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Guo T, Tian S, Xin H, Du J, Cao X, Feng B, He Y, He Y, Wang D, Zhang B, Liu Z, Yan J, Shen L, Di Y, Chen Y, Jin Q, Pan S, Kioumourtzoglou MA, Gao L, Gao X. Impact of fine particulate matter on latent tuberculosis infection and active tuberculosis in older adults: a population-based multicentre cohort study. Emerg Microbes Infect 2024; 13:2302852. [PMID: 38240283 PMCID: PMC10826784 DOI: 10.1080/22221751.2024.2302852] [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: 09/20/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
Evidence showed that air pollution was associated with an increased risk of tuberculosis (TB). This study aimed to study the impact of long-term exposure to ambient particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) on the acquisition of LTBI and on the risk of subsequent active disease development among rural older adults from a multicentre cohort, which have not yet been investigated to date. A total of 4790 older adults were included in a population-based, multicentre, prospective cohort study (LATENTTB-NSTM) from 2013 to 2018. The level of long-term exposure to PM2.5 for each participant was assessed by aggregating satellite-based estimates. Logistic regression and time-varying Cox proportional hazards models with province-level random intercepts were employed to assess associations of long-term exposures to PM2.5 with the risk of LTBI and subsequent development of active TB, respectively. Out of 4790 participants, 3284 were LTBI-free at baseline, among whom 2806 completed the one-year follow-up and 127 developed newly identified LTBI. No significant associations were identified between PM2.5 and the risk of LTBI. And among 1506 participants with LTBI at baseline, 30 active TB cases were recorded during the 5-year follow-up. Particularly, an increment of 5 μg/m3 in 2-year moving averaged PM2.5 was associated with a 50.6% increased risk of active TB (HR = 1.506, 95% CI: 1.161-1.955). Long-term air pollution might be a neglected risk factor for active TB development from LTBI, especially for those living in developing or less-developed areas where the air quality is poor.
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Affiliation(s)
- Tonglei Guo
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Sifan Tian
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Henan Xin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiang Du
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xuefang Cao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Boxuan Feng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yijun He
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yongpeng He
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Dakuan Wang
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, People’s Republic of China
| | - Bin Zhang
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, People’s Republic of China
| | - Zisen Liu
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, People’s Republic of China
| | - Jiaoxia Yan
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, People’s Republic of China
| | - Lingyu Shen
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yuanzhi Di
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yanxiao Chen
- College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Qi Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Shouguo Pan
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, People’s Republic of China
| | | | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xu Gao
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, People’s Republic of China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, People's Republic of China
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Yuan B, Ma CQ. Perianal tuberculous ulcer with active pulmonary, intestinal and orificial tuberculosis: A case report. World J Radiol 2024; 16:356-361. [PMID: 39239247 PMCID: PMC11372554 DOI: 10.4329/wjr.v16.i8.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/20/2024] [Accepted: 07/18/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Orificial tuberculosis is a rare type of tuberculosis, which is easy to be misdiagnosed, and can cause great damage to the perianal skin and mucosa. Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria. CASE SUMMARY Here, we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis, intestinal tuberculosis and orificial tuberculosis. This is an extremely rare case of cutaneous tuberculosis of the anus, which was misdiagnosed for nearly a year. The patient received conventional treatment in other medical institutions, but specific treatment was delayed. Ultimately, proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure. CONCLUSION For skin ulcers that do not heal with repeated conventional treatments, consider ulcers caused by rare bacteria, such as Mycobacterium tuberculosis.
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Affiliation(s)
- Bao Yuan
- Department of General Surgery, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi 214400, Jiangsu Province, China
| | - Chao-Qun Ma
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
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Wang Z, Guo T, Xu L, Liu J, Hou Y, Jin J, Zhang Q, Jiang T, Zhao Z, Xue Y. Regional differences of Mycobacterium tuberculosis complex infection and multidrug resistance epidemic in Luoyang. BMC Infect Dis 2024; 24:578. [PMID: 38862881 PMCID: PMC11167740 DOI: 10.1186/s12879-024-09395-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: 12/09/2023] [Accepted: 05/09/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a global public health event of great concern, however epidemic data on TB covering entire areas during the special period of the COVID-19 epidemic have rarely been reported. We compared the dissemination and multidrug-resistance patterns of Mycobacterium tuberculosis complex (MTBC) in the main urban area of Luoyang City, China (including six municipal jurisdictions) and nine county and township areas under its jurisdiction, aimed to establish the epidemiology of TB in this region and to provide reference for precision anti-TB in places with similar settings. METHODS From 2020 to 2022, sputum samples were collected from 18,504 patients with confirmed, suspected and unexcluded TB in 10 designated TB medical institutions. Insertion sequence 6110 was amplified by PCR (rpoB gene detection if necessary) to confirm the presence of MTBC. PCR-positive specimens were analyzed by multicolor melting curve analysis to detect multidrug resistance. RESULTS Among the 18,504 specimens, 2675 (14.5%) were MTBC positive. The positive rate was higher in the main urban area than in the county and township areas (29.8% vs. 10.9%, p < 0.001). Male, re-treated and smear-positive groups were high-burden carriers of MTBC. Individuals aged > 60 years were the largest group infected with MTBC in the main urban area, compared with individuals aged < 61 years in the county and township areas. The detection of multidrug-resistant TB (MDR-TB) was higher in the main urban area than in the county and township areas (13.9% vs. 7.8%, p < 0.001). In all areas, MDR-TB groups were dominated by males, patients with a history of TB treatment, and patients aged < 61 years. Stratified analysis of MDR-TB epidemiology showed that MDR4 (INH þ RIF þ EMB þ SM) was predominant in the main urban area, while MDR3 (INH þ RIF þ SM) was predominant in the county and township areas. MDR-TB detection rate and epidemiology differed among the county and township areas. CONCLUSIONS For local TB control, it is necessary to plan more appropriate and accurate prevention and control strategies according to the regional distribution of MTBC infection.
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Affiliation(s)
- Zhenzhen Wang
- The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, Luoyang, China
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Tengfei Guo
- The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, Luoyang, China
| | - Liyang Xu
- Luoyang Center for Disease Control and Prevention, Luoyang, China
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Jinwei Liu
- The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, Luoyang, China
| | - Yi Hou
- Luoyang Center for Disease Control and Prevention, Luoyang, China
| | - Junrong Jin
- The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, Luoyang, China
| | - Qing Zhang
- The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, Luoyang, China
| | - Tao Jiang
- The First Affiliated Hospital and Clinical Medical College, Henan University of Science and Technology, Luoyang, China
| | - Zhanqin Zhao
- College of Animal Science and Technology, Henan University of Science and Technology, Luoyang, China.
| | - Yun Xue
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China.
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Cao X, Guo T, Xin H, Du J, Yang C, Feng B, He Y, Shen L, Di Y, Li Z, Chen Y, Liang J, Jin Q, Wang L, Gao L. Cost-effectiveness of latent tuberculosis infection testing and treatment with 6-week regimen among key population in rural communities in China: a decision analysis study. Eur J Clin Microbiol Infect Dis 2024; 43:809-820. [PMID: 38383889 DOI: 10.1007/s10096-024-04777-z] [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: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Several model studies suggested the implementation of latent tuberculosis infection (LTBI) testing and treatment could greatly reduce the incidence of tuberculosis (TB) and achieve the 2035 target of the "End TB" Strategy in China. The present study aimed to evaluate the cost-effectiveness of LTBI testing and TB preventive treatment among key population (≥ 50 years old) susceptible to TB at community level in China. METHODS A Markov model was developed to investigate the cost-effectiveness of LTBI testing using interferon gamma release assay (IGRA) and subsequent treatment with 6-month daily isoniazid regimen (6H) (as a standard regimen for comparison) or 6-week twice-weekly rifapentine and isoniazid regimen (6-week H2P2) in a cohort of 10,000 adults with an average initial age of 50 years. RESULTS In the base-case analysis, LTBI testing and treatment with 6H was dominated (i.e., more expensive with a lower quality-adjusted life year (QALY)) by LTBI testing and treatment with 6-week H2P2. LTBI testing and treatment with 6-week H2P2 was more effective than no intervention at a cost of $20,943.81 per QALY gained, which was below the willingness-to-pay (WTP) threshold of $24,211.84 per QALY gained in China. The one-way sensitivity analysis showed the change of LTBI prevalence was the parameter that most influenced the results of the incremental cost-effectiveness ratios (ICERs). CONCLUSION As estimated by a Markov model, LTBI testing and treatment with 6-week H2P2 was cost-saving compared with LTBI testing and treatment with 6H, and it was considered to be a cost-effective option for TB control in rural China.
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Affiliation(s)
- Xuefang Cao
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Tonglei Guo
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Henan Xin
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Jiang Du
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Chenlu Yang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, 100005, Beijing, China
| | - Boxuan Feng
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Yijun He
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Lingyu Shen
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Yuanzhi Di
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Zihan Li
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, Key Laboratory of Tropical Translational Medicine of Ministry of Education, Hainan Medical University, 571199, Haikou, China
| | - Yanxiao Chen
- College of Public Health, Zhengzhou University, 450001, Zhengzhou, China
| | - Jianguo Liang
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Qi Jin
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, 100005, Beijing, China.
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China.
- Key Laboratory of Pathogen Infection Prevention and Control (Ministry of Education), National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, People's Republic of China.
