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Bobak CA, Botha M, Workman L, Hill JE, Nicol MP, Holloway JW, Stein DJ, Martinez L, Zar HJ. Gene Expression in Cord Blood and Tuberculosis in Early Childhood: A Nested Case-Control Study in a South African Birth Cohort. Clin Infect Dis 2023; 77:438-449. [PMID: 37144357 PMCID: PMC10425199 DOI: 10.1093/cid/ciad268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/21/2023] [Accepted: 04/29/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Transcriptomic profiling of adults with tuberculosis (TB) has become increasingly common, predominantly for diagnostic and risk prediction purposes. However, few studies have evaluated signatures in children, particularly in identifying those at risk for developing TB disease. We investigated the relationship between gene expression obtained from umbilical cord blood and both tuberculin skin test conversion and incident TB disease through the first 5 years of life. METHODS We conducted a nested case-control study in the Drakenstein Child Health Study, a longitudinal, population-based birth cohort in South Africa. We applied transcriptome-wide screens to umbilical cord blood samples from neonates born to a subset of selected mothers (N = 131). Signatures identifying tuberculin conversion and risk of subsequent TB disease were identified from genome-wide analysis of RNA expression. RESULTS Gene expression signatures revealed clear differences predictive of tuberculin conversion (n = 26) and TB disease (n = 10); 114 genes were associated with tuberculin conversion and 30 genes were associated with the progression to TB disease among children with early infection. Coexpression network analysis revealed 6 modules associated with risk of TB infection or disease, including a module associated with neutrophil activation in immune response (P < .0001) and defense response to bacterium (P < .0001). CONCLUSIONS These findings suggest multiple detectable differences in gene expression at birth that were associated with risk of TB infection or disease throughout early childhood. Such measures may provide novel insights into TB pathogenesis and susceptibility.
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Affiliation(s)
- Carly A Bobak
- Department of Biomedical Data Science, Dartmouth College, Hanover, New Hampshire
| | - Maresa Botha
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Lesley Workman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Jane E Hill
- School of Biomedical Engineering and the School of Chemical and Biological Engineering, University of British Columbia, Vancouver, Canada
| | - Mark P Nicol
- Marshall Centre, Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
- Division of Medical Microbiology, University of Cape Town, South Africa
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton
- National Institute for Health and Care Research Southampton Biomedical Research Center, University Hospital Southampton, United Kingdom
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council
- Neuroscience Institute, University of Cape Town, South Africa
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Massachusetts
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
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2
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Siddalingaiah N, Chawla K, Nagaraja SB, Hazra D. Risk factors for the development of tuberculosis among the pediatric population: a systematic review and meta-analysis. Eur J Pediatr 2023:10.1007/s00431-023-04988-0. [PMID: 37130994 DOI: 10.1007/s00431-023-04988-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/26/2023] [Accepted: 04/16/2023] [Indexed: 05/04/2023]
Abstract
Pediatric tuberculosis is a major cause of mortality and morbidity in children due to high transmission, poor diagnostic tools, and various respiratory diseases mimicking TB. Identifying risk factors will provide evidence for clinicians to strongly relate their diagnosis to the associated pathology. Studies were retrieved from PubMed, Embase, and Google Scholar, systematically reviewed, and meta-analyzed for various risk factors and their association with pediatric TB. Meta-analysis depicted that four out of eleven risk factors were significant-contact with known TB cases (OR 6.42 [3.85,10.71]), exposure to smoke (OR 2.61 [1.24, 5.51]), overcrowding in the houses (OR 2.29 [1.04, 5.03]), and, poor household conditions (OR 2.65 [1.38, 5.09]). Although significant odds ratio estimates were obtained, we observed heterogeneity in the studies included. Conclusion: The study findings demand the constant screening of risk factors such as contact with known TB cases, exposure to smoke, overcrowding, and, poor household conditions for the development of pediatric TB. What is Known: • Knowledge of the risk factors of a disease is of utmost importance in the planning and institution of its control measures. Well-established risk factors in the occurrence of TB in the pediatric group are HIV positivity, older age and close contact with a known case of TB. What is New: • In addition to what is already known; this review and meta-analysis has identified exposure to indoor smoking, overcrowding and poor household conditions as important risk factors for developing pediatric TB. • Implications of the study: The findings highlight that in addition to routine contact screening for the pediatric group, the children living in poor household conditions and getting exposed to passive indoor smoking demand more attention to prevent the development of pediatric TB.
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Affiliation(s)
- Nayana Siddalingaiah
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104, India
| | - Kiran Chawla
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104, India.
| | - Sharath Burugina Nagaraja
- Department of Community Medicine, Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and Research, Bengaluru, 560010, India
| | - Druti Hazra
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104, India
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3
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Harris RC, Sumner T, Knight GM, Zhang H, White RG. Potential impact of tuberculosis vaccines in China, South Africa, and India. Sci Transl Med 2020; 12:eaax4607. [PMID: 33028708 DOI: 10.1126/scitranslmed.aax4607] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 11/12/2019] [Accepted: 09/16/2020] [Indexed: 12/11/2022]
Abstract
More effective tuberculosis vaccines are needed to help reach World Health Organization tuberculosis elimination goals. Insufficient evidence exists on the potential impact of future tuberculosis vaccines with varying characteristics and in different epidemiological settings. To inform vaccine development decision making, we modeled the impact of hypothetical tuberculosis vaccines in three high-burden countries. We calibrated Mycobacterium tuberculosis (M.tb) transmission models to age-stratified demographic and epidemiological data from China, South Africa, and India. We varied vaccine efficacy to prevent infection or disease, effective in persons M.tb uninfected or infected, and duration of protection. We modeled routine early-adolescent vaccination and 10-yearly mass campaigns from 2025. We estimated median percentage population-level tuberculosis incidence rate reduction (IRR) in 2050 compared to a no new vaccine scenario. In all settings, results suggested vaccines preventing disease in M.tb-infected populations would have greatest impact by 2050 (10-year, 70% efficacy against disease, IRR 51%, 52%, and 54% in China, South Africa, and India, respectively). Vaccines preventing reinfection delivered lower potential impact (IRR 1, 12, and 17%). Intermediate impact was predicted for vaccines effective only in uninfected populations, if preventing infection (IRR 21, 37, and 50%) or disease (IRR 19, 36, and 51%), with greater impact in higher-transmission settings. Tuberculosis vaccines have the potential to deliver substantial population-level impact. For prioritizing impact by 2050, vaccine development should focus on preventing disease in M.tb-infected populations. Preventing infection or disease in uninfected populations may be useful in higher transmission settings. As vaccine impact depended on epidemiology, different development strategies may be required.
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Affiliation(s)
- Rebecca C Harris
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Tom Sumner
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Gwenan M Knight
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hui Zhang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Richard G White
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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4
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Gompo TR, Shrestha A, Ranjit E, Gautam B, Ale K, Shrestha S, Bhatta DD. Risk factors of tuberculosis in human and its association with cattle TB in Nepal: A one health approach. One Health 2020; 10:100156. [PMID: 33117873 PMCID: PMC7582213 DOI: 10.1016/j.onehlt.2020.100156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023] Open
Abstract
Tuberculosis (TB) in humans is primarily caused by Mycobacterium tuberculosis (M. tuberculosis), with millions of infections and hundreds of thousands of deaths worldwide. It creates a substantial economic burden on the community. Unlike M. tuberculosis, Mycobacterium bovis infects cattle and causes bovine TB, also known as zoonotic TB. People can contract zoonotic TB after consumption of unpasteurized dairy products, handling the sick animals, and via occupational exposures. The association between the zoonotic TB in humans and cattle is not well known in Nepal. The study examined the associated risk factors, including exposure to infected cattle, that contribute to TB's development in human beings in Nepal. The study consists of human and animal subjects. Firstly, a retrospective matched case-control study was conducted at the National Tuberculosis Center (NTC), Bhaktapur, Nepal. A total of 290 people (equal numbers of TB cases and control subjects) were interviewed to obtain information on socio-demographic, behavioral, and occupational risks, including the history of cattle related exposures. Secondly, a cross-sectional study was performed among the cattle owned by the TB-confirmed patients. Comparative tuberculin skin test, rapid antibody test, and ELISA were used in parallel to detect M. bovis infection in cattle. The risk factors for the development of TB in humans were smokers (OR = 4.6, 95% CI: 2.1–10.0, p < 0.001), previous history of TB (OR = 7.9, 95% CI: 3.0–20.6, p < 0.001) and history of cattle exposures (OR = 3.9, 95% CI: 2.1–7.4, p = 0.001). Out of 123 cattle sampled, 12 cattle (9.76%, 95% CI: 5.37–16.76, p < 0.0001) were positive by the tuberculin test, 46 (37.4%, 95% CI: 28.97–46.62, p = 0.007) were tested positive by the rapid test, and 7 (5.7%, 95% CI: 2.52–11.80, p < 0.0001) by ELISA test. The inter-test agreement between the tuberculin and ELISA was very strong (κ = 0.72, 95% CI: 0.48–0.95, p < 0.01). This study indicates that exposure to infected cattle and socio-demographic risk factors can contribute to the development of TB in human beings.
