of 5749 persons treated for TB (286 [5%] with SARS-CoV-2) were included in the Coinfection Review. Across five studies reporting our primary outcome, there was no significant association between SARS-CoV-2 coinfection and unfavorable TB treatment outcomes. Four studies of 1572 TB patients-of whom 291 (19%) received corticosteroids or other immunomodulating treatment-were included in the Clinical Management Review, and two addressed a primary outcome. Studies were likely confounded by indication and discordant findings existed among studies. When updating our search, we still did not identify any study reporting data relevant to this review in their primary publication. INTERPRETATION No study was designed to answer our research questions of interest. It remains unclear whether TB/SARS-CoV-2 and its therapeutic management are associated with unfavorable outcomes. Research is needed to improve our understanding of risk and optimal management of persons with TB and SARS-CoV-2 infection. TRIAL REGISTRATION Registration: PROSPERO (CRD42022309818).
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Affiliation(s)
- Nirma Khatri Vadlamudi
- Faculty of Medicine, Department of Pediatrics, The University of British Columbia, Vancouver, Canada
| | - C Andrew Basham
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - James C Johnston
- Faculty of Medicine, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Faiz Ahmad Khan
- Research Institute of the McGill University Health Centre, Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Giovanni Battista Migliori
- Istituti Clinici Scientifici Maugeri IRCCS, Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Tradate, Italy
| | - Rosella Centis
- Istituti Clinici Scientifici Maugeri IRCCS, Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Tradate, Italy
| | | | - Waasila Jassat
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Division of Public Health Surveillance and Response, Johannesburg, South Africa
- Right to Care, Pretoria, South Africa
| | - Mary-Ann Davies
- Western Cape Government, Health and Wellness, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kevin Schwartzman
- Research Institute of the McGill University Health Centre, Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
- Respiratory Division, McGill University, Montreal, Canada
| | - Jonathon R Campbell
- Research Institute of the McGill University Health Centre, Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
- Department of Medicine & Department of Global and Public Health, McGill University, Montreal, Canada
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Khader Y, Abaza H, Satyanarayana S, Abu Rumman AS, Alyousfi MN. Tuberculosis Notification in Jordan, 2016-2020. EPIDEMIOLOGIA 2023; 4:276-285. [PMID: 37489499 PMCID: PMC10366717 DOI: 10.3390/epidemiologia4030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
The burden of tuberculosis (TB) in Jordan is largely unknown due to the paucity of high-quality data, under-reporting, and a lack of good quality vital registration system. This study aimed to assess the characteristics of TB patients in Jordan, determine the TB notification rate and assess the trend of TB notification in Jordan between 2016 and 2020. Methods: This study analyzed the TB Surveillance data in Jordan for the period 2016-2020. The obtained data included information on age, gender, nationality, marital status, date of symptoms onset and date of diagnosis, and site of TB. Results: During the period 2016-2020, a total of 1711 patients (989 women and 722 men) were diagnosed with and treated for tuberculosis. The mean (SD) age of patients was 30.1 (17.2) years. Almost half of them (48.4%) were Jordanians. The majority of non-Jordanian patients were from Syria, Philippines, and Bangladesh. Two thirds of patients (66.0%) had pulmonary TB and 34.0% had extra-pulmonary TB. Almost half (50.7%) of the patients were diagnosed within one month of the symptoms' onset. The average annual TB notification rate during 2016-2020 was 3.32 per 100,000 pop (4.08 per 100,000 women and 2.64 per 100,000 men). The average annual standardized notification rate was 4.13 per 100,000 pop (4.52 per 100,000 women and 3.52 per 100,000 men). The overall age-standardized notification rate increased from 3.88 per 100,000 pop in 2016 to 4.58 per 100,000 pop in 2019 and declined to 2.46 per 100,000 pop in 2020. The trend in TB notification differed significantly according to gender. While the notification increased in the last three years among women, it decreased significantly among men. Conclusions: While TB notification increased in the last three years among women, it decreased significantly among men. There is a need to ensure that the national TB plans set clear targets for reducing the burden of TB.