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He CX, Wu C, Zhang L, Jin HZ. Interleukin-17A Inhibitors in Patients with Psoriasis and Tuberculosis Infection: A 2-Year Prospective Study on Safety Without Preventive Treatment. Dermatol Ther (Heidelb) 2024; 14:893-906. [PMID: 38483777 PMCID: PMC11052946 DOI: 10.1007/s13555-024-01130-2] [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: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION The necessity for tuberculosis preventive treatment (TPT) and routine T-SPOT.TB monitoring in patients with psoriasis and tuberculosis infection (TBI) undergoing interleukin (IL)-17A inhibitor therapy remains uncertain. This study aims to evaluate the long-term safety of IL-17A inhibitors administered without TPT and analyze changes in T-SPOT.TB among these patients. It also identifies risk factors for TBI in patients with psoriasis. METHODS This single-center prospective study enrolled adult patients with plaque psoriasis and TBI receiving IL-17A inhibitors. TBI was defined as positive T-SPOT.TB results (≥ 6 spots) without symptoms or evidence of active tuberculosis (ATB). TPT administration was based on contraindications, tuberculosis risk factors, and patient preferences. The primary endpoint was the incidence of ATB over 2 years. Secondary outcomes included T-SPOT.TB changes and TBI risk factors. RESULTS Of the 129 patients with psoriasis and TBI enrolled in the study, 97 (75.2%) did not receive TPT, while 32 (24.8%) did. Among them, 109 patients (84.5%) completed the 2-year follow-up. During the 235 person-years of observation, no ATB cases were identified. Median T-SPOT.TB values showed no significant changes from baseline to year 2 in both the non-TPT (20 vs. 17 spots, p = 0.975) and TPT groups (55 vs. 58 spots, p = 0.830). T-SPOT.TB reversed in 14 patients (12.8%), mostly in the non-TPT group. Moreover, for TBI risk factor analysis, a cohort of 212 patients with psoriasis with negative baseline T-SPOT.TB was evaluated, revealing a TBI prevalence of 37.8%. Logistic regression analysis highlighted age ≥ 45 years (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.50-3.99, p < 0.001) and body mass index (BMI) < 24.0 kg/m2 (OR 2.12, 95% CI 1.27-3.54, p = 0.004) as independent risk factors for TBI. CONCLUSION IL-17A inhibitors do not appear to reactivate tuberculosis in patients with psoriasis and TBI, potentially reducing the need for routine TBI screening and preventive treatment. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2100045823.
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Affiliation(s)
- Chun-Xia He
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Chao Wu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Li Zhang
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Zhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Schwalb A, Emery JC, Dale KD, Horton KC, Ugarte-Gil CA, Houben RMGJ. Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection. Am J Epidemiol 2023; 192:1937-1943. [PMID: 36749011 PMCID: PMC10691197 DOI: 10.1093/aje/kwad028] [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: 06/17/2022] [Revised: 12/26/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
A key metric in tuberculosis epidemiology is the annual risk of infection (ARI), which is usually derived from tuberculin skin test (TST) and interferon-γ release assay (IGRA) prevalence surveys carried out in children. Derivation of the ARI assumes that immunoreactivity is persistent over time; however, reversion of immunoreactivity has long been documented. We used a deterministic, compartmental model of Mycobacterium tuberculosis (Mtb) infection to explore the impact of reversion on ARI estimation using age-specific reversion probabilities for the TST and IGRA. Using empirical data on TST reversion (22.2%/year for persons aged ≤19 years), the true ARI was 2-5 times higher than that estimated from immunoreactivity studies in children aged 8-12 years. Applying empirical reversion probabilities for the IGRA (9.9%/year for youths aged 12-18 years) showed a 1.5- to 2-fold underestimation. ARIs are increasingly underestimated in older populations, due to the cumulative impact of reversion on population reactivity over time. Declines in annual risk did not largely affect the results. Ignoring reversion leads to a stark underestimation of the true ARI in populations and our interpretation of Mtb transmission intensity. In future surveys, researchers should adjust for the reversion probability and its cumulative effect with increasing age to obtain a more accurate reflection of the burden and dynamics of Mtb infection.
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Affiliation(s)
- Alvaro Schwalb
- Correspondence to Dr. Alvaro Schwalb, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (e-mail: )
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Huang J, Tan Z, Tang Y, Shi W. Screening for latent infectious disease in patients with alopecia areata before initiating JAK inhibitors therapy: a single-center real-world retrospective study. Front Med (Lausanne) 2023; 10:1287139. [PMID: 37920596 PMCID: PMC10619649 DOI: 10.3389/fmed.2023.1287139] [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: 09/01/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Although there is growing evidence supporting the effectiveness of Janus kinase (JAK) inhibitors in treating alopecia areata, the high rate of recurrence following drug discontinuation has led to prolonged treatment courses and raised concerns about long-term safety. In clinical practice, caution should be exercised while using JAK inhibitors for various indications, and a comprehensive pre-treatment screening. Methods This study presents an analysis of screening data collected from real-world settings before the initiation of Janus kinase inhibitors in patients with alopecia areata. Investigators collected retrospective medical data characterizing patients' screening data. Data on demographic and clinical data, including age, sex, disease duration, severity of alopecia tool scale, history of prior treatment, and treatment regimen were recorded. Results In this cohort (N = 218), JAK inhibitors were initiated for 163 of 218 (74.8%) alopecia areata patients. The numbers of patients positive for antinuclear antibodies, hepatitis B surface antigen, hepatitis C virus antibodies, human immunodeficiency virus antibody, treponema pallidum hemagglutination assay, and thyroid-stimulating hormone were 32 (32/176), 10(10/218), 0 (0/218), 0 (0/218), 3 (3/218) and 9 (9/176), respectively. The number of patients with T-cell spot positive or imaging of the chest indicating tuberculosis was 37 (37/218). Disccusion Our data provide additional information on the safety profile of JAK inhibitors in patients with alopecia areata. As such, it is necessary and crucial to screen for JAK inhibitors before it is used, particularly for individuals with a high risk of tuberculosis, hepatitis B, and other infections.
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Affiliation(s)
| | | | | | - Wei Shi
- Department of Dermatology, Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
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Xiao Y, Mi W, Wang J, Wen D, Wang Y, Gu Y, Hao D, Yan W, Chen X, Li W. A Propensity Score-Matched Study on the Changes of TB Status and TB-IGRA Values in Patients with Psoriasis with Latent TB Receiving Secukinumab. Dermatol Ther (Heidelb) 2023; 13:2387-2401. [PMID: 37615837 PMCID: PMC10539261 DOI: 10.1007/s13555-023-00998-w] [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: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION The utilization of biologics in patients with psoriasis with latent tuberculosis infection (LTBI) has garnered significant attention. Although the tuberculosis (TB) safety profile of second-generation biologics, including secukinumab, has been partially confirmed in both clinical trials and real-world studies, the necessity for prophylactic therapy in patients with LTBI prior to administering this class of biologics remains a topic of controversy. METHODS This study enrolled 62 patients with psoriasis with LTBI who underwent secukinumab with routine TB reexamination. Patients were divided into two groups based on whether they received antituberculosis therapy (ATB; n = 48) or not (NTB; n = 16). We performed a propensity score-matched (PSM) analysis between ATB and NTB subgroups and retrospectively reviewed their interferon-gamma release assays (IGRA) and radiographic results. RESULTS No active TB case was reported on the basis of medical records and chest radiographs in either two group. Before PSM, the mean reexamining IGRA value was significantly elevated in patients who received prophylactic therapy (P = 0.00), but no significant increase was observed in patients who were not. After PSM, there was no significant IGRA value enhancement whether or not patients received prophylactic treatment. CONCLUSION Our data provide additional information on the safety profile of secukinumab in patients with psoriasis with LTBI. Furthermore, our presentation of the reexamined IGRA results revealed no significant elevation in the ATB or NTB group. As such, we believe further exploration is necessary to determine whether anti-TB medication is required prior to administering secukinumab.
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Affiliation(s)
- Yue Xiao
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wenyao Mi
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jinqiu Wang
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yiyi Wang
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuanxia Gu
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Dan Hao
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wei Yan
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xuerong Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Wei Li
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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9
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Islam MS, Gurley ES, Banu S, Hossain K, Heffelfinger JD, Amin Chowdhury KI, Ahmed S, Afreen S, Islam MT, Rahman SMM, Rahman A, Pearson ML, Chai SJ. Prevalence and incidence of tuberculosis infection among healthcare workers in chest diseases hospitals, Bangladesh: Putting infection control into context. PLoS One 2023; 18:e0291484. [PMID: 37756289 PMCID: PMC10529546 DOI: 10.1371/journal.pone.0291484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at increased risk of tuberculosis infection (TBI). We estimated the prevalence and incidence of TBI and risk factors among HCWs in Bangladeshi hospitals to target TB infection prevention and control (IPC) interventions. METHODS During 2013-2016, we conducted a longitudinal study among HCWs in four chest disease hospitals. At baseline, we administered a questionnaire on sociodemographic and occupational factors for TB, tuberculin skin tests (TST) in all hospitals, and QuantiFERON ®-TB Gold in-Tube (QFT-GIT) tests in one hospital. We assessed factors associated with baseline TST positivity (induration ≥10mm), TST conversion (induration increase ≥10mm from baseline), baseline QFT-GIT positivity (interferon-gamma ≥0.35 IU/mL), and QFT-GIT conversion (interferon-gamma <0.35 IU/mL to ≥0.35 IU/mL). We included factors with a biologically plausible relationship with TBI identified in prior studies or having an association (p = <0.20) in the bivariate analyses with TST positivity or QFT-GIT positivity in multivariable generalized linear models. The Kaplan-Meier was used to estimate the cumulative TBI incidence rate per 100 person-years. RESULTS Of the 758 HCWs invited, 732 (97%) consented to participate and 731 completed the one-step TST, 40% had a positive TST result, and 48% had a positive QFT-GIT result. In multivariable models, HCWs years of service 11-20 years had 2.1 (95% CI: 1.5-3.0) times higher odds of being TST-positive and 1.6 (95% CI 1.1-2.5) times higher odds of QFT-GIT-positivity at baseline compared with those working ≤10 years. HCWs working 11-20 years in pulmonary TB ward had 2.0 (95% CI: 1.4-2.9) times higher odds of TST positivity, and those >20 years had 2.5 (95% CI: 1.3-4.9) times higher odds of QFT-GIT-positivity at baseline compared with those working <10 years. TBI incidence was 4.8/100 person-years by TST and 4.2/100 person-years by QFT-GIT. Females had 8.5 (95% CI: 1.5-49.5) times higher odds of TST conversion than males. CONCLUSIONS Prevalent TST and QFT-GIT positivity was associated with an increased number of years working as a healthcare worker and in pulmonary TB wards. The incidence of TBI among HCWs suggests ongoing TB exposure in these facilities and an urgent need for improved TB IPC in chest disease hospitals in Bangladesh.
