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Noor AM, Ghazali SM, Bakar ZA, Ruzan IN. Diagnostic performance of Xpert MTB/RIF ultra in detecting Mycobacterium tuberculosis and Rifampicin Resistance in AFB Smear-negative Pulmonary and Extrapulmonary Tuberculosis samples in Malaysia. Diagn Microbiol Infect Dis 2024; 109:116230. [PMID: 38507965 DOI: 10.1016/j.diagmicrobio.2024.116230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/19/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
Rapid and highly accurate diagnostic tools are critically needed to diagnose Mycobacterium tuberculosis and rifampicin resistance in AFB smear-negative samples. In this study, we evaluated the diagnostic performance of Xpert MTB/RIF Ultra (Ultra) as a rapid test to diagnose tuberculosis in smear-negative cases in Malaysia. A retrospective study of 1960 smear-negative pulmonary and extrapulmonary samples obtained from patients was conducted. Culture was used as the reference standard for the study. The overall sensitivity and specificity of Ultra on the tested samples were 88.7 % and 77.2 %, respectively, while the PPV was 32.3 % and the NPV was 98.2 %. Ultra showed slightly higher sensitivity in pulmonary (89.9 %) compared to extrapulmonary samples (86.1 %). The overall accuracy of Ultra was 78.5 % (kappa=0.37; 95 %CI: 0.32,0.42). Ultra showed good diagnostic accuracy for detecting MTB and rifampicin resistance in various AFB smear-negative samples. Ultra also had excellent capability in rifampicin resistance detection.
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Affiliation(s)
- Azura Mohd Noor
- Infectious Disease Research Center, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia 40170, Setia Alam, Shah Alam, Selangor, Malaysia.
| | - Sumarni Mohd Ghazali
- Biomedical Epidemiology Unit, Special Resource Center, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia 40170, Setia Alam, Shah Alam, Selangor, Malaysia
| | - Zamzurina Abu Bakar
- Institute of Respiratory Medicine, Jalan Pahang 50590, Kuala Lumpur, Malaysia
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Goussard P, Eber E, Venkatakrishna S, Frigati L, Greybe L, Janson J, Schubert P, Andronikou S. Interventional bronchoscopy in pediatric pulmonary tuberculosis. Expert Rev Respir Med 2023; 17:1159-1175. [PMID: 38140708 DOI: 10.1080/17476348.2023.2299336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Lymphobronchial tuberculosis (TB) is common in children with primary TB and enlarged lymph nodes can cause airway compression of the large airways. If not treated correctly, airway compression can result in persistent and permanent parenchymal pathology, as well as irreversible lung destruction. Bronchoscopy was originally used to collect diagnostic samples; however, its role has evolved, and it is now used as an interventional tool in the diagnosis and management of complicated airway disease. Endoscopic treatment guidelines for children with TB are scarce. AREAS COVERED The role of interventional bronchoscopy in the diagnosis and management of complicated pulmonary TB will be discussed. This review will provide practical insights into how and when to perform interventional procedures in children with complicated TB for both diagnostic and therapeutic purposes. This discussion incorporates current scientific evidence and refers to adult literature, as some of the interventions have only been done in adults but may have a role in children. Limitations and future perspectives will be examined. EXPERT OPINION Pediatric pulmonary TB lends itself to endoscopic interventions as it is a disease with a good outcome if treated correctly. However, interventions must be limited to safeguard the parenchyma and prevent permanent damage.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Leonore Greybe
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kagujje M, Nyangu S, Maimbolwa MM, Shuma B, Mutti L, Somwe P, Sanjase N, Chungu C, Kerkhoff AD, Muyoyeta M. Strategies to increase childhood tuberculosis case detection at the primary health care level: Lessons from an active case finding study in Zambia. PLoS One 2023; 18:e0288643. [PMID: 37467209 PMCID: PMC10355435 DOI: 10.1371/journal.pone.0288643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/01/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION In high TB burden settings, it is estimated that 10-20% of total notifications should be children, however, currently only 6-8% of the total TB notifications in Zambia are children. We assessed whether the implementation of a multicomponent strategy, at primary healthcare facilities, that systematically targets barriers at each step of the childhood TB diagnostic cascade can increase childhood TB case detection. METHODS We conducted a controlled, interrupted time series analysis to compare childhood TB case notifications before (January 2018-December 2019), and during implementation (January 2020-September 2021) in two intervention and two control Level 1 hospitals in Lusaka, Zambia. At each of the intervention facilities, we implemented a multicomponent strategy constituting: (1) capacity development on childhood TB and interpretation of chest x-ray, (2) TB awareness-raising and demand creation activities, (3) setting up fast track TB services, (4) strengthening of household contact tracing, and (5) improving access to digital chest X-ray for TB screening and Xpert MTB/Rif Ultra for TB diagnosis, through strengthening sample collection in children. FINDINGS Among 5,150 children < 15 years screened at the two intervention facilities during the study period, 503 (9.8% yield) were diagnosed with TB. Of these, 433 (86.1%) were identified through facility-based activities (10.5% yield) and 70 (13.9%) were identified through household contact tracing (6.9% yield). Overall, 446 children (88.7%) children with TB were clinically diagnosed. Following implementation of the multicomponent strategy, the proportion children contributed to total TB notifications immediately changed by +1.5% (95%CI: -3.5, 6.6) and -4.4% (95%CI: -7.5, 1.4) at the intervention and control sites, respectively (difference 6.0% [95%CI: -0.7, 12.7]), p = 0.08); the proportion of childhood notifications increased 0.9% (95%CI: -0.7, 2.5%) each quarter at the intervention sites relative to pre-implementation trends, while declining 1.2% (-95%CI: -1.8, -0.6) at the control sites (difference 2.1% [95%CI: 0.1, 4.2] per quarter between, p = 0.046); this translated into 352 additional and 85 fewer childhood TB notifications at the intervention and control sites, respectively, compared to the pre-implementation period. CONCLUSION A standardized package of strategies to improve childhood TB detection at primary healthcare facilities was feasible to implement and was associated with a sustained improvement in childhood TB notifications.
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Affiliation(s)
- Mary Kagujje
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sarah Nyangu
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Minyoi M. Maimbolwa
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Brian Shuma
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Lilungwe Mutti
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Strategic Information Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Nsala Sanjase
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Andrew D. Kerkhoff
- Department of Medicine, University of San Francisco California, San Francisco, California, United States of America
| | - Monde Muyoyeta
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
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Global impact of COVID-19 on childhood tuberculosis: an analysis of notification data. Lancet Glob Health 2022; 10:e1774-e1781. [PMID: 36400083 PMCID: PMC9671550 DOI: 10.1016/s2214-109x(22)00414-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is concern that the COVID-19 pandemic has damaged global childhood tuberculosis management. Quantifying changes in childhood tuberculosis notifications could support more targeted interventions to restore childhood tuberculosis services. We aimed to use time-series modelling to evaluate the impact of COVID-19 on child tuberculosis notifications. METHODS Annual tuberculosis case notification data reported to WHO by 215 countries were used to calculate annual notification counts for the years 2014-20, stratified by age groups (0-4, 5-14, and ≥15 years) and sex. We used time-series modelling to predict notification counts for 2020, and calculated differences between these predictions and observed notifications in 2020 for each of the six WHO regions and at the country level for 30 countries with high tuberculosis burden. We assessed associations between these differences and the COVID-19 stringency index, a measure of COVID-19 social impact. FINDINGS From 2014 to 2019, annual tuberculosis notification counts increased across all age groups and WHO regions. More males than females in the 0-4 years age group and ≥15 years age group had notifications in all years from 2014 to 2020 and in all WHO regions. In the 5-14 years age group, more females than males were notified globally in all years, although some WHO regions had higher notifications from males than females. In 2020, global notifications were 35·4% lower than predicted (95% prediction interval -30·3 to -39·9; 142 525 observed vs 220 794 predicted notifications [95% prediction interval 204 509 to 237 078]) for children aged 0-4 years, 27·7% lower (-23·4 to -31·5; 256 398 vs 354 578 [334 724 to 374 431]) in children aged 5-14 years, and 18·8% lower (-15·4 to -21·9; 5 391 753 vs 6 639 547 [6 375 086 to 6 904 007]) for people aged 15 years or older. Among those aged 5-14 years, the reduction in observed relative to predicted notifications for 2020 was greater in males (-30·9% [-24·8 to -36·1]) than females (-24·5% [-18·1 to -29·9]). Among 28 countries with high tuberculosis burden, no association was observed between the stringency of COVID-19 restrictions and the relative difference in observed versus predicted notifications. INTERPRETATION Our findings suggest that COVID-19 has substantially affected childhood tuberculosis services, with the youngest children most affected. Although children have mostly had fewer severe health consequences from COVID-19 than have adults, they have been disproportionately affected by the effects of the pandemic on tuberculosis care. Observed sex differences suggest that targeted interventions might be required. As countries rebuild health systems following the COVID-19 pandemic, it is crucial that childhood tuberculosis services are placed centrally within national strategic plans. FUNDING Medical Research Council.
