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BaoYing Z, XiaoJun L, HaiQun B, Fan L, LiuBo Z. Contamination and transmission of Mycobacteria in indoor environments of public buildings. Cent Eur J Public Health 2022; 30:26-31. [PMID: 35421295 DOI: 10.21101/cejph.a5198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to detect Mycobacterium tuberculosis complex, M. avium subsp. avium and M. intracellulare, Mycobacterium contamination and to explore the aerosol transmission of mycobacteria in public buildings in China. METHODS A total of 552 environmental samples, namely 165 aerosol, 199 water, 70 air duct dust, and 118 soil samples, were collected from 39 public buildings and analysed using nested polymerase chain reaction. RESULTS The positivity rate of Mycobacterium tuberculosis complex, M. avium subsp. avium and M. intracellulare in air samples were 0.6% and 1.8%, respectively. There was significant difference in the positivity rate of Mycobacterium aerosol among the three types of public building (χ2 = 6.108, p = 0.047). No positive results of Mycobacterium tuberculosis complex and M. avium and M. intracellulare were obtained from cooling, tap, shower, or fountain water. The positivity rate of Mycobacterium for water samples was 31.7% (63/199). The positivity rate of Mycobacterium tuberculosis complex, M. avium subsp. avium and M. intracellulare, Mycobacterium in soil samples were 1.1%, 34.6% and 43.6%, respectively. There was significant difference in the positivity rate of M. avium and M. intracellulare (χ2 = 47.219, p < 0.001) and Mycobacterium (χ2 = 33.535, p < 0.001) in the different origins of soil samples. CONCLUSIONS Mycobacteria are widespread in public buildings. Mycobacterium tuberculosis complex, M. avium and M. intracellulare were simultaneously present in the air ducts of central air conditioning systems and indoor air in public buildings, which indicates that aerosol transmission is a potential route.
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Affiliation(s)
- Zhang BaoYing
- National Institute of Environmental Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Liang XiaoJun
- Kunshan Centre for Disease Control and Prevention, Kunshan, Jiangsu Province, China
| | - Ban HaiQun
- National Institute of Environmental Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Liu Fan
- National Institute of Environmental Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Zhang LiuBo
- National Institute of Environmental Health, Chinese Centre for Disease Control and Prevention, Beijing, China
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2
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Lucey O, Potter J, Ricketts W, Castle L, Melzer M. Utility of EBUS-TBNA in diagnosing mediastinal tuberculous lymphadenitis in East London. J Infect 2021; 84:17-23. [PMID: 34706281 DOI: 10.1016/j.jinf.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To characterise and describe the diagnostic utility of Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) in intrathoracic tuberculosis in a cohort of patients with mediastinal lymphadenopathy of unknown aetiology. METHODS Consecutive patients with intrathoracic lymphadenopathy undergoing EBUS-TBNA between 2012 and 2016 were identified. Demographic data, biopsy cytopathology and mycobacteriology results, HIV and vitamin D status, susceptibility results and final diagnoses were recorded. Pre- and post-procedure probability scores were assigned to each case to reflect the probability of tuberculosis. RESULTS 315 cases were identified; 54 (17.1%) had tuberculosis and 261 (82.9%) had a non-tuberculosis diagnosis. amongst TB cases, the sensitivity of EBUS-TBNA was 59.3% (95% CI 45.06-72.14), specificity 100% (95% CI 98.19-100) and the negative predictive value (NPV) was 92.23% (95% CI 88.31-94.95). 19/54 (35%) TB cases were confirmed by EBUS mycobacterial culture and 13/54 (24.1%) by cytopathology. 33 (61.1%) of the TB cases, had a low to medium pre-test probability score assigned prior to EBUS-TBNA. Amongst EBUS culture-confirmed cases, we found a resistance rate of 10.5% to one or more first line TB drugs, with one case of multi-drug resistant TB. CONCLUSIONS We confirmed the utility of EBUS-TBNA in the diagnosis of intrathoracic tuberculosis in an undifferentiated cohort of patients with mediastinal lymphadenopathy of unknown aetiology and advocate sending samples for mycobacterial culture in all cases in high tuberculosis incidence areas.