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Affiliation(s)
- Md. Saiful Islam
- icddr,b, Dhaka, Bangladesh
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - James D. Heffelfinger
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | | | | | | | | | | | | | - Michele L. Pearson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Shua J. Chai
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Diao S, Liu Z, Liu D, Cheng X, Zeng L, Jiao XF, Chen Z, Ni X, He S, Wu B, Kang D, Wan C, Zhao R, Wang H, Zhang L. Long-term economic evaluation of the recombinant Mycobacterium tuberculosis fusion protein (EC) test for the diagnosis of Mycobacterium tuberculosis infection. Front Pharmacol 2023; 14:1161526. [PMID: 37261290 PMCID: PMC10228647 DOI: 10.3389/fphar.2023.1161526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/05/2023] [Indexed: 06/02/2023] Open
Abstract
Background: Tuberculosis continues to be a significant global burden. Purified protein derivative of tuberculin (TB-PPD) is one type of tuberculin skin test (TST) and is used commonly for the auxiliary diagnosis of tuberculosis. The recombinant Mycobacterium tuberculosis fusion protein (EC) test is a new test developed in China. Objective: Evaluate the long-term economic implications of using the EC test compared with the TB-PPD test to provide a reference for clinical decision-making. Methods: The target population was people at a high risk persons of being infected with Mycobacterium tuberculosis. The outcome indicator was quality-adjusted life years (QALY). A cost-utility analysis was used to evaluate the long-term economic implications of using the EC test compared with the TB-PPD test. We employed a decision tree-Markov model from the perspective of the whole society within 77 years. Results: Compared with the TB-PPD test, the EC test had a lower cost but higher QALY. The incremental cost-utility ratio was -119,800.7381 CNY/QALY. That is, for each additional QALY, the EC test could save 119,800.7381 CNY: the EC test was more economical than the TB-PPD test. Conclusion: Compared with the TB-PPD test, the EC test would be more economical in the long term for the diagnosis of M. tuberculosis infection according our study.
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Affiliation(s)
- Sha Diao
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zheng Liu
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Dan Liu
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xiao Cheng
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Linan Zeng
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xue-Feng Jiao
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zhe Chen
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xiaofeng Ni
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Siyi He
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Bin Wu
- Department of Pharmacy, Renji Hospital Affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Deying Kang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chaomin Wan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Huiqing Wang
- Medical Simulation Centre, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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11
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Zhang Q, Ding H, Gao S, Zhang S, Shen S, Chen X, Xu Z. Spatiotemporal Changes in Pulmonary Tuberculosis Incidence in a Low-Epidemic Area of China in 2005-2020: Retrospective Spatiotemporal Analysis. JMIR Public Health Surveill 2023; 9:e42425. [PMID: 36884278 PMCID: PMC10034607 DOI: 10.2196/42425] [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: 09/03/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In China, tuberculosis (TB) is still a major public health problem, and the incidence of TB has significant spatial heterogeneity. OBJECTIVE This study aimed to investigate the temporal trends and spatial patterns of pulmonary tuberculosis (PTB) in a low-epidemic area of eastern China, Wuxi city, from 2005 to 2020. METHODS The data of PTB cases from 2005 to 2020 were obtained from the Tuberculosis Information Management System. The joinpoint regression model was used to identify the changes in the secular temporal trend. Kernel density analysis and hot spot analysis were used to explore the spatial distribution characteristics and clusters of the PTB incidence rate. RESULTS A total of 37,592 cases were registered during 2005-2020, with an average annual incidence rate of 34.6 per 100,000 population. The population older than 60 years had the highest incidence rate of 59.0 per 100,000 population. In the study period, the incidence rate decreased from 50.4 to 23.9 per 100,000 population, with an average annual percent change of -4.9% (95% CI -6.8% to -2.9%). The incidence rate of pathogen-positive patients increased during 2017-2020, with an annual percent change of 13.4% (95% CI 4.3%-23.2%). The TB cases were mainly concentrated in the city center, and the incidence of hot spots areas gradually changed from rural areas to urban areas during the study period. CONCLUSIONS The PTB incidence rate in Wuxi city has been declining rapidly with the effective implementation of strategies and projects. The populated urban centers will become key areas of TB prevention and control, especially in the older population.
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Affiliation(s)
- Qi Zhang
- Department of Chronic Communicable Disease, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Huan Ding
- Department of Chronic Communicable Disease, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Song Gao
- Department of Chronic Communicable Disease, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Shipeng Zhang
- Department of Chronic Communicable Disease, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Shiya Shen
- Department of Chronic Communicable Disease, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Xiaoyan Chen
- Department of Chronic Communicable Disease, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Zhuping Xu
- Department of Chronic Communicable Disease, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, China
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12
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Teo AKJ, Rahevar K, Morishita F, Ang A, Yoshiyama T, Ohkado A, Kawatsu L, Yamada N, Uchimura K, Choi Y, Chen Z, Yi S, Yanagawa M, Oh KH, Viney K, Marais B, Kim H, Kato S, Liu Y, Ong CW, Islam T. Tuberculosis in older adults: case studies from four countries with rapidly ageing populations in the western pacific region. BMC Public Health 2023; 23:370. [PMID: 36810018 PMCID: PMC9942033 DOI: 10.1186/s12889-023-15197-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The Western Pacific Region has one of the fastest-growing populations of older adults (≥ 65 years) globally, among whom tuberculosis (TB) poses a particular concern. This study reports country case studies from China, Japan, the Republic of Korea, and Singapore reflecting on their experiences in managing TB among older adults. FINDINGS Across all four countries, TB case notification and incidence rates were highest among older adults, but clinical and public health guidance focused on this population was limited. Individual country reports illustrated a range of practices and challenges. Passive case finding remains the norm, with limited active case finding (ACF) programs implemented in China, Japan, and the Republic of Korea. Different approaches have been trialled to assist older adults in securing an early diagnosis, as well as adhering to their TB treatment. All countries emphasised the need for person-centred approaches that include the creative application of new technology and tailored incentive programs, as well as reconceptualisation of how we provide treatment support. The use of traditional medicines was found to be culturally entrenched among older adults, with a need for careful consideration of their complementary use. TB infection testing and the provision of TB preventive treatment (TPT) were underutilised with highly variable practice. CONCLUSION Older adults require specific consideration in TB response policies, given the burgeoning aging population and their high TB risk. Policymakers, TB programs and funders must invest in and develop locally contextualised practice guidelines to inform evidence-based TB prevention and care practices for older adults.
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Affiliation(s)
- Alvin Kuo Jing Teo
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW Australia
| | - Kalpeshsinh Rahevar
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines.
