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Villa S, Tagliani E, Borroni E, Castellotti PF, Ferrarese M, Ghodousi A, Lamberti A, Senatore S, Faccini M, Cirillo DM, Codecasa LR. Outbreak of pre- and extensively drug-resistant tuberculosis in northern italy: urgency of cross-border, multidimensional, surveillance systems. Eur Respir J 2021; 58:13993003.00839-2021. [PMID: 34049944 DOI: 10.1183/13993003.00839-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/11/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Simone Villa
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy.,co-first (equally contributed)
| | - Elisa Tagliani
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.,co-first (equally contributed)
| | - Emanuele Borroni
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maurizio Ferrarese
- Regional TB Reference Centre, Villa Marelli Institute and Laboratory/ASST Niguarda, Milan, Italy
| | - Arash Ghodousi
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Lamberti
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy
| | - Sabrina Senatore
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy
| | - Marino Faccini
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy.,co-last (equally contributed)
| | | | - Luigi Ruffo Codecasa
- Regional TB Reference Centre, Villa Marelli Institute, ASST Niguarda, Milan, Italy.,co-last (equally contributed)
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Goscé L, Girardi E, Allel K, Cirillo DM, Barcellini L, Stancanelli G, Matteelli A, Hagphrast-Bidgoli H, Abubakar I. Tackling TB in migrants arriving at Europe's southern border. Int J Infect Dis 2021; 113 Suppl 1:S28-S32. [PMID: 33713814 DOI: 10.1016/j.ijid.2021.02.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Over a quarter of the individuals diagnosed with tuberculosis [TB] in the European Union region are born outside of the area and the proportion has been increasing steadily. Italy is a low TB incidence country with over 50% of TB cases in the foreign-born population primarily due to the high numbers of migrants entering the country via land or sea. As a case study to evaluate the value of screening in newly arrived migrants, the EDETECT-TB project in Italy implemented and evaluated active TB screening in the migrant population at first reception centres to ensure early diagnosis to avoid further spread. Based on a cost-effectiveness analysis from a program provider perspective, a decision tree model allowed the assessment of the value for money of case finding by estimating the cost per case of active TB detected compared with the status quo of no screening. The analysis confirmed that early case detection is a cost-effective intervention in areas with migrants arriving from high TB risk settings. Targeted post-arrival early screening of high TB risk vulnerable new entrants to Italy has a potential role in reducing the spread of TB among migrants.
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Affiliation(s)
- Lara Goscé
- Institute for Global Health, University College London, United Kingdom.
| | - Enrico Girardi
- Istituto Nazionale per le Malattie Infettive "L. Spallanzani"- IRCCS, Italy.
| | - Kasim Allel
- Institute for Global Health, University College London, United Kingdom.
| | | | | | | | - Alberto Matteelli
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, Brescia, Italy.
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, United Kingdom.
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3
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Riccardi N, Pontarelli A, Alagna R, Saderi L, Ferrarese M, Castellotti P, Viggiani P, Cirillo D, Besozzi G, Sotgiu G, Codecasa L. Epidemiology and treatment outcome of MDR and pre-XDR TB in international migrants at two reference centers in the North of Italy: a cross-sectional study coordinated by Stop TB Italia Onlus. Public Health 2020; 180:17-21. [PMID: 31837610 DOI: 10.1016/j.puhe.2019.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/26/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We evaluated the epidemiology and treatment outcomes of multi-drug-resistant (MDR) and pre-extensively-resistant (pre-XDR) tuberculosis (TB) in migrants at two TB reference centers in Italy. STUDY DESIGN Patient selection criteria for the present study were as follows: age ≥18 years, international migrants (i.e., person who lives in a country other than his/her country of origin), MDR or pre-XDR-TB based on drug-susceptibility test findings, full availability of microbiological, radiological and clinical data. Non-intersecting populations between the two centers were selected. The primary outcome was the proportion of patients with a successful (i.e., cured and treatment completed) treatment outcome. METHODS A retrospective cross-sectional study was conducted, from 01/Jan/2000 to 01/Jan/2015, at the Regional TB Reference Centre of Lombardy Region, Villa Marelli Institute/ASST Niguarda Ca' Granda (Milan, Italy) and at the Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital ASST (Sondalo, Italy). All data were made anonymous. Qualitative and quantitative variables were collected in an ad hoc electronic database. The statistical software used for all computations was STATA version 15 (StataCorp, Texas, USA). RESULTS Overall, 116 MDR-TB and pre-XDR-TB cases were recorded: 82 (70.7%) MDR-TB and 34 (29.3%) pre-XDR-TB patients, respectively. The majority (53.5%) were from the World Health Organization European Region (excluding EU/EEA) and 75 (64.5%) were male. Median (interquartile range) age was 32 (26-39) years. TB/HIV coinfection was found in 12 (10.3%) patients. Pulmonary TB was diagnosed in 107/116 (92.2%) patients. Resistance to fluoroquinolones and second-line injectables was detected in 22/116 (19.0%) and 12/107 (11.2%) patients, respectively. Overall treatment success was reached in 95/116 (81.9%) cases. CONCLUSION Pre-XDR-TB in migrants coming from high-endemic countries represents a matter of concern; therefore, prevention and control activities targeted to high-risk populations are needed to progress toward TB elimination.