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Affiliation(s)
- Tulsi Ram Gompo
- Central Veterinary Laboratory (CVL), Department of Livestock Services, Nepal
| | - Asmita Shrestha
- Institute of Agriculture and Animal Science, Tribhuvan University, Nepal
| | - Eliza Ranjit
- Nepal Agriculture Research Council (NARC), Nepal
| | - Bhanu Gautam
- Agriculture and Forestry University (AFU), Nepal
| | - Khim Ale
- Agriculture and Forestry University (AFU), Nepal
| | | | - Diker Dev Bhatta
- Central Veterinary Laboratory (CVL), Department of Livestock Services, Nepal
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5
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Sarkar S, Rivas-Santiago CE, Ibironke OA, Carranza C, Meng Q, Osornio-Vargas Á, Zhang J, Torres M, Chow JC, Watson JG, Ohman-Strickland P, Schwander S. Season and size of urban particulate matter differentially affect cytotoxicity and human immune responses to Mycobacterium tuberculosis. PLoS One 2019; 14:e0219122. [PMID: 31295271 PMCID: PMC6622489 DOI: 10.1371/journal.pone.0219122] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 06/17/2019] [Indexed: 12/20/2022] Open
Abstract
Exposure to air pollution particulate matter (PM) and tuberculosis (TB) are two of the leading global public health challenges affecting low and middle income countries. An estimated 4.26 million premature deaths are attributable to household air pollution and an additional 4.1 million to outdoor air pollution annually. Mycobacterium tuberculosis (M.tb) infects a large proportion of the world's population with the risk for TB development increasing during immunosuppressing conditions. There is strong evidence that such immunosuppressive conditions develop during household air pollution exposure, which increases rates of TB development. Exposure to urban air pollution has been shown to alter the outcome of TB therapy. Here we examined whether in vitro exposure to urban air pollution PM alters human immune responses to M.tb. PM2.5 and PM10 (aerodynamic diameters <2.5μm, <10μm) were collected monthly from rainy, cold-dry and warm-dry seasons in Iztapalapa, a highly populated TB-endemic municipality of Mexico City with elevated outdoor air pollution levels. We evaluated the effects of seasonality and size of PM on cytotoxicity and antimycobacterial host immunity in human peripheral blood mononuclear cells (PBMC) from interferon gamma (IFN-γ) release assay (IGRA)+ and IGRA- healthy study subjects. PM10 from cold-dry and warm-dry seasons induced the highest cytotoxicity in PBMC. With the exception of PM2.5 from the cold-dry season, pre-exposure to all seasonal PM reduced M.tb phagocytosis by PBMC. Furthermore, M.tb-induced IFN-γ production was suppressed in PM2.5 and PM10-pre-exposed PBMC from IGRA+ subjects. This observation coincides with the reduced expression of M.tb-induced T-bet, a transcription factor regulating IFN-γ expression in T cells. Pre-exposure to PM10 compared to PM2.5 led to greater loss of M.tb growth control. Exposure to PM2.5 and PM10 collected in different seasons differentially impairs M.tb-induced human host immunity, suggesting biological mechanisms underlying altered M.tb infection and TB treatment outcomes during air pollution exposures.
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Affiliation(s)
- Srijata Sarkar
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ, United States of America
| | - César E. Rivas-Santiago
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ, United States of America
| | - Olufunmilola A. Ibironke
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ, United States of America
| | - Claudia Carranza
- Department of Microbiology, Instituto Nacional de Enfermedades Respiratorias, México City, México
| | - Qingyu Meng
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ, United States of America
| | | | - Junfeng Zhang
- Duke Global Health Institute and Nicholas School of the Environment, Duke University, Durham, NC, United States of America
| | - Martha Torres
- Department of Microbiology, Instituto Nacional de Enfermedades Respiratorias, México City, México
| | - Judith C. Chow
- Division of Atmospheric Sciences, Desert Research Institute, Reno, NV, United States of America
| | - John G. Watson
- Division of Atmospheric Sciences, Desert Research Institute, Reno, NV, United States of America
| | - Pamela Ohman-Strickland
- Department of Biostatistics, Rutgers University School of Public Health, Piscataway, NJ, United States of America
| | - Stephan Schwander
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ, United States of America
- Department of Urban-Global Public Health, Rutgers University School of Public Health, Newark, NJ, United States of America
- * E-mail:
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6
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Martinez L, Lo NC, Cords O, Hill PC, Khan P, Hatherill M, Mandalakas A, Kay A, Croda J, Horsburgh CR, Zar HJ, Andrews JR. Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies. THE LANCET RESPIRATORY MEDICINE 2019; 7:544-552. [PMID: 31078497 DOI: 10.1016/s2213-2600(19)30137-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Tuberculosis is a major cause of death and disability among children globally, yet children have been neglected in global tuberculosis control efforts. Historically, tuberculosis in children has been thought of as a family disease, and because of this, household contact tracing of children after identification of an adult tuberculosis case has been emphasised as the principal public health intervention. However, the population-level effect of household contact tracing is predicated on the assumption that most paediatric tuberculosis infections are acquired within the household. In this Personal View, we focus on accumulating scientific evidence indicating that the majority of Mycobacterium tuberculosis transmission to children in high-burden settings occurs in the community, outside of households in which a person has tuberculosis. We estimate the population-attributable fraction of M tuberculosis transmission to children due to household exposures to be between 10% and 30%. M tuberculosis transmission from the household was low (<30%) even in children younger than age 5 years. We propose that an effective public health response to childhood tuberculosis requires comprehensive, community-based interventions, such as active surveillance in select settings, rather than contact tracing alone. Importantly, the historical paradigm that most paediatric transmission occurs in households should be reconsidered on the basis of the scientific knowledge presented.
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Affiliation(s)
- Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Epidemiology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Olivia Cords
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - Palwasha Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Anna Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Alexander Kay
- The Global Tuberculosis Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; The Baylor Children's Foundation, Mbabane, Swaziland
| | - Julio Croda
- 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
| | - C Robert Horsburgh
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South Africa Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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7
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Baindara P. Host-directed therapies to combat tuberculosis and associated non-communicable diseases. Microb Pathog 2019; 130:156-168. [PMID: 30876870 DOI: 10.1016/j.micpath.2019.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 12/22/2022]
Abstract
Mycobacterium tuberculosis (Mtb) has coevolved with a human host to evade and exploit the immune system in multiple ways. Mtb is an enormously successful human pathogen that can remain undetected in hosts for decades without causing clinical disease. While tuberculosis (TB) represents a perfect prototype of host-pathogen interaction, it remains a major challenge to develop new therapies to combat mycobacterial infections. Additionally, recent studies emphasize on comorbidity of TB with different non-communicable diseases (NCDs), highlighting the impact of demographic and lifestyle changes on the global burden of TB. In the recent past, host-directed therapies have emerged as a novel and promising approach to treating TB. Drugs modulating host responses are likely to avoid the development of bacterial resistance which is a major public health concern for TB treatment. Interestingly, many of these drugs also form treatment strategies for non-communicable diseases. In general, technological advances along with novel host-directed therapies may open an exciting and promising research area, which can eventually deliver effective TB treatment as well as curtail the emergent synergy with NCDs.
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Affiliation(s)
- Piyush Baindara
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, USA.
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8
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Bai X, Aerts SL, Verma D, Ordway DJ, Chan ED. Epidemiologic Evidence of and Potential Mechanisms by Which Second-Hand Smoke Causes Predisposition to Latent and Active Tuberculosis. Immune Netw 2018; 18:e22. [PMID: 29984040 PMCID: PMC6026693 DOI: 10.4110/in.2018.18.e22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 12/13/2022] Open
Abstract
Many studies have linked cigarette smoke (CS) exposure and tuberculosis (TB) infection and disease although much fewer have studied second-hand smoke (SHS) exposure. Our goal is to review the epidemiologic link between SHS and TB as well as to summarize the effects SHS and direct CS on various immune cells relevant for TB. PubMed searches were performed using the key words "tuberculosis" with "cigarette," "tobacco," or "second-hand smoke." The bibliography of relevant papers were examined for additional relevant publications. Relatively few studies associate SHS exposure with TB infection and active disease. Both SHS and direct CS can alter various components of host immunity resulting in increased vulnerability to TB. While the epidemiologic link of these 2 health maladies is robust, more definitive, mechanistic studies are required to prove that SHS and direct CS actually cause increased susceptibility to TB.