| | - Fukushi Morishita
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Alicia Ang
- grid.508010.cDivision of Infectious Diseases, Department of Medicine, Woodlands Health, Singapore, Singapore
| | - Takashi Yoshiyama
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Akihiro Ohkado
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Lisa Kawatsu
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Norio Yamada
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Kazuhiro Uchimura
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Youngeun Choi
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Zi Chen
- Office of International Cooperation, Innovation Alliance on Tuberculosis Diagnosis and Treatment, Beijing, China
| | - Siyan Yi
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.513124.00000 0005 0265 4996KHANA Center for Population Health Research, Phnom Penh, Cambodia ,grid.265117.60000 0004 0623 6962Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA USA
| | - Manami Yanagawa
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kyung Hyun Oh
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- grid.3575.40000000121633745Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Ben Marais
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW Australia
| | - Heejin Kim
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Seiya Kato
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Yuhong Liu
- grid.24696.3f0000 0004 0369 153XBeijing Chest Hospital, Capital Medical University, Beijing, China
| | - Catherine W.M. Ong
- grid.412106.00000 0004 0621 9599Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Tauhid Islam
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
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Wang W, Chen X, Chen S, Zhang M, Wang W, Hao X, Liu K, Zhang Y, Wu Q, Zhu P, Chen B. The burden and predictors of latent tuberculosis infection among elder adults in high epidemic rural area of tuberculosis in Zhejiang, China. Front Cell Infect Microbiol 2022; 12:990197. [PMID: 36389154 PMCID: PMC9646974 DOI: 10.3389/fcimb.2022.990197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Diagnosis and treatment of latent tuberculosis infection (LTBI) is critical to tuberculosis (TB) control. Identifying the risk factors associated with LTBI can contribute to developing an optimized strategy for LTBI management. We conducted a survey of adults aged 65 years and older living in rural areas in Zhejiang Province during July 2021, followed by a one-year follow-up period to determine TB incidence. Participants underwent a physical examination and 5–6 mL of blood was drawn to test for Mycobacterium tuberculosis infection A total of 1856 individuals participated in the study, of whom 50.5% were men and 80.1% were married. Most participants (96.8%) often opened windows for ventilation at home. One-third (33.4%) of participants had abnormal chest radiographs and 34.9% had LTBI. Nine participants (0.5%) developed active TB patients during the one-year follow-up period. People who frequented closed entertainment places such as chess and card rooms had a relatively high percentage of LTBI (39.5%). Factors associated with a higher risk of LTBI in multivariable logistic regression analysis included being male (odds ratio [OR]:1.32; 95% confidence interval [CI] =:1.01-1.72), smoking (OR: 1.43; 95% CI:1.04-1.97), not opening windows for ventilation at home frequently (OR: 1.88; 95% CI: 1.10–3.22), and abnormal chest radiographs (OR; 1.48; 95% CI; 1.20–1.81). LTBI was prevalent among the elder adults living in high-epidemic rural areas of TB in Zhejiang province. Men, people who smoke, and people without the habit of ventilating at home should be targeted for LTBI screening to accelerate the decline of the TB epidemic in Zhejiang Province.
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Affiliation(s)
- Wei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xinyi Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Songhua Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Mingwu Zhang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Wei Wang
- Department of AIDS and Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Xiaogang Hao
- Department of AIDS and Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yu Zhang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qian Wu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Ping Zhu
- Department of AIDS and Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
- *Correspondence: Bin Chen, ; Ping Zhu,
| | - Bin Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- *Correspondence: Bin Chen, ; Ping Zhu,
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14
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Xiao Y, Chen H, Zou Q, Wang Y, Gu Y, Wang J, Yan W, Li W. The Tuberculosis Positive Conversion Rate Among Psoriasis Patients Treated with Adalimumab and Secukinumab: A Single-Center Retrospective Study in China. Dermatol Ther (Heidelb) 2022; 12:1493-1500. [PMID: 35616884 PMCID: PMC9133823 DOI: 10.1007/s13555-022-00745-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/10/2022] [Indexed: 02/08/2023] Open
Abstract
Introduction The tuberculosis (TB) positive conversion rate among psoriasis patients who received biologics has been reported worldwide, particularly in regions with low TB risk. Nonetheless, the TB-related safety of biologics such as adalimumab and secukinumab remains elusive in areas with high TB risk. According to the World Tuberculosis Report 2021, China is the country with the second highest TB burden, but data on TB conversion are also limited. Thus, we performed a retrospective, single-center study to profile the TB infection status conversion ratio among psoriasis patients treated with adalimumab and secukinumab in China. Methods Patients were enrolled between April 2019 and February 2021 from West China Hospital, Sichuan University. Baseline and relevant clinical information were summarized, and proper statistical analysis was used under different conditions. Results Five (5.43%) patients suffered TB conversion in the adalimumab group, two of whom developed active TB within the first 6 months. In the secukinumab group, four (5.26%) patients had TB positive conversion with no reports of active TB. Conclusion Our data show a relatively high rate of TB conversion among these psoriasis patients after mean treatment duration of 17.13 months. We recommend that, in patients who receive adalimumab, TB be reevaluated after the first 3 months and then monitored semiannually for the next 2 years. For patients treated with secukinumab, annual examination is sufficient.
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Affiliation(s)
- Yue Xiao
- Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hui Chen
- West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qin Zou
- Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yiyi Wang
- Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuanxia Gu
- Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jinqiu Wang
- Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wei Yan
- Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wei Li
- Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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15
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Dowdy DW, Behr MA. Are we underestimating the annual risk of infection with Mycobacterium tuberculosis in high-burden settings? THE LANCET. INFECTIOUS DISEASES 2022; 22:e271-e278. [PMID: 35526558 DOI: 10.1016/s1473-3099(22)00153-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/06/2022] [Accepted: 02/23/2022] [Indexed: 12/17/2022]
Abstract
The annual risk of infection with Mycobacterium tuberculosis determines a population's exposure level and thus the fraction of incident tuberculosis resulting from recent infection (often considered as having occurred within the past 2 years). Contemporary annual risk of infection estimates centre around 1% in most high-burden countries. We present three arguments why these estimates-primarily derived from cross-sectional tuberculin surveys in young school children (aged 5-12 years)-might underrepresent the true annual risk of infection. First, young children are expected to have lower risk of infection than older adolescents and adults (ie, those aged 15 years and older). Second, exposure might not lead to a positive test result in some individuals. Third, cross-sectional surveys might overlook transient immune responses. Accounting for these biases, the true annual risk of infection among adults in high-burden settings is probably closer to 5-10%. Consequently, most tuberculosis in those settings should reflect infection within the past 2 years rather than remote infection occurring many years ago. Under this reframing, major reductions in tuberculosis incidence could be achievable by focusing on the minority of people who have been recently infected.
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Affiliation(s)
- David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Marcel A Behr
- McGill International Tuberculosis Centre and Department of Medicine, McGill University, Montreal, QC, Canada
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Decreased annual risk of tuberculosis infection in South Korean healthcare workers using interferon-gamma release assay between 1986 and 2005. BMC Infect Dis 2021; 21:1161. [PMID: 34784896 PMCID: PMC8594200 DOI: 10.1186/s12879-021-06855-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background Tuberculosis (TB) has been a major public health problem in South Korea. Although TB notification rate in Korea is gradually decreasing, still highest among the member countries of the Organization for Economic Cooperation and Development. To effectively control TB, understanding the TB epidemiology such as prevalence of latent tuberculosis infection (LTBI) and annual risk of TB infection (ARI) are important. This study aimed to identify the prevalence of LTBI and ARI among South Korean health care workers (HCWs) based on their interferon-gamma release assays (IGRA). Methods This was single center, cross-sectional retrospective study in a tertiary hospital in South Korea. We performed IGRA in HCWs between May 2017 and March 2018. We estimated ARI based on IGRA results. Logistic regression model was used to identify factors affecting IGRA positivity. Results A total of 3233 HCWs were analyzed. Median age of participants was 38.0 and female was predominant (72.6%). Overall positive rate of IGRA was 24.1% and IGRA positive rates age-group wise were 6.6%, 14.4%, 34.3%, and around 50% in the age groups 20s, 30s, 40s, and 50s and 60s, respectively. The ARIs was 0.26–1.35% between 1986 and 2005; rate of TB infection has gradually decreased in the last two decades. Multivariable analysis indicated that older age, healed TB lesion in x-ray, and male gender were risk factors for IGRA positivity, whereas working in high-risk TB departments was not. Conclusions Results showed that ARI in South Korean HCWs gradually decreased over two decades, although LTBI remained prevalent. Our results suggest that the LTBI test result of HCWs might be greatly affected by age, rather than occupational exposure, in intermediate TB burden countries. Thus, careful interpretation considering the age structure is required. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06855-5.