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Affiliation(s)
- N Riccardi
- Clinic of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; StopTB Italia Onlus, Milan, Italy.
| | - A Pontarelli
- E. Morelli Hospital ASST, Reference Center for MDR-TB and HIV-TB, Sondalo, Italy
| | - R Alagna
- StopTB Italia Onlus, Milan, Italy; Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - M Ferrarese
- StopTB Italia Onlus, Milan, Italy; Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda, Milan, Italy
| | - P Castellotti
- StopTB Italia Onlus, Milan, Italy; Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda, Milan, Italy
| | - P Viggiani
- E. Morelli Hospital ASST, Reference Center for MDR-TB and HIV-TB, Sondalo, Italy
| | - D Cirillo
- StopTB Italia Onlus, Milan, Italy; Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - L Codecasa
- StopTB Italia Onlus, Milan, Italy; Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda, Milan, Italy
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Chiappini E, Matucci T, Lisi C, Petrolini C, Venturini E, Tersigni C, de Martino M, Galli L. Use of Second-line Medications and Treatment Outcomes in Children With Tuberculosis in a Single Center From 2007 to 2018. Pediatr Infect Dis J 2019; 38:1027-1034. [PMID: 31397749 DOI: 10.1097/inf.0000000000002410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of drug-resistant forms of tuberculosis (DR-TB) and the number of children treated with second-line drugs (SLDs) are increasing. However, limited amount of information is available regarding the use of SLDs in this population. METHODS To describe the treatment of pediatric TB with SLDs and factors associated with use of SLDs in children with and without documented DR-TB, records of pediatric TB patients referred to a center in Italy from 2007 to 2018 were reviewed retrospectively. RESULTS Of 204 children diagnosed with active TB during the study period, 42 were treated with SLDs because of confirmed or probable drug resistance (42.8%), adverse reactions to first-line drugs (7.1%), central nervous system involvement (11.9%) or unconfirmed possible drug resistance (38.1%). There were no deaths or adverse reactions to SLDs reported. Treatment was successful in 85.2% children treated with first-line drugs and 92.9% children treated with SLDs. After adjusting for calendar period, the only factor associated with DR-TB was <2 years old [odds ratio (OR): 5.24 for <2 years vs. 5-18 years; P = 0.008]. Factors associated with treatment with SLDs were TB at 2 or more sites (OR: 11.30; P < 0.001), extrapulmonary TB (OR: 8.48; P < 0.001) or adverse reactions to first-line drugs (OR: 7.48; P = 0.002). No differences were noted in age or region of origin. CONCLUSIONS A substantial proportion of TB children were treated with SLDs. The main reason for using SLDs was failure of a first-line drug regimen, suggesting possible DR-TB and underestimation of DR-TB in children. The use of SLD regimens was associated with a high success rate and good tolerability profile.