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Affiliation(s)
- Xiyuan Bai
- Department of Medicine, Denver Veterans Affairs Medical Center, University of Colorado Anschutz Medical Center, Denver, CO 80045, USA
- Department of Medicine and Office of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA
| | - Shanae L. Aerts
- Department of Medicine and Office of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
| | - Deepshikha Verma
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO 80523, USA
| | - Diane J. Ordway
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO 80523, USA
| | - Edward D. Chan
- Department of Medicine, Denver Veterans Affairs Medical Center, University of Colorado Anschutz Medical Center, Denver, CO 80045, USA
- Department of Medicine and Office of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA
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9
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Adetifa IMO, Kendall L, Donkor S, Lugos MD, Hammond AS, Owiafe PK, Ota MOC, Brookes RH, Hill PC. Mycobacterium tuberculosis Infection in Close Childhood Contacts of Adults with Pulmonary Tuberculosis is Increased by Secondhand Exposure to Tobacco. Am J Trop Med Hyg 2017; 97:429-432. [PMID: 28722570 PMCID: PMC5544071 DOI: 10.4269/ajtmh.16-0611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 04/06/2017] [Indexed: 11/07/2022] Open
Abstract
Tobacco use is a major risk factor for tuberculosis (TB). Secondhand smoke (SHS) is also a risk factor for TB and to a lesser extent, Mycobacterium tuberculosis infection without disease. We investigated the added risk of M. tuberculosis infection due to SHS exposure in childhood contacts of TB cases in The Gambia. Participants were childhood household contacts aged ≤ 14 years of newly diagnosed pulmonary TB (PTB) cases. The intensity of exposure to the case was categorized according to whether contacts slept in the same room, same house, or a different house as the case. Contacts were tested with an enzyme-linked immunospot interferon gamma release assay. In multivariate regression models, M. tuberculosis infection was associated with increasing exposure to a case (odds ratios [OR]: 3.9, 95% confidence interval [CI]: 2.11-71.4, P < 0.001]) and with male gender (OR: 1.5 [95% CI: 1.12-2.11], P = 0.008). Tobacco use caused a 3-fold increase in the odds of M. tuberculosis infection in children who slept closest to a case who smoked within the same home compared with a nonsmoking case (OR: 8.0 [95% CI: 2.74-23.29] versus 2.4 [95% CI: 1.17-4.92], P < 0.001). SHS exposure as an effect modifier appears to greatly increase the risk of M. tuberculosis infection in children exposed to PTB cases. Smoking cessation campaigns may be important for reducing transmission of M. tuberculosis to children within households.
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Affiliation(s)
- Ifedayo M. O. Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Medicine, University of Lagos, Lagos, Nigeria
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - Lindsay Kendall
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - Simon Donkor
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - Moses D. Lugos
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
- Department of Medical Laboratory Science, University of Jos, Plateau, Nigeria
| | - Abdulrahman S. Hammond
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - Patrick K. Owiafe
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - Martin O. C. Ota
- World Health Organization-Regional Office for Africa, Brazzaville, Congo
| | - Roger H. Brookes
- Bioprocess Research and Development, Sanofi Pasteur, Toronto, Ontario, Canada
| | - Philip C. Hill
- Department of Preventive and Social Medicine, Centre for International Health and the Otago International Health Research Network, University of Otago School of Medicine, Dunedin, New Zealand
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10
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Martinez L, Shen Y, Mupere E, Kizza A, Hill PC, Whalen CC. Transmission of Mycobacterium Tuberculosis in Households and the Community: A Systematic Review and Meta-Analysis. Am J Epidemiol 2017; 185:1327-1339. [PMID: 28982226 PMCID: PMC6248487 DOI: 10.1093/aje/kwx025] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 12/19/2022] Open
Abstract
The individual- and population-level impact of household tuberculosis exposure on transmission is unclear but may have implications for the effectiveness and implementation of control interventions. We systematically searched for and included studies in which latent tuberculosis infection was assessed in 2 groups: children exposed and unexposed to a household member with tuberculosis. We also extracted data on the smear and culture status of index cases, the age and bacillus Calmette-Guérin vaccination status of contacts, and study design characteristics. Of 6,176 citations identified from our search strategy, 26 studies (13,999 children with household exposure to tuberculosis and 174,097 children without) from 1929-2015 met inclusion criteria. Exposed children were 3.79 (95% confidence interval (CI): 3.01, 4.78) times more likely to be infected than were their community counterparts. Metaregression demonstrated higher infection among children aged 0-4 years of age compared with children aged 10-14 years (ratio of odds ratios = 2.24, 95% CI: 1.43, 3.51) and among smear-positive versus smear-negative index cases (ratio of odds ratios = 5.45, 95% CI: 3.43, 8.64). At the population level, we estimated that a small proportion (<20%) of transmission was attributable to household exposure. Our results suggest that targeting tuberculosis prevention efforts to household contacts is highly effective. However, a large proportion of transmission at the population level may occur outside the household.
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Affiliation(s)
- Leonardo Martinez
- Department of Epidemiology and Biostatistics, College of Public Health,
University of Georgia, Athens, Georgia
- Institute of Global Health, College of Public Health, University of
Georgia, Athens, Georgia
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health,
University of Georgia, Athens, Georgia
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, College of Health Sciences,
Makerere University, Kampala, Uganda
- Uganda–Case Western Reserve University Research Collaboration,
Tuberculosis Research Unit, Kampala, Uganda
| | - Allan Kizza
- Department of Epidemiology and Biostatistics, College of Public Health,
University of Georgia, Athens, Georgia
| | - Philip C. Hill
- Department of Preventive and Social Medicine, Centre for International
Health and the Otago International Health Research Network, University of Otago Medical
School, Dunedin, New Zealand
| | - Christopher C. Whalen
- Department of Epidemiology and Biostatistics, College of Public Health,
University of Georgia, Athens, Georgia
- Institute of Global Health, College of Public Health, University of
Georgia, Athens, Georgia
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11
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Ncayiyana JR, Bassett J, West N, Westreich D, Musenge E, Emch M, Pettifor A, Hanrahan CF, Schwartz SR, Sanne I, van Rie A. Prevalence of latent tuberculosis infection and predictive factors in an urban informal settlement in Johannesburg, South Africa: a cross-sectional study. BMC Infect Dis 2016; 16:661. [PMID: 27825307 PMCID: PMC5101651 DOI: 10.1186/s12879-016-1989-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 10/28/2016] [Indexed: 01/18/2023] Open
Abstract
Background South Africa has one of the highest burdens of latent tuberculosis infection (LTBI) in high-risk populations such as young children, adolescents, household contacts of TB cases, people living with HIV, gold miners and health care workers, but little is known about the burden of LTBI in its general population. Methods Using a community-based survey with random sampling, we examined the burden of LTBI in an urban township of Johannesburg and investigated factors associated with LTBI. The outcome of LTBI was based on TST positivity, with a TST considered positive if the induration was ≥5 mm in people living with HIV or ≥10 mm in those with unknown or HIV negative status. We used bivariate and multivariable logistic regression to identify factors associated with LTBI Results The overall prevalence of LTBI was 34.3 (95 % CI 30.0, 38.8 %), the annual risk of infection among children age 0–14 years was 3.1 % (95 % CI 2.1, 5.2). LTBI was not associated with HIV status. In multivariable logistic regression analysis, LTBI was associated with age (OR = 1.03 for every year increase in age, 95 % CI = 1.01–1.05), male gender (OR = 2.70, 95 % CI = 1.55–4.70), marital status (OR = 2.00, 95 % CI = 1.31–3.54), and higher socio-economic status (OR = 2.11, 95 % CI = 1.04–4.31). Conclusions The prevalence of LTBI and the annual risk of infection with M. tuberculosis is high in urban populations, especially in men, but independent of HIV infection status. This study suggests that LTBI may be associated with higher SES, in contrast to the well-established association between TB disease and poverty.
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Affiliation(s)
- Jabulani R Ncayiyana
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA. .,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa.
| | - Jean Bassett
- Witkoppen Health and Welfare Centre, 105 William Nicol Drive, Fourways, Johannesburg, 2055, South Africa
| | - Nora West
- Witkoppen Health and Welfare Centre, 105 William Nicol Drive, Fourways, Johannesburg, 2055, South Africa
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa
| | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Colleen F Hanrahan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sheree R Schwartz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Ian Sanne
- Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Perth Road, Auckland Park, Johannesburg, 2092, South Africa
| | - Annelies van Rie
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, University Square, Wilrijk, Antwerp, 2610, Belgium
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12
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Berraies A, Hamdi B, Ammar J, Snen H, Bouhaouel W, Hamzaoui A. [Results of tuberculosis screening in children with household contact]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:184-189. [PMID: 27113611 DOI: 10.1016/j.pneumo.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 02/18/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Tuberculosis screening in children is important to identify and treat latent tuberculosis infection and thus avoid progression to disease. METHODS It is a prospective study realized in 83 children between November 2009 and January 2013 who consulted after a household contact for tuberculosis in the pediatric department B of Abderrahmen Mami hospital of Ariana. RESULTS The mean age of the children was 4.8 years (3 months-15 years). A latent tuberculosis infection was diagnosed in 31.3% of children, 10.8% had tuberculosis and 57.8% were considered healthy. Fifty-seven children (68.7%) had a close daytime contact with the index and 57.8% slept in the same bedroom of the contaminator. The identified risk factors were the diagnosis delay of the index of more than 30 days (P=0.023), presence of cavitations on the chest X-ray of the index (P=0.029) and a close daytime contact (P=0.004). CONCLUSION Our study showed a high rate of contamination in children with a household contact. Efforts are needed to shorten the time to diagnosis of adults' tuberculosis.
