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Boast A, How JA, Lau C, Sett A, Gilby D, Burke A, McWhinney B, Wright C, Tramontana A, Globan M, Denholm J, Graham SM, Osowicki J. Pre-extensively Drug-Resistant Congenital Tuberculosis in an Extremely Premature Baby. Clin Infect Dis 2024; 78:149-153. [PMID: 37681559 PMCID: PMC10810709 DOI: 10.1093/cid/ciad540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/06/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023] Open
Abstract
We describe a case of congenital tuberculosis in an extremely premature baby, with rapid molecular detection of a pre-extensively drug-resistant (XDR) pattern of drug resistance. The baby was treated successfully with a regimen including bedaquline and delamanid, drugs not previously described in the treatment of congenital tuberculosis (TB).
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Affiliation(s)
- Alison Boast
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Antimicrobials Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jeu Ann How
- Newborn Services, Joan Kirner Women's and Children's Hospital, St Albans, Victoria, Australia
| | - Charis Lau
- Newborn Services, Joan Kirner Women's and Children's Hospital, St Albans, Victoria, Australia
- Pharmacy Department, Joan Kirner Women's and Children's Hospital, St Albans, Victoria, Australia
| | - Arun Sett
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Centre of Research Excellence in Newborn Medicine, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Damien Gilby
- Newborn Services, Joan Kirner Women's and Children's Hospital, St Albans, Victoria, Australia
| | - Andrew Burke
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Brett McWhinney
- Department of Chemical Pathology, Pathology Queensland, Queensland Health, Herston, Australia
| | - Connor Wright
- Department of Infectious Diseases, Western Health, St Albans, Victoria, Australia
| | - Adrian Tramontana
- Department of Infectious Diseases, Western Health, St Albans, Victoria, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Parkville, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Stephen M Graham
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Joshua Osowicki
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Schreiber BA, Denholm J, Jaeckle F, Arends MJ, Branson KM, Schönlieb CB, Soilleux EJ. Rapid artefact removal and H&E-stained tissue segmentation. Sci Rep 2024; 14:309. [PMID: 38172562 PMCID: PMC10764721 DOI: 10.1038/s41598-023-50183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
We present an innovative method for rapidly segmenting haematoxylin and eosin (H&E)-stained tissue in whole-slide images (WSIs) that eliminates a wide range of undesirable artefacts such as pen marks and scanning artefacts. Our method involves taking a single-channel representation of a low-magnification RGB overview of the WSI in which the pixel values are bimodally distributed such that H&E-stained tissue is easily distinguished from both background and a wide variety of artefacts. We demonstrate our method on 30 WSIs prepared from a wide range of institutions and WSI digital scanners, each containing substantial artefacts, and compare it to segmentations provided by Otsu thresholding and Histolab tissue segmentation and pen filtering tools. We found that our method segmented the tissue and fully removed all artefacts in 29 out of 30 WSIs, whereas Otsu thresholding failed to remove any artefacts, and the Histolab pen filtering tools only partially removed the pen marks. The beauty of our approach lies in its simplicity: manipulating RGB colour space and using Otsu thresholding allows for the segmentation of H&E-stained tissue and the rapid removal of artefacts without the need for machine learning or parameter tuning.
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Affiliation(s)
- B A Schreiber
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, Cambridgeshire, UK.
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, Cambridgeshire, UK.
| | - J Denholm
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, Cambridgeshire, UK
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, Cambridgeshire, UK
- Lyzeum Ltd., Cambridge, CB1 2LA, Cambridgeshire, UK
| | - F Jaeckle
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, Cambridgeshire, UK
- Lyzeum Ltd., Cambridge, CB1 2LA, Cambridgeshire, UK
| | - M J Arends
- Edinburgh Pathology, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road, Edinburgh, EH4 2XR, UK
| | - K M Branson
- Artificial Intelligence and Machine Learning, GSK plc., Great West Road, Brentford, TW8 9GS, Middlesex, UK
| | - C-B Schönlieb
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, Cambridgeshire, UK
- Lyzeum Ltd., Cambridge, CB1 2LA, Cambridgeshire, UK
| | - E J Soilleux
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, Cambridgeshire, UK.
- Lyzeum Ltd., Cambridge, CB1 2LA, Cambridgeshire, UK.
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Smith MZ, Turner M, Haurat J, Thevarajan I, Denholm J, Tong SYC, Matthews GV, Bull RA, Martinello M, McMahon J, Imrie A, Pillai PE. The APPRISE Virtual Biobank for Infectious Diseases. Commun Dis Intell (2018) 2023; 47. [PMID: 37968063 DOI: 10.33321/cdi.2023.47.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Indexed: 11/17/2023]
Abstract
The Australian Partnership for Preparedness Research on InfectiouS disease Emergencies (APPRISE) has developed a virtual biobank to support infectious disease research in Australia. The virtual biobank (https://apprise.biogrid.org.au) integrates access to existing distributed infectious disease biospecimen collections comprising multiple specimen types, including plasma, serum, and peripheral blood mononuclear cells. Through the development of a common data model, multiple collections can be searched simultaneously via a secure web portal. The portal enhances the visibility and searchability of existing collections within their current governance and custodianship arrangements. The portal is easily scalable for integration of additional collections.
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Affiliation(s)
- Miranda Z Smith
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia .
| | - Maureen Turner
- BioGrid Australia, North Melbourne, Victoria 3051, Australia
| | - Javier Haurat
- BioGrid Australia, North Melbourne, Victoria 3051, Australia
| | - Irani Thevarajan
- 1. Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia ;St Vincent's Hospital, NSW, 2010, Australia
| | - Justin Denholm
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia
| | - Steven YC Tong
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia
| | - Gail V Matthews
- The Kirby Institute, UNSW Sydney, NSW, 2052 Australia; St Vincent's Hospital, NSW, 2010, Australia
| | - Rowena A Bull
- The Kirby Institute, UNSW Sydney, NSW, 2052 Australia; School of Medical Sciences, UNSW Sydney, NSW 2052, Australia
| | - Marianne Martinello
- The Kirby Institute, UNSW Sydney, NSW, 2052 Australia; Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - James McMahon
- Monash Infectious Diseases, Monash Medical Centre, Monash Health, Victoria, 3168, Australia; Department of Infectious Diseases, Monash University and Alfred Hospital, Victoria, 3004, Australia
| | - Allison Imrie
- School of Biomedical Sciences, University of Western Australia, WA, 6009, Australia
| | - Priyanka E Pillai
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia; Melbourne Data Analytics Platform, University of Melbourne, Victoria, 3000, Australia
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Casco N, Jorge AL, Palmero DJ, Alffenaar JW, Fox GJ, Ezz W, Cho JG, Denholm J, Skrahina A, Solodovnikova V, Arbex MA, Alves T, Rabahi MF, Pereira GR, Sales R, Silva DR, Saffie MM, Salinas NE, Miranda RC, Cisterna C, Concha C, Fernandez I, Villalón C, Vera CG, Tapia PG, Cancino V, Carbonell M, Cruz A, Muñoz E, Muñoz C, Navarro I, Pizarro R, Cristina Sánchez GP, Vergara Riquelme MS, Vilca E, Soto A, Flores X, Garavagno A, Bahamondes MH, Merino LM, Pradenas AM, Revillot ME, Rodriguez P, Salinas AS, Taiba C, Valdés JF, Subiabre JN, Ortega C, Palma S, Castillo PP, Pinto M, Bidegain FR, Venegas M, Yucra E, Li Y, Cruz A, Guelvez B, Victoria Plaza R, Tello Hoyos KY, Cardoso-Landivar J, Van Den Boom M, Andréjak C, Blanc FX, Dourmane S, Froissart A, Izadifar A, Rivière F, Schlemmer F, Manika K, Diallo BD, Hassane-Harouna S, Artiles N, Mejia LA, Gupta N, Ish P, Mishra G, Patel JM, Singla R, Udwadia ZF, Alladio F, Angeli F, Calcagno A, Centis R, Codecasa LR, De Lauretis A, Esposito SMR, Formenti B, Gaviraghi A, Giacomet V, Goletti D, Gualano G, Matteelli A, Migliori GB, Motta I, Palmieri F, Pontali E, Prestileo T, Riccardi N, Saderi L, Saporiti M, Sotgiu G, Spanevello A, Stochino C, Tadolini M, Torre A, Villa S, Visca D, Kurhasani X, Furjani M, Rasheed N, Danila E, Diktanas S, Ridaura RL, Luna López FL, Torrico MM, Rendon A, Akkerman OW, Chizaram O, Al-Abri S, Alyaquobi F, Althohli K, Aguirre S, Teixeira RC, De Egea V, Irala S, Medina A, Sequera G, Sosa N, Vázquez F, Llanos-Tejada FK, Manga S, Villanueva-Villegas R, Araujo D, Sales Marques RD, Socaci A, Barkanova O, Bogorodskaya M, Borisov S, Mariandyshev A, Kaluzhenina A, Vukicevic TA, Stosic M, Beh D, Ng D, Ong CWM, Solovic I, Dheda K, Gina P, Caminero JA, De Souza Galvão ML, Dominguez-Castellano A, García-García JM, Pinargote IM, Fernandez SQ, Sánchez-Montalvá A, Huguet ET, Murguiondo MZ, Bart PA, Mazza-Stalder J, D'Ambrosio L, Kamolwat P, Bakko F, Barnacle J, Bird S, Brown A, Chandran S, Killington K, Man K, Papineni P, Ritchie F, Tiberi S, Utjesanovic N, Zenner D, Hearn JL, Heysell S, Young L. Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort. Eur Respir J 2023; 62:2300925. [PMID: 37827576 PMCID: PMC10627308 DOI: 10.1183/13993003.00925-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. METHODS We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. RESULTS Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). CONCLUSIONS In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes.