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Affiliation(s)
- Yousef Khader
- Center of Excellence for Applied Epidemiology, Global Health Development, Eastern Mediterranean Public Health Network, Amman 11195, Jordan
| | - Hiba Abaza
- Migration Health Division, International Organization for Migration (IOM), Amman 11953, Jordan
| | - Srinath Satyanarayana
- Migration Health Division, International Organization for Migration (IOM), Amman 11953, Jordan
| | - Ahmad Saleh Abu Rumman
- Department of Chest Disease and Foreigners, Jordan Ministry of Health, Amman 11118, Jordan
| | - Mohamad Nihad Alyousfi
- Center of Excellence for Applied Epidemiology, Global Health Development, Eastern Mediterranean Public Health Network, Amman 11195, Jordan
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Kawali A, Srinivasan S, Mishra SB, Mahendradas P, Shetty B. Epidemic retinitis during the COVID-19 pandemic. Indian J Ophthalmol 2023; 71:2779-2783. [PMID: 37417120 PMCID: PMC10491030 DOI: 10.4103/ijo.ijo_3349_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/17/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To study the impact of the novel coronavirus disease-2019 (COVID-19) pandemic on incidence, seasonal variation, clinical presentation, and disease outcome of epidemic retinitis (ER) and to compare clinical outcomes with positive and negative COVID-19 serology. Methods This is a retrospective, observational study conducted at a tertiary eye care hospital from August 2020 to June 2022. A graph of ER cases against the month of presentation was compared with the graph of the COVID-19 pandemic in the same region. Cases presented before COVID-19 vaccination, with positive COVID-19 serology (Group 1) were compared with cases with negative serology (Group 2). Results One hundred and thirty-two cases of ER were seen. The least number of cases were seen during and immediately after the peak of the pandemic (May 2021-August 2021). COVID-19 serology was positive in 13 (22 eyes)/60 (21.6%) unvaccinated cases. Along with COVID-19, positive serology for other ER etiologies was seen in 5/13 cases (38.4%). All patients received oral doxycycline with/without steroids. Groups 1 and 2 included 22 and 21 eyes of 13 cases each. Macular edema resolved in 43.6 and 32 days in groups 1 and 2, respectively. Retinitis resolved at 1 month in both groups. Corrected distant visual acuity was 20/50 and 20/70 at the presentation, which improved to 20/20 and 20/25 in groups 1 and 2, respectively. Mean and median follow-up was 6 months and 4.5 months, respectively, in both groups. No complications or recurrences were seen. Conclusion No significant impact of the COVID-19 pandemic on ER was observed.
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Affiliation(s)
- Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Sanjay Srinivasan
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Sai Bhakti Mishra
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Bhujang Shetty
- Department of General Ophthalmology, Narayana Nethralaya, Bangalore, Karnataka, India
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Jackson PD, Muyanja SZ, Sekitoleko I, Bbuye M, Helwig M, Padalkar R, Hammad M, Hopkinson D, Siddharthan T. Risk factors for disruptions in tuberculosis care in Uganda during the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001573. [PMID: 37267249 DOI: 10.1371/journal.pgph.0001573] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/22/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likely due to care disruption. In March, 2020, Uganda-a country with high TB burden, implemented a COVID-19 lockdown with associated decrease in TB diagnoses. This study aims to examine patient level risk factors for disruption in TB care during the COVID-19 pandemic in Uganda. This retrospective cross-sectional cohort study included six TB clinics in Uganda. Clustered sampling included phases of TB care and three time-periods: pre-lockdown, lockdown and post-lockdown. Characteristics of patients with TB care disruption (TBCD), defined as those with > 2 months of symptoms prior to diagnosis or who missed a TB clinic, and those without TB care disruption (non-TBCD) were analyzed between time-periods. 1,624 charts were reviewed; 1322 were contacted, 672 consented and completed phone interview; pre-lockdown (n = 213), lockdown (n = 189) and post-lockdown (n = 270). TBCD occurred in 57% (385/672) of patients. There was an increase in the proportion of urban patients in the TBCD and non-TBCD groups during post-lockdown (p <0.001). There was no difference in demographics, HIV co-infection, socioeconomic status, or distance to TB clinic between TBCD and non-TBCD groups or within TBCD by time-period. There were few differences amongst TBCD and all TB patients by time-period. The increase in urban patients' post-lockdown may represent a portion of urban patients who delayed care until post-lockdown. Insignificant trends suggesting more TBCD amongst those who lived further from clinics and those without HIV-coinfection require more investigation.