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Affiliation(s)
- A Berraies
- Pavillon B, hôpital Abderrahmen Mami, 2080 Ariana, Tunisie.
| | - B Hamdi
- Pavillon B, hôpital Abderrahmen Mami, 2080 Ariana, Tunisie.
| | - J Ammar
- Pavillon B, hôpital Abderrahmen Mami, 2080 Ariana, Tunisie.
| | - H Snen
- Pavillon B, hôpital Abderrahmen Mami, 2080 Ariana, Tunisie.
| | - W Bouhaouel
- Pavillon B, hôpital Abderrahmen Mami, 2080 Ariana, Tunisie.
| | - A Hamzaoui
- Pavillon B, hôpital Abderrahmen Mami, 2080 Ariana, Tunisie.
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13
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Lancella L, Lo Vecchio A, Chiappini E, Tadolini M, Cirillo D, Tortoli E, de Martino M, Guarino A, Principi N, Villani A, Esposito S, Galli L. How to manage children who have come into contact with patients affected by tuberculosis. J Clin Tuberc Other Mycobact Dis 2015; 1:1-12. [PMID: 31723675 PMCID: PMC6850253 DOI: 10.1016/j.jctube.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/14/2015] [Accepted: 07/05/2015] [Indexed: 11/21/2022] Open
Abstract
Childhood tuberculosis (TB) indicates a recent infection, particularly in children aged < 5 years, and therefore is considered a sentinel event insofar as it highlights the presence of an undiagnosed or untreated source case. The risk of acquiring TB is directly proportional to the number of bacilli to which a subject is exposed and the environment in which the contact occurred. This document contains the recommendations of a group of Italian scientific societies for managing a child exposed to a case of TB based on an analysis of the risk factors for acquiring latent tuberculous infection (LTBI) and developing the disease, and the particular aspects TB transmission during the first years of life. The guidance includes a detailed description of the methods used to identify the index case, the tests that the exposed child should receive and the possibilities of preventive chemoprophylaxis depending on the patient's age and immune status, the chemotherapy and monitoring methods indicated in the case of LTBI, the management of a child who has come into contact with a case of multidrug-resistant or extensively drug-resistant TB, and the use of molecular typing in the analysis of epidemics. The group of experts identified risk factors for tuberculous infection and disease in pediatric age as well as gave recommendation on management of contacts of cases of TB according to their age, risk factors and exposure to multidrug-resistant or extensively drug-resistant TB.
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Affiliation(s)
- Laura Lancella
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Andrea Lo Vecchio
- Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Elena Chiappini
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
| | - Marina Tadolini
- Section of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniela Cirillo
- Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Tortoli
- Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Villani
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
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14
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Reply: To PMID 25105895. Pediatr Infect Dis J 2015; 34:1138. [PMID: 26367806 DOI: 10.1097/inf.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Second-hand smoke and the risk of tuberculosis: a systematic review and a meta-analysis. Epidemiol Infect 2015; 143:3158-72. [DOI: 10.1017/s0950268815001235] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
SUMMARYThere is limited evidence and lack of consensus whether second-hand smoke (SHS) increases risk of tuberculosis (TB), which has substantial implications for unrestricted smoking indoors and TB control policies. We aimed to establish the association between SHS and the risk of acquiring and worsening of TB in non-smokers. We identified 428 articles in the initial search and 12 comparative epidemiological studies met our inclusion criteria. Exposure to SHS was found to have a higher risk of TB infection [risk ratio (RR) 1·19, 95% confidence interval (CI) 0·90–1·57] compared to non-exposure; however, this did not reach statistical significance. There was marked variability (I2 = 74%, P = 0·0008) between studies’ results, which could be explained by the differences in the diagnostic criteria used. Exposure to SHS was found to be statistically significantly associated (RR 1·59, 95% CI 1·11–2·27) with the risk of TB disease. There was significant heterogeneity (I2 = 77%, P = 0·0006) between studies’ results, which was sourced to the internal characteristics of the studies rather than combining different study designs. We did not find any studies for SHS and TB treatment-related outcomes. Thus, we conclude that SHS exposure may increase the risk of acquiring TB infection and progression to TB disease; however, the evidence remains scanty and weak.
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16
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Patra J, Bhatia M, Suraweera W, Morris SK, Patra C, Gupta PC, Jha P. Exposure to second-hand smoke and the risk of tuberculosis in children and adults: a systematic review and meta-analysis of 18 observational studies. PLoS Med 2015; 12:e1001835; discussion e1001835. [PMID: 26035557 PMCID: PMC4452762 DOI: 10.1371/journal.pmed.1001835] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/23/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND According to WHO Global Health Estimates, tuberculosis (TB) is among the top ten causes of global mortality and ranks second after cardiovascular disease in most high-burden regions. In this systematic review and meta-analysis, we investigated the role of second-hand smoke (SHS) exposure as a risk factor for TB among children and adults. METHODS AND FINDINGS We performed a systematic literature search of PubMed, Embase, Scopus, Web of Science, and Google Scholar up to August 31, 2014. Our a priori inclusion criteria encompassed only original studies where latent TB infection (LTBI) and active TB disease were diagnosed microbiologically, clinically, histologically, or radiologically. Effect estimates were pooled using fixed- and random-effects models. We identified 18 eligible studies, with 30,757 children and 44,432 adult non-smokers, containing SHS exposure and TB outcome data for inclusion in the meta-analysis. Twelve studies assessed children and eight studies assessed adult non-smokers; two studies assessed both populations. Summary relative risk (RR) of LTBI associated with SHS exposure in children was similar to the overall effect size, with high heterogeneity (pooled RR 1.64, 95% CI 1.00-2.83). Children showed a more than 3-fold increased risk of SHS-associated active TB (pooled RR 3.41, 95% CI 1.81-6.45), which was higher than the risk in adults exposed to SHS (summary RR 1.32, 95% CI 1.04-1.68). Positive and significant exposure-response relationships were observed among children under 5 y (RR 5.88, 95% CI 2.09-16.54), children exposed to SHS through any parent (RR 4.20, 95% CI 1.92-9.20), and children living under the most crowded household conditions (RR 5.53, 95% CI 2.36-12.98). Associations for LTBI and active TB disease remained significant after adjustment for age, biomass fuel (BMF) use, and presence of a TB patient in the household, although the meta-analysis was limited to a subset of studies that adjusted for these variables. There was a loss of association with increased risk of LTBI (but not active TB) after adjustment for socioeconomic status (SES) and study quality. The major limitation of this analysis is the high heterogeneity in outcomes among studies of pediatric cases of LTBI and TB disease. CONCLUSIONS We found that SHS exposure is associated with an increase in the relative risk of LTBI and active TB after controlling for age, BMF use, and contact with a TB patient, and there was no significant association of SHS exposure with LTBI after adjustment for SES and study quality. Given the high heterogeneity among the primary studies, our analysis may not show sufficient evidence to confirm an association. In addition, considering that the TB burden is highest in countries with increasing SHS exposure, it is important to confirm these results with higher quality studies. Research in this area may have important implications for TB and tobacco control programs, especially for children in settings with high SHS exposure and TB burden.
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Affiliation(s)
- Jayadeep Patra
- Centre for Global Health Research, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla-Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada
- * E-mail:
| | - Mehak Bhatia
- Centre for Global Health Research, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla-Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada
| | - Wilson Suraweera
- Centre for Global Health Research, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cyril Patra
- School of Public Health, University of Memphis, Memphis, Tennessee, United States of America
| | | | - Prabhat Jha
- Centre for Global Health Research, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla-Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada
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17
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Jiménez-Ruiz CA, Andreas S, Lewis KE, Tonnesen P, van Schayck CP, Hajek P, Tonstad S, Dautzenberg B, Fletcher M, Masefield S, Powell P, Hering T, Nardini S, Tonia T, Gratziou C. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J 2015; 46:61-79. [PMID: 25882805 DOI: 10.1183/09031936.00092614] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/24/2014] [Indexed: 12/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), lung cancer, asthma and pulmonary tuberculosis are common pulmonary diseases that are caused or worsened by tobacco smoking. Growing observational evidence suggests that symptoms and prognosis of these conditions improve upon smoking cessation. Despite increasing numbers of (small) randomised controlled trials suggesting intensive smoking cessation treatments work in people with pulmonary diseases many patients are not given specific advice on the benefits or referred for intensive cessation treatments and, therefore, continue smoking.This is a qualitative review regarding smoking cessation in patients with COPD and other pulmonary disorders, written by a group of European Respiratory Society experts. We describe the epidemiological links between smoking and pulmonary disorders, the evidence for benefits of stopping smoking, how best to assess tobacco dependence and what interventions currently work best to help pulmonary patients quit. Finally, we describe characteristics and management of any "hardcore" smoker who finds it difficult to quit with standard approaches.