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Xin H, Cao X, Zhang H, Feng B, Du Y, Zhang B, Wang D, Liu Z, Guan L, Shen F, Guan X, Yan J, He Y, He Y, Quan Z, Pan S, Liu J, Jin Q, Gao L. Protective efficacy of 6-week regimen for latent tuberculosis infection treatment in rural China: 5-year follow-up of a randomised controlled trial. Eur Respir J 2021; 60:13993003.02359-2021. [PMID: 34764183 PMCID: PMC9260122 DOI: 10.1183/13993003.02359-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
Abstract
Background Enlarging tuberculosis (TB) preventive treatment among at-risk populations is a critical component of the End TB Strategy. There is an urgent need to develop suitable latent tuberculosis infection (LTBI) testing and treatment tools according to the local TB epidemic and available resources worldwide. Methods Based on an open-label randomised controlled trial conducted since 2015 in China among rural residents aged 50–70 years with LTBI, the protective efficacy of a 6-week twice-weekly regimen of rifapentine plus isoniazid was further evaluated in a 5-year follow-up survey. Results 1298 treated participants and 1151 untreated controls were included in the 5-year protective efficacy analysis. In the per-protocol analysis, the incidence rate was 0.49 (95% CI 0.30–0.67) per 100 person-years in the untreated control group and 0.19 (95% CI 0.07–0.32) per 100 person-years in the treated group; the protection rate was 61.22%. Subgroup analysis showed that the protection rate was 76.82% in the per-protocol analysis among participants with baseline interferon (IFN)-γ levels in the highest quartile (≥3.25 IU·mL−1). Multiple logistic regression analysis indicated that participants with baseline body mass index <18.5 kg·m−2 and with pulmonary fibrotic lesions had increased hazard of developing active disease with an adjusted hazard ratio (aHR) of 3.64 (95% CI 1.20–11.00) and 5.99 (95% CI 2.20–16.27), respectively. In addition, individuals with higher baseline IFN-γ levels showed an increased risk of TB occurrence (aHR 2.27, 95% CI 1.13–4.58). Conclusions Our findings suggest the 6-week twice-weekly regimen of rifapentine plus isoniazid for LTBI treatment might be an optional tool for TB control in the Chinese population. A 6-week twice-weekly rifapentine plus isoniazid regimen showed a protective efficacy of >60% in 5 years, which indicated that preventive treatment based on a short-course regimen might be an optional tool for TB control in China.https://bit.ly/2Yeey7i
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Affiliation(s)
- Henan Xin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.,Contributed equally
| | - Xuefang Cao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.,Contributed equally
| | - Haoran Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.,Contributed equally
| | - Boxuan Feng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Ying Du
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Bin Zhang
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Dakuan Wang
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Zisen Liu
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Ling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Fei Shen
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Xueling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Jiaoxia Yan
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Yijun He
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Yongpeng He
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Zhusheng Quan
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Shouguo Pan
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Jianmin Liu
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Qi Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
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18
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Cords O, Martinez L, Warren JL, O'Marr JM, Walter KS, Cohen T, Zheng J, Ko AI, Croda J, Andrews JR. Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis. LANCET PUBLIC HEALTH 2021; 6:e300-e308. [PMID: 33765455 PMCID: PMC8168455 DOI: 10.1016/s2468-2667(21)00025-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 12/24/2022]
Abstract
Background Prisons are recognised as high-risk environments for tuberculosis, but there has been little systematic investigation of the global and regional incidence and prevalence of tuberculosis, and its determinants, in prisons. We did a systematic review and meta-analysis to assess the incidence and prevalence of tuberculosis in incarcerated populations by geographical region. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Knowledge, and the LILACS electronic database from Jan 1, 1980, to Nov 15, 2020, for cross-sectional and cohort studies reporting the incidence of Mycobacterium tuberculosis infection, incidence of tuberculosis, or prevalence of tuberculosis among incarcerated individuals in all geographical regions. We extracted data from individual studies, and calculated pooled estimates of incidence and prevalence through hierarchical Bayesian meta-regression modelling. We also did subgroup analyses by region. Incidence rate ratios between prisons and the general population were calculated by dividing the incidence of tuberculosis in prisons by WHO estimates of the national population-level incidence. Findings We identified 159 relevant studies; 11 investigated the incidence of M tuberculosis infection (n=16 318), 51 investigated the incidence of tuberculosis (n=1 858 323), and 106 investigated the prevalence of tuberculosis (n=6 727 513) in incarcerated populations. The overall pooled incidence of M tuberculosis infection among prisoners was 15·0 (95% credible interval [CrI] 3·8–41·6) per 100 person-years. The incidence of tuberculosis (per 100 000 person-years) among prisoners was highest in studies from the WHO African (2190 [95% CrI 810–4840] cases) and South-East Asia (1550 [240–5300] cases) regions and in South America (970 [460–1860] cases), and lowest in North America (30 [20–50] cases) and the WHO Eastern Mediterranean region (270 [50–880] cases). The prevalence of tuberculosis was greater than 1000 per 100 000 prisoners in all global regions except for North America and the Western Pacific, and highest in the WHO South-East Asia region (1810 [95% CrI 670–4000] cases per 100 000 prisoners). The incidence rate ratio between prisons and the general population was much higher in South America (26·9; 95% CrI 17·1–40·1) than in other regions, but was nevertheless higher than ten in the WHO African (12·6; 6·2–22·3), Eastern Mediterranean (15·6; 6·5–32·5), and South-East Asia (11·7; 4·1–27·1) regions. Interpretation Globally, people in prison are at high risk of contracting M tuberculosis infection and developing tuberculosis, with consistent disparities between prisons and the general population across regions. Tuberculosis control programmes should prioritise preventive interventions among incarcerated populations. Funding US National Institutes of Health.
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Affiliation(s)
- Olivia Cords
- Division of Infectious Diseases and Geographic Medicine, Stanford, CA, USA
| | - Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, Stanford, CA, USA; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA.
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Jamieson Michael O'Marr
- Division of Infectious Diseases and Geographic Medicine, Stanford, CA, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Katharine S Walter
- Division of Infectious Diseases and Geographic Medicine, Stanford, CA, USA
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Jimmy Zheng
- Stanford University School of Medicine, Stanford, CA, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Oswaldo Cruz Foundation, Salvador, Brazil
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Campo Grande, Mato Grosso do Sul, Brazil; Fundação Oswaldo Cruz, Campo Grande, Mato Grosso do Sul, Brazil
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford, CA, USA
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19
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Xin H, Zhang H, Yang S, Liu J, Lu W, Bai L, Cao X, Feng B, Jin Q, Gao L. 5-Year Follow-up of Active Tuberculosis Development From Latent Infection in Rural China. Clin Infect Dis 2021; 70:947-950. [PMID: 31253988 DOI: 10.1093/cid/ciz581] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/27/2019] [Indexed: 11/14/2022] Open
Abstract
A 5-year follow-up study found declining disease development rates from latent tuberculosis infection. In the latter 3 years, the incidence, per 100 person-years, was 0.26 for interferon-γ release assay positives and 0.19 for tuberculin skin test positives (P = .28). In addition, all round have been checked.
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Affiliation(s)
- Henan Xin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Haoran Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Shumin Yang
- Gansu Provincial Center for Diseases Control and Prevention, Lanzhou
| | - Jianmin Liu
- The Sixth People's Hospital of Zhengzhou, Nanjing, China
| | - Wei Lu
- Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China
| | - Liqiong Bai
- Hunan Provincial Institute of Tuberculosis Prevention and Control, Changsha, China
| | - Xuefang Cao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Boxuan Feng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Qi Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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20
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Horsburgh CR. “Plus Ça Change…”. Clin Infect Dis 2020; 70:2119-2120. [DOI: 10.1093/cid/ciz575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Robert Horsburgh
- Departments of Epidemiology, Biostatistics, Global Health, and Medicine, Boston University Schools of Medicine and Public Health, Massachusetts
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21
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Liu Q, Lu P, Martinez L, Peng H, Zhu T, Zhu L, Wang J, Lu W. Undiagnosed diabetes mellitus and tuberculosis infection: A population-based, observational study from eastern China. Diabetes Metab Res Rev 2020; 36:e3227. [PMID: 31655015 DOI: 10.1002/dmrr.3227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/23/2019] [Accepted: 10/14/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND China has the largest dual diabetes and tuberculosis epidemic globally. No studies from mainland China have assessed the relationship between tuberculosis infection and diabetes. We conducted a population-based, observational study in eastern China to further explore this relationship. METHODS A blood glucose, Quantiferon, and tuberculin skin test were administered at baseline. We compared tuberculosis infection in nondiabetics and diabetics. The cohort was additionally screened for tuberculosis progression over 5 years. RESULTS Among 5405 participants, diabetics had elevated levels of Quantiferon and tuberculin positivity, largely driven by undiagnosed diabetics (compared with nondiabetics, adjusted odds ratios of 1.53; 95% confidence interval [CI], 1.05-2.23 and 1.58; 95% CI, 1.07-2.35 for tuberculin and Quantiferon positivity). During follow-up, the annual tuberculosis incidence was three times higher for diabetics compared with the entire cohort. CONCLUSIONS These results suggest improving diabetic control through rapidly identifying undiagnosed diabetes may have indirect benefits to tuberculosis control. Targeting of preventive therapy to newly diagnosed diabetics at high-risk for progressive tuberculosis in China should be considered.
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Affiliation(s)
- Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, PR China
| | - Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
| | - Leonardo Martinez
- School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
| | - Hong Peng
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
| | - Tao Zhu
- Center for Disease Control and Prevention of Danyang City, Zhenjiang, Jiangsu Province, PR China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
| | - Jianming Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, PR China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China
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Cui X, Gao L, Cao B. Management of latent tuberculosis infection in China: Exploring solutions suitable for high-burden countries. Int J Infect Dis 2020; 92S:S37-S40. [PMID: 32114201 DOI: 10.1016/j.ijid.2020.02.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
China is one of the countries with a high burden of tuberculosis (TB) and latent tuberculosis infection (LTBI). It was recently estimated that China had the highest LTBI burden in the world, with approximately 350 million persons living with the infection. The prevalence of LTBI in China is overestimated by tuberculin skin test (TST) as compared to interferon-gamma release assay (IGRA). A population-based study found that IGRA positivity rates ranged between 13.5% and 19.8%. The annual TB infection rate in the rural population was 1.5% based on persistent positive IGRA results in converters. The development of active TB from LTBI in the general rural population was 0.87 per 100 person-years in the first 2 years among individuals who newly converted to IGRA-positive. TB control in students has been paid more attention by the government, which also improved LTBI management among students in close contact with active TB patients. A 3-month regimen of twice-weekly rifapentine plus isoniazid (3H2P2, both with a maximum dose of 600 mg) has been practiced for LTBI treatment in China for years. With respect to LTBI management in populations using immune inhibitors, an expert consensus on TB prevention and management in tumor necrosis factor antagonist application was published in 2013 in China. In order to achieve the global goals of the End TB Strategy, China needs innovative ideas and technologies to reduce the TB incidence by management of LTBI, such as the identification of populations for LTBI testing and treatment, selecting and developing reliable LTBI tests, exploring safe and effective preventive treatment tools, and establishing a set of optimized LTBI management systems.
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Affiliation(s)
- Xiaojing Cui
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, No. 2, East Yinghua Road, Chaoyang District, Beijing 100029, China
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, No. 2, East Yinghua Road, Chaoyang District, Beijing 100029, China.