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Goussard P, Andronikou S, Fourie B, Janson JT, Schubert PT. Tuberculous bronchial stenosis: Diagnosis and role of interventional bronchoscopy. Pediatr Pulmonol 2022; 57:2445-2454. [PMID: 35775331 DOI: 10.1002/ppul.26057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/10/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
The reported prevalence of tuberculous bronchial stenosis in children is unknown and rarely reported in English-speaking literature. In adult patients with pulmonary tuberculosis, it varies from 40% in an autopsied series in the preantibiotic era to 10% in patients who have undergone routine bronchofibroscopy in modern times. We describe our experience of four cases of confirmed bronchial stenosis due to MTB collected between January 2000 and June 2021 in this case series descriptive study. The diagnosis of bronchial stenosis due to TB was made on flexible bronchoscopy. A TB diagnosis was made if MTB was cultured from respiratory secretions, when Ziehl-Neelsen smear or GeneXpert MTB/RIF test was positive, or if a chest radiograph revealed radiographic features typical of MTB. Bronchial stenosis due to TB is rare even if airway compression is frequently seen. Although an early diagnosis of bronchial stenosis due to TB is difficult on chest X-rays, all children in this series demonstrated parenchymal changes distal to the stenosis ranging from hyperinflation and lobar collaps to bronchiectasis. If bronchial stenosis resulting from TB disease is diagnosed early, balloon dilatation as described in this report, may be an effective and safe intervention, preventing long-term complications such as irreversible lung destruction, that may require pneumonectomy.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Radiology, Perelman School, of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barend Fourie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Jacques T Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel T Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
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Dubois MM, Brooks MB, Malik AA, Siddiqui S, Ahmed JF, Jaswal M, Amanullah F, Becerra MC, Hussain H. Age-specific Clinical Presentation and Risk Factors for Extrapulmonary Tuberculosis Disease in Children. Pediatr Infect Dis J 2022; 41:620-625. [PMID: 35544720 PMCID: PMC9281512 DOI: 10.1097/inf.0000000000003584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan. METHODS In 2015-2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0-4, 5-9 and 10-14 years. RESULTS A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0-4, 53 (33.8%) were 5-9 and 58 (36.9%) were 10-14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0-4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05-7.47) and 10-14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28-6.07) groups, and the presence of cough was associated with a decreased risk of EPTB. CONCLUSIONS This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.
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Affiliation(s)
- Melanie M. Dubois
- From the Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Amyn A. Malik
- Yale Institute for Global Health, New Haven, Connecticut
- Interactive Research and Development Global, Singapore
| | - Sara Siddiqui
- The Indus Hospital and Health Network, Korangi Crossing, Karachi, Pakistan
| | - Junaid F. Ahmed
- The Indus Hospital and Health Network, Korangi Crossing, Karachi, Pakistan
| | - Maria Jaswal
- The Indus Hospital and Health Network, Korangi Crossing, Karachi, Pakistan
| | - Farhana Amanullah
- The Indus Hospital and Health Network, Korangi Crossing, Karachi, Pakistan
| | - Mercedes C. Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Deutsch-Feldman M, Springer YP, Felix D, Tsang CA, Brostrom R, Haddad M. Tuberculosis Among Native Hawaiian and Other Pacific Islander Persons: United States and U.S.-Affiliated Pacific Islands, 2010-2019. Health Equity 2022; 6:476-484. [PMID: 35801148 PMCID: PMC9257550 DOI: 10.1089/heq.2022.0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, tuberculosis (TB) incidence in the United States has declined overall but remained high among Native Hawaiian and Other Pacific Islander (NH/PI) persons. Few studies have examined the epidemiology of TB among NH/PI persons, particularly in the U.S.-Affiliated Pacific Islands (USAPI). We describe TB incidence and characteristics of NH/PI patients during 2010-2019. Methods We used data from the National Tuberculosis Surveillance System to characterize TB cases reported among NH/PI persons born in the 50 U.S. states (defined to include District of Columbia) and the USAPI. We calculated annual TB incidence among NH/PI patients, stratified by place of birth (U.S. states or USAPI). Using Asian persons born outside the United States-persons historically grouped with NH/PI persons as one racial category-as the reference, we compared demographic, clinical, and socio-behavioral characteristics of NH/PI TB patients. Results During 2010-2019, 4359 TB cases were reported among NH/PI patients born in the U.S. states (n=205) or the USAPI (n=4154). Median annual incidence per 100,000 persons was 6.5 cases (persons born in the U.S. states) and 150.7 cases (persons born in the USAPI). The proportion of TB patients aged <15 years was higher among NH/PI persons (U.S. states: 54%, USAPI: 24%) than among Asian persons born outside the United States (1%). Conclusions TB incidence among NH/PI persons is high, particularly among persons born in the USAPI, emphasizing the need to enhance TB prevention strategies in these communities. Interventions should be tailored toward those who experience the highest risk, including NH/PI children and adolescents.
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Affiliation(s)
- Molly Deutsch-Feldman
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yuri P Springer
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Derrick Felix
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clarisse A Tsang
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Brostrom
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maryam Haddad
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Heidary M, Shirani M, Moradi M, Goudarzi M, Pouriran R, Rezaeian T, Khoshnood S. Tuberculosis challenges: Resistance, co-infection, diagnosis, and treatment. Eur J Microbiol Immunol (Bp) 2022; 12:1-17. [PMID: 35420996 PMCID: PMC9036649 DOI: 10.1556/1886.2021.00021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/10/2022] [Indexed: 01/23/2023] Open
Abstract
Early diagnosis of tuberculosis (TB), followed by effective treatment, is the cornerstone of global TB control efforts. An estimated 3 million cases of TB remain undetected each year. Early detection and effective management of TB can prevent severe disease and reduce mortality and transmission. Intrinsic and acquired drug resistance of Mycobacterium tuberculosis (MTB) severely restricted the anti-TB therapeutic options, and public health policies are required to preserve the new medications to treat TB. In addition, TB and HIV frequently accelerate the progression of each other, and one disease can enhance the other effect. Overall, TB-HIV co-infections show an adverse bidirectional interaction. For HIV-infected patients, the risk of developing TB disease is approximately 22 times higher than for persons with a protective immune response. Analysis of the current TB challenges is critical to meet the goals of the end TB strategy and can go a long way in eradicating the disease. It provides opportunities for global TB control and demonstrates the efforts required to accelerate eliminating TB. This review will discuss the main challenges of the TB era, including resistance, co-infection, diagnosis, and treatment.
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Affiliation(s)
- Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Maryam Shirani
- Toxicology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Melika Moradi
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Pouriran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tayebe Rezaeian
- Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Chimsimbe M, Mucheto P, Juru TP, Chadambuka A, Govha E, Gombe NT, Tshimanga M. An evaluation of childhood tuberculosis program in Chegutu District, Zimbabwe, 2020: a descriptive cross-sectional study. BMC Health Serv Res 2022; 22:500. [PMID: 35421993 PMCID: PMC9008389 DOI: 10.1186/s12913-022-07918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. METHODS We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. RESULTS The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW's negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. CONCLUSION The childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.
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Affiliation(s)
- Memory Chimsimbe
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Pride Mucheto
- Department of Oral Health, University of Zimbabwe, Harare, Zimbabwe
| | - Tsitsi Patience Juru
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Addmore Chadambuka
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
- Zimbabwe Field Epidemiology Training Program, 3-68 Kaguvi Building, Corner 4th/Central Avenue, Harare, Zimbabwe
| | - Emmanuel Govha
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Notion Tafara Gombe
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
- African Field Epidemiology Network, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
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10
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du Preez K, Gabardo BMA, Kabra SK, Triasih R, Lestari T, Kal M, Tsogt B, Dorj G, Purev E, Nguyen TA, Naidoo L, Mvusi L, Schaaf HS, Hesseling AC, de Oliveira Rossoni AM, Carvalho ACC, Cardoso CAA, Sant’Anna CC, Orti DGD, Costa FD, Vega LR, Sant’Anna MDFP, Hoa NB, Phuc PH, Fiogbe AA, Affolabi D, Badoum G, Ouédraogo AR, Saouadogo T, Combary A, Kuate Kuate A, Prudence BNA, Magassouba AS, Bangoura AM, Soumana A, Hermana G, Gando H, Fall N, Gning B, Dogo MF, Mbitikon O, Deffense M, Zimba K, Chabala C, Sekadde MP, Luzze H, Turyahabwe S, Dongo JP, Lopes C, dos Santos M, Francis JR, Arango-Loboguerrero M, Perez-Velez CM, Koura KG, Graham SM. Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries. Pathogens 2022; 11:196. [PMID: 35215139 PMCID: PMC8878304 DOI: 10.3390/pathogens11020196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality-over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy-practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.
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Affiliation(s)
- Karen du Preez
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Betina Mendez Alcântara Gabardo
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Sushil K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Rina Triasih
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (R.T.); (T.L.)
| | - Trisasi Lestari
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (R.T.); (T.L.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia;
| | - Margaret Kal
- National Department of Health, Port Moresby 131, Papua New Guinea;
| | | | - Gantsetseg Dorj
- Tuberculosis Surveillance and Research Department, National Center for Communicable Diseases, Ulaanbaatar 210648, Mongolia;
| | - Enkhtsetseg Purev
- Tuberculosis Clinic, National Center for Communicable Diseases, Ulaanbaatar 210648, Mongolia;
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Ha Noi 100000, Vietnam;
| | - Lenny Naidoo
- Health Department, Cape Town 8000, South Africa;
| | - Lindiwe Mvusi
- National TB Control & Management Cluster, National Department of Health, Pretoria 0187, South Africa;
| | - Hendrik Simon Schaaf
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Anneke C. Hesseling
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Andrea Maciel de Oliveira Rossoni
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Anna Cristina Calçada Carvalho
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21045-900, Brazil
| | - Claudete Aparecida Araújo Cardoso
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Clemax Couto Sant’Anna
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Danielle Gomes Dell’ Orti
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Fernanda Dockhorn Costa
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Liliana Romero Vega
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Maria de Fátima Pombo Sant’Anna
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | | | - Phan Huu Phuc
- National Pediatric Hospital, Ha Noi 100000, Vietnam;
| | - Attannon Arnauld Fiogbe
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Cotonou 03 BP 2819, Benin;
| | - Dissou Affolabi
- National Tuberculosis Program, Cotonou 03 BP 2819, Benin;
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou 03 BP 2819, Benin
| | - Gisèle Badoum
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Health Sciences Unit, University Joseph Ki-Zerbo, Ouagadougou 03 BP 7047, Burkina Faso
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Abdoul Risgou Ouédraogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Health Sciences Unit, University Joseph Ki-Zerbo, Ouagadougou 03 BP 7047, Burkina Faso
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Tandaogo Saouadogo
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Adjima Combary
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Yaoundé BP 6000, Cameroon;
| | - Albert Kuate Kuate
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Yaoundé BP 6000, Cameroon;
| | | | - Aboubakar Sidiki Magassouba
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Conakry 63570, Guinea;
| | | | - Alphazazi Soumana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Niamey 22 646, Niger
| | - Georges Hermana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Hervé Gando
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Nafissatou Fall
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Dakar 12000, Senegal;
| | - Barnabé Gning
- National Tuberculosis Program, Dakar 12000, Senegal;
| | - Mohammed Fall Dogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Lomé BP 526, Togo
| | - Olivia Mbitikon
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Manon Deffense
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
| | - Kevin Zimba
- Lusaka Provincial Health Office, Ministry of Health, Lusaka 10101, Zambia;
| | - Chishala Chabala
- Department of Pediatrics and Child Health, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Children’s Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
| | | | - Henry Luzze
- National Tuberculosis and Leprosy Program, Kampala 7025, Uganda; (M.P.S.); (H.L.); (S.T.)