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Affiliation(s)
| | - Stefan Andreas
- Lungenfachklinik Immenhausen and Pneumology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Keir E Lewis
- Dept of Respiratory Medicine, Prince Philip Hospital and Swansea College of Medicine, Swansea, UK
| | - Philip Tonnesen
- Dept of Sleep Medicine, Glostrup Hospital, Glostrup, Denmark
| | - C P van Schayck
- Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, The Netherlands
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Serena Tonstad
- Section for Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | | | | | | | | | | | - Stefano Nardini
- Pulmonary and TB Unit, Ospedale Civile, Vittorio Veneto, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Christina Gratziou
- University Centre for Research and Smoking Cessation, Evgenidio Hospital, Medical School, Athens University, Athens, Greece
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18
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Bishwakarma R, Kinney WH, Honda JR, Mya J, Strand MJ, Gangavelli A, Bai X, Ordway DJ, Iseman MD, Chan ED. Epidemiologic link between tuberculosis and cigarette/biomass smoke exposure: Limitations despite the vast literature. Respirology 2015; 20:556-68. [PMID: 25808744 DOI: 10.1111/resp.12515] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/04/2015] [Accepted: 01/26/2015] [Indexed: 11/29/2022]
Abstract
The geographic overlap between the prevalence of cigarette smoke (CS) exposure and tuberculosis (TB) in the world is striking. In recent years, relatively large number of studies has linked cigarette or biomass fuel smoke exposure and various aspects of TB. Our goals are to summarize the significance of the known published studies, graphically represent reports that quantified the association and discuss their potential limitations. PubMed searches were performed using the key words 'tuberculosis' with 'cigarette', 'tobacco', 'smoke' or 'biomass fuel smoke.' The references of relevant articles were examined for additional pertinent papers. A large number of mostly case-control and cross-sectional studies significantly associate both direct and second-hand smoke exposure with tuberculous infection, active TB, and/or more severe and lethal TB. Fewer link biomass fuel smoke exposure and TB. While a number of studies interpreted the association with multivariate analysis, other confounders are often not accounted for in these analyses. It is also important to emphasize that these retrospective studies can only show an association and not any causal link. We further explored the possibility that even if CS exposure is a risk factor for TB, several mechanisms may be responsible. Numerous studies associate cigarette and biomass smoke exposure with TB but the mechanism(s) remains largely unknown. While the associative link of these two health maladies is well established, more definitive, mechanistic studies are needed to cement the effect of smoke exposure on TB pathogenesis and to utilize this knowledge in empowering public health policies.
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Affiliation(s)
- Raju Bishwakarma
- Departments of Medicine and Academic Affairs, National Jewish Health, Denver, Colorado, USA; Department of Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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19
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Sridhar S, Karnani N, Connell DW, Millington KA, Dosanjh D, Bakir M, Soysal A, Deeks J, Lalvani A. Increased risk of Mycobacterium tuberculosis infection in household child contacts exposed to passive tobacco smoke. Pediatr Infect Dis J 2014; 33:1303-6. [PMID: 25105895 PMCID: PMC5741175 DOI: 10.1097/inf.0000000000000506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Risk factors associated with Mycobacterium tuberculosis infection were investigated in a prospective cohort of household child tuberculosis contacts. A significantly increased risk of acquiring infection was associated with exposure to passive cigarette smoke, higher number of index cases, younger age and reduced household monthly income.
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Affiliation(s)
- Saranya Sridhar
- Tuberculosis Research Centre, Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, Norfolk Place, London
| | - Nisha Karnani
- Tuberculosis Research Centre, Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, Norfolk Place, London
| | - David W. Connell
- Tuberculosis Research Centre, Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, Norfolk Place, London
| | - Kerry A. Millington
- Tuberculosis Research Centre, Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, Norfolk Place, London
| | - Davinder Dosanjh
- Tuberculosis Research Centre, Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, Norfolk Place, London
| | - Mustafa Bakir
- Department of Paediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Soysal
- Department of Paediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Jonathan Deeks
- Department of Public Health, Epidemiology and Biostatistics, Public Health School of Health and Population Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Ajit Lalvani
- Tuberculosis Research Centre, Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, Norfolk Place, London
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20
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Leung CC, Yew WW, Chan CK, Chang KC, Law WS, Lee SN, Tai LB, Leung ECC, Au RKF, Huang SS, Tam CM. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. Eur Respir J 2014; 45:738-45. [PMID: 25359352 DOI: 10.1183/09031936.00114214] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The impact of smoking on tuberculosis outcome was evaluated in a territory-wide treatment programme. 16,345 consecutive patients undergoing chemotherapy for active tuberculosis in government chest clinics in Hong Kong from 2001 to 2003 were followed up prospectively for 2 years for treatment outcome and subsequently tracked through the territory-wide tuberculosis notification registry for relapse until the end of 2012. Smoking was associated with more extensive lung disease, lung cavitation and positive sputum smear and culture at the baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Both categories of smokers were significantly less likely to achieve cure or treatment completion within 2 years. Overall, 16.7% of unsuccessful treatment outcomes were attributable to smoking, with the key contributor being default in current smokers and death in ex-smokers. Among successful treatment completers, there was a clear gradient (hazard ratios of 1.00, 1.33 and 1.63) of relapse risk from never-smokers to ex-smokers and current smokers, with an overall population attributable risk of 19.4% (current smokers: 12.2%; ex-smokers: 7.2%). Smoking adversely affects baseline disease severity, bacteriological response, treatment outcome and relapse in tuberculosis. Smoking cessation likely reduces relapse and secondary transmission.
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Affiliation(s)
- Chi C Leung
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Wing W Yew
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi K Chan
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Kwok C Chang
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Wing S Law
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Shuk N Lee
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Lai B Tai
- TB and Chest Service, Dept of Health, Hong Kong, China
| | | | - Ronald K F Au
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Shan S Huang
- TB and Chest Service, Dept of Health, Hong Kong, China
| | - Cheuk M Tam
- TB and Chest Service, Dept of Health, Hong Kong, China
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Chen M, Deng J, Su C, Li J, Wang M, Abuaku BK, Hu S, Tan H, Wen SW. Impact of passive smoking, cooking with solid fuel exposure, and MBL/MASP-2 gene polymorphism upon susceptibility to tuberculosis. Int J Infect Dis 2014; 29:1-6. [PMID: 25312983 DOI: 10.1016/j.ijid.2014.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 07/15/2014] [Accepted: 08/16/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To explore the impact of passive smoking, cooking with solid fuel, mannose-binding lectin (MBL) gene, MBL-associated serine proteases 2 (MASP-2) gene, and gene-environment interactions on the susceptibility to tuberculosis (TB) in non-smokers. METHODS A total of 205 TB patients and 216 healthy controls were recruited to participate in this case-control study. PCR with sequence-specific primers (PCR-SSP) technology was leveraged to genotype rs7096206 of MBL genes and rs2273346 and rs6695096 of MASP-2 genes. Demographic data and information on exposures of participants were collected. Unconditioned logistic regression analysis was conducted to identify associations between the various factors and TB, and marginal structural linear odds models were used to estimate the interactions. RESULTS Passive smoking and cooking with solid fuel were associated with the risk of TB, with odds ratios (OR) of 1.58 and 2.93, respectively (p<0.05). Genotype CG at rs7096206 of MBL genes (OR 2.02) and genotype TC at rs6695096 of MASP-2 genes (OR 1.67) were more prevalent in the TB patients than in healthy controls (p<0.05). The relative excess risk of interaction (RERI) between rs7096206 of MBL genes and passive smoking or cooking with solid fuel exposure was 1.86 (95% confidence interval (CI) 0.59-3.16) and 2.66 (95% CI 1.85-3.47), respectively. The RERI between rs6695096 of MASP-2 genes and cooking with solid fuel exposure was 3.70 (95% CI 2.63-4.78), which was also a positive interaction. However, the RERI between rs6695096 of MASP-2 genes and passive smoking was not statistically significant. CONCLUSIONS Passive smoking, cooking with solid fuel, and polymorphisms of MBL (rs7096206) and MASP-2 (rs6695096) genes were associated with susceptibility to TB in non-smokers, and there were gene-environment interactions among them. Further studies are needed to explore details of the mechanisms of association.
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Affiliation(s)
- Mengshi Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China; Hunan Children's Hospital, Changsha, Hunan, PR China
| | - Jing Deng
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China
| | - Congxu Su
- Yueyanglou Center for Disease Control and Prevention, Yueyang, Hunan, PR China
| | - Jun Li
- Hunan Provincial Tumor Hospital, Changsha, Hunan, PR China
| | - Mian Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China
| | - Benjamin Kwaku Abuaku
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China
| | - ShiMin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China.
| | - Shi Wu Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan 410008, PR China; Department of Obstetrics and Gynecology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
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Physical, behavioral, and cognitive effects of prenatal tobacco and postnatal secondhand smoke exposure. Curr Probl Pediatr Adolesc Health Care 2014; 44:219-41. [PMID: 25106748 PMCID: PMC6876620 DOI: 10.1016/j.cppeds.2014.03.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 01/19/2023]
Abstract
The purpose of this review is to examine the rapidly expanding literature regarding the effects of prenatal tobacco and postnatal secondhand smoke (SHS) exposure on child health and development. Mechanisms of SHS exposure are reviewed, including critical periods during which exposure to tobacco products appears to be particularly harmful to the developing fetus and child. The biological, biochemical, and neurologic effects of the small fraction of identified components of SHS are described. Research describing these adverse effects of both in utero and childhood exposure is reviewed, including findings from both animal models and humans. The following adverse physical outcomes are discussed: sudden infant death syndrome, low birth weight, decreased head circumference, respiratory infections, otitis media, asthma, childhood cancer, hearing loss, dental caries, and the metabolic syndrome. In addition, the association between the following adverse cognitive and behavioral outcomes and such exposures is described: conduct disorder, attention-deficit/hyperactivity disorder, poor academic achievement, and cognitive impairment. The evidence supporting the adverse effects of SHS exposure is extensive yet rapidly expanding due to improving technology and increased awareness of this profound public health problem. The growing use of alternative tobacco products, such as hookahs (a.k.a. waterpipes), and the scant literature on possible effects from prenatal and secondhand smoke exposure from these products are also discussed. A review of the current knowledge of this important subject has implications for future research as well as public policy and clinical practice.