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Schreiber B, Denholm J, Gilbey J, Schönlieb CB, Soilleux E. Stain normalization gives greater generalizability than stain jittering in neural network training for the classification of coeliac disease in duodenal biopsy whole slide images. J Pathol Inform 2023; 14:100324. [PMID: 37577172 PMCID: PMC10416012 DOI: 10.1016/j.jpi.2023.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 08/15/2023] Open
Abstract
Around 1% of the population of the UK and North America have a diagnosis of coeliac disease (CD), due to a damaging immune response to the small intestine. Assessing whether a patient has CD relies primarily on the examination of a duodenal biopsy, an unavoidably subjective process with poor inter-observer concordance. Wei et al. [11] developed a neural network-based method for diagnosing CD using a dataset of duodenal biopsy whole slide images (WSIs). As all training and validation data came from one source, there was no guarantee that their results would generalize to WSIs obtained from different scanners and laboratories. In this study, the effects of applying stain normalization and jittering to the training data were compared. We trained a deep neural network on 331 WSIs obtained with a Ventana scanner (WSIs; CD: n = 190 ; normal: n = 141 ) to classify presence of CD. In order to test the effects of stain processing when validating on WSIs scanned on varying scanners and from varying laboratories, the neural network was validated on 4 datasets: WSIs of slides scanned on a Ventana scanner (WSIs; CD: n = 48 ; normal: n = 35 ), WSIs of the same slides rescanned on a Hamamatsu scanner (WSIs; CD: n = 48 ; normal: n = 35 ), WSIs of the same slides rescanned on an Aperio scanner (WSIs; CD: n = 48 ; normal: n = 35 ), and WSIs of different slides scanned on an Aperio scanner (WSIs; CD: n = 38 ; normal: n = 37 ). Without stain processing, the F1 scores of the neural network were 0.947 , 0.619 , 0.746 , and 0.727 when validating on the Ventana validation WSIs, Hamamatsu and Aperio rescans of the Ventana validation WSIs, and Aperio WSIs from a different source respectively. With stain normalization, the performance of the neural network improved significantly with respective F1 scores 0.982 , 0.943 , 0.903 , and 0.847 . Stain jittering resulted in a better performance than stain normalization when validating on data from the same source F1 score 1.000 , but resulted in poorer performance than stain normalization when validating on WSIs from different scanners (F1 scores 0.939 , 0.814 , and 0.747 ). This study shows the importance of stain processing, in particular stain normalization, when training machine learning models on duodenal biopsy WSIs to ensure generalizability between different scanners and laboratories.
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Affiliation(s)
- B.A. Schreiber
- Department of Pathology, University of Cambridge, Cambridge, UK
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - J. Denholm
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
- Lyzeum Ltd., Cambridge, UK
| | - J.D. Gilbey
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - C.-B. Schönlieb
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
- Lyzeum Ltd., Cambridge, UK
| | - E.J. Soilleux
- Department of Pathology, University of Cambridge, Cambridge, UK
- Lyzeum Ltd., Cambridge, UK
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Nalunjogi J, Mucching-Toscano S, Sibomana JP, Centis R, D'Ambrosio L, Alffenaar JW, Denholm J, Blanc FX, Borisov S, Danila E, Duarte R, García-García JM, Goletti D, Ong CWM, Rendon A, Thomas TA, Tiberi S, van den Boom M, Sotgiu G, Migliori GB. Impact of COVID-19 on diagnosis of TB, MDR-TB and on mortality in 11 countries in Europe, Northern America and Australia. A Global Tuberculosis Network study. Int J Infect Dis 2023:S1201-9712(23)00076-0. [PMID: 36893943 PMCID: PMC9991328 DOI: 10.1016/j.ijid.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE Although evidence is growing on the overall impact of the COVID-19 pandemic on tuberculosis (TB) services, global studies based on national data are needed to better quantify the extent of the impact and the countries' preparedness to tackle the two diseases. The aim of this study was to compare the number of people with new diagnosis or recurrence of TB disease, the number of drug-resistant (DR)-TB, and the number of TB deaths in 2020 versus 2019 in 11 countries in Europe, Northern America and Australia. METHODS TB managers or directors of national reference centres of the selected countries provided the agreed-upon variables through a validated questionnaire on a monthly basis. A descriptive analysis compared incidence of TB and drug-resistant TB and mortality of the pre-COVID-19 year (2019) versus the first year of the COVID-19 pandemic (2020). RESULTS Comparing 2020 vs 2019, lower number of TB cases (new diagnosis or recurrence) was notified in all countries (except USA-Virginia and Australia), and less DR-TB notifications (apart from France, Portugal and Spain). The deaths among TB cases were higher in 2020 compared to 2019 in most countries with three countries (France, Netherlands, USA-Virginia) reporting minimal TB-related mortality.
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Affiliation(s)
- Joanitah Nalunjogi
- Lung Institute, Makerere University College of Health Sciences, Upper Mulago Hill, P.O. Box 7749, Kampala, Uganda; Tuberculosis Research Programme (PII-TB), Spanish Society of Pneumology and Thoracic Surgery (SEPAR), C/ de Provença, 108, Bajos 2ª, Barcelona 08029, Spain.
| | | | - Jean Pierre Sibomana
- Pulmonary and Critical Care Department, University of Rwanda/Butare University Teaching Hospital, KN 4 Ave, Kigali, Rwanda.
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico), Via Roncaccio 16, Tradate 21049, Italy.
| | - Lia D'Ambrosio
- Public Health Consulting Group, Via S. Pelli 12, Lugano 6900, Switzerland.
| | - Jan-Willem Alffenaar
- The University of Sydney Pharmacy School, A15, Science Rd, Camperdown 2006, Sydney, New South Wales, Australia; Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead Sydney, New South Wales, Australia; Sydney Institute of Infectious Diseases, The University of Sydney, Camperdown 2006, New South Wales, Sydney, Australia.
| | - Justin Denholm
- Melbourne Health Victorian Tuberculosis Program, the Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, Australia; Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne 3000, Victoria, Australia.
| | - François-Xavier Blanc
- Nantes Université, Centre hospitalier universitaire (CHU) de Nantes, l'institut du thorax, 5 allée de l'Île-Gloriette 44093 Nantes Cedex 01, France.
| | - Sergey Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Yauzskaya Alleya, 2, Moscow 107564, Russia.
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, Vilnius 08661, Lithuania.
| | - Raquel Duarte
- Reference Centre for MDR-TB in the North of Portugal, Hospital Centre Vila Nova de Gaia, Department of Pneumology. ICBAS - School of Medicine and Biomedical Center, University of Porto, R. Jorge de Viterbo Ferreira 228, Porto 4050-313, Portugal; EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal. Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, Porto 4050-600, Portugal.
| | - José-María García-García
- Tuberculosis Research Programme (PII-TB), Spanish Society of Pneumology and Thoracic Surgery (SEPAR), C/ de Provença, 108, Bajos 2ª, Barcelona 08029, Spain.
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases (INMI) 'L. Spallanzani' - Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Portuense, 292, Rome 00149, Italy.
| | - Catherine W M Ong
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore, MD6, 14 Medical Drive #14-01 Singapore 117599.; Division of Infectious Diseases, Department of Medicine, National University Hospital Singapore, 5 Lower Kent Ridge Rd, Singapore 119074; Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore 117597.
| | - Adrian Rendon
- Facultad de Medicina, Servicio de Neumologia, Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Universidad Autonoma de Nuevo Leon, Av. Francisco I. Madero y, Mitras Centro, Monterrey 64460, N.L., Mexico..
| | - Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, 400 Emmet Street South, Charlottesville, VA 22903, Virginia, USA.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, Garrod Building, Turner St, London E1 2AD, London, UK; Royal London Hospital, Barts Health National Health Service Trust, the Royal Hospital, Whitechapel Rd, London E1 1BB, UK.
| | - Martin van den Boom
- World Health Organization, Regional Office for the Eastern Mediterranean Region, Monazamet El Seha El Alamia Str, Extension of Abdel Razak El Sanhouri Street, P.O. Box 7608, Nasr City Cairo 11371, Egypt.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Piazza Università 21, Sassari, Italy.
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico), Via Roncaccio 16, Tradate 21049, Italy.
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Abbas S, Kermode M, Khan MD, Denholm J, Adetunji H, Kane S. What Makes People With Chronic Illnesses Discontinue Treatment? A Practice Theory Informed Analysis of Adherence to Treatment among Patients With Drug-Resistant Tuberculosis in Pakistan. Int J Health Policy Manag 2023; 12:6576. [PMID: 37579474 PMCID: PMC10125133 DOI: 10.34172/ijhpm.2022.6576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/27/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Non-adherence to treatment is a frequently observed phenomenon amongst those on long-term treatment for chronic illnesses. This qualitative study draws upon the tenets of 'practice theory' to reveal what shapes patients' ability to adhere to the demanding treatment for drug-resistant tuberculosis (DR-TB) at three treatment sites in Khyber-Pakhtunkhwa (KP) province of Pakistan. METHODS This qualitative study involved observation of service provision over a period of nine months of stay at, and embedment within the three treatment sites and in-depth interviews with 13 service providers and 22 patients who became non-adherent to their treatment. RESULTS Consistent with the extensive research based on the barriers and facilitator approach, both patients, and providers in our study also talked of patients' doubts about diagnosis and treatment efficacy, side-effects of drugs, economic constraints, unreliable disbursements of monetary incentive, attitude of providers and co-morbidities as reasons for non-adherence to treatment. Applying a practice theory perspective yielded more contextualised insights; inadequate help with patients' physical complaints, unempathetic responses to their queries, and failure to provide essential information, created conditions which hindered the establishment and maintenance of the 'practice' of adhering to treatment. These supply-side gaps created confusion, bred resentment, and exacerbated pre-existing distrust of public health services among patients, and ultimately drove them to disengage with the TB services and stop their treatment. CONCLUSION We argue that the lack of supply-side 'responsiveness' to patient needs beyond the provision of a few material inputs is what is lacking in the existing DR-TB program in Pakistan. We conclude that unless Pakistan's TB program explicitly engages with these supply side, system level gaps, patients will continue to struggle to adhere to their treatments and the TB program will continue to lose patients. Conceptually, we make a case for reimagining the act of adherence (or not) to long-term treatment as a 'Practice.'