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Mycobacterium Tuberculosis infection among the elderly in 20 486 rural residents aged 50-70 years in Zhongmu County, China. Clin Microbiol Infect 2019; 25:1120-1126. [PMID: 30738995 DOI: 10.1016/j.cmi.2019.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/27/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Elderly individuals in rural China have been known to be at increased risk of contracting tuberculosis (TB) and developing active disease. This study aims to estimate the burden of mycobacterium tuberculosis (MTB) infection and to identify potential targeted subgroups for infection control. METHODS As part of the investigation of an interventional study, 50- to 70-year-old rural residents in Zhongmu County were targeted for MTB infection testing using QuantiFERON-TB Gold In-Tube (QFT). Questionnaires and physical examinations were conducted to acquire their demographic information and health status. RESULTS A total of 20 486 individuals were included in the analysis. The prevalence of QFT positivity was 20.79% (4259/20 486) and 50 participants (0.24%) had indeterminate results. A positive dose-response relation was found for QFT positivity with smoking intensity. Compared with non-drinkers, the risk of MTB infection was lower among participants with moderate alcohol consumption (<10 g/day) with adjusted odds ratio (OR) of 0.82 (95% CI 0.71-0.94). In addition, gender of male, with a history of previous TB or silicosis, and hepatitis B/C virus infection were associated with increased risk of MTB infection. An indeterminate QFT result was related to being underweight (adjusted OR 3.18; 95% CI 1.09-9.26). CONCLUSIONS Our results indicate a high burden of MTB infection among the elderly in this rural area. Smokers, individuals with a history of previous TB or silicosis, and those with hepatitis B/C virus infection should be prioritized for MTB infection control to reduce the risk of disease development from a new infection.
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24
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Zhang H, Xin H, Wang D, Pan S, Liu Z, Cao X, Wang J, Li X, Feng B, Li M, Yang Q, Zhang M, Jin Q, Gao L. Serial testing of Mycobacterium tuberculosis infection in Chinese village doctors by QuantiFERON-TB Gold Plus, QuantiFERON-TB Gold in-Tube and T-SPOT.TB. J Infect 2019; 78:305-310. [PMID: 30710557 DOI: 10.1016/j.jinf.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/04/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the performance of QuantiFERON-TB Gold Plus (QFT-Plus) on Mycobacterium tuberculosis (MTB) infection test among registered village doctors from China. METHODS MTB infection of the registered village doctors in Zhongmu County were tested using QFT-Plus and two other interferon-gamma release assays (IGRAs) in parallel: QuantiFERON-TB Gold In-Tube (QFT) and T-SPOT.TB (T-SPOT). Retests were carried out for baseline positives at 3 and 6 months later, respectively. RESULTS A total of 616 village doctors were included in the baseline examination. The positivity of QFT, QFT-Plus and T-SPOT was 27.91% (168/602), 31.22% (187/599) and 27.70% (169/610), respectively. The concordance between QFT and QFT-Plus was 94.81% (Kappa coefficient: 0.87) and between T-SPOT and QFT-Plus was 88.93% (Kappa coefficient: 0.73). Reversions were frequently observed for all three assays. With respect to QFT-Plus, the quantitative results of reversions in the serial testing were mostly distributed in an "uncertain range" zone (0.2-0.7 IU/mL). Similar patterns of distribution were observed for QFT and T-SPOT as well. CONCLUSION Village doctors should gain more attention as an at-risk group for TB infection control in rural China. Our results support, by means of serial testing, a good agreement between QFT-Plus and QFT in Chinese population.
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Affiliation(s)
- Haoran Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Henan Xin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Dakuan Wang
- Zhongmu County Center for Diseases Control and Prevention, Zhongmu 451450, China
| | - Shouguo Pan
- Zhongmu County Center for Diseases Control and Prevention, Zhongmu 451450, China
| | - Zisen Liu
- Zhongmu County Center for Diseases Control and Prevention, Zhongmu 451450, China
| | - Xuefang Cao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Jinxing Wang
- Zhongmu County Health Commission, Zhongmu 451450, China
| | - Xiangwei Li
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Boxuan Feng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Mufei Li
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Qianting Yang
- Guangdong Key Laboratory for Diagnosis & Treatment of Emerging Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen 518112, China
| | - Mingxia Zhang
- Guangdong Key Laboratory for Diagnosis & Treatment of Emerging Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen 518112, China
| | - Qi Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.
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25
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Gao L, Zhang H, Xin H, Liu J, Pan S, Li X, Guan L, Shen F, Liu Z, Wang D, Guan X, Yan J, Li H, Feng B, Cao X, Chen Y, Cui W, Zhang Z, Ma Y, Chen X, Zhou X, Jin Q. Short-course regimens of rifapentine plus isoniazid to treat latent tuberculosis infection in older Chinese patients: a randomised controlled study. Eur Respir J 2018; 52:13993003.01470-2018. [PMID: 30361241 DOI: 10.1183/13993003.01470-2018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/24/2018] [Indexed: 11/05/2022]
Abstract
Latent tuberculosis infection (LTBI) management is now a critical component of the World Health Organization's End TB Strategy.In this randomised controlled trial (Chinese Clinical Trial Registry identifier ChiCTR-IOR-15007202), two short-course regimens with rifapentine plus isoniazid (a 3-month once-weekly regimen and a 2-month twice-weekly regimen) were initially designed to be evaluated for rural residents aged 50-69 years with LTBI in China.Due to the increasingly rapid growth and unexpected high frequency of adverse effects, the treatments were terminated early (after 8 weeks for the once-weekly regimen and after 6 weeks for the twice-weekly regimen). In the modified intention-to-treat analysis on the completed doses, the cumulative rate of active disease during 2 years of follow-up was 1.21% (14 out of 1155) in the untreated controls, 0.78% (10 out of 1284) in the group that received the 8-week once-weekly regimen and 0.46% (six out of 1299) in the group that received the 6-week twice-weekly regimen. The risk of active disease was decreased, with an adjusted hazard ratio of 0.63 (95% CI 0.27-1.43) and 0.41 (95% CI 0.15-1.09) for the treatments, respectively. No significant difference was found in the occurrence of hepatotoxicity (1.02% (13 out of 1279) versus 1.17% (15 out of 1279); p=0.704).The short regimens tested must be used with caution among the elderly because of the high rates of adverse effects. Further work is necessary to test the ultrashort regimens in younger people with LTBI.
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Affiliation(s)
- Lei Gao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,These authors contributed equally to this work.,These authors contributed equally to this work
| | - Haoran Zhang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,These authors contributed equally to this work
| | - Henan Xin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,These authors contributed equally to this work
| | - Jianmin Liu
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China.,These authors contributed equally to this work
| | - Shouguo Pan
- Center for Diseases Control and Prevention of Zhongmu, Zhongmu, China.,These authors contributed equally to this work
| | - Xiangwei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Fei Shen
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Zisen Liu
- Center for Diseases Control and Prevention of Zhongmu, Zhongmu, China
| | - Dakuan Wang
- Center for Diseases Control and Prevention of Zhongmu, Zhongmu, China
| | - Xueling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Jiaoxia Yan
- Center for Diseases Control and Prevention of Zhongmu, Zhongmu, China
| | - Hengjing Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Boxuan Feng
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuefang Cao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Chen
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Wei Cui
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Zongde Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yu Ma
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xiaoyou Chen
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xinhua Zhou
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,These authors contributed equally to this work
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Hamaguchi Y, Yamaguchi T, Nishiura H. Estimating the annual risk of tuberculosis infection in Japan from interferon-gamma release assay data. J Theor Biol 2018; 460:125-133. [PMID: 30315813 DOI: 10.1016/j.jtbi.2018.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 11/30/2022]
Abstract
To assess tuberculosis transmission frequency at a population level, the age-dependent Mantoux test has been used widely to estimate the annual risk of infection (ARI) with Mycobacterium tuberculosis. However, the widespread Bacille Calmette-Guerin (BCG) immunization program implemented in Japan in the 20th century has made natural infections with M. tuberculosis difficult to distinguish from immune responses against this vaccine. Consequently, a recognized alternative method for measuring the frequency of primary infections, the interferon-gamma release assay (IGRA), which partially decays as a function of time after infection, is used. We aimed to estimate the ARI in Japan from IGRA data along with its response decay information using mathematical modeling. Devising a partial differential equation system, we computed the probability of IGRA positivity as a function of time and age, accounting for the time-varying force of infection and decay function of the IGRA response. Jointly estimating the force of infection and the parameters governing the decay function of the IGRA response, we found that the age-dependent increasing pattern of the IGRA response was captured by the proposed simple model, yielding estimates of the time-dependent force of infection. ARI decreased as a function of time in the study subjects for all geographic locations. By the year 2030, our model showed that the median age of infection is predicted to be delayed by 40-50 years compared with that in 1940. The geographic variations in the ARI were striking, ranging from under 0.1% to 0.6% in 2018, which echoes the longstanding notion of highly heterogeneous geographical tuberculosis transmission in Japan.
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Affiliation(s)
- Yuko Hamaguchi
- Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; CREST, Japan Science and Technology Agency, Saitama 332-0012, Japan
| | - Takayuki Yamaguchi
- Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; CREST, Japan Science and Technology Agency, Saitama 332-0012, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; CREST, Japan Science and Technology Agency, Saitama 332-0012, Japan.