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Affiliation(s)
- Peter D Jackson
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Stella Zawedde Muyanja
- Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Sekitoleko
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, England
| | - Mudarshiru Bbuye
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Madeline Helwig
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Roma Padalkar
- Rowan University School of Osteopathic Medicine, Glassboro, New Jersey, United States of America
| | - Mariam Hammad
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Dennis Hopkinson
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Division of Pulmonary and Critical Care, Department of Medicine, Duke University, Durham, North Carolina
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, Department of Medicine, University of Miami, Miami, Florida, United States of America
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Scheunemann A, Moolla A, Mongwenyana C, Mkize N, Rassool M, Jezile V, Evans D. The lived experiences of Tuberculosis survivors during the COVID-19 pandemic and government lockdown in South Africa: a qualitative analysis. RESEARCH SQUARE 2023:rs.3.rs-2857896. [PMID: 37205375 PMCID: PMC10187427 DOI: 10.21203/rs.3.rs-2857896/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Tuberculosis (TB) is a major health concern in South Africa, where prior to COVID-19 it was associated with more deaths than any other infectious disease. The COVID-19 pandemic disrupted gains made in the global response to TB, having a serious impact on the most vulnerable. COVID-19 and TB are both severe respiratory infections, where infection with the one place individuals at increased risk for negative health outcomes for the other. Even after completing TB treatment, TB survivors remain economically vulnerable and continue to be negatively affected by TB. Methods This cross-sectional qualitative study, which was part of a larger longitudinal study in South Africa, explored how TB survivors' experienced the COVID-19 pandemic and government restrictions. Participants were identified through purposive sampling and were recruited and interviewed at a large public hospital in Gauteng. Data were analyzed thematically, using a constructivist research paradigm and both inductive and deductive codebook development. Results Participants (n = 11) were adults (24-74 years of age; more than half male or foreign nationals) who had successfully completed treatment for pulmonary TB in the past two years. Participants were generally found to be physically, socioeconomically, and emotionally vulnerable, with the COVID-19 pandemic exacerbating or causing a recurrence of many of the same stressors they had faced with TB. Coping strategies during COVID similarly mirrored those used during TB diagnosis and treatment, including social support, financial resources, distraction, spirituality, and inner strength. Conclusions Implications and suggestions for future directions include fostering and maintaining a strong network of social support for TB survivors.
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Dutta D, Liu J, Xiong H. The Impact of COVID-19 on People Living with HIV-1 and HIV-1-Associated Neurological Complications. Viruses 2023; 15:1117. [PMID: 37243203 PMCID: PMC10223371 DOI: 10.3390/v15051117] [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: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen of the coronavirus disease 2019 (COVID-19) pandemic, a fatal respiratory illness. The associated risk factors for COVID-19 are old age and medical comorbidities. In the current combined antiretroviral therapy (cART) era, a significant portion of people living with HIV-1 (PLWH) with controlled viremia is older and with comorbidities, making these people vulnerable to SARS-CoV-2 infection and COVID-19-associated severe outcomes. Additionally, SARS-CoV-2 is neurotropic and causes neurological complications, resulting in a health burden and an adverse impact on PLWH and exacerbating HIV-1-associated neurocognitive disorder (HAND). The impact of SARS-CoV-2 infection and COVID-19 severity on neuroinflammation, the development of HAND and preexisting HAND is poorly explored. In the present review, we compiled the current knowledge of differences and similarities between SARS-CoV-2 and HIV-1, the conditions of the SARS-CoV-2/COVID-19 and HIV-1/AIDS syndemic and their impact on the central nervous system (CNS). Risk factors of COVID-19 on PLWH and neurological manifestations, inflammatory mechanisms leading to the neurological syndrome, the development of HAND, and its influence on preexisting HAND are also discussed. Finally, we have reviewed the challenges of the present syndemic on the world population, with a particular emphasis on PLWH.
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Affiliation(s)
- Debashis Dutta
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | | | - Huangui Xiong
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
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Thong PM, Chong HT, Chang AJW, Ong CWM. COVID-19, the escalation of diabetes and the repercussions on Tuberculosis. Int J Infect Dis 2023:S1201-9712(23)00055-3. [PMID: 36898428 PMCID: PMC9993733 DOI: 10.1016/j.ijid.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/12/2023] Open
Abstract
The COVID-19 pandemic has significantly disrupted the global tuberculosis (TB) control efforts. The mobilisation of healthcare resources and personnel to combat the pandemic, and the nationwide lockdown measures resulted in an accumulation of large number of undiagnosed TB cases. Exacerbating the situation, recent meta-analyses showed COVID-19 induced diabetes (DM) is on the rise. DM is an established risk factor for TB disease and worsen outcomes. Patients with concurrent DM and TB had more lung cavitary lesions, and are more likely to fail TB treatment and suffering disease relapse. This may pose a significant challenge to TB control in low- and middle-income countries where high TB burden are found. There is a need to step up the efforts to end the TB epidemic, which include increased screening for DM among TB patients, optimise glycaemic control among TB-DM patients and intensify TB-DM research to improve TB-DM patient treatment outcome.
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Affiliation(s)
- Pei Min Thong
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hai Tarng Chong
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anabel J W Chang
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Catherine W M Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore.