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Affiliation(s)
- Olivia Lucey
- Division of Infection, Barts Health NHS Trust, 80 Newark Street,Whitechapel, London E1 2ES, United Kingdom; Department of Infectious Diseases, Imperial College London, South Kensington, London, United Kingdom.
| | - Jessica Potter
- Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - William Ricketts
- Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Lianne Castle
- Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Mark Melzer
- Division of Infection, Barts Health NHS Trust, 80 Newark Street,Whitechapel, London E1 2ES, United Kingdom
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Ruzangi J, Iwagami M, Smeeth L, Mangtani P, Nitsch D. The association between chronic kidney disease and tuberculosis; a comparative cohort study in England. BMC Nephrol 2020; 21:420. [PMID: 32998703 PMCID: PMC7528250 DOI: 10.1186/s12882-020-02065-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 09/15/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND People with end-stage kidney disease have an increased risk of active tuberculosis (TB). Previous systematic reviews have demonstrated that patients with chronic kidney disease (CKD) have increased risk of severe community-acquired infections. We investigated the association between CKD (prior to renal replacement therapy) and incidence of TB in UK General Practice. METHODS Using the UK Clinical Practice Research Datalink, 242,349 patients with CKD (stages 3-5) (estimated glomerular filtration rate < 60 mL/min/1.73 m2 for ≥3 months) between April 2004 and March 2014 were identified and individually matched (by age, gender, general practice and calendar time) to a control from the general population without known CKD. The association between CKD (overall and by stage) and incident TB was investigated using a Poisson regression analysis adjusted for age, gender, ethnicity, socio-economic status, chronic obstructive pulmonary disease (COPD) and diabetes. RESULTS The incidence of TB was higher amongst patients with CKD compared to those without CKD: 14.63 and 9.89 cases per 100,000 person-years. After adjusting for age, gender, ethnicity, socio-economic status, diabetes and COPD, the association between CKD and TB remained (adjusted rate ratio [RR] 1.42, 95% confidence interval [CI] 1.01-1.85). The association may be stronger amongst those from non-white ethnic minorities (adjusted RR 2.83, 95%CI 1.32-6.03, p-value for interaction with ethnicity = 0.061). Amongst those with CKD stages 3-5, there was no evidence of a trend with CKD severity. CONCLUSIONS CKD is associated with an increased risk of TB diagnosis in a UK General Practice cohort. This group of patients should be considered for testing and treating for latent TB.
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Affiliation(s)
- Judith Ruzangi
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, building #861, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan.
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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4
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Adam BU, Cosford P, Anderson SR, Abubakar I. Sustaining tuberculosis decline in the UK. Lancet 2017; 389:1176-1177. [PMID: 28353429 DOI: 10.1016/s0140-6736(17)30755-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Bilaal U Adam
- Medical Directorate, Public Health England, London, UK
| | - Paul Cosford
- Medical Directorate, Public Health England, London, UK
| | - Sarah R Anderson
- Tuberculosis Section, National Infection Service, Public Health England, London, UK
| | - Ibrahim Abubakar
- Medical Directorate, Public Health England, London, UK; Institute for Global Health, University College London, London WC1N 1EH, UK.
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5
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Appleton SC, Connell DW, Singanayagam A, Bradley P, Pan D, Sanderson F, Cleaver B, Rahman A, Kon OM. Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis: the role of chest radiography, risk factors and symptoms. BMJ Open Respir Res 2017; 4:e000154. [PMID: 28123749 PMCID: PMC5253606 DOI: 10.1136/bmjresp-2016-000154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION London has a high rate of tuberculosis (TB) with 2572 cases reported in 2014. Cases are more common in non-UK born, alcohol-dependent or homeless patients. The emergency department (ED) presents an opportunity for the diagnosis of TB in these patient groups. This is the first study describing the clinico-radiological characteristics of such attendances in two urban UK hospitals for pulmonary TB (PTB) and extrapulmonary TB (EPTB). METHODS We conducted a retrospective cohort study using the London TB Register (LTBR) and hospital records to identify patients who presented to two London ED's in the 6 months prior to their ultimate TB diagnosis 2011-2012. RESULTS 397 TB cases were identified. 39% (154/397) had presented to the ED in the 6 months prior to diagnosis. In the study population, the presence of cough, weight loss, fever and night sweats only had prevalence rates of 40%, 34%, 34% and 21%, respectively. Chest radiography was performed in 76% (117/154) of patients. For cases where a new diagnosis of TB was suspected, 73% (41/56) had an abnormal radiograph, compared with 36% (35/98) of patients where it was not. There was an abnormality on a chest radiograph in 73% (55/75) of PTB cases and also in 40% (21/52) of EPTB cases where a film was requested. CONCLUSIONS A large proportion of patients with TB present to ED. A diagnosis was more likely in the presence of an abnormal radiograph, suggesting opportunities for earlier diagnosis if risk factors, symptoms and chest radiograph findings are combined.