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Xin H, Zhang H, Cao X, Li X, Li M, Feng B, Jin Q, Gao L. Serum level of IL-8 is associated with reversion of QuantiFERON-TB gold in-tube tests. J Infect 2018; 78:292-298. [PMID: 30138640 DOI: 10.1016/j.jinf.2018.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frequent reversion has been commonly observed in serial QuantiFERON-TB Gold In-Tube (QFT) tests, which limited its accuracy in defining the status of Mycobacterium tuberculosis (MTB) infection. Serum cytokine profiles might provide additional information to clarify the infection status. METHOD Based on a population-based cohort study aiming to track MTB infection acquisition and disease development, serum profiles of 12 cytokines were determined by bead-based multiplex assays in parallel with QFT and tuberculin skin tests (TST) to explore potential relation between serum cytokines and MTB infection status. RESULTS Totally, 309 subjects got QFT conversion in one year (2013-2014) and 46.92% (145/309) of them got reversion in 2015. The study subjects were classified into three groups according to their QFT and TST results in 2015 (QFT persistence positive, QFT-/TST + and QFT-/TST-). The serum levels of MCP-1 and IL-8 were significantly different among the three groups. Furthermore, level of IL-8 was dramatically lower in QFT-/TST- group as compared to the other two groups, and no significant difference was observed for QFT-/TST + group as comparing with persistent positive group. CONCLUSION Our results suggested that the decreased serum level of IL-8 might be potential biomarker to identify QFT reversion caused by infection clearance.
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Affiliation(s)
- Henan Xin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Haoran Zhang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Xuefang Cao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Xiangwei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Mufei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Boxuan Feng
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Lei Gao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China.
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28
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Yew WW, Yoshiyama T, Leung CC, Chan DP. Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people. Respirology 2018; 23:567-575. [PMID: 29607596 DOI: 10.1111/resp.13303] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/25/2018] [Accepted: 03/14/2018] [Indexed: 12/18/2022]
Abstract
With the ageing population globally, tuberculosis (TB) in older people becomes a major clinical and public health challenge. In many Asian countries, especially those located in the eastern and southeastern parts of the continent, geriatric TB is a significant problem. TB in the older patients is more difficult to diagnose in the early course of disease, and has poorer treatment outcomes, largely as increased failure and death. More drug-induced adverse reactions are also experienced by this population during TB therapy. Oxidative stress and mitochondrial dysfunction are now well recognized to be associated with the ageing process, and it is likely that the cellular and molecular perturbations interact inextricably with the immunological dysfunction biophysiologically inherent to ageing. These underlying mechanistic bases putatively contribute to the development of TB in the geriatric population and worsen the disease outcomes, especially when the TB is compounded by co-morbid conditions such as smoking and diabetes mellitus. Unravelling these mechanisms further would yield knowledge that might potentially help to prevent reactivated TB in older people, and also to better manage the established disease with drug regimens and other new therapeutic strategies. In addition, addressing the social elements associated with geriatric TB is also imperative in the relief of individual patient suffering and improvement of overall disease control.
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Affiliation(s)
- Wing W Yew
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Takashi Yoshiyama
- Japan Anti Tuberculosis Association, The Research Institute of Tuberculosis and Fukujuji Hospital, Tokyo, Japan
| | - Chi C Leung
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong
| | - Denise P Chan
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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29
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Socio-Economic Predictors and Distribution of Tuberculosis Incidence in Beijing, China: A Study Using a Combination of Spatial Statistics and GIS Technology. Med Sci (Basel) 2018; 6:medsci6020026. [PMID: 29561814 PMCID: PMC6024827 DOI: 10.3390/medsci6020026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/10/2018] [Accepted: 03/12/2018] [Indexed: 01/06/2023] Open
Abstract
Evidence shows that multiple factors, such as socio-economic status and access to health care facilities, affect tuberculosis (TB) incidence. However, there is limited literature available with respect to the correlation between socio-economic/health facility factors and tuberculosis incidence. This study aimed to explore the relationship between TB incidence and socio-economic/health service predictors in the study settings. A retrospective spatial regression analysis was carried out based on new sputum smear-positive pulmonary TB cases in Beijing districts. Global Moran’s I analysis was adopted to detect the spatial dependency followed by spatial regression models (spatial lag model, and spatial error model) along with the ordinary least square model were applied to examine the correlation between TB incidence and predictors. A high incidence of TB was seen in densely populated districts in Beijing, e.g., Haidian, Mentougou, and Xicheng. After comparing the R2, log-likelihood, and Akaike information criterion (AIC) values among three models, the spatial error model (R2 = 0.413; Log Likelihood = −591; AIC = 1199.76) identified the best model fit for the spatial regression model. The study showed that the number of beds in health institutes (p < 0.001) and per capita gross domestic product (GDP) (p = 0.025) had a positive effect on TB incidence, whereas population density (p < 0.001) and migrated population (p < 0.001) had an adverse impact on TB incidence in the study settings. High TB incidence districts were detected in urban and densely populated districts in Beijing. Our findings suggested that socio-economic predictors influence TB incidence. These findings may help to guide TB control programs and promote targeted intervention.
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Gao L, Li X, Zhang H, Xin H, Jin Q. Incidence of active tuberculosis in rural China - Authors' reply. THE LANCET. INFECTIOUS DISEASES 2018; 18:145-146. [PMID: 29412964 DOI: 10.1016/s1473-3099(18)30022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 12/28/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Lei Gao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Xiangwei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Haoran Zhang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Henan Xin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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31
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Zeng G, Zhang G, Chen X. Th1 cytokines, true functional signatures for protective immunity against TB? Cell Mol Immunol 2017; 15:206-215. [PMID: 29151578 DOI: 10.1038/cmi.2017.113] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
The lack of an effective preventative vaccine against tuberculosis (TB) presents a great challenge to TB control. Since it takes an extremely long time to accurately determine the protective efficacy of TB vaccines, there is a great need to identify the surrogate signatures of protection to facilitate vaccine development. Unfortunately, antigen-specific Th1 cytokines that are currently used to evaluate the protective efficacy of the TB vaccine, do not align with the protection and failure of TB vaccine candidates in clinical trials. In this review, we discuss the limitation of current Th1 cytokines as surrogates of protection and address the potential elements that should be considered to finalize the true functional signatures of protective immunity against TB.
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Affiliation(s)
- Gucheng Zeng
- Department of Microbiology, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Guoliang Zhang
- Guangdong Key Laboratory of Emerging Infectious Diseases, Shenzhen Third People's Hospital, Guangdong Medical University, Shenzhen, Guangdong 518112, China
| | - Xinchun Chen
- Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China
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32
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Li H, Xin H, Qian S, Li X, Zhang H, Li M, Feng B, Jin Q, Gao L. Testing of tuberculosis infection among Chinese adolescents born after terminating the Bacillus Calmette-Guérin booster vaccination: subgroup analysis of a population-based cross-sectional study. Front Med 2017; 11:528-535. [PMID: 29101754 DOI: 10.1007/s11684-017-0573-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/19/2017] [Indexed: 10/18/2022]
Abstract
The prevalence of tuberculosis infection among adolescents born after terminating the Bacillus Calmette-Guérin (BCG) booster vaccination in China was estimated using tuberculin skin testing (TST) and QuantiFERON-TB Gold assay (QFT) to investigate the influence of neonatal BCG vaccination on the performance of TST. Data analysis was conducted for 2831 eligible participants aged 5-15 years from the baseline survey of a population-based multi-center prospective study. The prevalence rates of TST (induration = 10 mm) and QFT positivity were 9.3% (264/2827) and 2.5% (71/2831), respectively. The rate of QFT indeterminate result was 2.2% (62/2831). The overall agreement between TST and QFT was low (concordance = 88.0%; ? coefficient = 0.125). Only TST was positively associated with BCG vaccination with an adjusted odds ratio of 1.71 [95% confidence interval, 1.26-2.31]. A history of close contact with patients of active TB was significantly associated with positivity for TST and QFT. Our results suggested that BCG neonatal vaccination still affects TST performance, and a twostep approach might be considered for TB infection testing among adolescents in China.