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Seddon JA, Shingadia D. Epidemiology and disease burden of tuberculosis in children: a global perspective. Infect Drug Resist 2014; 7:153-65. [PMID: 24971023 PMCID: PMC4069045 DOI: 10.2147/idr.s45090] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Our understanding of the tuberculosis (TB) epidemic in children is incomplete due to challenges in diagnosis and reporting. Children have also been largely excluded from research and advocacy. However, the tide appears to be turning and interest in pediatric TB is increasing. In this article, we explore the epidemiology of childhood TB by first reviewing the natural history of TB in children and the factors that impact on each of the stages from exposure to disease. We then discuss how these factors affect what we see at a country and regional level. Finally, we assess the burden of childhood TB globally.
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Affiliation(s)
- James A Seddon
- Department of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Delane Shingadia
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK
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Lindsay RP, Shin SS, Garfein RS, Rusch MLA, Novotny TE. The Association between active and passive smoking and latent tuberculosis infection in adults and children in the united states: results from NHANES. PLoS One 2014; 9:e93137. [PMID: 24664240 PMCID: PMC3963991 DOI: 10.1371/journal.pone.0093137] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/01/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies assessing the relationship between active and passive smoking and tuberculosis have used biomarkers to measure smoke exposure. We sought to determine the association between active and passive smoking and LTBI in a representative sample of US adults and children. METHODS We used the 1999-2000 US National Health and Nutrition Examination Survey (NHANES) dataset with tuberculin skin test (TST) data to assess the association between cotinine-confirmed smoke exposure and latent tuberculosis infection (LTBI) among adults ages ≥20 years (n = 3598) and children 3-19 years (n = 2943) and estimate the prevalence of smoke exposure among those with LTBI. Weighted multivariate logistic regression was used to measure the associations between active and passive smoking and LTBI. RESULTS LTBI prevalence in 1999-2000 among cotinine-confirmed active, passive, and non-smoking adults and children was 6.0%, 5.2%, 3.3% and 0.3%, 1.0%, 1.5%, respectively. This corresponds to approximately 3,556,000 active and 3,379,000 passive smoking adults with LTBI in the US civilian non-institutionalized population in 1999-2000. Controlling for age, gender, socioeconomic status, race, birthplace (US vs. foreign-born), household size, and having ever lived with someone with TB, adult active smokers were significantly more likely to have LTBI than non-smoking adults (AOR = 2.31 95% CI 1.17-4.55). Adult passive smokers also had a greater odds of LTBI compared with non-smokers, but this association did not achieve statistical significance (AOR = 2.00 95% CI 0.87-4.60). Neither active or passive smoking was associated with LTBI among children. Among only the foreign-born adults, both active (AOR = 2.56 (95% CI 1.20-5.45) and passive smoking (AOR = 2.27 95% CI 1.09-4.72) were significantly associated with LTBI. CONCLUSIONS Active adult smokers and both foreign-born active and passive smokers in the United States are at elevated risk for LTBI. Targeted smoking prevention and cessation programs should be included in comprehensive national and international TB control efforts.
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Affiliation(s)
- Ryan P. Lindsay
- University of California San Francisco, Center for Tobacco Control Research and Education, San Francisco, California, United States of America
| | - Sanghyuk S. Shin
- University of California Los Angeles, David Geffen School of Medicine, Program in Global Health, Los Angeles, California, United States of America
| | - Richard S. Garfein
- University of California San Diego, Department of Medicine, Division of Global Public Health, San Diego, California, United States of America
| | - Melanie L. A. Rusch
- Vancouver Island Health Authority and University of Victoria, School of Public Health and Social Policy, Victoria, British Columbia, Canada
| | - Thomas E. Novotny
- San Diego State University, Graduate School of Public Health, San Diego, California, United States of America
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Jubulis J, Kinikar A, Ithape M, Khandave M, Dixit S, Hotalkar S, Kulkarni V, Mave V, Gupte N, Kagal A, Jain S, Bharadwaj R, Gupta A. Modifiable risk factors associated with tuberculosis disease in children in Pune, India. Int J Tuberc Lung Dis 2014; 18:198-204. [PMID: 24429313 PMCID: PMC4487622 DOI: 10.5588/ijtld.13.0314] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING India accounts for the largest burden of tuberculosis (TB) worldwide, with 26% of the world's cases. OBJECTIVE To assess the association between novel modifiable risk factors and TB in Indian children. DESIGN Cases were children aged ≤ 5 years with confirmed/probable TB based on World Health Organization definitions (definition 1). Controls were healthy children aged ≤ 5 years. Logistic regression was performed to estimate the adjusted odds ratio (aOR) of being a TB case given exposure, including indoor air pollution (IAP; exposure to tobacco smoke and/or biomass fuels) and vitamin D deficiency. Cases were re-analyzed according to a new consensus research definition of pediatric TB (definition 2). RESULTS Sixty cases and 118 controls were enrolled. Both groups had high levels of vitamin D deficiency (55% vs. 50%, P = 0.53). In multivariable analysis, TB was associated with household TB exposure (aOR 25.41, 95%CI 7.03-91.81), household food insecurity (aOR 11.55, 95%CI 3.33-40.15) and IAP exposure (aOR 2.67, 95%CI 1.02-6.97), but not vitamin D deficiency (aOR 1.00, 95%CI 0.38-2.66). Use of definition 2 reduced the number of cases to 25. In multivariate analysis, TB exposure, household food insecurity and IAP remained associated with TB. CONCLUSIONS Household TB exposure, exposure to IAP and household food insecurity were independently associated with pediatric TB.
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Affiliation(s)
- J Jubulis
- Johns Hopkins University, Baltimore, Maryland, USA; Maine Medical Center, Portland, Maine, USA
| | - A Kinikar
- Byramji Jeejeebhoy Medical College (BJMC), Pune, India
| | - M Ithape
- BJMC Clinical Trials Unit, Pune, India
| | | | - S Dixit
- Byramji Jeejeebhoy Medical College (BJMC), Pune, India
| | | | | | - V Mave
- BJMC Clinical Trials Unit, Pune, India
| | - N Gupte
- BJMC Clinical Trials Unit, Pune, India
| | - A Kagal
- BJMC Clinical Trials Unit, Pune, India
| | - S Jain
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - A Gupta
- Johns Hopkins University, Baltimore, Maryland, USA
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Seddon JA, Hesseling AC, Godfrey-Faussett P, Fielding K, Schaaf HS. Risk factors for infection and disease in child contacts of multidrug-resistant tuberculosis: a cross-sectional study. BMC Infect Dis 2013; 13:392. [PMID: 23977834 PMCID: PMC3765928 DOI: 10.1186/1471-2334-13-392] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 08/20/2013] [Indexed: 12/03/2022] Open
Abstract
Background Young children exposed to Mycobacterium tuberculosis have a high risk of disease progression following infection. This study aimed to determine risk factors for M. tuberculosis infection and disease in children following exposure to adults with multidrug-resistant (MDR) tuberculosis (TB). Methods Cross-sectional study; all children aged < 5 years, routinely referred per local guidelines to the provincial specialist MDR-TB clinic, Western Cape Province, South Africa, following identification as contacts of adult MDR-TB source cases, were eligible for enrolment from May 2010 through April 2011. Demographic, clinical and social characteristics were collected. All children underwent HIV and tuberculin skin testing. Results Of 228 children enrolled (median age: 30 months), 102 (44.7%) were classified as infected. Of these, 15 (14.7%) had TB disease at enrolment. Of 217 children tested for HIV, 8 (3.7%) were positive. In adjusted analysis, child’s age (AOR: 1.43; 95% CI: 1.13-1.91; p = 0.002) and previous TB treatment history (AOR: 2.51; 95% CI: 1.22-5.17; p = 0.01) were independent risk factors for infection. Increasing age of the MDR-TB source case (AOR: 0.67; 95% CI: 0.45-1.00; p = 0.05) was protective and source case alcohol use (AOR: 2.59; 95% CI: 1.29-5.22; p = 0.007) was associated with increased odds of infection in adjusted analysis. Decreasing age of the child (p = 0.01) and positive HIV status (AOR: 25.3; 95% CI: 1.63-393; p = 0.01) were associated with prevalent TB disease. Conclusion A high proportion of children exposed to MDR-TB are infected or diseased. Early contact tracing might provide opportunities to prevent the progression to TB disease in children identified as having been exposed to MDR-TB.
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Affiliation(s)
- James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Clinical Building, Room 0085, P, O, Box 19063, Tygerberg, South Africa.