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Kampala 7025, Uganda; (M.P.S.); (H.L.); (S.T.)
| | | | - Constantino Lopes
- National Tuberculosis Program, Ministerio da Saude, Dili NM 87109, Timor-Leste;
| | - Milena dos Santos
- Hospital Nacional Guido Valadares, Ministerio da Saude, Dili NM 87109, Timor-Leste;
| | | | | | - Carlos M. Perez-Velez
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ 85721, USA;
| | - Kobto Ghislain Koura
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- COMUE Sorbonne Paris Cité, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, 75006 Paris, France
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou 03 BP 351, Benin
| | - Stephen M. Graham
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Department of Pediatrics, Murdoch Childrens Research Institute, University of Melbourne Royal Children’s Hospital, Melbourne, VIC 3052, Australia
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Yerramsetti S, Cohen T, Atun R, Menzies NA. Global estimates of paediatric tuberculosis incidence in 2013-19: a mathematical modelling analysis. Lancet Glob Health 2022; 10:e207-e215. [PMID: 34895517 PMCID: PMC8800006 DOI: 10.1016/s2214-109x(21)00462-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/18/2021] [Accepted: 09/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many children who develop tuberculosis are thought to be missed by diagnostic and reporting systems. We aimed to estimate paediatric tuberculosis incidence and underreporting between 2013 and 2019 in countries representing more than 99% of the global tuberculosis burden. METHODS We developed a mathematical model of paediatric tuberculosis natural history, accounting for key mechanisms and risk factors for infectious exposure (HIV, malnutrition, and BCG non-vaccination), the probability of infection given exposure, and progression to disease among infected individuals. We extracted paediatric population estimates from UN Population Division data, and we used WHO estimates for adult tuberculosis incidence rates. We parameterised this model for 185 countries and calibrated it using data from countries with stronger case detection and reporting systems. Using this model, we estimated trends in paediatric incidence, and the proportion of these cases that are diagnosed and reported (case detection ratio [CDR]) for each country, age group, and year. FINDINGS For 2019, we estimated 997 500 (95% credible interval [CrI] 868 700-1 163 100) incident tuberculosis cases among children, with 481 000 cases (398 400-587 400) among those aged 0-4 years and 516 500 cases (442 900-608 000) among those aged 5-14 years. The paediatric CDR was estimated to be lower in children aged 0-4 years (41%, 95% CrI 34-50) than in those aged 5-14 years (63%, 53-75) and varied widely between countries. Estimated CDRs increased substantially over the study period, from 18% (15-20) in 2013 to 53% (45-60) in 2019, with improvements concentrated in the Eastern Mediterranean, South-East Asia, and Western Pacific regions. Over the study period, global incidence was estimated to have declined slowly at an average annual rate of 1·52% (1·42-1·66). INTERPRETATION Paediatric tuberculosis causes substantial morbidity and mortality, and these data indicate that cases (and, thus, probably associated mortality) are currently substantially underreported. These findings reinforce the need to ensure prompt diagnosis and care for children developing tuberculosis, strengthen reporting systems, and invest in research to develop more accurate and easy-to-use diagnostics for paediatric tuberculosis in high-burden settings. FUNDING National Institutes of Health.
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Affiliation(s)
- Sita Yerramsetti
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA.
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du Preez K, Jenkins HE, Donald PR, Solomons RS, Graham SM, Schaaf HS, Starke JR, Hesseling AC, Seddon JA. Tuberculous Meningitis in Children: A Forgotten Public Health Emergency. Front Neurol 2022; 13:751133. [PMID: 35370901 PMCID: PMC8970690 DOI: 10.3389/fneur.2022.751133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Tuberculous meningitis (TBM) remains a major cause of morbidity and mortality in children with tuberculosis (TB), yet there are currently no estimates of the global burden of pediatric TBM. Due to frequent non-specific clinical presentation and limited and inadequate diagnostic tests, children with TBM are often diagnosed late or die undiagnosed. Even when diagnosed and treated, 20% of children with TBM die. Of survivors, the majority have substantial neurological disability with significant negative impact on children and their families. Surveillance data on this devastating form of TB can help to quantify the contribution of TBM to the overall burden, morbidity and mortality of TB in children and the epidemiology of TB more broadly. Pediatric TBM usually occurs shortly after primary infection with Mycobacterium tuberculosis and reflects ongoing TB transmission to children. In this article we explain the public health importance of pediatric TBM, discuss the epidemiology within the context of overall TB control and health system functioning and the limitations of current surveillance strategies. We provide a clear rationale for the benefit of improved surveillance of pediatric TBM using a TB care cascade framework to support monitoring and evaluation of pediatric TB, and TB control more broadly. Considering the public health implications of a diagnosis of TBM in children, we provide recommendations to strengthen pediatric TBM surveillance and outline how improved surveillance can help us identify opportunities for prevention, earlier diagnosis and improved care to minimize the impact of TBM on children globally.
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Affiliation(s)
- Karen du Preez
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- *Correspondence: Karen du Preez
| | - Helen E. Jenkins
- 2Department of Biostatistics, School of Public Health, Boston University, Boston, MA, United States
| | - Peter R. Donald
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Regan S. Solomons
- 3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen M. Graham
- 4Department of Paediatrics and Murdoch Children's Research Institute, Centre for International Child Health, University of Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
- 5International Union Against Tuberculosis and Lung Disease, Paris, France
| | - H. Simon Schaaf
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- 3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jeffrey R. Starke
- 6Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Anneke C. Hesseling
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A. Seddon
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- 7Department of Infectious Diseases, Imperial College London, London, United Kingdom
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13
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Tuberculous Meningitis in Children: Reducing the Burden of Death and Disability. Pathogens 2021; 11:pathogens11010038. [PMID: 35055986 PMCID: PMC8778027 DOI: 10.3390/pathogens11010038] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
Tuberculous meningitis disproportionately affects young children. As the most devastating form of tuberculosis, it is associated with unacceptably high rates of mortality and morbidity even if treated. Challenging to diagnose and treat, tuberculous meningitis commonly causes long-term neurodisability in those who do survive. There remains an urgent need for strengthened surveillance, improved rapid diagnostics technology, optimised anti-tuberculosis drug therapy, investigation of new host-directed therapy, and further research on long-term functional and neurodevelopmental outcomes to allow targeted intervention. This review focuses on the neglected field of paediatric tuberculous meningitis and bridges current clinical gaps with research questions to improve outcomes from this crippling disease.
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Goussard P, Croucamp R, Bosch C, Demers AM, Morrison J, Mfingwana L, Palmer M, van der Zalm MM, Friedrich SO, Janson JT, Whitelaw AC, Andronikou S, Hesseling AC, Walters E, Lopez-Varela E. Diagnostic utility of bronchoalveolar lavage in children with complicated intrathoracic tuberculosis. Pediatr Pulmonol 2021; 56:2186-2194. [PMID: 33818927 DOI: 10.1002/ppul.25405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Bronchoscopy can be a useful tool in children with pulmonary tuberculosis (PTB) with severe disease potentially requiring intervention or in the face of diagnostic dilemmas. The aim of this study was to determine the value of Xpert MTB/RIF assay (Xpert) on bronchoalveolar lavage (BAL) samples in children with complicated PTB. METHODS Retrospective analysis of children with clinically diagnosed PTB, who underwent routine bronchoscopy over a 5-year period at a large referral hospital. BAL and other respiratory samples were tested by microscopy, culture, and Xpert. We explored whether clinical, radiographic and bronchoscopy findings, and duration of antituberculosis treatment were associated with bacteriological confirmation. RESULTS One hundred and twelve out of one hundred and forty-six (76.7%) children (median age 16 months) were on antituberculosis treatment for a median of 10 days at the time of bronchoscopy. Overall, bacteriological confirmation was achieved in 115 (78.7%), with 101 (69.2%) detected on BAL. Of those bacteriologically confirmed on BAL, 61.4% were positive by both Xpert and culture, 34.7% only by Xpert, and 3.9% only by culture. Sensitivity and specificity of Xpert compared with culture on BAL samples for children not on antituberculosis treatment were 94.1% (95% confidence interval [CI]: 71.3, 99.8) and 68.7% (95% CI: 41.3, 89.0), respectively. CONCLUSIONS In children undergoing bronchoscopy for complicated PTB, Xpert testing of BAL had a high diagnostic yield in children already on antituberculosis treatment. Bronchoscopy should be considered if noninvasive respiratory specimens fail to confirm complicated TB.