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Starshinova A, Belyaeva E, Doktorova N, Korotkevich I, Kudlay D. Tuberculosis in the Russian Federation: Prognosis and Epidemiological Models in a Situation After the COVID-19 Pandemic. J Epidemiol Glob Health 2023; 13:11-22. [PMID: 36740623 PMCID: PMC9900203 DOI: 10.1007/s44197-023-00085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/10/2023] [Indexed: 02/07/2023] Open
Abstract
AIM Because of the COVID-19 pandemic, many support programs for tuberculosis (TB) patients have been discontinued and TB mass screening activities decreased worldwide, resulting in a decrease in new case detection and an increase in TB deaths (WHO, WHO global lists of high burden countries for TB, multidrug/rifampicin-resistant TB (MDR/RR-TB) and TB/HIV, 2021-2025, 2021). The study aimed to assess changes in epidemiological indicators of tuberculosis in the Russian Federation and to simulate these indicators in the post-COVID-19 period. MATERIALS AND METHODS The main epidemiological indicators of tuberculosis were analyzed with the use of government statistical data for the period from 2009 to 2021. Further mathematical modeling of epidemiological indicators for the coming years was carried out, taking into account the TB screening by chest X-ray. Statistical analysis was carried out using the software environment R (v.3.5.1) for statistical computing and the commercial software Statistical Package for the Social Sciences (SPSS Statistics for Windows, version 24.0, IBM Corp., 2016). Time series forecasting was performed using the programming language for statistical calculations R, version 4.1.2 and the bsts package, version 0.9.8. STUDY RESULTS The study has found that the mean regression coefficient of a single predictor differs in the model for TB incidence and mortality (0.0098 and 0.0002, respectively). Forecast of overall incidence, the incidence of children and the forecast for mortality using the basic scenario (screening 75-78%) for the period from 2022 to 2026 was characterized by a mean decrease rate of 23.1%, 15.6% and 6.0% per year, respectively. A conservative scenario (screening 47-63%) of overall incidence indicates that the incidence of children and the forecast for mortality will continue to decrease with a mean decrease rate of 23.2%, 15.6% and 6.0% per year, respectively. Comparable data were obtained from the forecast of overall incidence, the incidence of children and the forecast for mortality using the optimistic scenario (screening 82-89%) with a mean decrease rate of 22.9%, 15.4% and 6.0% per year, respectively. CONCLUSIONS It has been proven that the significance of screening with chest X-ray as a predictor of mortality is minimal. However, TB screening at least 60% of the population (chest X-ray in adults and immunological tests in children) have provided relationship between the TB screening rate and TB mortality rate (TB mortality rate increases with an increase in the population coverage and, conversely, decreases with a decrease in the population coverage).
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Affiliation(s)
- Anna Starshinova
- Almazov National Medical Research Centre, 197341, St. Petersburg, Russia.
| | - Ekaterina Belyaeva
- The Republic of Karelia "The Republic TB Healthcare Dispensary", 185032, Petrozavodsk, Russia
| | | | | | - Dmitry Kudlay
- First Moscow State Medical University (Sechenov University), 119991, Moscow, Russia.,NRC Institute of Immunology FMBA of Russia, 115522, Moscow, Russia
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Hu H, Xiong S, Zhang X, Liu S, Gu L, Zhu Y, Xiang D, Skitmore M. The COVID-19 pandemic in various restriction policy scenarios based on the dynamic social contact rate. Heliyon 2023; 9:e14533. [PMID: 36945346 PMCID: PMC10017169 DOI: 10.1016/j.heliyon.2023.e14533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
The social contact rate has influenced the transmission of COVID-19, with more social contact resulting in more contagion cases. We chose 18 countries with the most confirmed cases in the first 200 days after the Wuhan lockdown. This was the first study using the dynamic social contact rate to simulate the epidemic under diverse restriction policies over 500 days since the COVID-19 outbreak. The developed General Dynamic Model suggested that the probability of contagion ranged from 12.52% to 39.39% in the epidemic. The geometric mean of the social contact rates differed from 18.21% to 96.00% between countries. The restriction policies in developed economies were 3.5 times more efficient than in developing economies. We compare the effectiveness of different policies for disease prevention and discuss the influence of policy adjustment frequency for each country. Maintaining the tightest restriction or alternate tightening and loosening restrictions was recommended, with each having an average 72.45% and 79.78% reduction in maximum active cases, respectively.