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Affiliation(s)
- Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Justin Denholm
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - Hamed Adetunji
- Faculty of Public Health & Health Informatics, Umm Al Qura University, Makkah Almukarramah, Saudi Arabia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Dale K, Globan M, Horan K, Sherry N, Ballard S, Tay EL, Bittmann S, Meagher N, Price DJ, Howden BP, Williamson DA, Denholm J. Whole genome sequencing for tuberculosis in Victoria, Australia: A genomic implementation study from 2017 to 2020. Lancet Reg Health West Pac 2022; 28:100556. [PMID: 36034164 PMCID: PMC9405109 DOI: 10.1016/j.lanwpc.2022.100556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Whole genome sequencing (WGS) is increasingly used by tuberculosis (TB) programs to monitor Mycobacterium tuberculosis (Mtb) transmission. We aimed to characterise the molecular epidemiology of TB and Mtb transmission in the low-incidence setting of Victoria, Australia, and assess the utility of WGS. METHODS WGS was performed on all first Mtb isolates from TB cases from 2017 to 2020. Potential clusters (≤12 single nucleotide polymorphisms [SNPs]) were investigated for epidemiological links. Transmission events in highly-related (≤5 SNPs) clusters were classified as likely or possible, based on the presence or absence of an epidemiological link, respectively. Case characteristics and transmission settings (as defined by case relationship) were summarised. Poisson regression was used to examine associations with secondary case number. FINDINGS Of 1844 TB cases, 1276 (69.2%) had sequenced isolates, with 182 (14.2%) in 54 highly-related clusters, 2-40 cases in size. Following investigation, 140 cases (11.0% of sequenced) were classified as resulting from likely/possible local-transmission, including 82 (6.4%) for which transmission was likely. Common identified transmission settings were social/religious (26.4%), household (22.9%) and family living in different households (7.1%), but many were uncertain (41.4%). While household transmission featured in many clusters (n = 24), clusters were generally smaller (median = 3 cases) than the fewer that included transmission in social/religious settings (n = 12, median = 7.5 cases). Sputum-smear-positivity was associated with higher secondary case numbers. INTERPRETATION WGS results suggest Mtb transmission commonly occurs outside the household in our low-incidence setting. Further work is required to optimise the use of WGS in public health management of TB. FUNDING The Victorian Tuberculosis Program receives block funding for activities including case management and contact tracing from the Victorian Department of Health. No specific funding for this report was received by manuscript authors or the Victorian Tuberculosis Program, and the funders had no role in the study design, data collection, data analysis, interpretation or report writing.
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Affiliation(s)
- Katie Dale
- Victorian Tuberculosis Program, Melbourne Health, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Maria Globan
- Victorian Infectious Diseases Reference Laboratory (VIDRL), at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Norelle Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Susan Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ee Laine Tay
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Public Health Division, Department of Health, Victoria, Australia
| | - Simone Bittmann
- Victorian Tuberculosis Program, Melbourne Health, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Niamh Meagher
- Department of Infectious Diseases at the Doherty Institute for Infection & Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David J. Price
- Department of Infectious Diseases at the Doherty Institute for Infection & Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah A. Williamson
- Victorian Infectious Diseases Reference Laboratory (VIDRL), at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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9
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Denholm J, Schreiber B, Evans S, Crook O, Sharma A, Watson J, Bancroft H, Langman G, Gilbey J, Schönlieb CB, Arends M, Soilleux E. Multiple-instance-learning-based detection of coeliac disease in histological whole-slide images. J Pathol Inform 2022; 13:100151. [PMID: 36605111 PMCID: PMC9808019 DOI: 10.1016/j.jpi.2022.100151] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
We present a multiple-instance-learning-based scheme for detecting coeliac disease, an autoimmune disorder affecting the intestine, in histological whole-slide images (WSIs) of duodenal biopsies. We train our model to detect 2 distinct classes, normal tissue and coeliac disease, on the patch-level, and in turn leverage slide-level classifications. Using 5-fold cross-validation in a training set of 1841 (1163 normal; 680 coeliac disease) WSIs, our model classifies slides as normal with accuracy (96.7±0.6)%, precision (98.0±1.7)%, and recall (96.8±2.5)%, and as coeliac disease with accuracy (96.7±0.5)%, precision (94.9±3.7)%, and recall (96.5±2.9)% where the error bars are the cross-validation standard deviation. We apply our model to 2 test sets: one containing 191 WSIs (126 normal; 65 coeliac) from the same sources as the training data, and another from a completely independent source, containing 34 WSIs (17 normal; 17 coeliac), obtained with a scanner model not represented in the training data. Using the same-source test data, our model classifies slides as normal with accuracy 96.5%, precision 98.4% and recall 96.1%, and positive for coeliac disease with accuracy 96.5%, precision 93.5%, and recall 97.3%. Using the different-source test data the model classifies slides as normal with accuracy 94.1% (32/34), precision 89.5%, and recall 100%, and as positive for coeliac disease with accuracy 94.1%, precision 100%, and recall 88.2%. We discuss generalising our approach to screen for a range of pathologies.
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Affiliation(s)
- J. Denholm
- Lyzeum Ltd, Salisbury House, Station Road, Cambridge CB1 2LA, Cambridgeshire, UK,Department of Applied Maths and Theoretical Physics, University of Cambridge, Centre for Mathematical Sciences, Wilberforce Road, Cambridge CB3 0WA, Cambridgeshire, UK,Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK,Corresponding author.
| | - B.A. Schreiber
- Department of Applied Maths and Theoretical Physics, University of Cambridge, Centre for Mathematical Sciences, Wilberforce Road, Cambridge CB3 0WA, Cambridgeshire, UK,Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK
| | - S.C. Evans
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK
| | - O.M. Crook
- The Alan Turing Institute, 96 Euston Rd, London NW1 2DB, UK
| | - A. Sharma
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK
| | - J.L. Watson
- Oxford Medical School, University of Oxford, S Parks Road, Oxford OX1 3PL, Oxfordshire, UK
| | - H. Bancroft
- Department of Cellular Pathology, Birmingham Heartlands Hospital, University Hospitals Birmingham, 45 Bordesley Green East, Birmingham B9 5SS, West Midlands, UK
| | - G. Langman
- Department of Cellular Pathology, Birmingham Heartlands Hospital, University Hospitals Birmingham, 45 Bordesley Green East, Birmingham B9 5SS, West Midlands, UK
| | - J.D. Gilbey
- Department of Applied Maths and Theoretical Physics, University of Cambridge, Centre for Mathematical Sciences, Wilberforce Road, Cambridge CB3 0WA, Cambridgeshire, UK
| | - C.-B. Schönlieb
- Department of Applied Maths and Theoretical Physics, University of Cambridge, Centre for Mathematical Sciences, Wilberforce Road, Cambridge CB3 0WA, Cambridgeshire, UK
| | - M.J. Arends
- Division of Pathology, University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XR, Lothian, Scotland
| | - E.J. Soilleux
- Lyzeum Ltd, Salisbury House, Station Road, Cambridge CB1 2LA, Cambridgeshire, UK,Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK
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10
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Akkerman OW, Duarte R, Tiberi S, Schaaf HS, Lange C, Alffenaar JWC, Denholm J, Carvalho ACC, Bolhuis MS, Borisov S, Bruchfeld J, Cabibbe AM, Caminero JA, Carvalho I, Chakaya J, Centis R, Dalcomo MP, D Ambrosio L, Dedicoat M, Dheda K, Dooley KE, Furin J, García-García JM, van Hest NAH, de Jong BC, Kurhasani X, Märtson AG, Mpagama S, Torrico MM, Nunes E, Ong CWM, Palmero DJ, Ruslami R, Saktiawati AMI, Semuto C, Silva DR, Singla R, Solovic I, Srivastava S, de Steenwinkel JEM, Story A, Sturkenboom MGG, Tadolini M, Udwadia ZF, Verhage AR, Zellweger JP, Migliori GB. Clinical standards for drug-susceptible pulmonary TB. Int J Tuberc Lung Dis 2022; 26:592-604. [PMID: 35768923 PMCID: PMC9272737 DOI: 10.5588/ijtld.22.0228] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB.
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Affiliation(s)
- O W Akkerman
- TB Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren, the Netherlands, Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R Duarte
- Centro Hospitalar de Vila Nova de Gaia/Espinho; Instituto de Ciencias Biomédicas de Abel Saalazar, Universidade do Porto, Instituto de Saúde Publica da Universidade do Porto, Unidade de Investigação Clínica, ARS Norte, Porto, Portugal
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - 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
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Borstel, Germany, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, The Global Tuberculosis Program, Texas Children´s Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - J W C Alffenaar
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW, Australia, School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Sydney, NSW, Australia, Westmead Hospital, Sydney, NSW, Australia
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Department of Infectious diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - A C C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - M S Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow, Russia
| | - J Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden, Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden
| | - A M Cabibbe
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - J A Caminero
- Department of Pneumology, University General Hospital of Gran Canaria "Dr Negrin", Las Palmas, Spain, ALOSA (Active Learning over Sanitary Aspects) TB Academy, Spain
| | - I Carvalho
- Pediatric Department, Vila Nova de Gaia Outpatient Tuberculosis Centre, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - J Chakaya
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences. Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - M P Dalcomo
- Reference Center Helio Fraga, FIOCRUZ, Brazil
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - M Dedicoat
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K Dheda
- Centre for Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa, South African Medical Research Council Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K E Dooley
- Center for Tuberculosis Research, Johns Hopkins, Baltimore, MD
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - N A H van Hest
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Municipal Public Health Service Groningen, Groningen, The Netherlands
| | - B C de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - X Kurhasani
- UBT-Higher Education Institution Prishtina, Kosovo
| | - A G Märtson
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - S Mpagama
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzani, Kibong´oto Infectious Diseases Hospital, Sanya Juu, Siha, Kilimanjaro, United Republic of Tanzania
| | - M Munoz Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, México City, Mexico
| | - E Nunes
- Department of Pulmonology of Central Hospital of Maputo, Maputo, Mozambique, Faculty of Medicine of Eduardo Mondlane University, Maputo, Mozambique
| | - C W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - D J Palmero
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - R Ruslami
- Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, Research Center for Care and Control of Infectious Disease (RC3iD), Universitas Padjadjaran, Bandung, Indonesia
| | - A M I Saktiawati
- Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - C Semuto
- Research, Innovation and Data Science Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - D R Silva
- Instituto Vaccarezza, Hospital Muñiz, Buenos Aires, Argentina
| | - R Singla
- National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - I Solovic
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, Faculty of Health, Catholic University, Ružomberok, Vyšné Hágy, Slovakia
| | - S Srivastava
- Department of Pulmonary Immunology, University of Texas Health Science Centre at Tyler, Tyler, TX, USA
| | - J E M de Steenwinkel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - A Story
- Institute of Epidemiology and Healthcare, University College London, London, UK, Find and Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - M G G Sturkenboom
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Z F Udwadia
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - A R Verhage
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J P Zellweger
- TB Competence Center, Swiss Lung Association, Berne, Switzerland
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
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11
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Burke A, Alffenaar J, Denholm J. Evidence of safety for pretomanid and male reproductive health. Int J Tuberc Lung Dis 2022; 26:473-474. [PMID: 35650707 DOI: 10.5588/ijtld.22.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Burke
- The Prince Charles Hospital, Brisbane, QLD, Australia, Faculty of Medicine, The University of Queensland School of Medicine, Herston, QLD, Australia
| | - J Alffenaar
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia, Westmead Hospital, Sydney, NSW, Australia, Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia, Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
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12
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Habel JR, Chua BY, Kedzierski L, Selva KJ, Damelang T, Haycroft ER, Nguyen THO, Koay HF, Nicholson S, McQuilten H, Jia X, Allen LF, Hensen L, Zhang W, van de Sandt CE, Neil JA, Amanant F, Krammer F, Wragg K, Juno JA, Wheatley AK, Tan HX, Pell G, Audsley J, Reynaldi A, Thevarajan I, Denholm J, Subbarao K, Davenport MP, Hogarth M, Godrey DI, Cheng AC, Tong SYC, Bond K, Williamson DA, James F, Holmes NE, Smibert OC, Trubiano JA, Gordon CL, Chung AW, Whitehead C, Kent SJ, Lappas M, Rowntree LC, Kedzierska K. Integrated immune networks in SARS-CoV-2 infected pregnant women reveal differential NK cell and unconventional T cell activation. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.125.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
Although pregnancy poses a greater risk for severe COVID-19, the underlying immunological changes associated with SARS-CoV-2 infection during pregnancy are poorly understood. We defined immune responses to SARS-CoV-2 in pregnant and non-pregnant women during acute and convalescent COVID-19 up to 258 days post symptom onset, quantifying 217 immunological parameters. Additionally, matched maternal and cord blood were collected from COVID-19 convalescent pregnancies. Although serological responses to SARS-CoV-2 were similar in pregnant and non-pregnant women, cellular immune analyses revealed marked differences in key NK cell and unconventional T cell responses during COVID-19 in pregnant women. While NK cells, γδ T cells and MAIT cells displayed pre-activated phenotypes in healthy pregnant women when compared to non-pregnant age-matched women, activation profiles of these pre-activated NK and unconventional T cells remained unchanged at acute and convalescent COVID-19 in pregnancy. Conversely, activation dynamics of NK and unconventional T cells were prototypical in non-pregnant women in COVID-19. In contrast, activation of αβ CD4+ and CD8+ T cells, T follicular helper cells and antibody-secreting cells was similar in pregnant and non-pregnant women with COVID-19. Elevated levels of IL-1β, IFN-γ, IL-8, IL-18 and IL-33 were also found in pregnant women in their healthy state, and these cytokine levels remained elevated during acute and convalescent COVID-19. Collectively, our study provides key insight to innate T cell and NK cell perturbations occurring in pregnant women with COVID-19, which will potentially inform patient management and education for those with COVID-19 during pregnancy.