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27
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Arokiasamy P, Agrawal G. Population attributable risk fraction for selected chronic diseases in India. J Prim Care Community Health 2013; 1:192-9. [PMID: 23804611 DOI: 10.1177/2150131910378527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND India's current health transition stage poses a critical challenge of dealing with the unfinished agenda of communicable diseases and the steadily rising burden of noncommunicable diseases. A significant burden of chronic diseases in India is attributable to household and individual level health risk factors coupled with socioeconomic conditions. From this perspective, this article made a first time effort to assess disease burden attributable to health risk factors using cross-sectional population health survey data. METHODS Population attributable fractions (PAF) were estimated for a cluster of health risk factors that include unsafe water, lack of sanitation, exposure to cooking smoke, tobacco and alcohol use, physical inactivity, and socioeconomic conditions on a set of widely prevalent chronic diseases such as tuberculosis, malaria, diarrhea, diabetes, angina, and asthma. Data from the 2003 World Health Survey was used. RESULTS The analysis revealed evidence of a significant contribution of health risk factors to India's escalating chronic disease burden. The contribution of health risk factors toward chronic disease burden varied by residence. CONCLUSION Results suggest that promotional health care based policies to deal with health risks should be a major priority in policy agenda to combat with the challenge of emerging noncommunicable disease coupled with the persistent burden of communicable diseases. Disease burden in India could be halved by effectively modifying exposure to the risk factors through promotional health care.
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28
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Millet JP, Moreno A, Fina L, del Baño L, Orcau A, de Olalla PG, Caylà JA. Factors that influence current tuberculosis epidemiology. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22 Suppl 4:539-48. [PMID: 22565801 PMCID: PMC3691414 DOI: 10.1007/s00586-012-2334-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 04/17/2012] [Indexed: 11/30/2022]
Abstract
According to WHO estimates, in 2010 there were 8.8 million new cases of tuberculosis (TB) and 1.5 million deaths. TB has been classically associated with poverty, overcrowding and malnutrition. Low income countries and deprived areas, within big cities in developed countries, present the highest TB incidences and TB mortality rates. These are the settings where immigration, important social inequalities, HIV infection and drug or alcohol abuse may coexist, all factors strongly associated with TB. In spite of the political, economical, research and community efforts, TB remains a major global health problem worldwide. Moreover, in this new century, new challenges such as multidrug-resistance extension, migration to big cities and the new treatments with anti-tumour necrosis alpha factor for inflammatory diseases have emerged and threaten the decreasing trend in the global number of TB cases in the last years. We must also be aware about the impact that smoking and diabetes pandemics may be having on the incidence of TB. The existence of a good TB Prevention and Control Program is essential to fight against TB. The coordination among clinicians, microbiologists, epidemiologists and others, and the link between surveillance, control and research should always be a priority for a TB Program. Each city and country should define their needs according to the epidemiological situation. Local TB control programs will have to adapt to any new challenge that arises in order to respond to the needs of their population.
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Affiliation(s)
- Juan-Pablo Millet
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Antonio Moreno
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Laia Fina
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Lucía del Baño
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Angels Orcau
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Patricia García de Olalla
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
| | - Joan A. Caylà
- />Epidemiology Service, Public Health Agency of Barcelona, Plaza Lesseps, 1, 08023 Barcelona, Spain
- />CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- />Tuberculosis Investigation Unit of Barcelona (UiTB), Barcelona, Spain
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Bonacci RA, Cruz-Hervert LP, García-García L, Reynales-Shigematsu LM, Ferreyra-Reyes L, Bobadilla-del-Valle M, Canizales-Quintero S, Ferreira-Guerrero E, Báez-Saldaña R, Téllez-Vázquez N, Mongua-Rodríguez N, Montero-Campos R, Delgado-Sánchez G, Martínez-Gamboa RA, Cano-Arellano B, Sifuentes-Osornio J, de León AP. Impact of cigarette smoking on rates and clinical prognosis of pulmonary tuberculosis in Southern Mexico. J Infect 2013; 66:303-12. [PMID: 22982014 PMCID: PMC3543482 DOI: 10.1016/j.jinf.2012.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 09/07/2012] [Accepted: 09/09/2012] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To examine the relationship between cigarette smoking and incidence and mortality rates of pulmonary tuberculosis (TB) and treatment outcomes. MATERIALS From 1995 to 2010, we analyzed data from 1062 patients with TB and from 2001 to 2004, 2951 contacts in Southern Mexico. Patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and mycobacteriological evaluation and received treatment by the local DOTS program. RESULTS Consumers of 1-10 (LS) or 11 or more (HS) cigarettes per day incidence (1.75 and 11.79) and mortality (HS, 17.74) smoker-non-smoker rate ratios were significantly higher for smokers. Smoker population was more likely to experience unfavorable treatment outcomes (HS, adjusted OR 2.36) and retreatment (LS and HS, adjusted hazard ratio (HR) 2.14 and 2.37). Contacts that smoked had a higher probability of developing active TB (HR 2.38) during follow up. CONCLUSIONS Results indicate the need of incorporating smoking prevention and cessation, especially among men, into international TB control strategies.
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Affiliation(s)
- Robert A. Bonacci
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
- Department of Microbiology, The Ohio State University, W. Lane Ave., Columbus, Ohio, USA, 43210
| | - Luis Pablo Cruz-Hervert
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Lourdes García-García
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Luz Myriam Reynales-Shigematsu
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Leticia Ferreyra-Reyes
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Miriam Bobadilla-del-Valle
- Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Col. Belisario Domínguez Sección 16, Ciudad de México, Distrito Federal México, D.F., México,14000
| | - Sergio Canizales-Quintero
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Elizabeth Ferreira-Guerrero
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Renata Báez-Saldaña
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Norma Téllez-Vázquez
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Norma Mongua-Rodríguez
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Rogelio Montero-Campos
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Guadalupe Delgado-Sánchez
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - Rosa Areli Martínez-Gamboa
- Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Col. Belisario Domínguez Sección 16, Ciudad de México, Distrito Federal México, D.F., México,14000
| | - Bulmaro Cano-Arellano
- Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, México, 62100
| | - José Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Col. Belisario Domínguez Sección 16, Ciudad de México, Distrito Federal México, D.F., México,14000
| | - Alfredo Ponce de León
- Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Col. Belisario Domínguez Sección 16, Ciudad de México, Distrito Federal México, D.F., México,14000
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Cigarette-Smoking Intensity and Interferon-Gamma Release Assay Conversion among Persons Who Inject Drugs: A Cohort Study. Pulm Med 2012; 2012:828106. [PMID: 23304497 PMCID: PMC3529865 DOI: 10.1155/2012/828106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/15/2012] [Indexed: 11/17/2022] Open
Abstract
We analyzed data from a longitudinal cohort study of persons who inject drugs (PWID) in Tijuana, Mexico, to explore whether cigarette smoking increases the risk of interferon gamma release assay (IGRA) conversion. PWID were recruited using respondent driven sampling (RDS). QuantiFERON-TB Gold In-Tube (QFT) assay conversion was defined as interferon-gamma concentrations <0.35 IU/mL at baseline and ≥0.7 IU/mL at 18 months. We used multivariable Poisson regression adjusted for RDS weights to estimate risk ratios (RRs). Of 129 eligible participants, 125 (96.9%) smoked at least one cigarette during followup with a median of 11 cigarettes smoked daily, and 52 (40.3%) had QFT conversion. In bivariate analysis, QFT conversion was not associated with the number of cigarettes smoked daily (P = 0.716). Controlling for age, gender, education, and alcohol use, the RRs of QFT conversion for smoking 6–10, 11–15, and ≥16 cigarettes daily compared to smoking 0–5 cigarettes daily were 0.9 (95% confidence interval (CI), 0.5–1.6), 0.5 (95% CI, 0.3–1.2), and 0.7 (95% CI, 0.3–1.6), respectively. Although this study did not find an association between self-reported smoking intensity and QFT conversion, it was not powered sufficiently to negate such an association. Larger longitudinal studies are needed to fully explore this relationship.
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Abstract
Cigarette smoke contains harmful chemicals with hazardous adverse effects on almost every organ in the body of smokers as well as of nonsmokers exposed to environmental tobacco smoke (ETS). There has been increasing interest in the effects of passive smoking on the health of children. In order to detect the magnitude of passive smoking in children, parental questionnaires, measuring nicotine and cotinine body levels, and evaluating expired carbon monoxide (CO) concentrations, have been used. Passive smoking causes respiratory illness, asthma, poor growth, neurological disorders, and coronary heart diseases. Herein, we focused on the deleterious influences of passive smoking on immunity and liver. Besides, its effects on the concentrations of various biomarker levels related to the oxidant/antioxidant status were considered. Understanding these effects may help clinicians to counsel parents on smoking cessation and smoke exposure elimination. It may also help to develop interventions to improve the health of children. This review potentially demonstrated some nutraceuticals with a promising role in the prevention of smoking-related diseases.