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Affiliation(s)
- Hui Hu
- Economic Development Research Centre, Wuhan University, Hubei, China
- Health Economics and Management Centre, Wuhan University, Hubei, China
- School of Economics & Management, Wuhan University, Hubei, China
| | - Shuaizhou Xiong
- School of Economics & Management, Wuhan University, Hubei, China
| | - Xiaoling Zhang
- Department of Public and International Affairs, City University of Hong Kong, Kowloon, Hong Kong
- School of Energy and Environment, City University of Hong Kong, Kowloon, Hong Kong
- Shenzhen Research Institute, City University of Hong Kong, Shenzhen, China
| | - Shuzhou Liu
- School of Mathematics and Physics, China University of Geosciences, Hubei, China
| | - Lin Gu
- RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
- Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
| | - Yuqi Zhu
- School of Economics & Management, Wuhan University, Hubei, China
| | - Dongjin Xiang
- School of Mathematics and Physics, China University of Geosciences, Hubei, China
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Jeong Y, Min J. Impact of COVID-19 Pandemic on Tuberculosis Preventive Services and Their Post-Pandemic Recovery Strategies: A Rapid Review of Literature. J Korean Med Sci 2023; 38:e43. [PMID: 36747365 PMCID: PMC9902666 DOI: 10.3346/jkms.2023.38.e43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/14/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has disrupted tuberculosis (TB) care and prevention around the world. The aim of this study is to review literature on the impact of COVID-19 on TB preventive services and discuss their policy options during and after the pandemic. METHODS We conducted a rapid review of scientific literature on the impact of COVID-19 on TB preventive services and their recovery strategies. After conducting a line-by-line open coding, their codes were applied in the descriptive theme building process, which was guided by the End TB strategy. TB preventive measures were selected and classified into five analytical categories: 1) vaccination against TB, 2) detection and treatment of latent TB infection (LTBI), 3) screening and diagnostics, 4) active case finding and contact tracing, and 5) surveillance. RESULTS We identified 93 articles, of which 65 were research articles. During the pandemic, we observed decrease in Bacillus Calmette-Guérin (BCG) coverage, TB diagnostic services, case finding activities, and LTBI management. TB case detection was declined, which was not resumed to the pre-pandemic level after loosening the lock-down. Several recommendations were highlighted: 1) secure BCG stocks and its supply chains, 2) consider catch-up activities of routine immunization and LTBI screening, 3) maintain minimal TB health services, infection prevention and control, and surveillance, 4) leverage laboratory capacity and contact tracing mechanisms, 5) consider simultaneous testing for TB and COVID-19, and 6) Incorporate digital health technologies. CONCLUSIONS Our findings and lessons learnt from the pandemic can aid in the development of future national TB control program.
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Affiliation(s)
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Ryckman T, Robsky K, Cilloni L, Zawedde-Muyanja S, Ananthakrishnan R, Kendall EA, Shrestha S, Turyahabwe S, Katamba A, Dowdy DW. Ending tuberculosis in a post-COVID-19 world: a person-centred, equity-oriented approach. THE LANCET. INFECTIOUS DISEASES 2023; 23:e59-e66. [PMID: 35963272 PMCID: PMC9365311 DOI: 10.1016/s1473-3099(22)00500-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
The COVID-19 pandemic has disrupted systems of care for infectious diseases-including tuberculosis-and has exposed pervasive inequities that have long marred efforts to combat these diseases. The resulting health disparities often intersect at the individual and community levels in ways that heighten vulnerability to tuberculosis. Effective responses to tuberculosis (and other infectious diseases) must respond to these realities. Unfortunately, current tuberculosis programmes are generally not designed from the perspectives of affected individuals and fail to address structural determinants of health disparities. We describe a person-centred, equity-oriented response that would identify and focus on communities affected by disparities, tailor interventions to the mechanisms by which disparities worsen tuberculosis, and address upstream determinants of those disparities. We detail four key elements of the approach (data collection, programme design, implementation, and sustainability). We then illustrate how organisations at multiple levels might partner and adapt current practices to incorporate these elements. Such an approach could generate more substantial, sustainable, and equitable reductions in tuberculosis burden at the community level, highlighting the urgency of restructuring post-COVID-19 health systems in a more person-centred, equity-oriented way.
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Affiliation(s)
- Theresa Ryckman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Katherine Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Lucia Cilloni
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Emily A Kendall
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sourya Shrestha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Lalitha R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda: healthcare provider perspectives. Implement Sci Commun 2023; 4:8. [PMID: 36650596 PMCID: PMC9844180 DOI: 10.1186/s43058-023-00391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Following the first wave of the COVID-19 outbreak, Uganda experienced a 40% drop in tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCPs) at a National Referral Hospital in Kampala, Uganda. DESIGN/METHODS We conducted a cross-sectional study using in-depth interviews with 12 HCPs involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral Hospital, Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and we denoted the emergent themes as barriers to and facilitators of COVID-19/TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation, and Behavior (COM-B) model. RESULTS The facilitators to integrated COVID-19 and TB screening included the availability of TB focal persons and already existing training forums at the hospital that could be utilized to strengthen the capacity of HCP to integrate COVID-19 and TB screening. The barriers included HCP's inadequate knowledge on how to integrate screening of COVID-19 and TB, the absence of simple easy-to-use standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), understaffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. CONCLUSIONS These findings provided a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19. Future studies should evaluate the effect of addressing these barriers to the integration of COVID-19 and TB as well as the effect of this on TB case finding in high-burden TB settings.