Supported by National Health and Medical Research Council, Australia
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Affiliation(s)
- Jennifer R Habel
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Brendon Y Chua
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 2Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Lukasz Kedzierski
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 3Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Kevin J Selva
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Timon Damelang
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Ebene R Haycroft
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Thi HO Nguyen
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Hui-Fern Koay
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Suellen Nicholson
- 4Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Hayley McQuilten
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Xiaoxiao Jia
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Lilith F Allen
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Luca Hensen
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Wuji Zhang
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Carolien E van de Sandt
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Jessica A Neil
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Fatima Amanant
- 5Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY
- 6Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Kathleen Wragg
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Jennifer A Juno
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Adam K Wheatley
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 8ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Hyon-Xhi Tan
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Gabrielle Pell
- 9Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria 3084, Australia
| | - Jennifer Audsley
- 10Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Arnold Reynaldi
- 11Kirby Institute, University of New South Wales, Sydney, Australia
| | - Irani Thevarajan
- 10Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 12Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Justin Denholm
- 10Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 12Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Kanta Subbarao
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 13World Health Organisation (WHO) Collaborating Centre for Reference and Research on Influenza, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | | | - Mark Hogarth
- 14Immune therapies Laboratory, Burnet Institute, Melbourne, Victoria 3000, Australia
- 15Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria 3000, Australia
- 16Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria 3000, Australia
| | - Dale I Godrey
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Allen C Cheng
- 17School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Steven YC Tong
- 18Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Australia
- 19Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Katherine Bond
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 20Department of Microbiology, Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Deborah A Williamson
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 20Department of Microbiology, Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Fiona James
- 21Department of Infectious Diseases, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Natasha E Holmes
- 21Department of Infectious Diseases, Austin Health, Heidelberg, Victoria 3084, Australia
- 22Department of Critical Care, University of Melbourne, Parkville, Victoria 3000, Australia
- 23Data Analytics Research and Evaluation (DARE) Centre, Austin Health and University of Melbourne, Heidelberg, Victoria 3084, Australia
- 24Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Olivia C Smibert
- 21Department of Infectious Diseases, Austin Health, Heidelberg, Victoria 3084, Australia
- 25Department of Infectious Diseases, Peter McCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- 26National Centre for Infections in Cancer, Peter McCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Jason A Trubiano
- 24Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria 3084, Australia
- 25Department of Infectious Diseases, Peter McCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- 26National Centre for Infections in Cancer, Peter McCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- 27Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria 3084, Australia
| | - Claire L Gordon
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 21Department of Infectious Diseases, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Amy W Chung
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Claire Whitehead
- 28Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3052, Australia
- 29Pregnancy Research Centre, The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Stephen J Kent
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 8ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Martha Lappas
- 9Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria 3084, Australia
- 30Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Louise C Rowntree
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Katherine Kedzierska
- 1Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- 2Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
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13
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Coorey NJ, Kensitt L, Davies J, Keller E, Sheel M, Chani K, Barry S, Boyd R, Denholm J, Watts K, Fox G, Lowbridge C, Perera R, Waring J, Marais B, Viney K. Risk factors for TB in Australia and their association with delayed treatment completion. Int J Tuberc Lung Dis 2022; 26:399-405. [PMID: 35505484 PMCID: PMC9067427 DOI: 10.5588/ijtld.21.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Australia has a low incidence of TB and has committed to eliminating the disease. Identification of risk factors associated with TB is critical to achieving this goal.METHODS: We undertook a prospective cohort study involving persons receiving TB treatment in four Australian jurisdictions. Risk factors and their association with delayed treatment completion (treatment delayed by at least 1 month) were analysed using univariate analyses and multivariate logistic regression.RESULTS: Baseline surveys were completed for 402 persons with TB. Most (86.1%) were born overseas. Exposure to a person with TB was reported by 19.4%. Diabetes mellitus (10.2%), homelessness (9.2%), cigarette smoking (8.7%), excess alcohol consumption (6.0%) and mental illness (6.2%) were other common risk factors. At follow-up, 24.8% of patients had delayed treatment completion, which was associated with adverse events (34.1%, aOR 6.67, 95% CI 3.36-13.27), excess alcohol consumption (6.0%, aOR 21.94, 95% CI 6.03-79.85) and HIV co-infection (2.7%, aOR 8.10, 95% CI 1.16-56.60).CONCLUSIONS: We identified risk factors for TB and their association with delayed treatment completion, not all of which are routinely collected for surveillance purposes. Recognition of these risk factors should facilitate patient-centred care and assist Australia in reaching TB elimination.
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Affiliation(s)
- N J Coorey
- Australian National University Medical School, Canberra ACT, Australia
| | - L Kensitt
- Australian National University Medical School, Canberra ACT, Australia
| | - J Davies
- Australian National University Medical School, Canberra ACT, Australia
| | - E Keller
- Australian National University Medical School, Canberra ACT, Australia
| | - M Sheel
- Research School of Population Health, Australian National University College of Health and Medicine, Australian National University, Canberra ACT, Australia
| | - K Chani
- Research School of Population Health, Australian National University College of Health and Medicine, Australian National University, Canberra ACT, Australia
| | - S Barry
- South Australia Health, Adelaide, SA, Australia
| | - R Boyd
- Northern Territory Health, Darwin, NT, Australia
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, VIC, Australia, Department of Infectious Diseases, Doherty Institute, The University of Melbourne, VIC, Australia
| | - K Watts
- Victorian Tuberculosis Program, Melbourne Health, VIC, Australia
| | - G Fox
- Sydney Medical School-Central, The University of Sydney, Sydney, NSW, Australia
| | - C Lowbridge
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - R Perera
- Western Australia Health, Perth, WA, Australia
| | - J Waring
- Western Australia Health, Perth, WA, Australia, Western Australia Tuberculosis Control Program, Perth, WA, Australia
| | - B Marais
- Centre for Research Excellence in Tuberculosis (TB-CRE), The University of Sydney, Sydney, NSW, Australia, Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, NSW, Australia
| | - K Viney
- Research School of Population Health, Australian National University College of Health and Medicine, Australian National University, Canberra ACT, Australia, School of Public Health, The University of Sydney, Sydney, NSW, Australia, Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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14
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Migliori GB, Thong PM, Alffenaar JW, Denholm J, Tadolini M, Alyaquobi F, Al-Abri S, Blanc FX, Buonsenso D, Chakaya J, Cho JG, Codecasa LR, Danila E, Duarte R, Dukpa R, García-García JM, Gualano G, Kurhasani X, Manika K, Mello FCDQ, Pahl K, Rendon A, Sotgiu G, Souleymane MB, Thomas TA, Tiberi S, Kunst H, Udwadia ZF, Goletti D, Centis R, D’Ambrosio L, Silva DR. Country-specific lockdown measures in response to the COVID-19 pandemic and its impact on tuberculosis control: a global study. J Bras Pneumol 2022; 48:e20220087. [PMID: 35475873 PMCID: PMC9064628 DOI: 10.36416/1806-3756/e20220087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to describe country-specific lockdown measures and tuberculosis indicators collected during the first year of the COVID-19 pandemic. Data on lockdown/social restrictions (compulsory face masks and hand hygiene; international and local travel restrictions; restrictions to family visits, and school closures) were collected from 24 countries spanning five continents. The majority of the countries implemented multiple lockdowns with partial or full reopening. There was an overall decrease in active tuberculosis, drug-resistant tuberculosis, and latent tuberculosis cases. Although national lockdowns were effective in containing COVID-19 cases, several indicators of tuberculosis were affected during the pandemic.