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Affiliation(s)
- S C Appleton
- Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK
| | - D W Connell
- Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK
| | - A Singanayagam
- Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK
| | - P Bradley
- Department of Emergency Medicine , Imperial College Healthcare NHS Trust , London , UK
| | - D Pan
- Department of Emergency Medicine , Imperial College Healthcare NHS Trust , London , UK
| | - F Sanderson
- Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK
| | - B Cleaver
- Department of Emergency Medicine , Imperial College Healthcare NHS Trust , London , UK
| | - A Rahman
- Department of Emergency Medicine , Imperial College Healthcare NHS Trust , London , UK
| | - O M Kon
- Tuberculosis Service , Imperial College Healthcare NHS Trust , London , UK
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MacPherson P, Squire SB, Cleary P, Davies S, Wake C, Dee K, Walker J, Farrow S, McMaster P, Woodhead M, Sloan DJ. Equitable tuberculosis care in the North West of England: analysis of tuberculosis cohort review data. Int J Tuberc Lung Dis 2016; 20:778-85. [PMID: 27155181 PMCID: PMC4857719 DOI: 10.5588/ijtld.15.0772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: In the United Kingdom, tuberculosis (TB) predominantly affects the most deprived populations, yet the extent to which deprivation affects TB care outcomes is unknown. METHODS: Since 2011, the North West TB Cohort Audit collaboration has undertaken quarterly reviews of outcomes against consensus-defined care standard indicators for all individuals notified with TB. We investigated associations between adverse TB care outcomes and Index of Multiple Deprivation (IMD) 2010 scores measured at lower super output area of residence using logistic regression models. RESULTS: Of 1831 individuals notified with TB between 2011 and 2014, 62% (1131/1831) came from the most deprived national quintile areas. In single variable analysis, greater deprivation was significantly associated with increased likelihood of the completion of a standardised risk assessment (OR 2.99, 95%CI 5.27–19.65) and offer of a human immunodeficiency virus test (OR 1.72, 95%CI 1.10–2.62). In multivariable analysis, there were no significant associations. CONCLUSIONS: TB patients in the most deprived areas had similar care indicators across a range of standards to those of individuals living in the more affluent areas, suggesting that the delivery of TB care in the North West of England is equitable. The extent to which the cohort review process contributes to, and sustains, this standard of care deserves further study.
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Affiliation(s)
- P MacPherson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; North West Public Health England Centre, Liverpool, Liverpool, UK
| | - S B Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - P Cleary
- Public Health England Field Epidemiology Service North West, Liverpool, UK
| | - S Davies
- Public Health England Field Epidemiology Service North West, Liverpool, UK
| | - C Wake
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Dee
- North West Public Health England Centre, Liverpool, Liverpool, UK
| | - J Walker
- TB Section, Liverpool Community Health, Liverpool, UK
| | - S Farrow
- Department of TB Services, Pennine Acute Hospitals NHS Trust, Oldham, UK
| | - P McMaster
- North Manchester General Hospital, Manchester, UK
| | - M Woodhead
- Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - D J Sloan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Nnadi CD, Anderson LF, Armstrong LR, Stagg HR, Pedrazzoli D, Pratt R, Heilig CM, Abubakar I, Moonan PK. Mind the gap: TB trends in the USA and the UK, 2000-2011. Thorax 2016; 71:356-63. [PMID: 26907187 DOI: 10.1136/thoraxjnl-2015-207915] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/05/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND TB remains a major public health concern, even in low-incidence countries like the USA and the UK. Over the last two decades, cases of TB reported in the USA have declined, while they have increased