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Affiliation(s)
- Pierre Goussard
- Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Roland Croucamp
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Corne Bosch
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anne-Marie Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julie Morrison
- Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Lunga Mfingwana
- Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sven O Friedrich
- Division of Medical Physiology, MRC Centre for Tuberculosis Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Jacques T Janson
- Department of Cardio-Thoracic Surgery, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Andrew C Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisa Lopez-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Danchuk SN, Behr MA. Bacille Calmette-Guérin: One Hundred Years, One Hundred Questions. Clin Infect Dis 2021; 71:1894-1895. [PMID: 31677382 DOI: 10.1093/cid/ciz1083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sarah N Danchuk
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,McGill International TB Centre, Montreal, Quebec, Canada
| | - Marcel A Behr
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,McGill International TB Centre, Montreal, Quebec, Canada.,Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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16
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Bamford A, Dixon G, Klein N, Marks SD, Ritz N, Welch SB, Tebruegge M. Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries? Pediatr Nephrol 2021; 36:3023-3031. [PMID: 33245418 PMCID: PMC8445864 DOI: 10.1007/s00467-020-04844-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/27/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
The risk of tuberculosis (TB) disease is increased in children with chronic kidney disease (CKD), even higher in stage 5 CKD/kidney failure and especially high after kidney transplantation due to immunosuppression. TB disease may follow recent primary infection, or result from reactivation of latent infection. Reactivation is more common in adults, while progression following primary infection makes up a greater proportion of disease in children. Recommendations for preventing TB disease in some low TB incidence countries have previously included offering Bacillus Calmette-Guérin (BCG) vaccine to all children listed for kidney transplant if they had not received this as part of previous national immunisation programmes. Based on the available evidence, we recommend modifying this practice, focusing instead on awareness of risk factors for TB exposure, infection and disease and the use of appropriate testing strategies to identify and treat TB infection and disease.
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Affiliation(s)
- Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
| | - Garth Dixon
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.424537.30000 0004 5902 9895Department of Paediatirc Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nigel Klein
- grid.424537.30000 0004 5902 9895Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Stephen D. Marks
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.424537.30000 0004 5902 9895Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicole Ritz
- grid.6612.30000 0004 1937 0642University of Basel Children’s Hospital, Paediatric Infectious Disease and Vaccinology Department, Migrant Health Service, Basel, Switzerland ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Steven B. Welch
- grid.412563.70000 0004 0376 6589Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Marc Tebruegge
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia ,grid.420545.2Department of Paediatric Infectious Diseases & Immunology, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
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17
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Goussard P, Retief F, Burke J, Malherbe A, Janson J. The role of bronchoscopy in the diagnosis and management of pediatric pulmonary tuberculosis. Ther Adv Infect Dis 2021; 8:20499361211037168. [PMID: 34422266 PMCID: PMC8377312 DOI: 10.1177/20499361211037168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchoscopy is useful as a diagnostic and therapeutic procedure in children with Tuberculosis (TB) disease complicated by airway obstruction. It is needed in children when surgical intervention may be required for airway compression, when drug resistance is suspected, and to rule out an alternative diagnosis for airway obstruction. Bronchoscopy with bronchoalveolar lavage (BAL) should be performed when other, less invasive samples cannot be collected, or when they fail to provide useful diagnostic information. BAL specimens collected at bronchoscopy can be tested using molecular TB assays and mycobacterial culture. The aim of this review is to evaluate the role of bronchoscopy in the diagnosis and management of pulmonary TB in children, and, specifically, to review the role of interventional bronchoscopy. A search of electronic databases was undertaken using the online databases PubMed, Ovid MEDLINE, EMBASE, Google Advanced Scholar, and Web of Science to identify relevant literature. The search was limited to pediatrics, pulmonology, bronchoscopy, and pediatric pulmonary tuberculosis for all articles published in English on pediatric bronchoscopy between 2010 and 2020. Recent advances in pediatric bronchoscopy was included, as well as recent research on improving the diagnosis with the use of interventional bronchoscopy. The role of bronchoscopy in pediatric pulmonary tuberculosis has changed during the last decade, from a simple method of collecting samples for bacteriological conformation to an more sophisticate procedure. New methods are available for collecting samples, which includes the use of Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and also better methods of bacteriological conformation. Interventions are now possible; not only to improve the diagnostic abilities of bronchoscopy but also to diagnose, manage, and follow-up upon airway-related complications. Bronchoscopy services remain limited in resource-limited countries due to the high cost of equipment.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Francois Retief
- Department of Anaesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jonathan Burke
- Department of Anaesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Annemie Malherbe
- Department of Anaesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
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18
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Pembi E, John S, Dumre SP, Ahmadu BU, Vuong NL, Ebied A, Mizukami S, Huy NT, Cuevas LE, Hirayama K. Impact of political conflict on tuberculosis notifications in North-east Nigeria, Adamawa State: a 7-year retrospective analysis. BMJ Open 2020; 10:e035263. [PMID: 32938590 PMCID: PMC7497531 DOI: 10.1136/bmjopen-2019-035263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We assessed the impact of political conflict (Boko Haram) on tuberculosis (TB) case notifications in Adamawa State in North-east Nigeria. DESIGN A retrospective analysis of TB case notifications from TB registers (2010-2016) to describe changes in TB notification, sex and age ratios by the degree of conflict by local government area. SETTING Adamawa State. PARTICIPANTS 21 076 TB cases notified. RESULTS 21 076 cases (62% male) were notified between 2010 and 2016, of which 19 604 (93%) were new TB cases. Areas affected by conflict in 2014 and 2015 had decreased case notification while neighbouring areas reported increased case notifications. The male to female ratio of TB cases changed in areas in conflict with more female cases being notified. The young and elderly (1-14 and >65 years old) had low notifications in all areas, with a small increase in case notifications during the years of conflict. CONCLUSION TB case notifications decreased in conflict areas and increased in areas without conflict. More males were notified during peace times and more female cases were reported from areas in conflict. Young and elderly populations had decreased case notifications but experienced a slight increase during the conflict years. These changes are likely to reflect population displacement and a dissimilar effect of conflict on the accessibility of services. TB services in conflict areas deserve further study to identify resilient approaches that could reach affected populations.
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Affiliation(s)
- Emmanuel Pembi
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Stephen John
- Adamawa State Agency for the Control of HIV/AIDs, Yola, Nigeria
| | - Shyam Prakash Dumre
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Baba Usman Ahmadu
- Department of Pediatrics, Federal Medical Centre, Yola, Adamawa State, Nigeria
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Amr Ebied
- Therapeutic Department, Egyptian National Blood Transfusion Services, Cairo, Egypt
| | - Shusaku Mizukami
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Sakamoto, Nagasaki, Japan
- Department of Immune Regulation, Shionogi Global Infectious Diseases Division (SHINE), Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Sakamoto, Nagasaki, Japan
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
| | - Luis E Cuevas
- Department of International Health and Epidemiology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Sakamoto, Nagasaki, Japan
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19
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Denoeud-Ndam L, Otieno-Masaba R, Tchounga B, Machekano R, Simo L, Mboya JP, Kose J, Tchendjou P, Bissek ACZK, Okomo GO, Casenghi M, Cohn J, Tiam A. Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial. BMC Public Health 2020; 20:623. [PMID: 32375741 PMCID: PMC7201651 DOI: 10.1186/s12889-020-08741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB. The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age. Methods Two strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records. The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation. Discussion Study enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services. Trial resistration NCT03862261, initial release 12 February 2019.
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Affiliation(s)
| | | | | | | | | | | | - Judith Kose
- EGPAF, Nairobi, Kenya.,Erasmus University Medical Centre, Rotterdam, the Netherlands
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20
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du Preez K, Schaaf HS, Dunbar R, Swartz A, Naidoo P, Hesseling AC. Closing the reporting gap for childhood tuberculosis in South Africa: improving hospital referrals and linkages. Public Health Action 2020; 10:38-46. [PMID: 32368523 DOI: 10.5588/pha.19.0053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/08/2019] [Indexed: 12/29/2022] Open
Abstract
Setting A referral hospital in Cape Town, Western Cape Province, Republic of South Africa. Objective To measure the impact of a hospital-based referral service (intervention) to reduce initial loss to follow-up among children with tuberculosis (TB) and ensure the completeness of routine TB surveillance data. Design A dedicated TB referral service was established in the paediatric wards at Tygerberg Hospital, Cape Town, in 2012. Allocated personnel provided TB education and counselling, TB referral support and weekly telephonic follow-up after hospital discharge. All children identified with TB were matched to electronic TB treatment registers (ETR.Net/EDRWeb). Multivariable logistic regression was used to compare reporting of culture-confirmed and drug-susceptible TB cases before (2007-2009) and during (2012) the intervention. Results Successful referral with linkage to care was confirmed in 267/272 (98%) and successful reporting in 227/272 (84%) children. Children with drug-susceptible, culture-confirmed TB were significantly more likely to be reported during the intervention period than in the pre-intervention period (OR 2.52, 95%CI 1.33-4.77). The intervention effect remained consistent in multivariable analysis (adjusted OR 2.62; 95%CI 1.31-5.25) after adjusting for age, sex, human immunodeficiency virus status and the presence of TB meningitis. Conclusions A simple hospital-based TB referral service can reduce initial loss to follow-up and improve recording and reporting of childhood TB in settings with decentralised TB services.