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Affiliation(s)
| | - Pei Min Thong
- . National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jan-Willem Alffenaar
- . The University of Sydney, Pharmacy School, Sydney (NSW) Australia
- . The University of Sidney at Westmead Hospital, Sydney (NSW) Australia
- . Sydney Institute for Infectious Diseases, The University of Sydney, Sydney (NSW) Australia
| | - Justin Denholm
- . Melbourne Health Victorian Tuberculosis Program, Melbourne (VIC) Australia
- . Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne (VIC) Australia
| | - Marina Tadolini
- . Infectious Diseases Unit, Istituti Clinici Scientifici Maugeri - IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italia
- . Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fatma Alyaquobi
- . TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control, National TB Programme, MoH Oman, Muscat, Sultanate of Oman
| | - Seif Al-Abri
- . Directorate General for Disease Surveillance and Control, MoH Oman, Muscat, Sultanate of Oman
| | - François-Xavier Blanc
- . Nantes Université, CHU Nantes, Service de Pneumologie, L’Institut du Thorax, Nantes, France
| | - Danilo Buonsenso
- . Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli - IRCCS - Roma, Italia
| | - Jeremiah Chakaya
- . Department of Medicine, Dermatology and Therapeutics, Kenyatta University, Nairobi, Kenya
- . Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jin-Gun Cho
- . The University of Sidney at Westmead Hospital, Sydney (NSW) Australia
- . Parramatta Chest Clinic, Parramatta (NSW) Australia
| | - Luigi Ruffo Codecasa
- . TB Reference Centre of Villa Marelli Institute, Niguarda Hospital, Milano, Italia
| | - Edvardas Danila
- . Vilnius University Hospital Santaros Kilinkos, Vilinius, Lithuania
| | - Raquel Duarte
- . National Reference Centre for MDR-TB, Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal e Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rada Dukpa
- . National TB Control Program, Ministry of Health, Timbu, Bhutan
| | - José-María García-García
- . Programa Integrado de Investigación en Tuberculosis - PII-TB - Sociedad Española de Neumología y Cirugía Torácica - SEPAR - Barcelona, España
| | - Gina Gualano
- . Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani” - INMI - IRCCS, Roma, Italia
| | - Xhevat Kurhasani
- . UBT - Higher Education Institution, Prishtina, Kosovo
- . NGO KeA, Prishtina, Kosovo
| | - Katerina Manika
- . Pulmonary Department, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Thessaloniki, Greece
| | | | - Kristin Pahl
- . Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Adrian Rendon
- . Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias -CIPTIR - Hospital Universitario de Monterrey, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Giovanni Sotgiu
- . Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Tania A. Thomas
- . Division of Infectious Diseases and International Health, University of Virginia, Charlottesville (VA) USA
| | - Simon Tiberi
- . Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- . Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Heinke Kunst
- . Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- . Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Zarir F. Udwadia
- . P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Delia Goletti
- . Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani” - INMI - IRCCS, Roma, Italia
| | - Rosella Centis
- . Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | | | - Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS- Porto Alegre, Brasil
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15
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D’Ambrosio L, Centis R, Dobler CC, Tiberi S, Matteelli A, Denholm J, Zenner D, Al-Abri S, Alyaquobi F, Arbex MA, Belilovskiy E, Blanc FX, Borisov S, Carvalho ACC, Chakaya JM, Cocco N, Codecasa LR, Dalcolmo MP, Dheda K, Dinh-Xuan AT, Esposito SR, García-García JM, Li Y, Manga S, Marchese V, Muñoz Torrico M, Pontali E, Rendon A, Rossato Silva D, Singla R, Solovic I, Sotgiu G, van den Boom M, Nhung NV, Zellweger JP, Migliori GB. Screening for Tuberculosis in Migrants: A Survey by the Global Tuberculosis Network. Antibiotics (Basel) 2021; 10:1355. [PMID: 34827293 PMCID: PMC8615134 DOI: 10.3390/antibiotics10111355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/02/2023] Open
Abstract
Tuberculosis (TB) does not respect borders, and migration confounds global TB control and elimination. Systematic screening of immigrants from TB high burden settings and-to a lesser degree TB infection (TBI)-is recommended in most countries with a low incidence of TB. The aim of the study was to evaluate the views of a diverse group of international health professionals on TB management among migrants. Participants expressed their level of agreement using a six-point Likert scale with different statements in an online survey available in English, French, Mandarin, Spanish, Portuguese and Russian. The survey consisted of eight sections, covering TB and TBI screening and treatment in migrants. A total of 1055 respondents from 80 countries and territories participated between November 2019 and April 2020. The largest professional groups were pulmonologists (16.8%), other clinicians (30.4%), and nurses (11.8%). Participants generally supported infection control and TB surveillance established practices (administrative interventions, personal protection, etc.), while they disagreed on how to diagnose and manage both TB and TBI, particularly on which TBI regimens to use and when patients should be hospitalised. The results of this first knowledge, attitude and practice study on TB screening and treatment in migrants will inform public health policy and educational resources.
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Affiliation(s)
- Lia D’Ambrosio
- Public Health Consulting Group, 6900 Lugano, Switzerland;
| | - Rosella Centis
- Servizio di Epidemiologia, Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy;
| | - Claudia C. Dobler
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia;
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW 2107, Australia
| | - Simon Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK;
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | - Alberto Matteelli
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, 25123 Brescia, Italy; (A.M.); (V.M.)
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, 25123 Brescia, Italy
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia;
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC 3010, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Dominik Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University, London E1 2AB, UK;
| | - Seif Al-Abri
- Directorate General of Disease Surveillance and Control, Ministry of Health, Muscat 100, Oman; (S.A.-A.); (F.A.)
| | - Fatma Alyaquobi
- Directorate General of Disease Surveillance and Control, Ministry of Health, Muscat 100, Oman; (S.A.-A.); (F.A.)
| | - Marcos Abdo Arbex
- Nestor Goulart Reis Hospital, Health Secretary São Paulo State, Sao Paulo 14801-320, Brazil;
- Faculdade de Medicina, Universidade de Araraquara, Sao Paulo 14801-320, Brazil
| | - Evgeny Belilovskiy
- Moscow Research and Clinical Center for Tuberculosis Control, 107014 Moscow, Russia; (E.B.); (S.B.)
| | - François-Xavier Blanc
- Service de Pneumologie, Centre Hospitalier Universitaire, L’institut du Thorax, F-44093 Nantes, France;
| | - Sergey Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, 107014 Moscow, Russia; (E.B.); (S.B.)
| | - Anna Cristina C. Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil;
| | - Jeremiah Muhwa Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi P.O. Box 43844-00100, Kenya;
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nicola Cocco
- ASST Santi Paolo e Carlo—Medicina Penitenziaria, 21100 Milan, Italy;
| | - Luigi Ruffo Codecasa
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, 20159 Milan, Italy;
| | - Margareth Pretti Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz), Ministry of Health, Rio de Janeiro 21040-360, Brazil;
| | - Keertan Dheda
- South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town 7701, South Africa;
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town 7701, South Africa
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London 400706, UK
| | - Anh Tuan Dinh-Xuan
- Respiratory Physiology Unit, Department of Respiratory Medicine, Cochin Hospital, Université de Paris, 75014 Paris, France;
| | - Susanna R. Esposito
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, 43126 Parma, Italy;
| | | | - Yang Li
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Selene Manga
- Ministry of Health, Direccion General de Gestion de Riesgos en y Desastres en Salud, Lima 15072, Peru;
| | - Valentina Marchese
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, 25123 Brescia, Italy; (A.M.); (V.M.)
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, 25123 Brescia, Italy
| | - Marcela Muñoz Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico;
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy;
| | - Adrián Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey 64000, Mexico;
| | - Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil;
| | - Rupak Singla
- Department of TB & Respiratory Diseases, National Institute of TB & Respiratory Diseases, Sri Aurobindo Marg, New Delhi 110030, India;
| | - Ivan Solovic
- National Institute for TB, Vysne Hagy, Catholic University, 05984 Ruzomberok, Slovakia;
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Martin van den Boom
- WHO Regional Office for the Eastern Mediterranean Region, Cairo 11571, Egypt;
| | | | | | - Giovanni Battista Migliori
- Servizio di Epidemiologia, Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy;
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16
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Horter S, Daftary A, Keam T, Bernays S, Bhanushali K, Chavan D, Denholm J, Furin J, Jaramillo E, Khan A, Lin YD, Lobo R, Loveday M, Majumdar SS, Mistry N, Patel H, Rane S, Swaminathan A, Triasih R, Venkatesan N, Viney K, du Cros P. Person-centred care in TB. Int J Tuberc Lung Dis 2021; 25:784-787. [PMID: 34615573 DOI: 10.5588/ijtld.21.0327] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Horter
- Burnet Institute, Melbourne, VIC, Australia
| | - A Daftary
- Dahdaleh Institute of Global Health Research, York University, Toronto, ON, Canada, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - T Keam
- Burnet Institute, Melbourne, VIC, Australia
| | - S Bernays
- School of Public Health, University of Sydney, Sydney, NSW, Australia, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - D Chavan
- Survivors Against TB, Mumbai, India
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia, Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - E Jaramillo
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - A Khan
- Stop TB Partnership, Geneva, Switzerland
| | - Y D Lin
- Burnet Institute, Melbourne, VIC, Australia
| | | | - M Loveday
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - S S Majumdar
- Burnet Institute, Melbourne, VIC, Australia, Department of Paediatrics, University of Melbourne and Murdoch Children´s Research Institute, Melbourne, VIC, Australia
| | - N Mistry
- Foundation for Medical Research, Mumbai, India
| | - H Patel
- Survivors Against TB, Mumbai, India
| | - S Rane
- Survivors Against TB, Mumbai, India
| | | | - R Triasih
- Centre for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Department of Paediatric, Dr Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - N Venkatesan
- Blavatnik School of Government, Oxford University, Oxford, UK
| | - K Viney
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - P du Cros
- Burnet Institute, Melbourne, VIC, Australia
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17
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Abbas S, Denholm J, Kermode M, Xiaoguang Y, Kane S. Receiving healthcare for drug-resistant TB: a cross-sectional survey from Pakistan. Public Health Action 2021; 11:114-119. [PMID: 34567986 DOI: 10.5588/pha.20.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe and quantify patients' self-reported experiences of receiving healthcare from Pakistan's Programmatic Management of Drug-Resistant Tuberculosis (PMDT) model of care, and to understand these experiences within the broader context of Pakistan's health system. METHOD This was a cross-sectional survey of patients attending three PMDT clinics in Khyber-Pakhtunkhwa Province in Pakistan. RESULTS The median consultation time at the PMDT clinics was 10 minutes. In their most recent visit to the PMDT clinic, 34.9% of patients spent >40% of their monthly income to access treatment. To specify, 71% of patients reported spending out-of-pocket for ancillary medicines and 44.7% for laboratory tests. In 10.5% of cases, medicines for drug-resistant TB (DR-TB) were dispensed without the patient attending the clinic. Only 43.7% of treatment supporters regularly accompanied patients to the clinic, and 6% supervised the patient's intake of medicines. Disbursement of financial support was irregular in 98.6% of cases. Only 6.2% of patients received their daily injections from a public facility, the rest went elsewhere. CONCLUSION Several shortcomings in PMDT services, including hurried consultations, irregularities in financial support, and gaps in Pakistan's broader health system undermined healthcare experience of patients with DR-TB. To improve health outcomes and patients' care experience these service gaps need to be addressed.