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Affiliation(s)
- Elena Chiappini
- From the Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Evaluation of IVD 3.0 Vitek MS matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of Mycobacterium tuberculosis and nontuberculous mycobacteria and its use in routine diagnostics. Eur J Clin Microbiol Infect Dis 2018; 37:2027-2029. [DOI: 10.1007/s10096-018-3326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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Mustazzolu A, Borroni E, Cirillo DM, Giannoni F, Iacobino A, Fattorini L. Trend in rifampicin-, multidrug- and extensively drug-resistant tuberculosis in Italy, 2009-2016. Eur Respir J 2018; 52:13993003.00070-2018. [PMID: 29724919 DOI: 10.1183/13993003.00070-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/24/2018] [Indexed: 11/05/2022]
Affiliation(s)
| | - Emanuele Borroni
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Federico Giannoni
- Dept of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Iacobino
- Dept of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Cannas A, Camassa S, Sali M, Butera O, Mazzarelli A, Sanguinetti M, Di Caro A, Delogu G, Girardi E. Genetic Diversity of Mycobacterium tuberculosis Isolates in the Metropolitan Area of Rome. Chemotherapy 2018; 63:148-154. [PMID: 29902788 DOI: 10.1159/000489860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The presence in a geographic area of Mycobacterium tuberculosis (Mtb) strains belonging to different phylogeographic lineages and showing different drug susceptibility patterns may suggest recent transmission, with implications in terms of patient clinical management and disease control. The aim of this study was to carry out a preliminary epidemiological investigation of tuberculosis (TB) cases in Rome. METHODS A total of 232 Mtb isolates, collected from new or previously treated patients, admitted between 2008 and 2014 at 2 hospital settings in Rome with a diagnosis of TB, were analyzed by spoligotyping and analyzing 24 variable-number tandem repeats (VNTR) mycobacterial interspersed repetitive-unit (MIRU) loci. The SITVIT2 database and the MIRU-VNTRplus web applications were used to identify the strain genotypes and to generate phylogenetic trees. RESULTS Based on the position on the phylogenetic tree, 97.4% of the strains were associated with 1 of the 7 main lineages. The Euro-American lineage was the most commonly represented (81.9%) within both Italian and foreign-born populations, although all main lineages were present. The highest frequency of drug-resistant strains was found among the East-Asian lineage (Beijing genotype) isolated from foreign-born patients. CONCLUSIONS Dynamics of TB transmission in Rome indicate recent spread of Mtb strains belonging to phylogeographic lineages and clades usually found in countries and geographic areas with a high incidence of TB, similarly to what is observed in most metropolitan areas in Western Europe. Knowledge from molecular and classical epidemiology provides an important tool for disease control.
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Affiliation(s)
- Angela Cannas
- Department of Epidemiology, Preclinical Research, and Advanced Diagnostics, National Institute for Infectious Diseases Lazzaro Spallanzani - IRCCS, Rome, Italy
| | - Serena Camassa
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Michela Sali
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Ornella Butera
- Department of Epidemiology, Preclinical Research, and Advanced Diagnostics, National Institute for Infectious Diseases Lazzaro Spallanzani - IRCCS, Rome, Italy
| | - Antonio Mazzarelli
- Department of Epidemiology, Preclinical Research, and Advanced Diagnostics, National Institute for Infectious Diseases Lazzaro Spallanzani - IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Antonino Di Caro
- Department of Epidemiology, Preclinical Research, and Advanced Diagnostics, National Institute for Infectious Diseases Lazzaro Spallanzani - IRCCS, Rome, Italy
| | - Giovanni Delogu
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Enrico Girardi
- Department of Epidemiology, Preclinical Research, and Advanced Diagnostics, National Institute for Infectious Diseases Lazzaro Spallanzani - IRCCS, Rome, Italy
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Cabibbe AM, Trovato A, De Filippo MR, Ghodousi A, Rindi L, Garzelli C, Baretti S, Allodi G, Mannino R, Rossolini GM, Bartoloni A, Tortoli E, Cirillo DM. Countrywide implementation of whole genome sequencing: an opportunity to improve tuberculosis management, surveillance and contact tracing in low incidence countries. Eur Respir J 2018; 51:13993003.00387-2018. [DOI: 10.1183/13993003.00387-2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/02/2018] [Indexed: 11/05/2022]