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Affiliation(s)
- Fred C. Semitala
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rodgers Katwesigye
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Dennis Kalibbala
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Mary Mbuliro
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rejani Lalitha
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- grid.513250.0Kiruddu National Referral Hospital, Kampala, Uganda
| | - Edgar Atine
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Josephine Nassazi
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Stavia Turyahabwe
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
| | - Moorine Sekadde
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
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Zheng Y, Emam M, Lu D, Tian M, Wang K, Peng X. Analysis of the effect of temperature on tuberculosis incidence by distributed lag non-linear model in Kashgar city, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:11530-11541. [PMID: 36094714 PMCID: PMC9466343 DOI: 10.1007/s11356-022-22849-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to explore the effect of temperature on tuberculosis (TB) incidence using the distributed lag non-linear model (DLNM) from 2017 to 2021 in Kashgar city, the region with higher TB incidence than national levels, and assist public health prevention and control measures. From January 2017 to December 2021, a total of 8730 cases of TB were reported, with the higher incidence of male than that of female. When temperature was below 1 °C, it was significantly correlated with TB incidence compared to the median observed temperature (15 °C) at lag 7, 14, and 21, and lower temperatures showed larger RR (relative risk) values. High temperature produced a protective effect on TB transmission, and higher temperature from 16 to 31 °C has lower RR. In discussion stratified by gender, the maximum RRs were achieved for both male group and female group at - 15 °C with lag 21, reporting 4.28 and 2.02, respectively. At high temperature (higher than 20 °C), the RR value of developing TB for female group was significantly larger than 1. In discussion stratified by age, the maximum RRs were achieved for all age groups (≤ 35, 36-64, ≥ 65) at - 15 °C with lag 21, reporting 3.20, 2.07, and 3.45, respectively. When the temperature was higher than 20 °C, the RR of the 36-64-year-old group and the ≥ 65-year-old group was significantly larger than 1 at lag 21, while significantly smaller than 1 for cumulative RR at lag 21, reporting 0.11, 95% confidence interval (CI) (0.01, 0.83) and 0.06, 95% CI (0.01, 0.44), respectively. In conclusion, low temperature, especially in extreme level, acts as a high-risk factor inducing TB transmission in Kashgar city. Males exhibit a significantly higher RR of developing TB at low temperature than female, as well as the elderly group in contrast to the young or middle-aged groups. High temperature has a protective effect on TB transmission in the total population, but female and middle-aged and elderly groups are also required to be alert to the delayed RR induced by it.
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Affiliation(s)
- Yanling Zheng
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830017, China.
| | - Mawlanjan Emam
- Center for Disease Control and Prevention, Kashgar, China
| | - Dongmei Lu
- Center of Respiratory and Critical Care Medicine of the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Maozai Tian
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830017, China
| | - Kai Wang
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830017, China
| | - Xiaowang Peng
- Center for Disease Control and Prevention, Kashgar, China.
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Bereda G. A case report of COVID-19 associated with AIDS-related pulmonary tuberculosis.. [DOI: 10.21203/rs.3.rs-2373106/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Patients immunocompromised by HIV or with TB lung disease could be more susceptible to severe COVID-19 infection. The COVID-19 pandemic poses a serious hazard to tuberculosis sufferers. A 67-year-old black African house wife with an HIV/AIDS diagnosis arrived at the emergency room on September 28, 2022. The admitted woman had significant complaints included muscle weakness, a loss of weight about 33 pounds during the preceding week, headache, and a cough. Reduced breath sounds were audible on chest auscultation in the right middle and upper lungs. His electrocardiogram showed sinus tachycardia and anterior-lateral lead ST-depression. She had two nasopharyngeal swabs for COVID-19 testing, which were positive. For the first five days of her stay in the hospital, the patient needed continuous oxygen delivered through a nasal cannula at a rate of four liters per minute, and she is still taking her ART regimen. For TB treatment, she took rifampicin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg, and ethambutol 275 mg during a two-month intensive phase of her TB therapy, then rifampicin 150 mg and isoniazid 75 mg for a four-month continuous phase.
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Wu Z, Chen Z, Long S, Wu A, Wang H. Incidence of pulmonary tuberculosis under the regular COVID-19 epidemic prevention and control in China. BMC Infect Dis 2022; 22:641. [PMID: 35871653 PMCID: PMC9308895 DOI: 10.1186/s12879-022-07620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background The COVID-19 pandemic has driven public health intervention strategies, including keeping social distance, wearing masks in crowded places, and having good health habits, to prevent the transmission of the novel coronavirus (SARS-CoV-2). However, it is unknown whether the use of these intervention strategies influences morbidity in other human infectious diseases, such as tuberculosis. Methods In this study, three prediction models were constructed to compare variations in PTB incidences after January 2020 without or with intervention includes strict and regular interventions, when the COVID-19 outbreak began in China. The non-interventional model was developed with an autoregressive integrated moving average (ARIMA) model that was trained with the monthly incidence of PTB in China from January 2005 to December 2019. The interventional model was established using an ARIMA model with a continuing intervention function that was trained with the monthly PTB incidence in China from January 2020 to December 2020. Results Starting with the assumption that no COVID-19 outbreak had occurred in China, PTB incidence was predicted, and then the actual incidence was compared with the predicted incidence. A remarkable overall decline in PTB incidence from January 2020 to December 2020 was observed, which was likely due to the potential influence of intervention policies for COVID-19. If the same intervention strategy is applied for the next 2 years, the monthly PTB incidence would reduce on average by about 1.03 per 100,000 people each month compared with the incidence predicted by the non-interventional model. The annual incidence estimated 59.15 under regular intervention per 100,000 in 2021, and the value would decline to 50.65 with strict interventions. Conclusions Our models quantified the potential knock-on effect on PTB incidence of the intervention strategy used to control the transmission of COVID-19 in China. Combined with the feasibility of the strategies, these results suggested that continuous regular interventions would play important roles in the future prevention and control of PTB. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07620-y.