substantially in the UK. We examined factors associated with this divergence in TB trends between the two countries. METHODS We analysed all cases of TB reported to the US and UK national TB surveillance systems from 1 January 2000 through 31 December 2011. Negative binominal regression was used to assess potential demographic, clinical and risk factor variables associated with differences in observed trends. FINDINGS A total of 259,609 cases were reported. From 2000 to 2011, annual TB incidence rates declined from 5.8 to 3.4 cases per 100,000 in the USA, whereas in the UK, TB incidence increased from 11.4 to 14.4 cases per 100,000. The majority of cases in both the USA (56%) and the UK (64%) were among foreign-born persons. The number of foreign-born cases reported in the USA declined by 15% (7731 in 2000 to 6564 in 2011) while native-born cases fell by 54% (8442 in 2000 to 3883 in 2011). In contrast, the number of foreign-born cases reported in the UK increased by 80% (3380 in 2000 to 6088 in 2011), while the number of native-born cases remained largely unchanged (2158 in 2000 to 2137 in 2011). In an adjusted negative binomial regression model, significant differences in trend were associated with sex, age, race/ethnicity, site of disease, HIV status and previous history of TB (p<0.01). Among the foreign-born, significant differences in trend were also associated with time since UK or US entry (p<0.01). INTERPRETATION To achieve TB elimination in the UK, a re-evaluation of current TB control policies and practices with a focus on foreign-born are needed. In the USA, maintaining and strengthening control practices are necessary to sustain the progress made over the last 20 years.
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Affiliation(s)
- Chimeremma D Nnadi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Lori R Armstrong
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helen R Stagg
- Research Department of Infection and Population Health, University College London, London, UK
| | - Debora Pedrazzoli
- TB Modelling Group, TB Centre and CMMID, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Robert Pratt
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Charles M Heilig
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ibrahim Abubakar
- Tuberculosis Section, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Patrick K Moonan
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Machiyama K, Semenza JC, Silverwood RJ, Palmer MJ, Lim TA, Manissero D, Sandgren A, Ploubidis GB. School life expectancy and risk for tuberculosis in Europe. Int J Public Health 2015; 61:603-11. [PMID: 26650454 DOI: 10.1007/s00038-015-0768-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE This study aims to investigate the effect of country-level school life expectancy on Tuberculosis (TB) incidence to gain further understanding of substantial variation in TB incidence across Europe. METHODS An ecological study examined the prospective association between baseline country-level education in 2000 measured by school life expectancy and TB incidence in 2000-2010 in 40 countries of the WHO European region using quantile regression. Subsequently, to validate the ecological associations between education and TB incidence, an individual-level analysis was performed using case-based data in 29 EU/EEA countries from the European Surveillance System (TESSy) and simulating a theoretical control group. RESULTS The ecological analysis showed that baseline school life expectancy had a negative prospective association with TB incidence. We observed consistent negative effects of school life expectancy on individuals' TB infections prospectively. CONCLUSIONS These findings suggests that country-level education is an important determinant of individual-level TB infection in the region, and in the absence of a social determinants indicator that is routinely collected for reportable infectious diseases, the adoption of country-level education for reportable infectious diseases would significantly advance the field.
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Affiliation(s)
- Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden.
