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Zhang X, Lam C, Sim E, Martinez E, Crighton T, Marais BJ, Sintchenko V. Genomic characteristics of prospectively sequenced Mycobacterium tuberculosis from respiratory and non-respiratory sources. iScience 2024; 27:110327. [PMID: 39055934 PMCID: PMC11269812 DOI: 10.1016/j.isci.2024.110327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/23/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
Understanding the differences between Mycobacterium tuberculosis strains isolated from respiratory and non-respiratory sources may inform clinical care and control strategies. We examined demographic and genomic characteristics of all culture-confirmed M. tuberculosis cultures isolated from respiratory and non-respiratory sources in New South Wales, Australia, from January 2017 to December 2021, using logistic regression models. M. tuberculosis strains from 1,831 patients were sequenced; 64.7% were from respiratory, 32.1% from non-respiratory, and 2.2% from both sources. Female patients had more frequent isolation from a non-respiratory source (p = 0.03), and older adults (≧65 years) from a respiratory source (p < 0.0001). Lineage 2 strains were relatively over-represented among respiratory isolates (p = 0.01). Among 39 cases with sequenced isolates from both sources, 43.6% had 1-10 single nucleotide polymorphism differences. The finding that older adults were more likely to have M. tuberculosis isolated from respiratory sources has relevance for TB control given the expected rise of TB among older adults.
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Affiliation(s)
- Xiaomei Zhang
- Centre for Research Excellence in Tuberculosis (TB-CRE), Centenary Institute, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Connie Lam
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Eby Sim
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Elena Martinez
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
- NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology-Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, NSW, Australia
| | - Taryn Crighton
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
- NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology-Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, NSW, Australia
| | - Ben J. Marais
- Centre for Research Excellence in Tuberculosis (TB-CRE), Centenary Institute, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia
| | - Vitali Sintchenko
- Centre for Research Excellence in Tuberculosis (TB-CRE), Centenary Institute, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
- NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology-Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, NSW, Australia
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Son E, Choi H, Mok J, Kang YA, Jeong D, Jeon D. Timing and predictors of death during treatment in patients with multidrug/rifampin-resistant tuberculosis in South Korea. Korean J Intern Med 2024; 39:640-649. [PMID: 38910510 PMCID: PMC11236803 DOI: 10.3904/kjim.2024.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND/AIMS This study aimed to investigate the timing and predictors of death during treatment among patients with multidrug/rifampin-resistant tuberculosis (MDR/RR-TB) in South Korea. METHODS This was a retrospective cohort study that included MDR/RR-TB cases notified between 2011 and 2017 in South Korea. RESULTS Among 7,226 MDR/RR-TB cases, 699 (9.7%) died at a median of 167 days (IQR 51-358 d) from the initiation of MDR-TB treatment. The cumulative proportion of all-cause death was 35.5% at 90 days and 52.8% at 180 days from treatment initiation. TB-related deaths occurred at a median of 133 days (IQR 32-366 d), which was significantly earlier than the median of 184 days (IQR 68-356 d) for non-TB-related deaths (p = 0.002). In a multivariate analysis, older age was the factor most strongly associated with death, with those aged ≥ 75 years being 68 times more likely to die (aHR 68.11, 95% CI 21.75-213.26), compared those aged ≤ 24 years. In addition, male sex, comorbidities (cancer, human immunodeficiency virus, and end stage renal disease), the lowest household income class, and TB-specific factors (previous history of TB treatment, smear positivity, and fluoroquinolone resistance) were identified as independent predictors of all-cause death. CONCLUSION This nationwide study highlights increased deaths during the intensive phase and identifies high-risk groups including older people and those with comorbidities or socioeconomic vulnerabilities. An integrated and comprehensive strategy is required to reduce mortality in patients with MDR/RR-TB, particularly focusing on the early stages of treatment and target populations.