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Affiliation(s)
- K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Paediatrics and Child Health, Tygerberg Hospital, Cape Town, South Africa
| | - R Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Swartz
- Western Cape Department of Health, Cape Town, South Africa
| | - P Naidoo
- Public health management consultant, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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21
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Abstract
Tuberculosis (TB) in children represents a missed opportunity for diagnosis and preventive therapy. The magnitude or burden of disease in children is not fully understood due to our limitations with respect to exploring sensitive diagnostic algorithms. In a setting of TB endemicity in Pakistan, we carried out a proof-of-concept study to evaluate for the first time the performance of B cell analyses by the use of well-defined diagnostic criteria and NIH consensus guidelines as “culture-confirmed,” “probable,” and “possible” TB groups. In contrast to detection of serum antibody, we focused on mycobacterial-antibody-secreting cell (MASC) detection as a marker of active disease in children with a strong suspicion of TB. Further work exploring a larger panel of inflammatory biomarkers and enrichment of B cells with the objective of increasing the sensitivity of the current MASC assay would lead to the development of a field-friendly assay for timely diagnosis of childhood TB. Reliance on microbiologic methods to diagnose Mycobacterium tuberculosis infection is a suboptimal approach for children due in part to the paucibacillary nature of the disease. A blood-based biomarker assay, such as the mycobacterial-antibody-secreting cell (MASC) assay, could be a major advance for the field of study of pediatric tuberculosis (TB). Children <15 years of age with clinical concern for TB and age-matched children with no concern for TB were enrolled from outpatient clinics in Karachi, Pakistan. MASC, ferritin, and C-reactive protein (CRP) assays were performed, and results were compared among cases and controls, as well as among children with a case definition of “confirmed TB,” “probable TB,” or “possible TB.” MASC responses were significantly higher among children with TB than among controls (0.41 optical density [OD] versus 0.28 OD, respectively, P < 0.001), and the differences were largely driven by the data from children with confirmed TB (P = 0.002). Ferritin and CRP values were significantly higher among those with confirmed TB than among those with the other disease states and controls (P = 0.004 and P = 0.019, respectively). The use of the MASC assay as a blood-based biomarker for TB disease shows some promise among children with microbiologically confirmed disease; however, the performance characteristics for the majority of young children with unconfirmed TB were suboptimal in this cohort. IMPORTANCE Tuberculosis (TB) in children represents a missed opportunity for diagnosis and preventive therapy. The magnitude or burden of disease in children is not fully understood due to our limitations with respect to exploring sensitive diagnostic algorithms. In a setting of TB endemicity in Pakistan, we carried out a proof-of-concept study to evaluate for the first time the performance of B cell analyses by the use of well-defined diagnostic criteria and NIH consensus guidelines as “culture-confirmed,” “probable,” and “possible” TB groups. In contrast to detection of serum antibody, we focused on mycobacterial-antibody-secreting cell (MASC) detection as a marker of active disease in children with a strong suspicion of TB. Further work exploring a larger panel of inflammatory biomarkers and enrichment of B cells with the objective of increasing the sensitivity of the current MASC assay would lead to the development of a field-friendly assay for timely diagnosis of childhood TB.
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22
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Sousa GJB, Silva JCDO, Queiroz TVD, Bravo LG, Brito GCB, Pereira ADS, Pereira MLD, Santos LKXD. Clinical and epidemiological features of tuberculosis in children and adolescents. Rev Bras Enferm 2019; 72:1271-1278. [PMID: 31531651 DOI: 10.1590/0034-7167-2018-0172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the clinical and epidemiological features of tuberculosis in children and adolescents in an infectious diseases reference hospital. METHOD A documental and retrospective study was carried out with 88 medical files in an infectious diseases reference hospital in the state of Ceará. Data were analyzed by univariate, bivariate and multivariate approaches. RESULTS It was found that, depending on the tuberculosis type, its manifestations may vary. The logistic regression model considered only pulmonary tuberculosis due to a number of observations and included female sex (95% CI: 1.4-16.3), weight loss (95% CI: 1.8-26.3), bacilloscopic screening (95% CI: 1.5-16.6) and sputum collected (95% CI: 1.4-19.4) as possible predictors. CONCLUSIONS Children and adolescents present different manifestations of the disease depending on the tuberculosis type that affects them. Knowing the most common features of each condition could enhance early diagnosis and, consequently, result in adequate treatment and care.
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23
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Oliwa JN, Gathara D, Ogero M, van Hensbroek MB, English M, van’t Hoog A. Diagnostic practices and estimated burden of tuberculosis among children admitted to 13 government hospitals in Kenya: An analysis of two years' routine clinical data. PLoS One 2019; 14:e0221145. [PMID: 31483793 PMCID: PMC6726144 DOI: 10.1371/journal.pone.0221145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND True burden of tuberculosis (TB) in children is unknown. Hospitalised children are low-hanging fruit for TB case detection as they are within the system. We aimed to explore the process of recognition and investigation for childhood TB using a guideline-linked cascade of care. METHODS This was an observational study of 42,107 children admitted to 13 county hospitals in Kenya from 01Nov 15-31Oct 16, and 01Nov 17-31Oct 18. We estimated those that met each step of the cascade, those with an apparent (or "Working") TB diagnosis and modelled associations with TB tests amongst guideline-eligible children. RESULTS 23,741/42,107 (56.4%) met step 1 of the cascade (≥2 signs and symptoms suggestive of TB). Step 2(further screening of history of TB contact/full respiratory exam) was documented in 14,873/23,741 (62.6%) who met Step 1. Step 3(chest x-ray or Mantoux test) was requested in 2,451/14,873 (16.5%) who met Step 2. Step 4(≥1 bacteriological test) was requested in 392/2,451 (15.9%) who met Step 3. Step 5("Working TB" diagnosis) was documented in 175/392 (44.6%) who met Step 4. Factors associated with request of TB tests in patients who met Step 1 included: i) older children [AOR 1.19(CI 1.09-1.31)]; ii) co-morbidities of HIV, malnutrition or pneumonia [AOR 3.81(CI 3.05-4.75), 2.98(CI 2.69-3.31) and 2.98(CI 2.60-3.40) respectively]; iii) sicker children, readmitted/referred [AOR 1.24(CI 1.08-1.42) and 1.15(CI 1.04-1.28) respectively]. "Working TB" diagnosis was made in 2.9%(1,202/42,107) of all admissions and 0.2%(89/42,107) were bacteriologically-confirmed. CONCLUSIONS More than half of all paediatric admissions had symptoms associated with TB and nearly two-thirds had more specific history documented. Only a few amongst them got TB tests requested. TB was diagnosed in 2.9% of all admissions but most were inadequately investigated. Major challenges remain in identifying and investigating TB in children in hospitals with access to Xpert MTB/RIF and a review is needed of existing guidelines.
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Affiliation(s)
- Jacquie Narotso Oliwa
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
- University of Nairobi, Department of Paediatrics and Child Health, Nairobi, Kenya
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
| | - Morris Ogero
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
| | - Michaël Boele van Hensbroek
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- The Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
- Oxford University, Nuffield Department of Medicine, Oxford, England, United Kingdom
| | - Anja van’t Hoog
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- The Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
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24
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Cowger TL, Wortham JM, Burton DC. Epidemiology of tuberculosis among children and adolescents in the USA, 2007-17: an analysis of national surveillance data. LANCET PUBLIC HEALTH 2019; 4:e506-e516. [PMID: 31446052 DOI: 10.1016/s2468-2667(19)30134-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Understanding tuberculosis epidemiology among children and adolescents informs treatment and prevention efforts, and efforts to eliminate disparities in tuberculosis incidence and mortality. We sought to describe the epidemiology of children and adolescents with tuberculosis disease in the USA, including tuberculosis incidence rates by parental country of birth and for US territories and freely associated states, which have not been previously described. METHODS We analysed data for children aged younger than 15 years and adolescents aged 15-17 years with tuberculosis disease reported to the National Tuberculosis Surveillance System during 2007-17, and calculated tuberculosis incidence rates using population estimates from the US Census Bureau. FINDINGS During 2010-17, 6072 tuberculosis cases occurred among children and adolescents; of these, 5175 (85%) of 6072 occurred in the 50 US states or the District of Columbia and 897 (15%) of 6072 in US-affiliated islands. In US states, 3520 (68%) of 5175 cases occurred among US-born people overall, including 2977 (76%) of 3896 children and 543 (42%) of 1279 adolescents. The incidence rate among children and adolescents was 1·0 per 100 000 person-years during 2007-17 and declined 47·8% (95% CI -51·4 to -44·1) during this period. We observed disproportionately high tuberculosis rates among children and adolescents of all non-white racial or ethnic groups, people living in US-affiliated islands, and children born in or with parents from tuberculosis-endemic countries. INTERPRETATION Overall, tuberculosis incidence among children and adolescents in the USA is low and steadily declining, but additional efforts are needed to eliminate disparities in incidence and mortality. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Tori L Cowger
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Jonathan M Wortham
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deron C Burton
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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25
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Metlo A, Shah SI, Rehan A, Bin Waqar SH, Siddiqi R. Solitary Splenic Tuberculosis in an Immunocompetent Child: A Case Report. Cureus 2019; 11:e5210. [PMID: 31565614 PMCID: PMC6758994 DOI: 10.7759/cureus.5210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tuberculosis (TB) is a lethal infectious disease that still remains a major threat in developing countries. Solitary splenic tuberculosis is a rare entity and there have been very few cases of it reported in literature. It is mostly encountered in patients who have an immunocompromised state. It may occur with a myriad of non-specific presentations, making it complex to diagnose. Here, we report a case of an eight-year-old female, immunocompetent, who had complaints of fever, abdominal pain and chronic diarrhea. Laboratory data failed to provide any information about the final diagnosis. On physical examination, splenomegaly was present. Imaging studies were conducted with an abdominal ultrasound showcasing mild ascites, splenomegaly, with a homogeneous echo pattern and no focal mass. Computed tomography (CT) of the abdomen showed two hypodense areas in the subcapsular region of the spleen and extending into the capsule, suggestive of a tuberculous abscess with mesenteric lymphadenopathy. The diagnosis was further corroborated when the patient showed remarkable improvement on anti-tuberculous therapy. This is a very uncommon phenomenon, especially in an immunocompetent patient and hence, it is very important to keep this on the list of differentials especially in an area where TB is endemic.