| | - R J Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Melissa J Palmer
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Tek-Ang Lim
- European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden
| | - Davide Manissero
- European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden
| | - Andreas Sandgren
- European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, 171 82, Stockholm, Sweden
| | - George B Ploubidis
- Department of Social Science, Centre for Longitudinal Studies, UCL - Institute of Education, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK
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Fiebig L, Hauer B, Brodhun B, Altmann D, Haas W. Tuberculosis in Germany: a declining trend coming to an end? Eur Respir J 2015; 47:667-70. [PMID: 26493803 DOI: 10.1183/13993003.01410-2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/09/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Lena Fiebig
- Dept for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Dept for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Dept for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Doris Altmann
- Dept for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Dept for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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10
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Marx FM, Fiebig L, Hauer B, Brodhun B, Glaser-Paschke G, Magdorf K, Haas W. Higher Rate of Tuberculosis in Second Generation Migrants Compared to Native Residents in a Metropolitan Setting in Western Europe. PLoS One 2015; 10:e0119693. [PMID: 26061733 PMCID: PMC4465484 DOI: 10.1371/journal.pone.0119693] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We aimed to characterize migration among tuberculosis cases in Berlin and to estimate annual rates of tuberculosis in two subsequent migrant generations. We hypothesized that second generation migrants born in Germany are at higher risk of tuberculosis compared to native (non-migrant) residents. METHODS A prospective cross-sectional study was conducted. All tuberculosis cases reported to health authorities in Berlin between 11/2010 and 10/2011 were eligible. Interviews were conducted using a structured questionnaire including demographic data, migration history of patients and their parents, and language use. Tuberculosis rates were estimated using 2011 census data. RESULTS Of 314 tuberculosis cases reported, 154 (49.0%) participated. Of these, 81 (52.6%) were first-, 14 (9.1%) were second generation migrants, and 59 (38.3%) were native residents. The tuberculosis rate per 100,000 individuals was 28.3 (95CI: 24.0-32.6) in first-, 10.2 (95%CI: 6.1-16.6) in second generation migrants, and 4.6 (95%CI: 3.7-5.6) in native residents. When combining information from the standard notification variables country of birth and citizenship, the sensitivity to detect second generation migration was 28.6%. CONCLUSIONS There is a higher rate of tuberculosis among second generation migrants compared to native residents in Berlin. This may be explained by presumably frequent contact and transmission within migrant populations. Second generation migration is insufficiently captured by the surveillance variables country of birth and citizenship. Surveillance systems in Western Europe should allow for quantifying the tuberculosis burden in this important risk group.
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Affiliation(s)
- Florian M. Marx
- Department of Pediatric Pneumology and Immunology, Charité –Universitätsmedizin, Berlin, Germany
- Division of Global Health Equity, Brigham and Women’s Hospital and Harvard Medical School, Boston, United States of America
- * E-mail:
| | - Lena Fiebig
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Klaus Magdorf
- Department of Pediatric Pneumology and Immunology, Charité –Universitätsmedizin, Berlin, Germany
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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11
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Pealing L, Wing K, Mathur R, Prieto-Merino D, Smeeth L, Moore DAJ. Risk of tuberculosis in patients with diabetes: population based cohort study using the UK Clinical Practice Research Datalink. BMC Med 2015; 13:135. [PMID: 26048371 PMCID: PMC4470065 DOI: 10.1186/s12916-015-0381-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/21/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous cohort studies demonstrate diabetes as a risk factor for tuberculosis (TB) disease. Public Health England has identified improved TB control as a priority area and has proposed a primary care-based screening program for latent TB. We investigated the association between diabetes and risk of tuberculosis in a UK General Practice cohort in order to identify potential high-risk groups appropriate for latent TB screening. METHODS Using data from the UK Clinical Practice Research Datalink we constructed a cohort of patients with incident diabetes. We included 222,731 patients with diabetes diagnosed from 1990-2013 and 1,218,616 controls without diabetes at index date who were matched for age, sex and general practice. The effect of diabetes was explored using a Poisson analysis adjusted for age, ethnicity, body mass index, socioeconomic status, alcohol intake and smoking. We explored the effects of age, diabetes duration and severity. The effects of diabetes on risk of incident TB were explored across strata of chronic disease care defined by cholesterol and blood pressure measurement and influenza vaccination rates. RESULTS During just under 7 million person-years of follow-up, 969 cases of TB were identified. The incidence of TB was higher amongst patients with diabetes compared with the unexposed group: 16.2 and 13.5 cases per 100,000 person-years, respectively. After adjustment for potential confounders the association between diabetes and TB remained (adjusted RR 1.30, 95 % CI 1.01 to 1.67, P = 0.04). There was no evidence that age, time since diagnosis and severity of diabetes affected the association between diabetes and TB. Diabetes patients with the lowest and highest rates of chronic disease management had a higher risk of TB (P <0.001 for all comparisons). CONCLUSIONS Diabetes as an independent risk factor is associated with only a modest overall increased risk of TB in our UK General Practice cohort and is unlikely to be sufficient cause to screen for latent TB. Across different consulting patterns, diabetes patients accessing the least amount of chronic disease care are at highest risk for TB.