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Affiliation(s)
- Eunjeong Son
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hongjo Choi
- Division of Health Policy and Management, Korea University College of Health Science, Seoul, Korea
| | - Jeongha Mok
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dawoon Jeong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Oh KH, Yanagawa M, Morishita F, Glaziou P, Rahevar K, Yadav RP. Changing epidemic of tuberculosis amidst the COVID-19 pandemic in the Western Pacific Region: analysis of tuberculosis case notifications and treatment outcomes from 2015 to 2022. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 47:101104. [PMID: 38911260 PMCID: PMC11190483 DOI: 10.1016/j.lanwpc.2024.101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/26/2024] [Accepted: 05/15/2024] [Indexed: 06/25/2024]
Abstract
Background Coronavirus disease-2019 (COVID-19) pandemic has deeply impacted tuberculosis (TB) services globally. This study aims to assess the COVID-19 pandemic's impact on TB diagnosis and care and explore associated factors in the Western Pacific Region. Methods We analysed TB case notifications and treatment outcomes for the Region and 14 selected countries and areas from 2015 to 2022. We further explored differences in reported cases from predicted cases by the UHC service coverage index and Human Development Index (HDI), and the relationship between the Stringency Index and TB case notifications during the pandemic. Findings TB case notifications declined in 2020 (21%) and 2021 (23%) compared to predicted cases and partly recovered in 2022 (18%). The shortfalls in 2020 and 2021 were more prominent in priority countries with high TB burden, where the decrease in clinically diagnosed pulmonary cases and paediatric cases was particularly pronounced. In priority countries, TB case notifications have a positive relationship with UHC service coverage index and HDI in 2021 and an inverse relationship with Stringency Index during the pandemic. In contrast, treatment outcomes have not changed significantly due to the pandemic across countries in the Region. Interpretation The COVID-19 pandemic has adversely impacted TB diagnosis and care in the Western Pacific Region, especially TB case detection. Stringent government policies against the pandemic, coupled with weak health systems and suboptimal socio-economic development, may have brought a more profound and prolonged impact in priority countries. Funding The Korea Disease Control and Prevention Agency and the Japan Ministry of Health, Labour and Welfare.
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Affiliation(s)
- Kyung Hyun Oh
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Manami Yanagawa
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Fukushi Morishita
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | - Kalpeshsinh Rahevar
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Rajendra Prasad Yadav
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
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Medrano BA, Lee M, Gemeinhardt G, Yamba L, Restrepo BI. High all-cause mortality and increasing proportion of older adults with tuberculosis in Texas, 2008-2020. Epidemiol Infect 2024; 152:e82. [PMID: 38736419 PMCID: PMC11131009 DOI: 10.1017/s0950268824000669] [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: 01/02/2024] [Revised: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024] Open
Abstract
Pulmonary tuberculosis (PTB) elimination efforts must consider the global growth of the ageing population. Here we used TB surveillance data from Texas, United States (2008-2020; total n = 10656) to identify unique characteristics and outcomes in older adults (OA, ≥65 years) with PTB, compared to young adults (YA, 18-39 years) or middle-aged adults (40-64 years). We found that the proportion of OA with PTB increased from 15% in 2008 to 24% in 2020 (trend p < 0.05). Diabetes was highly prevalent in OA (32%) but not associated with adverse outcomes. Death was 13-fold higher in OA compared to YA and was 7% at the time of diagnosis which suggests diagnostic delays. However, once TB was suspected, we found no differences in culture, smear, or nucleic acid detection of mycobacteria (although less lung cavitations) in OA. During treatment, OA had less drug-resistant TB, few adverse reactions and adhered with TB treatment. We recommend training healthcare workers to 'think TB' in OA, for prompt treatment initiation to diminish deaths. Furthermore, OA should be added as a priority group to the latent TB treatment guidelines by the World Health Organization, to prevent TB disease in this highly vulnerable group.
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Affiliation(s)
- Belinda A. Medrano
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Miryoung Lee
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Gretchen Gemeinhardt
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lana Yamba
- Tuberculosis Elimination Division, Texas Department of Health and Human Services, Austin, TX, USA
| | - Blanca I. Restrepo
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville, TX, USA
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, USA
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Suhairi MH, Mohamad M, Isa MR, Mohd Yusoff MAS, Ismail N. Risk factors for tuberculosis-related death among adults with drug-sensitive pulmonary tuberculosis in Selangor, Malaysia from 2013 to 2019: a retrospective cohort study using surveillance data. BMJ Open 2024; 14:e080144. [PMID: 38413152 PMCID: PMC10900436 DOI: 10.1136/bmjopen-2023-080144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES Due to the paucity of literature on risk factors for tuberculosis (TB)-related death, we determine the sociodemographic and clinical risk factors associated with TB-related deaths among adult pulmonary TB (PTB) patients on treatment in Selangor, Malaysia. DESIGN Retrospective cohort study. SETTING Routinely collected primary care data from all government TB clinics in Selangor. PARTICIPANTS Data of 24 570 eligible adult PTB patients from 2013 to 2019 were obtained from Selangor's State Health Department surveillance records. We included PTB patients aged at least 15 years old at the time of diagnosis with complete documentation of the dates of