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Panchal J, Acharya F, Joshi K. A noninteger order SEITR dynamical model for TB. ADVANCES IN CONTINUOUS AND DISCRETE MODELS 2022; 2022:27. [PMID: 35450198 PMCID: PMC8959566 DOI: 10.1186/s13662-022-03700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
This research paper designs the noninteger order SEITR dynamical model in the Caputo sense for tuberculosis. The authors of the article have classified the infection compartment into four different compartments such as newly infected unrecognized individuals, diagnosed patients, highly infected patients, and patients with delays in treatment which provide better detail of the TB infection dynamic. We estimate the model parameters using the least square curve fitting and demonstrate that the proposed model provides a good fit to tuberculosis confirmed cases of India from the year 2000 to 2020. Further, we compute the basic reproduction number as \documentclass[12pt]{minimal}
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\begin{document}$\Re _{0} \approx 1.73$\end{document}ℜ0≈1.73 of the model using the next-generation matrix method and the model equilibria. The existence and uniqueness of the approximate solution for the SEITR model is validated using the generalized Adams–Bashforth–Moulton method. The graphical representation of the fractional order model is given to validate the result using the numerical simulation. We conclude that the fractional order model is more realistic than the classical integer order model and provide more detailed information about the real data of the TB disease dynamics.
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Global impact of COVID-19 on childhood tuberculosis: an analysis of notification data. Lancet Glob Health 2022; 10:e1774-e1781. [PMID: 36400083 PMCID: PMC9671550 DOI: 10.1016/s2214-109x(22)00414-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is concern that the COVID-19 pandemic has damaged global childhood tuberculosis management. Quantifying changes in childhood tuberculosis notifications could support more targeted interventions to restore childhood tuberculosis services. We aimed to use time-series modelling to evaluate the impact of COVID-19 on child tuberculosis notifications. METHODS Annual tuberculosis case notification data reported to WHO by 215 countries were used to calculate annual notification counts for the years 2014-20, stratified by age groups (0-4, 5-14, and ≥15 years) and sex. We used time-series modelling to predict notification counts for 2020, and calculated differences between these predictions and observed notifications in 2020 for each of the six WHO regions and at the country level for 30 countries with high tuberculosis burden. We assessed associations between these differences and the COVID-19 stringency index, a measure of COVID-19 social impact. FINDINGS From 2014 to 2019, annual tuberculosis notification counts increased across all age groups and WHO regions. More males than females in the 0-4 years age group and ≥15 years age group had notifications in all years from 2014 to 2020 and in all WHO regions. In the 5-14 years age group, more females than males were notified globally in all years, although some WHO regions had higher notifications from males than females. In 2020, global notifications were 35·4% lower than predicted (95% prediction interval -30·3 to -39·9; 142 525 observed vs 220 794 predicted notifications [95% prediction interval 204 509 to 237 078]) for children aged 0-4 years, 27·7% lower (-23·4 to -31·5; 256 398 vs 354 578 [334 724 to 374 431]) in children aged 5-14 years, and 18·8% lower (-15·4 to -21·9; 5 391 753 vs 6 639 547 [6 375 086 to 6 904 007]) for people aged 15 years or older. Among those aged 5-14 years, the reduction in observed relative to predicted notifications for 2020 was greater in males (-30·9% [-24·8 to -36·1]) than females (-24·5% [-18·1 to -29·9]). Among 28 countries with high tuberculosis burden, no association was observed between the stringency of COVID-19 restrictions and the relative difference in observed versus predicted notifications. INTERPRETATION Our findings suggest that COVID-19 has substantially affected childhood tuberculosis services, with the youngest children most affected. Although children have mostly had fewer severe health consequences from COVID-19 than have adults, they have been disproportionately affected by the effects of the pandemic on tuberculosis care. Observed sex differences suggest that targeted interventions might be required. As countries rebuild health systems following the COVID-19 pandemic, it is crucial that childhood tuberculosis services are placed centrally within national strategic plans. FUNDING Medical Research Council.