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Affiliation(s)
- Eman M Al-Sayed
- Department of Food Science and Nutrition, National Research Center, Dokki, Giza, Egypt
| | - Khadiga Salah Ibrahim
- Department of Environmental and Occupational Medicine, National Research Centre, Dokki, Giza, Egypt
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32
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Underner M, Perriot J, Trosini-Desert V, Ouedreaogo G, Peiffer G, Meurice JC, Dautzenberg B. Tabagisme et infection tuberculeuse latente. Rev Mal Respir 2012; 29:1007-16. [PMID: 23101642 DOI: 10.1016/j.rmr.2012.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 05/07/2012] [Indexed: 02/08/2023]
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Fox GJ, Barry SE, Britton WJ, Marks GB. Contact investigation for tuberculosis: a systematic review and meta-analysis. Eur Respir J 2012; 41:140-56. [PMID: 22936710 PMCID: PMC3533588 DOI: 10.1183/09031936.00070812] [Citation(s) in RCA: 458] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Investigation of contacts of patients with tuberculosis (TB) is a priority for TB control in high-income countries, and is increasingly being considered in resource-limited settings. This review was commissioned for a World Health Organization Expert Panel to develop global contact investigation guidelines. We performed a systematic review and meta-analysis of all studies reporting the prevalence of TB and latent TB infection, and the annual incidence of TB among contacts of patients with TB. After screening 9,555 titles, we included 203 published studies. In 95 studies from low- and middle-income settings, the prevalence of active TB in all contacts was 3.1% (95% CI 2.2-4.4%, I(2)=99.4%), microbiologically proven TB was 1.2% (95% CI 0.9-1.8%, I(2)=95.9%), and latent TB infection was 51.5% (95% CI 47.1-55.8%, I(2)=98.9%). The prevalence of TB among household contacts was 3.1% (95% CI 2.1-4.5%, I(2)=98.8%) and among contacts of patients with multidrug-resistant or extensively drug-resistant TB was 3.4% (95% CI 0.8-12.6%, I(2)=95.7%). Incidence was greatest in the first year after exposure. In 108 studies from high-income settings, the prevalence of TB among contacts was 1.4% (95% CI 1.1-1.8%, I(2)=98.7%), and the prevalence of latent infection was 28.1% (95% CI 24.2-32.4%, I(2)=99.5%). There was substantial heterogeneity among published studies. Contacts of TB patients are a high-risk group for developing TB, particularly within the first year. Children <5 yrs of age and people living with HIV are particularly at risk. Policy recommendations must consider evidence of the cost-effectiveness of various contact tracing strategies, and also incorporate complementary strategies to enhance case finding.
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Affiliation(s)
- Gregory J Fox
- Woolcock Institute of Medical Research, University of Sydney, Glebe, Sydney 2037, Australia.
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Seddon JA, Godfrey-Faussett P, Hesseling AC, Gie RP, Beyers N, Schaaf HS. Management of children exposed to multidrug-resistant Mycobacterium tuberculosis. THE LANCET. INFECTIOUS DISEASES 2012; 12:469-79. [PMID: 22373591 DOI: 10.1016/s1473-3099(11)70366-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Children exposed to multidrug-resistant (MDR) Mycobacterium tuberculosis are at risk of developing MDR tuberculosis. Where treatment is available, it is lengthy, expensive, and associated with poor adherence and notable morbidity and mortality. Preventive treatment effectively lowers the risk of disease progression for contacts of individuals with drug-susceptible tuberculosis, but this strategy is poorly studied for contacts of people with MDR tuberculosis. In this Review we discuss the management of child contacts of source cases with MDR tuberculosis. We pay particular attention to assessment, existing international guidelines, possible preventive treatments, rationales for different management strategies, and the interaction with and implications of HIV infection.
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Affiliation(s)
- James A Seddon
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK .
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Delacourt C. [Specific features of tuberculosis in childhood]. Rev Mal Respir 2011; 28:529-41. [PMID: 21549907 DOI: 10.1016/j.rmr.2010.10.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
Abstract
Primary infection with Mycobacterium tuberculosis usually occurs during childhood. The source of infection is most often an adult. The risk of infection in exposed children is modulated by various factors related to the infectiousness of the index case, exposure conditions, and the child himself. This review aims to describe the specific diagnostic and therapeutic features of latent TB infection and TB disease in childhood.
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Affiliation(s)
- C Delacourt
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, 161, rue de Sèvres, 75015 Paris, France.
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Hassmiller Lich K, Osgood ND, Mahamoud A. Using System Dynamics tools to gain insight into intervention options related to the interaction between tobacco and tuberculosis. Glob Health Promot 2010; 17:7-20. [DOI: 10.1177/1757975909358255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tobacco exposure is an important risk factor for tuberculosis (TB) when considering its effects on population-level disease outcomes. If we hope to gain control over TB globally, we must begin to think ‘outside of the box’ to identify an extended and multi-faceted intervention strategy that is grounded in an understanding of the particular ways in which key risk factors worsen TB. In light of the role of tobacco exposure as an important, identifiable, modifiable, and preventable risk factor for TB, efforts aiming at reducing tobacco use merit inclusion in such a comprehensive TB control program. The goal of this paper is to share the conceptual framework we have developed using System Dynamics methodology, which diagrams the likely effects of tobacco exposure on TB dynamics in a typical low-income country setting. Using this framework as a guide, we leverage an understanding of the likely mechanisms by which tobacco exposure affects TB risk to systematically explore TB control intervention options. We hope that this paper will help inspire new approaches to extend and enhance traditional TB control efforts. We also hope that the conceptual framework will spark further discussion and research on this important and potentially explosive combination of global public health crises.
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Affiliation(s)
- Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA,
| | - Nathaniel D. Osgood
- Department of Computer Science, College of Arts and
Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, School of Public Health, University of Saskatchewan,
Saskatoon, Saskatchewan, Canada
| | - Aziza Mahamoud
- School of Public Health, University of Saskatchewan,
Saskatoon, Saskatchewan, Canada
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37
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Best D. From the American Academy of Pediatrics: Technical report--Secondhand and prenatal tobacco smoke exposure. Pediatrics 2009; 124:e1017-44. [PMID: 19841110 DOI: 10.1542/peds.2009-2120] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Secondhand tobacco smoke (SHS) exposure of children and their families causes significant morbidity and mortality. In their personal and professional roles, pediatricians have many opportunities to advocate for elimination of SHS exposure of children, to counsel tobacco users to quit, and to counsel children never to start. This report discusses the harms of tobacco use and SHS exposure, the extent and costs of tobacco use and SHS exposure, and the evidence that supports counseling and other clinical interventions in the cycle of tobacco use. Recommendations for future research, policy, and clinical practice change are discussed. To improve understanding and provide support for these activities, the harms of SHS exposure are discussed, effective ways to eliminate or reduce SHS exposure are presented, and policies that support a smoke-free environment are outlined.
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Abstract
The effects of tobacco smoke exposure on the respiratory health of school-aged children relate to persisting effects of exposure to tobacco smoke during pregnancy and early infancy, passive exposure to environmental tobacco smoke in the home and elsewhere, and active smoking during later childhood. Much of the current evidence comes from cross-sectional and longitudinal observational studies and suggests that, for asthma and pulmonary function outcomes, the strongest associations are with smoke exposure in pregnancy and early childhood, although independent effects of later exposure are reported. Exposure in later childhood to environmental tobacco smoke is associated with increased respiratory symptoms, although for some of these, the effect appears to diminish with increasing age of the child. There is currently a paucity of evidence on the long-term adverse respiratory consequences of active smoking by children and adolescents, but such evidence there is suggests that these may be substantial.
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Aissa K, Madhi F, Ronsin N, Delarocque F, Lecuyer A, Decludt B, Remus N, Abel L, Poirier C, Delacourt C. Evaluation of a model for efficient screening of tuberculosis contact subjects. Am J Respir Crit Care Med 2008; 177:1041-7. [PMID: 18263798 DOI: 10.1164/rccm.200711-1756oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Contact tracing is an important component of tuberculosis (TB) control programs. Standardization of contact investigation protocols can make them more efficient. OBJECTIVES To develop a model to select contact subjects for screening. METHODS We prospectively collected standardized data on 325 TB index cases and their 2,009 contacts. Factors that independently influenced the risk of TB infection were included in the model, which was then validated in a second prospective cohort of 88 cases of TB and their 618 contacts. MEASUREMENTS AND MAIN RESULTS A total of eight independent risk factors were identified (odds ratio; 95% confidence interval): age, with three subgroups: 6-14 years (3.6; 1.6-8.0); 15-29 years (3.7; 1.8-7.7); > or =30 years (4.1; 2.0-8.5); cavitation on the index case's chest radiograph (1.6; 1.1-2.2); an index case sputum smear with 100 or more acid-fast bacilli per field (1.8; 1.2-2.8); household contact at night (2.1; 1.3-3.2); first-degree family relationship with the index case (2.1; 1.3-3.3); active smoking by the contact (1.6; 1.1-2.4); free health care (2.0; 1.2-3.2); and birth in a country with TB incidence rate higher than 25 of 100,000 (2.2; 1.5-3.2). Predictive probabilities were chosen to ensure false-negative rates lower than estimated TB infection background. The number of contacts to be investigated was reduced by 26% while maintaining a false-negative rate of 8%. CONCLUSIONS This study provides a standardized contact screening model which reduces resources required without negatively affecting disease control.
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Affiliation(s)
- Khaoula Aissa
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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