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Affiliation(s)
| | - Sm Ismail Shah
- Internal Medicine, Ziauddin Medical College, Karachi, PAK
| | - Aiman Rehan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Syed Hamza Bin Waqar
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Rabbia Siddiqi
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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26
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The Changing Landscape of Childhood Tuberculosis in the United Kingdom: A Retrospective Cohort (2000-2015). Pediatr Infect Dis J 2019; 38:470-475. [PMID: 30256311 DOI: 10.1097/inf.0000000000002200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology of tuberculosis (TB) is changing in the United Kingdom and globally. Childhood TB is a key indicator of recent transmission and provides a marker of wider TB control. We describe the recent epidemiology of childhood TB in the United Kingdom, how this compares to TB in adults, and document changes with time. METHODS TB cases notified in the United Kingdom between 2000 and 2015 were categorized as children (<15 years of age) or adults (≥15 years of age). Descriptive analyses were carried out on demographic, clinical and microbiologic data. We carried out logistic regressions to identify risk factors associated with children having no microbiologic confirmation. RESULTS In the study period, 6293 TB cases (5%) in the United Kingdom were notified in children. Childhood TB incidence declined from 487 cases in 2000 (3.4 per 100,000) to 232 cases (2.0 per 100,000) in 2015. The majority (68%) of children with TB were UK born, with a high proportion of Pakistani (24%) and Black-African (22%) ethnicity. Sixty-four percent of children had pulmonary disease. Culture confirmation was low (24%). Children who were younger, UK born and those with extrapulmonary disease were less likely to have microbiologically confirmed TB. A high proportion (87%) of children completed treatment at last-recorded outcome, with few deaths (39 cases; 0.7%). CONCLUSIONS The incidence of TB in children in the United Kingdom has decreased in the past 16 years, with the majority of children completing TB treatment. Ongoing monitoring of childhood TB will provide a measure of the effectiveness of the national TB program.
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Tichenor M, Sridhar D. Metric partnerships: global burden of disease estimates within the World Bank, the World Health Organisation and the Institute for Health Metrics and Evaluation. Wellcome Open Res 2019; 4:35. [PMID: 30863794 PMCID: PMC6406176 DOI: 10.12688/wellcomeopenres.15011.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 01/30/2023] Open
Abstract
The global burden of disease study—which has been affiliated with the World Bank and the World Health Organisation (WHO) and is now housed in the Institute for Health Metrics and Evaluation (IHME)—has become a very important tool to global health governance since it was first published in the 1993 World Development Report. In this article, based on literature review of primary and secondary sources as well as field notes from public events, we present first a summary of the origins and evolution of the GBD over the past 25 years. We then analyse two illustrative examples of estimates and the ways in which they gloss over the assumptions and knowledge gaps in their production, highlighting the importance of historical context by country and by disease in the quality of health data. Finally, we delve into the question of the end users of these estimates and the tensions that lie at the heart of producing estimates of local, national, and global burdens of disease. These tensions bring to light the different institutional ethics and motivations of IHME, WHO, and the World Bank, and they draw our attention to the importance of estimate methodologies in representing problems and their solutions in global health. With the rise in the investment in and the power of global health estimates, the question of representing global health problems becomes ever more entangled in decisions made about how to adjust reported numbers and to evolving statistical science. Ultimately, more work needs to be done to create evidence that is relevant and meaningful on country and district levels, which means shifting resources and support for quantitative—and qualitative—data production, analysis, and synthesis to countries that are the targeted beneficiaries of such global health estimates.
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Affiliation(s)
- Marlee Tichenor
- Global Health Governance Programme, University of Edinburgh, Edinburgh, UK
| | - Devi Sridhar
- Global Health Governance Programme, University of Edinburgh, Edinburgh, UK
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Tichenor M, Sridhar D. Metric partnerships: global burden of disease estimates within the World Bank, the World Health Organisation and the Institute for Health Metrics and Evaluation. Wellcome Open Res 2019. [PMID: 30863794 DOI: 10.12688/wellcomeopenres.15011.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The global burden of disease study-which has been affiliated with the World Bank and the World Health Organisation (WHO) and is now housed in the Institute for Health Metrics and Evaluation (IHME)-has become a very important tool to global health governance since it was first published in the 1993 World Development Report. In this article, based on literature review of primary and secondary sources as well as field notes from public events, we present first a summary of the origins and evolution of the GBD over the past 25 years. We then analyse two illustrative examples of estimates and the ways in which they gloss over the assumptions and knowledge gaps in their production, highlighting the importance of historical context by country and by disease in the quality of health data. Finally, we delve into the question of the end users of these estimates and the tensions that lie at the heart of producing estimates of local, national, and global burdens of disease. These tensions bring to light the different institutional ethics and motivations of IHME, WHO, and the World Bank, and they draw our attention to the importance of estimate methodologies in representing problems and their solutions in global health. With the rise in the investment in and the power of global health estimates, the question of representing global health problems becomes ever more entangled in decisions made about how to adjust reported numbers and to evolving statistical science. Ultimately, more work needs to be done to create evidence that is relevant and meaningful on country and district levels, which means shifting resources and support for quantitative-and qualitative-data production, analysis, and synthesis to countries that are the targeted beneficiaries of such global health estimates.
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Affiliation(s)
- Marlee Tichenor
- Global Health Governance Programme, University of Edinburgh, Edinburgh, UK
| | - Devi Sridhar
- Global Health Governance Programme, University of Edinburgh, Edinburgh, UK
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Abstract
Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. The World Health Organization estimates that annually 1 million children have tuberculosis (TB) disease and many more harbor a latent form. Accurate estimates are hindered by under-recognition and challenges in diagnosis. To date, an accurate diagnostic test to confirm TB in children does not exist. Treatment is lengthy but outcomes are generally favorable with timely initiation. With the End TB Strategy, there is an urgent need for improved diagnostics and treatment to prevent the unnecessary morbidity and mortality from TB in children.
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Affiliation(s)
- Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA.
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Arockiaraj J, Robert M, Rose W, Amritanand R, David KS, Krishnan V. Early Detection and Analysis of Children with Multidrug-Resistant Tuberculosis of the Spine. Asian Spine J 2018; 13:77-85. [PMID: 30326699 PMCID: PMC6365795 DOI: 10.31616/asj.2017.0217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective case series. Purpose The aim of the study is to report the clinical characteristics, early diagnosis, management, and outcome of children with multidrug-resistant (MDR) tubercular spondylodiscitis and to assess the early detection of rifampicin resistance using the Xpert MTB/ RIF assay. Overview of Literature MDR tuberculosis is on the rise, especially in developing countries. The incidence rate of MDR has been reported as 8.9% in children. Methods A retrospective study of children aged <15 years of age who were diagnosed and treated for MDR tuberculosis of the spine was conducted. Confirmed cases of MDR tuberculosis and patients who had completed at least 18 months of second-line antituberculous treatment (ATT) were included. Children were treated with ATT for 24 months according to drug-susceptibility-test results. Outcome measures included both clinical and radiological measures. Clinical measures included pain, neurological status, and return to school. Radiological measures included kyphosis correction and healing status. Results Six children with a mean age of 10 years were enrolled. The mean follow-up period was 12 months. All the children had previous history of treatment with first-line ATT, with an average of 13.6 months before presentation. Clinically, 50% (3/6 children) had psoas abscesses and 50% had spinal deformities. Radiologically, 50% (three of six children) had multicentric involvement. Three children underwent surgical decompression; two needed posterior stabilization with pedicle screws posteriorly followed by anterior column reconstruction. Early diagnosis of MDR was achieved in 83.3% (five of six children) with Xpert MTB/RIF assay. A total of 83.3% of the children were cured of the disease. Conclusions Xpert MTB/RIF assay confers the advantage of early detection, with initiation of MDR drugs within an average of 10.5 days from presentation. The cost of second-line ATT drugs was 30 times higher than that of first-line ATT.
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Affiliation(s)
- Justin Arockiaraj
- Spinal Disorder Surgery Unit, Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India
| | - Magdalenal Robert
- Department of Paediatrics, Christian Medical College and Hospital, Vellore, India
| | - Winsley Rose
- Department of Paediatrics, Christian Medical College and Hospital, Vellore, India
| | - Rohit Amritanand
- Spinal Disorder Surgery Unit, Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India
| | - Kenny Samuel David
- Spinal Disorder Surgery Unit, Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India
| | - Venkatesh Krishnan
- Spinal Disorder Surgery Unit, Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India
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Jenum S, Selvam S, Jesuraj N, Ritz C, Hesseling AC, Cardenas V, Lau E, Doherty TM, Grewal HMS, Vaz M. Incidence of tuberculosis and the influence of surveillance strategy on tuberculosis case-finding and all-cause mortality: a cluster randomised trial in Indian neonates vaccinated with BCG. BMJ Open Respir Res 2018; 5:e000304. [PMID: 30397482 PMCID: PMC6203048 DOI: 10.1136/bmjresp-2018-000304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/14/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Accurate tuberculosis (TB) incidence and optimal surveillance strategies are pertinent to TB vaccine trial design. Infants are a targeted population for new TB vaccines, but data from India, with the highest global burden of TB cases, is limited. Methods In a population-based prospective trial conducted between November 2006 and July 2008, BCG-vaccinated neonates in South India were enrolled and cluster-randomised to active or passive surveillance. We assessed the influence of surveillance strategy on TB incidence, case-finding rates and all-cause mortality. Predefined criteria were used to diagnose TB. All deaths were evaluated using a verbal autopsy. Results 4382 children contributed to 8164 person-years (py) of follow-up (loss to follow-up 6.9%); 749 children were admitted for TB evaluation (active surveillance: 641; passive surveillance: 108). The TB incidence was 159.2/100 000 py and the overall case-finding rate was 3.19 per 100 py (95% CI 0.82 to 18.1). Whereas, the case-finding rate for definite TB was similar using active or passive case finding, the case-finding rate for probable TB was 1.92/100 py (95% CI 0.83 to 3.78) with active surveillance, significantly higher than 0.3/100 py (95% CI 0.01 to 1.39, p=0.02) with passive surveillance. Compared to passive surveillance, children with active surveillance had decreased risk of dying (OR 0.68, 95%CI 0.47 to 0.98) which was mostly attributable to reduction of death from pneumonia/respiratory infections (OR 0.34, 95%CI 0.14 to 0.80). Conclusion We provide reliable estimates of TB incidence in South Indian children <2 years of age. Active surveillance increased the case-finding rates for probable TB and was associated with reduced all-cause mortality.