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Affiliation(s)
- S Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - J Denholm
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - M Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Y Xiaoguang
- School of Public Health, Fudan University, Shanghai, China
| | - S Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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18
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Migliori GB, Thong PM, Alffenaar JW, Denholm J, Tadolini M, Alyaquobi F, Blanc FX, Buonsenso D, Cho JG, Codecasa LR, Danila E, Duarte R, García-García JM, Gualano G, Rendon A, Silva DR, Souleymane MB, Tham SM, Thomas TA, Tiberi S, Udwadia ZF, Goletti D, Centis R, D'Ambrosio L, Sotgiu G, Ong CWM. Gauging the impact of the COVID-19 pandemic on tuberculosis services: a global study. Eur Respir J 2021; 58:13993003.01786-2021. [PMID: 34446465 PMCID: PMC8581650 DOI: 10.1183/13993003.01786-2021] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
The effects of the coronavirus disease 2019 (COVID-19) pandemic on tuberculosis (TB) disease and TB services emerged in the beginning of 2020 [1, 2]. Epidemiological and clinical studies, including mortality rates of the first cohort of patients with COVID-19 and TB co-infection were described [3, 4]. Several reports from individual countries suggested that the COVID-19 pandemic significantly affected TB services [5–9], including validation by modelling studies [10]. The Global Tuberculosis Network (GTN) reported that the COVID-19 pandemic affected TB services in 33 TB centres from 16 countries in the first 4 months of 2020 [11]. An increased use of telehealth during the COVID-19 pandemic was observed in some TB centres [11]. The major limitations of that study were the short period of observation (January to April 2020 compared to the same period in 2019) and the limited number of variables analysed [11–14]. This global study of 43 TB centres from 19 countries demonstrates the impact of COVID-19 pandemic on TB services. Newly diagnosed TB disease, drug-resistant TB, TB deaths, outpatient clinic attendances and newly diagnosed TB infection were reduced.https://bit.ly/3sdHbfk
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Affiliation(s)
| | - Pei Min Thong
- Dept of Medicine, Infectious Disease Translational Research Programme, National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Jan-Willem Alffenaar
- The University of Sydney, Pharmacy School, Sydney, Australia.,Westmead Hospital, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - Justin Denholm
- Melbourne Health Victorian Tuberculosis Program, Melbourne, Australia.,Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Marina Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Dept of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fatma Alyaquobi
- TB and Acute Respiratory Diseases Section, Dept of Communicable Diseases, Directorate General of Disease Surveillance and Control, Ministry of Health, Oman
| | | | - Danilo Buonsenso
- Dept of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jin-Gun Cho
- Westmead Hospital, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia.,Parramatta Chest Clinic, Parramatta, Australia
| | | | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Raquel Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Dept of Pneumology, Public Health Science and Medical Education Dept, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Gina Gualano
- National Institute for Infectious Diseases (INMI) 'L. Spallanzani' - IRCCS, Rome, Italy
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon) Monterrey, Monterrey, Mexico
| | - Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brasil
| | | | - Sai Meng Tham
- Division of Infectious Diseases, Dept of Medicine, National University Hospital, Singapore
| | - Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK.,Royal London Hospital, Barts Health National Health Service Trust, London, UK
| | - Zarir F Udwadia
- P.D. Hinduja National Hospital and Medical research Centre, Mumbai, India
| | - Delia Goletti
- National Institute for Infectious Diseases (INMI) 'L. Spallanzani' - IRCCS, Rome, Italy
| | - Rosella Centis
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Catherine W M Ong
- Dept of Medicine, Infectious Disease Translational Research Programme, National University of Singapore, Yong Loo Lin School of Medicine, Singapore .,Division of Infectious Diseases, Dept of Medicine, National University Hospital, Singapore.,National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore
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Taylor JW, Curtis N, Denholm J. BCG vaccination: An update on current Australian practices. Aust J Gen Pract 2021; 49:651-655. [PMID: 33015679 DOI: 10.31128/ajgp-06-20-5490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Bacille Calmette-Guérin (BCG) vaccine is primarily used to prevent tuberculosis (TB) infection and disease in settings with high TB incidence. OBJECTIVE The aim of this review article is to describe the current uses of BCG vaccination in Australia, including the indications and contraindications, efficacy and other off-target effects, and the role of the general practitioner. DISCUSSION BCG vaccination in Australia is primarily used to prevent TB in neonates and children with a high risk of TB exposure. The BCG vaccine is most effective at preventing severe disseminated TB disease in young children and has variable efficacy in preventing adult disease. The BCG vaccine is usually well tolerated; however, given the small risk of adverse effects, vaccination should be undertaken by a practitioner experienced in its administration. When indicated, the BCG vaccine is available from specialist TB or travel medicine centres.
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Affiliation(s)
- Jemma Wittner Taylor
- BBNSc, MBBS, DTMH, Infectious Diseases Advanced Trainee, The Royal Melbourne Hospital, Vic
| | - Nigel Curtis
- MA, MBBS, DCH, DTM@H, FRCPCH, PhD, Professor of Paediatric Infectious Diseases, Department of Paediatrics, The University of Melbourne, Vic; Leader of Infectious Diseases Group, Murdoch Children@s Research Institute, Vic; Head of Infectious Diseases Unit, The Royal Children@s Hospital Melbourne, Vic
| | - Justin Denholm
- BMed, MBioethics, MPH+TM, PhD,@FRACP, Medical Director, Victorian Tuberculosis@Program, Vic; Principle Investigator, Doherty Institute, The University of Melbourne, Vic
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20
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Wild V, Frick M, Denholm J. WHO ethics guidance on TB care and migration: challenges to the implementation process. Int J Tuberc Lung Dis 2021; 24:32-37. [PMID: 32553041 DOI: 10.5588/ijtld.17.0882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We summarise the current ethical guidance on tuberculosis (TB) care and migration, as set out in the WHO "Ethics Guidance for the Implementation of the End TB Strategy." Among other aspects, the Ethics Guidance states that there should be firm legal principles in place that ensure the enforcement of migration law on the one hand and the protection of human rights, including the right to health, on the other are separated from one another. As a challenge to the Ethics Guidance and its implementation, we describe two cases, each of which typifies particular problems. Case one describes the experience of a migrant worker in the United Arab Emirates who is deported when mandatory medical exams show evidence of current or prior TB. Case two raises the issue of providing more than TB care, which may also be needed for holistic care. The paper concludes with our suggestions for ways in which we could make progress towards ethically optimal TB care for migrants.
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Affiliation(s)
- V Wild
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M Frick
- Treatment Action Group, New York, NY, USA
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute, Melbourne, VIC, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
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Abstract
I examine the fate of a kinetic Potts ferromagnet with a high ground-state degeneracy that undergoes a deep quench to zero temperature. I consider single spin-flip dynamics on triangular lattices of linear dimension 8≤L≤128 and set the number of spin states q equal to the number of lattice sites L×L. The ground state is the most abundant final state, and is reached with probability ≈0.71. Three-hexagon states occur with probability ≈0.26, and hexagonal tessellations with more than three clusters form with probabilities of O(10^{-3}) or less. Spanning stripe states-where the domain walls run along one of the three lattice directions-appear with probability ≈0.03. "Blinker" configurations, which contain perpetually flippable spins, also emerge, but with a probability that is vanishingly small with the system size.
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Affiliation(s)
- J Denholm
- SUPA, Department of Physics, University of Strathclyde, Glasgow, G4 0NG Scotland, United Kingdom
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22
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Migliori GB, Thong PM, Akkerman O, Alffenaar JW, Álvarez-Navascués F, Assao-Neino MM, Bernard PV, Biala JS, Blanc FX, Bogorodskaya EM, Borisov S, Buonsenso D, Calnan M, Castellotti PF, Centis R, Chakaya JM, Cho JG, Codecasa LR, D'Ambrosio L, Denholm J, Enwerem M, Ferrarese M, Galvão T, García-Clemente M, García-García JM, Gualano G, Gullón-Blanco JA, Inwentarz S, Ippolito G, Kunst H, Maryandyshev A, Melazzini M, de Queiroz Mello FC, Muñoz-Torrico M, Njungfiyini PB, Palmero DJ, Palmieri F, Piccioni P, Piubello A, Rendon A, Sabriá J, Saporiti M, Scognamiglio P, Sharma S, Silva DR, Souleymane MB, Spanevello A, Tabernero E, Tadolini M, Tchangou ME, Thornton ABY, Tiberi S, Udwadia ZF, Sotgiu G, Ong CWM, Goletti D. Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January-April 2020. Emerg Infect Dis 2020; 26:2709-2712. [PMID: 32917293 PMCID: PMC7588533 DOI: 10.3201/eid2611.203163] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.
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Abstract
Abstract In 2018, the National Notifiable Diseases Surveillance System received 1,438 tuberculosis (TB) notifications, representing a rate of 5.8 per 100,000 population, consistent with the preceding three years. Australia has achieved and maintained good tuberculosis (TB) control since the mid-1980s, sustaining a low annual TB incidence rate of approximately five to six cases per 100,000 population. The number of multi-drug-resistant TB (MDR-TB) cases diagnosed in Australia is low by international standards, with approximately 2% of TB notifications per year classified as MDR-TB. Australia's overseas-born population continue to represent the majority of TB notifications (between 86% to 89% across the four reporting years) and the Aboriginal and Torres Strait Islander population continues to record TB rates around four to five times higher than the Australian-born Non-Indigenous population. Whilst Australia has achieved and maintained excellent control of TB in Australia, sustained effort is required to reduce local rates further, especially among Aboriginal and Torres Strait Islander populations, and to contribute to the achievement of the World Health Organization's goal to end the global TB epidemic by 2035.