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Affiliation(s)
- Hengjing Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Henan Xin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Shukun Qian
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, 100043, China
| | - Xiangwei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Haoran Zhang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Mufei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Boxuan Feng
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Lei Gao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Zellweger JP. Latent tuberculosis infection in rural China: who will develop tuberculosis? THE LANCET. INFECTIOUS DISEASES 2017; 17:1007-1008. [PMID: 28716676 DOI: 10.1016/s1473-3099(17)30441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
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34
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Gao L, Li X, Liu J, Wang X, Lu W, Bai L, Xin H, Zhang H, Li H, Zhang Z, Ma Y, Li M, Feng B, Du J, Sui H, Zhao R, Su H, Pan S, Guan L, Shen F, He J, Yang S, Si H, Cheng X, Xu Z, Tan Y, Chen T, Xu W, Peng H, Wang Z, Zhu T, Chen X, Zhou X, Guan X, Jin Q. Incidence of active tuberculosis in individuals with latent tuberculosis infection in rural China: follow-up results of a population-based, multicentre, prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1053-1061. [PMID: 28716677 DOI: 10.1016/s1473-3099(17)30402-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The management of latent Mycobacterium tuberculosis infection is a new priority action for the WHO End Tuberculosis (TB) Strategy. However, national guidelines on latent tuberculosis infection testing and treatment have not yet been developed in China. Here, we present the results from the 2-year follow-up of a study that aimed to track the development of active disease in individuals with latent tuberculosis infection, identify priority populations for latent infection management, and explore the most suitable latent infection diagnostic approach. METHODS A population-based multicentre prospective study was done in four sites in rural China, between 2013 and 2015. The baseline survey in 2013 measured the prevalence of latent tuberculosis infection using QuantiFERON-TB Gold In-Tube (QFT) and tuberculin skin test (TST) in eligible participants. During the follow-up phase between 2014-15, we assessed individuals who had tuberculosis infection at baseline (QFT-positivity or TST tuberculin reaction size [induration] of ≥10 mm) for the development of active disease through active case finding. Eligible participants included in follow-up survey had a birth date before June 1, 2008 (5 years or older in 2013), and continuous residence at the study site for 6 months or longer in the past year. Participants with current active tuberculosis at baseline survey were excluded. FINDINGS Between Sept 1, 2013, and Aug 31, 2015, 7505 eligible participants (aged 5 years or older) were included in tuberculosis infection test positive cohorts (4455 were QFT positive, 6404 had TST induration ≥10 mm, and 3354 were positive for both tests) after baseline examination. During the 2-year follow-up period, 84 incident cases of active tuberculosis were diagnosed. Of participants who developed active tuberculosis, 75 were diagnosed with latent infection by QFT, 62 were diagnosed by TST, and 53 were diagnosed by both tests. An incidence rate of 0·87 (95% CI 0·68-1·07) per 100 person-years was observed for individuals who tested positive with QFT, 0·50 (0·38-0·63) per 100 person-years for those who tested positive with TST (p<0·0001), and 0·82 (0·60-1·04) per 100 person-years for those who tested positive with both tests. Male sex and a history of tuberculosis were significantly associated with increased risk of disease development with adjusted hazard ratios of 2·36 (95% CI 1·30-4·30) for male sex and 5·40 (3·34-8·71) for a history of tuberculosis. INTERPRETATION Our results suggest that high-risk populations in communities in rural China, such as individuals at a high risk of disease reactivation from previous tuberculosis, should be targeted for latent infection screening and treatment with an interferon-γ releasing assay rather than a TST. FUNDING National Science and Technology Major Project of China, Program for Changjiang Scholars and Innovative Research Team in University of China, CAMS Innovation Fund for Medical Sciences, and Sanming Project of Medicine in Shenzhen.
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Affiliation(s)
- Lei Gao
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangwei Li
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianmin Liu
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Xinhua Wang
- Gansu Provincial Center for Diseases Control and Prevention, Lanzhou, China
| | - Wei Lu
- Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China
| | - Liqiong Bai
- Hunan Provincial Institute of Tuberculosis Prevention and Control, Changsha, China
| | - Henan Xin
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoran Zhang
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengjing Li
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zongde Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yu Ma
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Mufei Li
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Boxuan Feng
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang Du
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongtao Sui
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Zhao
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoxiang Su
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shouguo Pan
- Zhongmu County Center for Diseases Control and Prevention, Zhongmu, China
| | - Ling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Fei Shen
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Jian He
- Gansu Provincial Center for Diseases Control and Prevention, Lanzhou, China
| | - Shumin Yang
- Gansu Provincial Center for Diseases Control and Prevention, Lanzhou, China
| | - Hongyan Si
- Gansu Provincial Center for Diseases Control and Prevention, Lanzhou, China
| | - Xu Cheng
- Longxi County Center for Diseases Control and Prevention, Longxi, China
| | - Zuhui Xu
- Hunan Provincial Institute of Tuberculosis Prevention and Control, Changsha, China
| | - Yunhong Tan
- Hunan Provincial Institute of Tuberculosis Prevention and Control, Changsha, China
| | - Tianzhu Chen
- Xiangtan County Center for Diseases Control and Prevention, Xiangtan, China
| | - Weiguo Xu
- Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China
| | - Hong Peng
- Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China
| | - Zhijian Wang
- Danyang City Center for Diseases Control and Prevention, Danyang, China
| | - Tao Zhu
- Danyang City Center for Diseases Control and Prevention, Danyang, China
| | - Xiaoyou Chen
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xinhua Zhou
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xueling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Qi Jin
- Ministry of Health Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Li X, Yang Q, Feng B, Xin H, Zhang M, Deng Q, Deng G, Shan W, Yue J, Zhang H, Li M, Li H, Jin Q, Chen X, Gao L. Tuberculosis infection in rural labor migrants in Shenzhen, China: Emerging challenge to tuberculosis control during urbanization. Sci Rep 2017; 7:4457. [PMID: 28667275 PMCID: PMC5493641 DOI: 10.1038/s41598-017-04788-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/19/2017] [Indexed: 11/28/2022] Open
Abstract
During China’s urbanization process, rural labor migrants have been suggested to be one important bridge population to change urban-rural distribution on tuberculosis (TB) burden. Aiming to estimate the prevalence of TB infection and to track the active disease development in rural labor migrants, a prospective study was conducted in Shenzhen city, southern China. TB infection was detected using interferon-γ release assay (IGRA). Here we mainly report the characteristics of TB infection in the study population based on the baseline survey. A total of 4,422 eligible participants completed baseline survey in July 2013. QuantiFERON (QFT) positivity rates 17.87% (790/4,422) and was found to be consistent with the local TB epidemic of the areas where the participants immigrated from. Age, smoking, residence registered place, and present of BCG scars were found to be independently associated with QFT positivity. Additionally, evidence for interaction between smoking and age was observed (p for likelihood ratio test < 0.001). Our results suggested that the development of TB control strategy including latent TB infection management should pay more attention to the rural flowing population due to their high mobility and higher prevalence of TB infection.
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Affiliation(s)
- Xiangwei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qianting Yang
- Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen, China
| | - Boxuan Feng
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Henan Xin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - MingXia Zhang
- Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen, China
| | - Qunyi Deng
- Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen, China
| | - Guofang Deng
- Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen, China
| | - Wanshui Shan
- Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen, China
| | - Jianrong Yue
- Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen, China
| | - Haoran Zhang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Mufei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hengjing Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xinchun Chen
- Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen, China. .,Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, 518060, China.
| | - Lei Gao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Zhang H, Xin H, Li X, Li H, Li M, Lu W, Bai L, Wang X, Liu J, Jin Q, Gao L. A dose-response relationship of smoking with tuberculosis infection: A cross-sectional study among 21008 rural residents in China. PLoS One 2017; 12:e0175183. [PMID: 28384350 PMCID: PMC5383252 DOI: 10.1371/journal.pone.0175183] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/21/2017] [Indexed: 12/24/2022] Open
Abstract
Objectives China has high burden on both of tuberculosis (TB) and tobacco use. This study aims to explore the potential link between smoking and TB infection using baseline survey data of a large-scale population-based prospective study in rural China Methods Between July 1 and Sept 30, 2013, based on the baseline survey of a population-based, prospective study in rural China, the relationship between smoking and TB infection, assessed by interferon-gamma release assays (IGRA), was investigated among the total study population and only among those smokers, respectively. Results A total of 21,008 eligible rural registered residents (≥ 5 years old) from 4 rural sites were included in the analysis. Ever-smokers were more likely to be QuantiFERON-TB Gold In-Tube (QFT) positive than never smokers with an adjusted odds ratio (OR) of 1.34 (95% confidence interval (CI): 1.21–1.49). Among ever smokers, a significant linear dose–response relation was observed between duration of smoking (by years) and QFT positivity (p < 0.001). Stratified analysis suggested that such an association was not influenced by gender and age. Evidence for interaction of smoking status with age was found. Conclusions Our results provide further evidence to support smoking might increase host susceptibility to TB infection. Populations under high risk of infection, such as elderly smokers, should be prior to TB infection controlling under a premise of community level intervention.
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Affiliation(s)
- Haoran Zhang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Henan Xin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangwei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengjing Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mufei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Lu
- Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China
| | - Liqiong Bai
- Hunan Provincial Institute of Tuberculosis Prevention and Control, Changsha, China
| | - Xinhua Wang
- Gansu Provincial Center for Diseases Control and Prevention, Lanzhou, China
| | - Jianmin Liu
- The Sixth People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Gao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail:
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Association of Body Mass Index with the Tuberculosis Infection: a Population-based Study among 17796 Adults in Rural China. Sci Rep 2017; 7:41933. [PMID: 28176883 PMCID: PMC5296872 DOI: 10.1038/srep41933] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 01/04/2017] [Indexed: 01/13/2023] Open
Abstract
Body mass index (BMI) has been shown to be associated with host susceptibility to several infections. However, the link between BMI and the risk of tuberculosis (TB) infection has been sparsely studied in China and in worldwide. Based on the baseline survey of a population-based, prospective study in rural China, the association between BMI and TB infection among adults was estimated by means of cross-sectional analysis. TB infection status was tested using QuantiFERON-TB Gold In-Tube (QFT), a commercial of interferon-γ release assay (IGRA). Totally, 17796 eligible participants aged ≥18 years from 4 study sites, were included in the analysis. 21.76% (3873/17796) were observed to be QFT positive. Age and gender standardized prevalence ranged from 16.49% to 23.81% across the study sites. 42.19% study participants were obese/overweight with BMI ≥ 24.0 kg/m2. BMI ≥ 28.0 kg/m2 was observed to be independently associated with QFT positivity (adjusted odds ratio: 1.17, 95% confidence interval: 1.04–1.33). The strength of the association was found to be geographically diversity, which might be explained, at least partly, by the varied local TB epidemic status. Our results suggest that individuals with obesity might be one important target population for TB infection control in rural China.
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