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Affiliation(s)
- Synne Jenum
- Department of Clinical Science, University of Bergen, Bergen N-5021, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Sumithra Selvam
- Division of Epidemiology, Biostatistics and Population Health, St. John's Research Institute, Bangalore, Koramangala, India
| | - Nelson Jesuraj
- St. John's Research Institute, Bangalore, Koramangala, India
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Anneke C Hesseling
- Desmond Tutu TB Center, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Vicky Cardenas
- Aeras, Rockville, Maryland, USA (Present affiliation: Aurum Institute, Rockville, Maryland, USA)
| | | | | | - Harleen M S Grewal
- Department of Clinical Science, University of Bergen, Bergen N-5021, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Mario Vaz
- Division of Health and Humanities, St. John's Research Institute, Bangalore, Koramangala, India
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Osman M, Lee K, Du Preez K, Dunbar R, Hesseling AC, Seddon JA. Excellent Treatment Outcomes in Children Treated for Tuberculosis Under Routine Operational Conditions in Cape Town, South Africa. Clin Infect Dis 2018; 65:1444-1452. [PMID: 29048512 DOI: 10.1093/cid/cix602] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background Tuberculosis (TB) remains a leading cause of death in children globally. It is recognized that human immunodeficiency virus (HIV) infection increases the risk of developing TB, but our understanding of the impact of HIV on risk of mortality for children treated for TB is limited. We aimed to identify predictors of mortality in children treated for drug-susceptible TB. Methods A retrospective analysis of all children (<15 years of age) routinely treated between 2005 and 2012 for drug-susceptible TB in Cape Town was conducted using the programmatic electronic TB treatment database. Survival analysis using Cox regression was used to estimate hazard ratios for death. Logistic regression was used to estimate the odds of unfavorable outcomes. Results Of 29519 children treated for and notified with TB over the study period, <1% died during TB treatment and 89.5% were cured or completed treatment. The proportion of children with known HIV status increased from 13% in 2005 to 95% in 2012. Children aged <2 years had an increased hazard of death (adjusted hazard ratio [aHR], 3.13; 95% confidence interval [CI], 1.78-5.52) and greater odds of unfavorable outcome (adjusted odds ratio [aOR], 1.44; 95% CI, 1.24-1.66) compared with children aged 10-14 years. HIV-infected children had increased mortality compared to HIV-negative children (aHR, 6.85; 95% CI, 4.60-10.19) and increased odds of unfavorable outcome (aOR, 2.01; 95% CI, 1.81-2.23). Later year of TB treatment was a protective predictor for both mortality and unfavorable outcome. Conclusions We demonstrate a dramatic improvement in HIV testing in children with TB over time and excellent overall treatment outcomes. HIV infection and young age were associated with increased risk of death and unfavorable outcome.
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Affiliation(s)
- Muhammad Osman
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - Kevin Lee
- City of Cape Town Health Directorate, South Africa
| | - Karen Du Preez
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - Rory Dunbar
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - Anneke C Hesseling
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - James A Seddon
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg.,Centre for International Child Health, Imperial College London, United Kingdom
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Abstract
BACKGROUND Tuberculosis (TB) is the major cause of mortality in HIV-infected children globally. Current guidelines about the management of antiretroviral therapy in children with TB are based on a limited number of nonrandomized studies involving small numbers of participants. The aim of the study was to systematically retrieve and critically appraise available evidence on the efficacy and safety of different antiretroviral regimens in children with HIV infection who are receiving treatment for active TB. METHODS We conducted a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Records were retrieved through March 2016 from Medline, Embase and manual screening of key conference proceedings. Four specific research questions assessing available treatment options were defined. RESULTS Although 4 independent searches were conducted (1 for each Population, Intervention, Comparator, Outcomes question), results were elaborated and interpreted together because of significant overlap among the retrieved records. Six observational studies were selected for qualitative synthesis while meta-analysis could not be performed. CONCLUSION Evidence for optimal treatment options for HIV/TB coinfected children is limited. As the global community strives to reach the fast-track HIV treatment targets and eliminate childhood TB deaths, it must ensure that coinfected children are included in key treatment studies and expand this neglected but crucial area of research.
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Brent AJ, Nyundo C, Langat J, Mulunda C, Wambua J, Bauni E, Sande J, Park K, Williams TN, Newton CRJ, Levin M, Scott JAG. Prospective Observational Study of Incidence and Preventable Burden of Childhood Tuberculosis, Kenya. Emerg Infect Dis 2018; 24:514-523. [PMID: 29460738 PMCID: PMC5823335 DOI: 10.3201/eid2403.170785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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García-Basteiro AL, Schaaf HS, Diel R, Migliori G. Adolescents and young adults: a neglected population group for tuberculosis surveillance. Eur Respir J 2018; 51:51/2/1800176. [DOI: 10.1183/13993003.00176-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/01/2018] [Indexed: 12/20/2022]
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Mwangwa F, Chamie G, Kwarisiima D, Ayieko J, Owaraganise A, Ruel TD, Plenty A, Tram KH, Clark TD, Cohen CR, Bukusi EA, Petersen M, Kamya MR, Charlebois ED, Havlir DV, Marquez C. Gaps in the Child Tuberculosis Care Cascade in 32 Rural Communities in Uganda and Kenya. J Clin Tuberc Other Mycobact Dis 2017; 9:24-29. [PMID: 29291251 PMCID: PMC5743212 DOI: 10.1016/j.jctube.2017.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/11/2017] [Accepted: 10/24/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Reducing tuberculosis (TB) deaths among children requires a better understanding of the gaps in the care cascade from TB diagnosis to treatment completion. We sought to assess the child TB care cascade in 32 rural communities in Uganda and Kenya using programmatic data. METHODS This is a retrospective cohort study of 160,851 children (ages <15 years) living in 12 rural communities in Kenya and 22 in Uganda. We reviewed national TB registries from health centers in and adjacent to the 32 communities, and we included all child TB cases recorded from January 1, 2013 to June 30, 2016. To calculate the first step of the child TB care cascade, the number of children with active TB, we divided the number of reported child TB diagnoses by the 2015 World Health Organization (WHO) child TB case detection ratio for Africa of 27%. The remaining components of the Child TB Care Cascade were ascertained directly from the TB registries and included: diagnosed with TB, started on TB treatment, and completed TB treatment. RESULTS In two and a half years, a total of 42 TB cases were reported among children living in 32 rural communities in Uganda and Kenya. 40% of the children were co-infected with HIV. Using the WHO child TB case detection ratio, we calculated that 155 children in this cohort had TB during the study period. Of those 155 children, 42 were diagnosed and linked to TB care, 42 were started on treatment, and 31 completed treatment. Among the 42 children who started TB treatment, reasons for treatment non-completion were loss to follow up (7%), death (5%), and un-recorded reasons (5%). Overall, 20% (31/155) of children completed the child TB care cascade. CONCLUSION In 32 rural communities in Uganda and Kenya, we estimate that 80% of children with TB fell off the care cascade. Reducing morbidity and mortality from child TB requires strengthening of the child TB care cascade from diagnosis through treatment completion.
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Affiliation(s)
| | - Gabriel Chamie
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Dalsone Kwarisiima
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
- Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Theodore D. Ruel
- University of California, San Francisco, Division Pediatric Infectious Diseases and Global Medicine, Department of Pediatrics, San Francisco, USA
| | - Albert Plenty
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Khai Hoan Tram
- Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Tamara D. Clark
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Craig R. Cohen
- University of California, San Francisco, Department of Obstetrics and Gynecology, San Francisco, USA
| | | | - Maya Petersen
- University of California, Berkeley School of Public Health, Berkeley, United States
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies, University of California, San Francisco, United States
| | - Diane V. Havlir
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Carina Marquez
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
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Charles M, Richard M, Joseph P, Bury MR, Perrin G, Louis FJ, Fitter DL, Marston BJ, Deyde V, Boncy J, Morose W, Pape JW, Lowrance DW. Trends in Tuberculosis Case Notification and Treatment Success, Haiti, 2010-2015. Am J Trop Med Hyg 2017; 97:49-56. [PMID: 29064365 PMCID: PMC5676628 DOI: 10.4269/ajtmh.16-0863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since the 2010 earthquake, tuberculosis (TB) control has been a major priority for health sector response and recovery efforts in Haiti. The goal of this study was to analyze trends in TB case notification in Haiti from the aggregate data reported by the National TB Control Program to understand the effects of such efforts. A total of 95,745 TB patients were registered for treatment in Haiti between 2010 and 2015. Three regions, the West, Artibonite, and North departments accounted for 68% of the TB cases notified during the period. Patients in the 15–34 age groups represented 53% (50,560) of all cases. Case notification rates of all forms of TB increased from 142.7/100,000 in 2010 to 153.4 in 2015, peaking at 163.4 cases/100,000 in 2013. Case notification for smear-positive pulmonary TB increased from 85.5 cases/100,000 to 105.7 cases/100,000, whereas treatment success rates remained stable at 79–80% during the period. Active TB case finding efforts in high-risk communities and the introduction of new diagnostics have contributed to increasing TB case notification trends in Haiti from 2010 to 2015. Targeted interventions and novel strategies are being implemented to reach high-risk populations and underserved communities.