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Affiliation(s)
- Amy Bright
- Office of Health Protection and Response Division, Department of Health, Canberra, ACT
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne Vic
| | - Chris Coulter
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane Qld
| | - Justin Waring
- Western Australia Tuberculosis Program, WA Health, Perth WA
| | - Rick Stapledon
- South Australian Tuberculosis Services, Royal Adelaide Hospital, Adelaide SA
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24
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Abstract
BACKGROUND Latent tuberculosis infection (LTBI) is an asymptomatic condition that may progress to active tuberculosis (TB), sometimes decades after exposure. Most people with active TB in Australia have not had recent contact and have been unaware of their risk. Tests for LTBI are available, allowing for diagnosis and preventive therapy to avoid active disease. OBJECTIVE The aim of this article is to review current approaches to the diagnosis and management of LTBI, with particular focus on the Australian general practice setting. Groups at elevated risk of having LTBI and progressing to active disease are outlined. Recent research into the prevalence and distribution of LTBI in Australia is reviewed, and Australian guidelines for testing and treatment are summarised. DISCUSSION LTBI occurs in an estimated 5% of all Australian residents. However, this is a particular issue for those born in TB-endemic countries. Approximately 17% of all overseas-born Australian residents, but only 0.4% of Australian-born residents, have LTBI. Appropriate diagnosis and management is an important long-term health promotion activity, and many people with LTBI can be managed safely and effectively in Australian general practice settings.
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Affiliation(s)
- Justin Denholm
- BMed, MBioethics, MPHTM, PhD, FRACP, Medical Director, Victorian Tuberculosis Program, Vic
| | - Ann-Marie Baker
- RN, Grad Dip Community Health, Clinical Nurse Consultant, Victorian Tuberculosis Program, Vic
| | - Mark Timlin
- MBBS, MPH, MBE, General Practitioner, Member Refugee Health Special Interest Group, Vic
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Degeling C, Carter SM, Dale K, Singh K, Watts K, Hall J, Denholm J. Perspectives of Vietnamese, Sudanese and South Sudanese immigrants on targeting migrant communities for latent tuberculosis screening and treatment in low-incidence settings: A report on two Victorian community panels. Health Expect 2020; 23:1431-1440. [PMID: 32918523 PMCID: PMC7752196 DOI: 10.1111/hex.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Tuberculosis (TB) elimination strategies in Australia require a focus on groups who are at highest risk of TB infection, such as immigrants from high‐burden settings. Understanding attitudes to different strategies for latent TB infection (LTBI) screening and treatment is an important element of justifiable elimination strategies. Method Two community panels were conducted in Melbourne with members of the Vietnamese (n = 11), Sudanese and South Sudanese communities (n = 9). Panellists were provided with expert information about LTBI and different screening and health communication strategies, then deliberated on how best to pursue TB elimination in Australia. Findings Both panels unanimously preferred LTBI screening to occur pre‐migration rather than in Australia. Participants were concerned that post‐migration screening would reach fewer migrants, noted that conducting LTBI screening in Australia could stigmatize participants and that poor awareness of LTBI would hamper participation. If targeted screening was to occur in Australia, the Vietnamese panel preferred ‘place‐based’ communication strategies, whereas the Sudanese and South Sudanese panel emphasized that community leaders should lead communication strategies to minimize stigma. Both groups emphasized the importance of maintaining community trust in Australian health service providers, and the need to ensure targeting did not undermine this trust. Conclusion Pre‐migration screening was preferred. If post‐migration screening is necessary, the potential for stigma should be reduced, benefit and risk profile clearly explained and culturally appropriate communication strategies employed. Cultural attitudes to health providers, personal health management and broader social vulnerabilities of targeted groups need to be considered in the design of screening programs.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement Evidence and Values, School of Health & Society, University of Wollongong, Wollongong, NSW, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement Evidence and Values, School of Health & Society, University of Wollongong, Wollongong, NSW, Australia
| | - Katie Dale
- Victorian Tuberculosis Program, Melbourne Health at The Doherty Institute for Infection & Immunity, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
| | - Kasha Singh
- Victorian Infectious Diseases Service, Melbourne Health at The Doherty Institute for Infection & Immunity, Melbourne, VIC, Australia
| | - Krista Watts
- Victorian Tuberculosis Program, Melbourne Health at The Doherty Institute for Infection & Immunity, Melbourne, VIC, Australia
| | - Julie Hall
- Australian Centre for Health Engagement Evidence and Values, School of Health & Society, University of Wollongong, Wollongong, NSW, Australia
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health at The Doherty Institute for Infection & Immunity, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
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Affiliation(s)
- K. Watts
- Victorian Tuberculosis Program, Melbourne Health at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | - A. McKeown
- Victorian Tuberculosis Program, Melbourne Health at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | - J. Denholm
- Victorian Tuberculosis Program, Melbourne Health at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia, ,
| | - A. M. Baker
- Victorian Tuberculosis Program, Melbourne Health at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
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27
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Affiliation(s)
- J. Denholm
- Royal Melbourne Hospital, Victorian Tuberculosis Program, Parkville, VIC, Australia, ,
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28
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Al Abri S, Kasaeva T, Migliori GB, Goletti D, Zenner D, Denholm J, Al Maani A, Cirillo DM, Schön T, Lillebæk T, Al-Jardani A, Go UY, Dias HM, Tiberi S, Al Yaquobi F, Khamis FA, Kurup P, Wilson M, Memish Z, Al Maqbali A, Akhtar M, Wejse C, Petersen E. Tools to implement the World Health Organization End TB Strategy: Addressing common challenges in high and low endemic countries. Int J Infect Dis 2020; 92S:S60-S68. [PMID: 32114195 DOI: 10.1016/j.ijid.2020.02.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
AIM The purpose of this viewpoint is to summarize the advantages and constraints of the tools and strategies available for reducing the annual incidence of tuberculosis (TB) by implementing the World Health Organization (WHO) End TB Strategy and the linked WHO TB Elimination Framework, with special reference to Oman. METHODS The case-study was built based on the presentations and discussions at an international workshop on TB elimination in low incidence countries organized by the Ministry of Health, Oman, which took place from September 5 to September 7, 2019, and supported by the WHO and European Society of Clinical Microbiology and Infectious Diseases (ESCMID). RESULTS Existing tools were reviewed, including the screening of migrants for latent TB infection (LTBI) with interferon-gamma release assays, clinical examination for active pulmonary TB (APTB) including chest X-rays, organization of laboratory services, and the existing centres for mandatory health examination of pre-arrival or arriving migrants, including examination for APTB. The need for public-private partnerships to handle the burden of screening arriving migrants for active TB was discussed at length and different models for financing were reviewed. CONCLUSIONS In a country with a high proportion of migrants from high endemic countries, screening for LTBI is of high priority. Molecular typing and the development of public-private partnerships are needed.
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Affiliation(s)
- Seif Al Abri
- Directorate General for Diseases Surveillance and Control, Ministry of Health, Muscat, Oman.
| | | | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy; ESCMID Study Group on Mycobacteria, Basel, Switzerland
| | - Dominik Zenner
- Regional Office of the European Economic Area, EU and NATO and International Organization for Migration, IOM, Brussels, Belgium
| | - Justin Denholm
- Department of Infectious Diseases, Royal Melbourne Hospital and Victorian TB Programme, Melbourne, Australia
| | - Amal Al Maani
- Paediatric Infectious Diseases, The Royal Hospital and Central Department of Infection Prevention and Control, Directorate General for Diseases Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogen Research Unit, Italian Reference Centre for Molecular Typing of Mycobacteria, San Rafaele Scientific Institute, Milan, Italy
| | - Thomas Schön
- Department of Clinical Microbiology and Infectious Diseases, Kalmar Hospital and University of Linköping, Sweden
| | - Troels Lillebæk
- International Reference Laboratory of Mycobacteriology, WHO TB Supranational Reference Laboratory Copenhagen, Infectious Disease Preparedness Area, Statens Serum Institute and Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amina Al-Jardani
- Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Un-Yeong Go
- International Tuberculosis Research Centre, Seoul, Republic of Korea
| | - Hannah Monica Dias
- WHO Global TB Programme Unit on Policy, Strategy and Innovations, Geneva, Switzerland
| | - Simon Tiberi
- Infectious Diseases, Barts Health NHS Trust, London, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - Fatma Al Yaquobi
- Tuberculosis and Acute Respiratory Diseases Surveillance, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Faryal Ali Khamis
- Department of Infectious Diseases, The Royal Hospital, Ministry of Health, Muscat, Oman
| | - Padmamohan Kurup
- Department of Disease Surveillance and Control, Muscat Governorate, Muscat, Oman
| | | | - Ziad Memish
- Prince Mohammed bin Abdulaziz Hospital, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Rollings School of Public Health, Emory University, Atlanta, GA, USA
| | - Ali Al Maqbali
- Disease Surveillance and Control, North Bathinah Governorate, Sohar, Oman
| | | | - Christian Wejse
- Department of Infectious Disease, Aarhus University Hospital and School of Public Health, Faculty of Health Sciences, University of Aarhus, Denmark; ESCMID Study Group for Travel and Migration, Basel, Switzerland
| | - Eskild Petersen
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman; Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark; ESCMID Emerging Infections Task Force, Basel, Switzerland
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Borisov S, Danila E, Maryandyshev A, Dalcolmo M, Miliauskas S, Kuksa L, Manga S, Skrahina A, Diktanas S, Codecasa LR, Aleksa A, Bruchfeld J, Koleva A, Piubello A, Udwadia ZF, Akkerman OW, Belilovski E, Bernal E, Boeree MJ, Cadiñanos Loidi J, Cai Q, Cebrian Gallardo JJ, Dara M, Davidavičienė E, Forsman LD, De Los Rios J, Denholm J, Drakšienė J, Duarte R, Elamin SE, Escobar Salinas N, Ferrarese M, Filippov A, Garcia A, García-García JM, Gaudiesiute I, Gavazova B, Gayoso R, Gomez Rosso R, Gruslys V, Gualano G, Hoefsloot W, Jonsson J, Khimova E, Kunst H, Laniado-Laborín R, Li Y, Magis-Escurra C, Manfrin V, Marchese V, Martínez Robles E, Matteelli A, Mazza-Stalder J, Moschos C, Muñoz-Torrico M, Mustafa Hamdan H, Nakčerienė B, Nicod L, Nieto Marcos M, Palmero DJ, Palmieri F, Papavasileiou A, Payen MC, Pontarelli A, Quirós S, Rendon A, Saderi L, Šmite A, Solovic I, Souleymane MB, Tadolini M, van den Boom M, Vescovo M, Viggiani P, Yedilbayev A, Zablockis R, Zhurkin D, Zignol M, Visca D, Spanevello A, Caminero JA, Alffenaar JW, Tiberi S, Centis R, D'Ambrosio L, Pontali E, Sotgiu G, Migliori GB. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: first global report. Eur Respir J 2019; 54:13993003.01522-2019. [PMID: 31601711 DOI: 10.1183/13993003.01522-2019] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/17/2019] [Indexed: 11/05/2022]
Abstract
The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1-2) and 57 (11.3%) as serious (grade 3-5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.