diagnosis, treatment initiation, end of treatment/follow-up and treatment outcomes. We excluded patients whose diagnoses were changed to non-TB, post-mortem TB diagnosis and multidrug-resistant TB (MDR-TB) patients. PRIMARY AND SECONDARY OUTCOME MEASURES TB-related death, determined from the recorded physicians' consensus during the TB mortality meeting. RESULTS TB-related death was significantly associated with far (adjusted HR (aHR) 9.98, 95% CI 4.28 to 23.28) and moderately advanced (aHR 3.23, 95% CI 1.43 to 7.31) radiological findings at diagnosis; concurrent TB meningitis (aHR 7.67, 95% CI 4.53 to 12.98) and miliary TB (aHR 6.32, 95% CI 4.10 to 9.74) involvement; HIV positive at diagnosis (aHR 2.81, 95% CI 2.21 to 3.57); Hulu Selangor (aHR 1.95, 95% CI 1.29 to 2.93), Klang (aHR 1.53, 95% CI 1.18 to 1.98) and Hulu Langat (aHR 1.31, 95% CI 1.03 to 1.68) residing districts; no formal education (aHR 1.70, 95% CI 1.23 to 2.35); unemployment (aHR 1.54, 95% CI 1.29 to 1.84), positive sputum smear acid-fast bacilli (AFB) at diagnosis (aHR 1.51, 95% CI 1.22 to 1.85); rural residency (aHR 1.39, 95% CI 1.13 to 1.72) and advancing age (aHR 1.03, 95% CI 1.02 to 1.03). CONCLUSIONS Far and moderately advanced radiological findings, concurrent TB meningitis and miliary TB involvement, HIV positive, Hulu Selangor, Klang and Hulu Langat residing districts, no formal education, unemployment, positive sputum smear AFB, rural residency and advancing age are risk factors of TB-related death. Our findings should assist in identifying high-risk patients requiring interventions against TB-related death.
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Affiliation(s)
- Mohammad Haikal Suhairi
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Bahagian Pengurusan Latihan Kementerian Kesihatan Malaysia, Putrajaya, Malaysia
| | - Mariam Mohamad
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | | | - Nurhuda Ismail
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
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Lisson Y, Lal A, Marais BJ, Glynn-Robinson A. Tuberculosis in elderly Australians: a 10-year retrospective review. Western Pac Surveill Response J 2024; 15:1-10. [PMID: 38249315 PMCID: PMC10796269 DOI: 10.5365/wpsar.2024.15.1.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Objective This report describes the epidemiology of active tuberculosis (TB) in elderly Australians (≥ 65 years) with analysis of the factors associated with TB disease and successful treatment outcomes. Methods A retrospective study of TB cases reported to the National Notifiable Diseases Surveillance System over a 10-year period from 2011 to 2020 was conducted. Cases were stratified by sex, age, risk factors, drug resistance, treatment type and outcome. Notification rates and incidence rate ratios with 95% confidence intervals were calculated and factors associated with treatment success analysed using multivariable logistic regression. Results A total of 2231 TB cases among elderly people were reported over the study period, with a 10-year mean incidence rate of 6.2 per 100 000 population. The median age of cases was 75 years (range 65-100 years); most were male (65%) and born overseas (85%). Multivariable analysis found that successful treatment outcome was strongly associated with younger age, while unsuccessful treatment outcome was associated with being diagnosed within the first 2 years of arrival in Australia, ever having resided in an aged-care facility and resistance to fluoroquinolones. Discussion Compared to other low-incidence settings in the Western Pacific Region, TB incidence in elderly people is low and stable in Australia, with most cases occurring among recent migrants from TB-endemic settings. Continued efforts to reduce TB importation and address migrant health, especially among elderly people, are important.
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Affiliation(s)
- Yasmin Lisson
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Office of Health Protection and Response Division, Australian Government Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Aparna Lal
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ben J Marais
- Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Glynn-Robinson
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Wingfield T. Ending Tuberculosis in Older People: New Strategies for an Age-old Disease. Clin Infect Dis 2023; 77:1476-1479. [PMID: 37506252 PMCID: PMC10654857 DOI: 10.1093/cid/ciad439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 07/30/2023] Open
Affiliation(s)
- Tom Wingfield
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- World Health Organization Collaborating Centre in Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Norrbackagatan 4, 171 76 Stockholm, Sweden
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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 CWM, Islam T. Correction: Tuberculosis in older adults: case studies from four countries with rapidly ageing populations in the western pacific region. BMC Public Health 2023; 23:1100. [PMID: 37287046 PMCID: PMC10245401 DOI: 10.1186/s12889-023-15576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The 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
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Alicia Ang
- Division of Infectious Diseases, Department of Medicine, Woodlands Health, Singapore, Singapore
| | - Takashi Yoshiyama
- Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Akihiro Ohkado
- Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Lisa Kawatsu
- Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Norio Yamada
- Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Kazuhiro Uchimura
- Research 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
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA, USA
| | - Manami Yanagawa
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kyung Hyun Oh
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Ben Marais
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The 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
- Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Catherine W M Ong
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Tauhid Islam
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
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