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Affiliation(s)
| | - Milo Richard
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | - Margarette R Bury
- Pan American Health Organization/World Health Organization, Port-au-Prince, Haiti
| | - Georges Perrin
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | - David L Fitter
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | - Varough Deyde
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Willy Morose
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | - David W Lowrance
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
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Feasibility and Effectiveness of Tuberculosis Active Case-Finding among Children Living with Tuberculosis Relatives: a Cross-Sectional Study in Guinea-Bissau. Mediterr J Hematol Infect Dis 2017; 9:e2017059. [PMID: 29181136 PMCID: PMC5667531 DOI: 10.4084/mjhid.2017.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background and objectives The World Health Organization End tuberculosis (TB) Strategy, approved in 2014, aims at a 90% reduction in TB deaths and an 80% reduction in TB incidence rate by 2030. One of the suggested interventions is the systematic screening of people with suspected TB, belonging to specific risk groups. The Hospital Raoul Follereau (HRF) in Bissau, Guinea-Bissau, is the National Reference Hospital for Tuberculosis and Lung Disease of the country. We performed an active case-finding program among pediatric age family members and cohabitants of admitted adult TB patients, from January to December 2013. Methods Newly admitted adult patients with a diagnosis of TB were invited to bring their family members or cohabitants in childhood age for clinical evaluation in a dedicated outpatient setting within the hospital compound. All the children brought to our attention underwent a medical examination and chest x-ray. In children with clinical and/or radiologic finding consistent with pulmonary TB, a sputum-smear was requested. Results All admitted adult patients accepted to bring their children cohabitants. In total, 287 children were examined in 2013. Forty-four patients (15%) were diagnosed with TB. The number needed to screen (NNS) to detect one case of TB was 7. 35 patients (80%) had pulmonary TB; 2 of them were sputum smear-positive. No adjunctive personnel cost was necessary for the intervention. Conclusions A hospital-based TB active case-finding program targeted to high-risk groups like children households of severely ill admitted patients with TB can successfully be implemented in a country with limited resources.
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Abstract
Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. The World Health Organization estimates that annually 1 million children have tuberculosis (TB) disease and many more harbor a latent form. Accurate estimates are hindered by under-recognition and challenges in diagnosis. To date, an accurate diagnostic test to confirm TB in children does not exist. Treatment is lengthy but outcomes are generally favorable with timely initiation. With the End TB Strategy, there is an urgent need for improved diagnostics and treatment to prevent the unnecessary morbidity and mortality from TB in children.
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Affiliation(s)
- Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA.
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40
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Cano APG, Romaneli MTN, Pereira RM, Tresoldi AT. TUBERCULOSIS IN PEDIATRIC PATIENTS: HOW HAS THE DIAGNOSIS BEEN MADE? ACTA ACUST UNITED AC 2017; 35:165-170. [PMID: 28977322 PMCID: PMC5496715 DOI: 10.1590/1984-0462/;2017;35;2;00004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/09/2016] [Indexed: 12/02/2022]
Abstract
Objective: To describe clinical, radiological, epidemiological, and microbiological characteristics of pediatric patients with diagnosis of tuberculosis in a period of 15 years. Methods: Retrospective study including children and adolescents younger than 18 years diagnosed with tuberculosis in the Clinical Hospital of the Universidade Estadual de Campinas in São Paulo State, Brazil. Active tuberculosis was defined by the identification of Mycobacterium tuberculosis in culture, microscopy, or histopathological examination. Children with positive clinical history and radiological tests who had been exposed to sick adults or with positive tuberculin skin test were also considered as having active tuberculosis. Statistical analysis compared the data obtained from children younger and older than 10 years of age, since they present a disease pattern more similar to adults. Results: There were 145 identified cases, 61.4% in patients under 10 years of age. The main symptoms reported were coughing (55.9%) and fever (46.9%), and the variables of fever, coughing, weight-loss, and pain were significantly influenced by age, with a higher frequency in older children. Diagnosis was confirmed by culture, microscopy, or histopathology in 67.6% of the cases. The other cases (32.4%) had the diagnosis of tuberculosis based on clinical, radiological, and epidemiological characteristics, as well as tuberculin skin test. The positivity for culture, microscopy, and tuberculin skin test was, respectively, 65.8, 35.7, and 72.3%. History of contact with a sick adult was confirmed in 37.2%, without influence of age. Conclusions: Diagnosis of tuberculosis in children is still a challenge, since all the confirmation tests have low positivity. These results demonstrate the need for new diagnostic methods and improved strategies for searching sick contacts.
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Affiliation(s)
- Ana Paula Ghussn Cano
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | | | - Ricardo Mendes Pereira
- Departamento de Pediatria da Faculdade de Ciências Médicas da Unicamp, Campinas, SP, Brasil
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Marais BJ. Improving access to tuberculosis preventive therapy and treatment for children. Int J Infect Dis 2016; 56:122-125. [PMID: 27993688 DOI: 10.1016/j.ijid.2016.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Children suffer a huge burden of disease in tuberculosis (TB) endemic countries. This disease burden was largely invisible when TB control programmes focused exclusively on adults with sputum smear-positive disease. High-level advocacy and better data have improved visibility, but the establishment of functional paediatric TB programmes remains challenging. The key issues that limit children's access to TB preventive therapy and treatment in endemic areas are briefly discussed. Barriers to preventive therapy include (1) the perceived inability to rule out active disease, (2) fear of creating drug resistance, (3) non-implementation of existing guidelines in the absence of adequate monitoring, and (4) poor adherence with long preventive therapy courses. Barriers to TB treatment include (1) perceived diagnostic difficulties, (2) non-availability of chest radiography, (3) young children presenting to unprepared maternal and child health (MCH) services, and (4) the absence of child-friendly formulations. With drug-resistant disease there is currently no guidance on the use of preventive therapy and treatment is usually restricted to cases with bacteriologically confirmed disease, which excludes most young children from care, even if their likely source case has documented drug-resistant TB.
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Affiliation(s)
- Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), Sydney Medical School, University of Sydney, Locked Bag 4001, Sydney, New South Wales, 2145, Australia.
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Abstract
In 2015, the World Health Organization (WHO) declared tuberculosis (TB) to be responsible for more deaths than any other single infectious disease. The burden of TB among children has frequently been dismissed as relatively low with resulting deaths contributing very little to global under-five all-cause mortality, although without rigorous estimates of these statistics, the burden of childhood TB was, in reality, unknown. Recent work in the area has resulted in a WHO estimate of 1 million new cases of childhood TB in 2014 resulting in 136,000 deaths. Around 3% of these cases likely have multidrug-resistant TB and at least 40,000 are in HIV-infected children. TB is now thought to be a major or contributory cause of many deaths in children under five years old, despite not being recorded as such, and is likely in the top ten causes of global mortality in this age group. In particular, recent work has shown that TB is an under-lying cause of a substantial proportion of pneumonia deaths in TB-endemic countries. Childhood TB should be given higher priority: we need to identify children at greatest risk of TB disease and death and make more use of tools such as active case-finding and preventive therapy. TB is a preventable and treatable disease from which no child should die.
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Affiliation(s)
- Helen E. Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118 USA
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Dodd PJ, Sismanidis C, Seddon JA. Global burden of drug-resistant tuberculosis in children: a mathematical modelling study. THE LANCET. INFECTIOUS DISEASES 2016; 16:1193-1201. [DOI: 10.1016/s1473-3099(16)30132-3] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/26/2022]
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Bates M, Shibemba A, Mudenda V, Chimoga C, Tembo J, Kabwe M, Chilufya M, Hoelscher M, Maeurer M, Sinyangwe S, Mwaba P, Kapata N, Zumla A. Burden of respiratory tract infections at post mortem in Zambian children. BMC Med 2016; 14:99. [PMID: 27363601 PMCID: PMC4929772 DOI: 10.1186/s12916-016-0645-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Autopsy studies are the gold standard for determining cause-of-death and can inform on improved diagnostic strategies and algorithms to improve patient care. We conducted a cross-sectional observational autopsy study to describe the burden of respiratory tract infections in inpatient children who died at the University Teaching Hospital in Lusaka, Zambia. METHODS Gross pathology was recorded and lung tissue was analysed by histopathology and molecular diagnostics. Recruitment bias was estimated by comparing recruited and non-recruited cases. RESULTS Of 121 children autopsied, 64 % were male, median age was 19 months (IQR, 12-45 months). HIV status was available for 97 children, of whom 34 % were HIV infected. Lung pathology was observed in 92 % of cases. Bacterial bronchopneumonia was the most common pathology (50 %) undiagnosed ante-mortem in 69 % of cases. Other pathologies included interstitial pneumonitis (17 %), tuberculosis (TB; 8 %), cytomegalovirus pneumonia (7 %) and pneumocystis Jirovecii pneumonia (5 %). Comorbidity between lung pathology and other communicable and non-communicable diseases was observed in 80 % of cases. Lung tissue from 70 % of TB cases was positive for Mycobacterium tuberculosis by molecular diagnostic tests. A total of 80 % of TB cases were comorbid with malnutrition and only 10 % of TB cases were on anti-TB therapy when they died. CONCLUSIONS More proactive testing for bacterial pneumonia and TB in paediatric inpatient settings is needed.
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Affiliation(s)
- Matthew Bates
- HerpeZ, University Teaching Hospital, Lusaka, Zambia. .,University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia. .,Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research centre at UCL Hospitals, London, UK.
| | - Aaron Shibemba
- Department of Pathology & Microbiology, University Teaching Hospital, Lusaka, Zambia
| | - Victor Mudenda
- Department of Pathology & Microbiology, University Teaching Hospital, Lusaka, Zambia
| | - Charles Chimoga
- HerpeZ, University Teaching Hospital, Lusaka, Zambia.,University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia
| | - John Tembo
- HerpeZ, University Teaching Hospital, Lusaka, Zambia.,University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.,Institute for Infectious Diseases, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mwila Kabwe
- HerpeZ, University Teaching Hospital, Lusaka, Zambia.,University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia
| | - Moses Chilufya
- HerpeZ, University Teaching Hospital, Lusaka, Zambia.,University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Markus Maeurer
- Therapeutic Immunology, Department of Laboratory Medicine, Department of Microbiology, and Department of Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Sylvester Sinyangwe
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Peter Mwaba
- University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.,Ministry of Health, Lusaka, Zambia
| | - Nathan Kapata
- University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.,National Tuberculosis Control Programme, Ministry of Community Development, Maternal and Child Health, Lusaka, Zambia
| | - Alimuddin Zumla
- University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.,Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research centre at UCL Hospitals, London, UK
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