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Mustazzolu A, Iacobino A, Giannoni F, Piersimoni C, Fattorini L. Improved Bactec MGIT 960 Pyrazinamide Test Decreases Detection of False Mycobacterium tuberculosis Pyrazinamide Resistance. J Clin Microbiol 2017; 55:3552-3553. [PMID: 28904184 PMCID: PMC5703819 DOI: 10.1128/jcm.01437-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Angelo Iacobino
- Istituto Superiore di Sanità, Department of Infectious Diseases, Rome, Italy
| | - Federico Giannoni
- Istituto Superiore di Sanità, Department of Infectious Diseases, Rome, Italy
| | - Claudio Piersimoni
- Regional Reference Mycobacteria Laboratory, United Hospitals, Ancona, Italy
| | - Lanfranco Fattorini
- Istituto Superiore di Sanità, Department of Infectious Diseases, Rome, Italy
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Multidrug resistant tuberculosis in prisons located in former Soviet countries: A systematic review. PLoS One 2017; 12:e0174373. [PMID: 28334036 PMCID: PMC5363920 DOI: 10.1371/journal.pone.0174373] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/08/2017] [Indexed: 12/16/2022] Open
Abstract
Background A systematic literature review was performed to investigate the occurrence of multidrug-resistant tuberculosis (MDR TB) in prisons located in countries formerly part of the Soviet Union. Methods A systematic search of published studies reporting MDR TB occurrence in prisons located in former Soviet countries was conducted by probing PubMed and Cumulative Index Nursing and Allied Health Literature for articles that met predetermined inclusion criteria. Results Seventeen studies were identified for systematic review. Studies were conducted in six different countries. Overall, prevalence of MDR TB among prisoners varied greatly between studies. Our findings suggest a high prevalence of MDR TB in prisons of Post-Soviet states with percentages as high as 16 times more than the worldwide prevalence estimated by the WHO in 2014. Conclusion All studies suggested a high prevalence of MDR TB in prison populations in Post-Soviet states.
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Codecasa LR, Toumi M, D’Ausilio A, Aiello A, Damele F, Termini R, Uglietti A, Hettle R, Graziano G, De Lorenzo S. Cost-effectiveness of bedaquiline in MDR and XDR tuberculosis in Italy. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1283105. [PMID: 28265350 PMCID: PMC5328329 DOI: 10.1080/20016689.2017.1283105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 06/06/2023]
Abstract
Objective: To evaluate the cost-effectiveness of bedaquiline plus background drug regimens (BR) for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in Italy. Methods: A Markov model was adapted to the Italian setting to estimate the incremental cost-effectiveness ratio (ICER) of bedaquiline plus BR (BBR) versus BR in the treatment of MDR-TB and XDR-TB over 10 years, from both the National Health Service (NHS) and societal perspective. Cost-effectiveness was evaluated in terms of life-years gained (LYG). Clinical data were sourced from trials; resource consumption for compared treatments was modelled according to advice from an expert clinicians panel. NHS tariffs for inpatient and outpatient resource consumption were retrieved from published Italian sources. Drug costs were provided by reference centres for disease treatment in Italy. A 3% annual discount was applied to both cost and effectiveness. Deterministic and probabilistic sensitivity analyses were conducted. Results: Over 10 years, BBR vs. BR alone is cost-effective, with ICERs of €16,639/LYG and €4081/LYG for the NHS and society, respectively. The sensitivity analyses confirmed the robustness of the results from both considered perspectives. Conclusion: In Italy, BBR vs. BR alone has proven to be cost-effective in the treatment of MDR-TB and XDR-TB under a range of scenarios.
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Affiliation(s)
- Luigi R. Codecasa
- Regional TB Reference Centre, Villa Marelli Institute/ASST Niguarda Ca’ Granda, Milano, Italy
| | - Mondher Toumi
- Faculty of Medicine, Public Health Department, Aix-Marseille University, Marseille, France
| | | | | | | | | | | | | | - Giorgio Graziano
- Post-graduate Residency School in Hygiene and Preventive Medicine, University of Palermo, Palermo, Italy
| | - Saverio De Lorenzo
- E. Morelli Hospital ASST, Reference Center for MDR-TB and HIV-TB, Sondalo, Italy
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Blasi F, Matteelli A, Sotgiu G, Cirillo DM, Palmieri F, Fattorini L, Migliori GB. Moving towards tuberculosis elimination: a call for action from Italy and a possible model for other low tuberculosis incidence countries. Eur Respir J 2017; 49:49/2/1602242. [DOI: 10.1183/13993003.02242-2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/05/2016] [Indexed: 11/05/2022]
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