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Affiliation(s)
- Louise Pealing
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK. .,TB Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Kevin Wing
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Rohini Mathur
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - David Prieto-Merino
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - David A J Moore
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK. .,TB Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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12
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Abubakar I, Thomas HL, Morgan M, Anderson S, Zenner D, Cosford P. A collaborative strategy to tackle tuberculosis in England. Lancet 2015; 385:312-3. [PMID: 25608753 DOI: 10.1016/s0140-6736(14)61638-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ibrahim Abubakar
- Centre for Infectious Disease Epidemiology and MRC Clinical Trials Unit, University College London, London WC1E 6JB, UK; Public Health England, London, UK.
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Engaging new migrants in infectious disease screening: a qualitative semi-structured interview study of UK migrant community health-care leads. PLoS One 2014; 9:e108261. [PMID: 25330079 PMCID: PMC4198109 DOI: 10.1371/journal.pone.0108261] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/27/2014] [Indexed: 11/19/2022] Open
Abstract
Migration to Europe - and in particular the UK - has risen dramatically in the past decades, with implications for public health services. Migrants have increased vulnerability to infectious diseases (70% of TB cases and 60% HIV cases are in migrants) and face multiple barriers to healthcare. There is currently considerable debate as to the optimum approach to infectious disease screening in this often hard-to-reach group, and an urgent need for innovative approaches. Little research has focused on the specific experience of new migrants, nor sought their views on ways forward. We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers to screening, acceptability of screening, and innovative approaches to screening for four key diseases (HIV, TB, hepatitis B, and hepatitis C). Participants unanimously agreed that current screening models are not perceived to be widely accessible to new migrant communities. Dominant barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly. New migrants are likely to be disproportionately affected by these barriers, with implications for health status. Screening is certainly acceptable to new migrants, however, services need to be developed to become more community-based, proactive, and to work more closely with community organisations; findings that mirror the views of migrants and health-care providers in Europe and internationally. Awareness raising about the benefits of screening within new migrant communities is critical. One innovative approach proposed by participants is a community-based package of health screening combining all key diseases into one general health check-up, to lessen the associated stigma. Further research is needed to develop evidence-based community-focused screening models - drawing on models of best practice from other countries receiving high numbers of migrants.
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Craig GM, Joly LM, Zumla A. 'Complex' but coping: experience of symptoms of tuberculosis and health care seeking behaviours--a qualitative interview study of urban risk groups, London, UK. BMC Public Health 2014; 14:618. [PMID: 24943308 PMCID: PMC4074136 DOI: 10.1186/1471-2458-14-618] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis awareness, grounded in social cognition models of health care seeking behaviour, relies on the ability of individuals to recognise symptoms, assess their risk and access health care (passive case finding). There is scant published research into the health actions of 'hard-to-reach' groups with tuberculosis, who represent approximately 17% of the London TB caseload. This study aimed to analyse patients' knowledge of tuberculosis, their experiences of symptoms and their health care seeking behaviours. METHODS Qualitative interviews were conducted with 17 participants, predominantly homeless and attending a major tuberculosis centre in London, UK. Most had complex medical and social needs including drug and alcohol use or immigration problems affecting entitlement to social welfare. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions. RESULTS Although participants demonstrated some knowledge of tuberculosis their awareness of personal risk was low. Symptoms commonly associated with tuberculosis were either not recognised or were attributed to other causes for which participants would not ordinarily seek health care. Many accessed health care by chance and, for some, for health concerns other than tuberculosis. CONCLUSIONS Health education, based on increasing awareness of symptoms, may play a limited role in tuberculosis care for populations with complex health and social needs. The findings support the intensification of outreach initiatives to identify groups at risk of tuberculosis and the development of structured care pathways which support people into prompt diagnosis and treatment.
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Affiliation(s)
- Gillian M Craig
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
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Affiliation(s)
- Juraj Ivanyi
- Guy's Campus of Kings College London, London SE1 1UL, UK.
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16
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Shah N, Young S, Ghani R, John L, Davidson RN. Reversing the tide of the UK tuberculosis epidemic. Lancet 2014; 383:215. [PMID: 24439734 DOI: 10.1016/s0140-6736(14)60068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nikita Shah
- Imperial College London, School of Medicine, London SW7 2AZ, UK
| | - Sarah Young
- Imperial College London, School of Medicine, London SW7 2AZ, UK.
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