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Adzic-Vukicevic T, Stosic M, Antonijevic G, Jevtic M, Radovanovic-Spurnic A, Velickovic J. Tuberculosis and COVID-19 co-infection in Serbia: Pandemic challenge in a low-burden country. Front Med (Lausanne) 2022; 9:971008. [DOI: 10.3389/fmed.2022.971008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
IntroductionCOVID-19 and tuberculosis (TB) represent global threats to the public health system. The impact of COVID-19 on TB results in a reduction in the number of notified TB cases, delayed diagnosis and treatment, and increased case fatality and mortality rates. The aim of the study was to analyze the TB/COVID-19 co-infected cohort in Serbia as a low-burden country and compare it to the global TB/COVID-19 cohort.MethodsA retrospective analysis was done on 53 TB and COVID-19 co-infected patients treated in COVID hospital “Batajnica” in Belgrade and Special Hospital for Pulmonary Diseases “Ozren” Sokobanja in the period from 6 March 2020 to 1 April 2022. A comparative analysis with the global cohort published recently was also performed.ResultsTB/COVID-19 cohort in Serbia included significantly fewer migrants and diabetes cases, but more cases with chronic respiratory diseases compared to the global. Descriptive analysis of TB cases in the Serbian TB/COVID-19 cohort showed fewer cases diagnosed with sputum smear and Gene Xpert/HAIN, fewer EPTB and mono-resistant cases, and more cases diagnosed with solid culture, unilateral pulmonary infiltrate (with bilateral cavity lesions), and bilateral pulmonary infiltrate (no cavities) compared to TB/COVID-19 cases worldwide. Nasal congestion and fever were more common COVID-19 symptoms in the global cohort. Radiology was more commonly used for the diagnosis of COVID-19 in Serbia. Typical bilateral ground opacities were less common among Serbian patients. Serbian patients spent fewer days in the hospital and achieved a higher PCR conversion rate and TB treatment success rate.ConclusionThe Serbian TB/COVID-19 cohort achieved a higher treatment success rate compared to the global cohort. Encouraging vaccination against SARS-CoV-2 for people with a current or past TB disease, as well as rapid diagnosis and targeted treatment of TB in highly specialized pulmonology institutions, presents key points to avoid excessive morbidity and mortality.
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McQuaid CF, Henrion MYR, Burke RM, MacPherson P, Nzawa-Soko R, Horton KC. Inequalities in the impact of COVID-19-associated disruptions on tuberculosis diagnosis by age and sex in 45 high TB burden countries. BMC Med 2022; 20:432. [PMID: 36372899 PMCID: PMC9660190 DOI: 10.1186/s12916-022-02624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Tuberculosis remains a major public health priority and is the second leading cause of mortality from infectious disease worldwide. TB case detection rates are unacceptably low for men, the elderly and children. Disruptions in TB services due to the COVID-19 pandemic may have exacerbated these and other inequalities. METHODS We modelled trends in age- and sex- disaggregated case notifications for all forms of new and relapse TB reported to the World Health Organization for 45 high TB, TB/HIV and MDR-TB burden countries from 2013 to 2019. We compared trend predicted notifications to observed notifications in 2020 to estimate the number of people with TB likely to have missed or delayed diagnosis. We estimated the risk ratio (RR) of missed or delayed TB diagnosis for children (aged < 15 years) or the elderly (aged ≥ 65 years) compared to adults (aged 15-64 years) and women compared to men (both aged ≥ 15 years) using a random-effects meta-analysis. RESULTS An estimated 195,449 children (95% confidence interval, CI: 189,673-201,562, 37.8% of an expected 517,168), 1,126,133 adults (CI: 1,107,146-1,145,704, 21.8% of an expected 5,170,592) and 235,402 elderly (CI: 228,108-243,202, 28.5% of an expected 826,563) had a missed or delayed TB diagnosis in 2020. This included 511,546 women (CI: 499,623-523,869, 22.7%, of an expected 2,250,097) and 863,916 men (CI: 847,591-880,515, 23.0% of an expected 3,763,363). There was no evidence globally that the risk of having TB diagnosis missed or delayed was different for children and adults (RR: 1.09, CI: 0.41-2.91), the elderly and adults (RR: 1.40, CI: 0.62-3.16) or men and women (RR: 0.59, CI: 0.25-1.42). However, there was evidence of disparities in risk by age and/or sex in some WHO regions and in most countries. CONCLUSIONS There is no evidence at an aggregate global level of any difference by age or sex in the risk of disruption to TB diagnosis as a result of the COVID-19 pandemic. However, in many countries, disruptions in TB services have been greater for some groups than others. It is important to recognise these context-specific inequalities when prioritising key populations for catch-up campaigns.
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Affiliation(s)
- C Finn McQuaid
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rachael M Burke
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter MacPherson
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Katherine C Horton
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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