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Affiliation(s)
- Sergey Borisov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.,These authors contributed equally
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Margareth Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil
| | - Skaidrius Miliauskas
- Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Liga Kuksa
- MDR-TB Dept, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia
| | - Selene Manga
- Dept of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Peru
| | - Alena Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Saulius Diktanas
- Tuberculosis Dept, 3rd Tuberculosis Unit, Republican Klaipėda Hospital, Klaipėda, Lithuania
| | | | - Alena Aleksa
- Dept of Phthisiology and Pulmonology, Grodno State Medical University, Grodno, Belarus
| | - Judith Bruchfeld
- Division of Infectious Diseases, Dept of Medicine, Karolinska Institute, Solna, Sweden.,Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,These authors contributed equally
| | - Antoniya Koleva
- Pulmonology and Physiotherapy Dept, Gabrovo Lung Diseases Hospital, Gabrovo, Bulgaria
| | - Alberto Piubello
- Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France.,Tuberculosis Division, Damien Foundation, Niamey, Niger.,These authors contributed equally
| | - Zarir Farokh Udwadia
- Dept of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India
| | - Onno W Akkerman
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, TB Center Beatrixoord, Haren, The Netherlands.,These authors contributed equally
| | - Evgeny Belilovski
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - Enrique Bernal
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Murcia, Spain
| | - Martin J Boeree
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | | | - Qingshan Cai
- Zhejiang Integrated Traditional and Western Medicine Hospital, Hangzhou, China
| | | | - Masoud Dara
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Edita Davidavičienė
- National TB Registry, Public Health Dept, Ministry of Health, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Davies Forsman
- Division of Infectious Diseases, Dept of Medicine, Karolinska Institute, Solna, Sweden.,Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jorge De Los Rios
- Centro de Excelencia de TB "Niño Jesus", Servicio de Neumologia, Hospital Maria Auxiliadora, Lima, Peru
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Australia.,Dept of Microbiology and Immunology, University of Melbourne, Melbourne, Australia.,These authors contributed equally
| | - Jacinta Drakšienė
- Tuberculosis Dept, 3rd Tuberculosis Unit, Republican Klaipėda Hospital, Klaipėda, Lithuania
| | - Raquel Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Dept of Pneumology, Public Health Science and Medical Education Dept, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Nadia Escobar Salinas
- Division of Disease Prevention and Control, Dept of Communicable Diseases, National Tuberculosis Control and Elimination Programme, Ministry of Health, Santiago, Chile
| | - Maurizio Ferrarese
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - Alexey Filippov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - Ana Garcia
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina
| | | | - Ieva Gaudiesiute
- Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Regina Gayoso
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil
| | - Roscio Gomez Rosso
- National Institute of Respiratory and Environmental Diseases "Prof. Dr. Juan Max Boettner" Asunción, Paraguay
| | - Vygantas Gruslys
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Wouter Hoefsloot
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | - Jerker Jonsson
- Dept of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Elena Khimova
- Northern State Medical University, Arkhangelsk, Russian Federation
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rafael Laniado-Laborín
- Universidad Autónoma de Baja California, Baja California, Mexico; Clínica de Tuberculosis del Hospital General de Tijuana, Tijuana, Mexico.,These authors contributed equally
| | - Yang Li
- Dept of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Cecile Magis-Escurra
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | | | - Valentina Marchese
- Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB elimination and TB/HIV co-infection, University of Brescia, Brescia, Italy
| | - Elena Martínez Robles
- Internal Medicine Dept, Tuberculosis Unit, Hospital de Cantoblanco - Hospital General Universitario La Paz, Madrid, Spain
| | - Alberto Matteelli
- Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB elimination and TB/HIV co-infection, University of Brescia, Brescia, Italy
| | - Jesica Mazza-Stalder
- Division of Pulmonary Medicine, University Hospital of Lausanne CHUV, Lausanne, Switzerland.,These authors contributed equally
| | - Charalampos Moschos
- Dept of Tuberculosis, Sotiria Athens Hospital of Chest Diseases, Athens, Greece
| | - Marcela Muñoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional De Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad De Mexico, Mexico.,These authors contributed equally
| | | | - Birutė Nakčerienė
- National TB Registry, Public Health Dept, Ministry of Health, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Laurent Nicod
- Division of Pulmonary Medicine, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | | | | | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | | | - Marie-Christine Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Agostina Pontarelli
- Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy
| | - Sarai Quirós
- Pneumology Dept, Tuberculosis Unit, Hospital de Cantoblanco - Hospital General Universitario La Paz, Madrid, Spain
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,These authors contributed equally
| | - Agnese Šmite
- MDR-TB Dept, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Ruzomberok, Slovakia
| | | | - Marina Tadolini
- Unit of Infectious Diseases, Dept of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Martin van den Boom
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.,These authors contributed equally
| | - Marisa Vescovo
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina
| | - Pietro Viggiani
- Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy
| | - Askar Yedilbayev
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Rolandas Zablockis
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dmitry Zhurkin
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Matteo Zignol
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.,Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Italy.,These authors contributed equally
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.,Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Italy
| | - José A Caminero
- Pneumology Dept, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain.,MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France.,These authors contributed equally
| | - Jan-Willem Alffenaar
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia.,Westmead Hospital, Sydney, Australia.,University of Groningen, University Medical Center Groningen, Dept of Pharmacy and Pharmacology, Groningen, The Netherlands.,These authors contributed equally
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Dept of Infection, Royal London and Newham Hospitals, Barts Health NHS Trust, London, UK.,These authors contributed equally
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.,These authors contributed equally
| | - Lia D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland.,These authors contributed equally
| | - Emanuele Pontali
- Dept of Infectious Diseases, Galliera Hospital, Genova, Italy.,These authors contributed equally
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,These authors contributed equally
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy .,These authors contributed equally
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30
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Degeling C, Carroll J, Denholm J, Marais B, Dawson A. Ending TB in Australia: Organizational challenges for regional tuberculosis programs. Health Policy 2019; 124:106-112. [PMID: 31818484 DOI: 10.1016/j.healthpol.2019.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/17/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022]
Abstract
The World Health Organization's End TB Strategy aims to eliminate tuberculosis (TB) by 2050. Low-burden countries such as Australia are targeted for early elimination (2035), which will require an increase in the intensity and scope of case finding and treatment of people with latent TB infection (LTBI). Because 80 % of TB disease in Australia occurs in metropolitan Sydney (New South Wales) and Melbourne (Victoria), the commitment to move towards elimination has major implications for TB programs in these jurisdictions. We report on a case study analysis that compares and contrasts key attributes of each of these healthcare organizations. Such analysis has important implications for all countries seeking to implement international agreements within local health structures. Differences in the organizational structure, culture and systems of care in NSW and Victoria may facilitate or create barriers to changes in organizational system functions, especially the way in which TB prevention and LTBI treatment is delivered. Ratification of global health treaties and the development of national strategies, alone, is insufficient for realizing the promised outcomes. Even in high income countries, global health agendas such as TB elimination can be complicated by differences in local system structure and funding. As the timelines tighten towards 2035, more work must be done to identify the organizational conditions and service models that will facilitate progress towards TB elimination.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, Faculty of Social Science, University of Wollongong, NSW, Australia.
| | - Jane Carroll
- Senior Medical Officer of the Commonwealth, Bupa Medical Visa Services, Sydney, NSW, Australia.
| | - Justin Denholm
- Victorian Tuberculosis Program and the Doherty Institute, University of Melbourne, VIC, Australia.
| | - Ben Marais
- Western Sydney Local Health District and the Marie Bashir Institute, University of Sydney, NSW, Australia.
| | - Angus Dawson
- Sydney Health Ethics, School of Public Health and the Marie Bashir Institute, University of Sydney, NSW, Australia.
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31
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Abstract
We uncover unusual topological features in the long-time relaxation of the q-state kinetic Potts ferromagnet on the triangular lattice that is instantaneously quenched to zero temperature from a zero-magnetization initial state. For q=3, the final state is either the ground state (frequency ≈0.75), a frozen three-hexagon state (frequency ≈0.16), a two-stripe state (frequency ≈0.09), or a three-stripe state (frequency <2×10^{-4}). Other final state topologies, such as states with more than three hexagons, occur with probability 10^{-5} or smaller, for q=3. The relaxation to the frozen three-hexagon state is governed by a time that scales as L^{2}lnL. We provide a heuristic argument for this anomalous scaling and present additional new features of Potts coarsening on the triangular lattice for q=3 and for q>3.
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Affiliation(s)
- J Denholm
- SUPA and Department of Physics, University of Strathclyde, Glasgow G4 0NG, Scotland, United Kingdom
| | - S Redner
- Santa Fe Institute, 1399 Hyde Park Rd, Santa Fe, New Mexico 87501, USA
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32
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Francis JR, Manchikanti P, Blyth CC, Denholm J, Lowbridge C, Coulter C, Donnan E, Stapledon R, Krause VL, Waring J. Multidrug-resistant tuberculosis in Australia, 1998-2012. Int J Tuberc Lung Dis 2019; 22:294-299. [PMID: 29471907 DOI: 10.5588/ijtld.17.0412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the epidemiology and outcomes of multidrug-resistant tuberculosis (MDR-TB) diagnosed in Australia between 1998 and 2012. DESIGN A retrospective review was undertaken involving all patients with laboratory-confirmed MDR-TB notified in Australia between 1998 and 2012 inclusive. Demographic, clinical and laboratory features are described. Clinical outcomes were defined according to World Health Organization definitions of treatment success (cure and treatment completion), treatment failure, death, loss to follow-up (including transfer out), or not evaluated at treatment completion. RESULTS A total of 244 cases of MDR-TB were diagnosed in Australia during the study period, representing 1.4% of all TB cases notified. The majority were born outside Australia, including one third in Papua New Guinea. Of those with treatment outcome data available, treatment success was demonstrated in 81%. Treatment success was positively associated with use of a second-line injectable agent. Those born in Papua New Guinea were less likely to achieve treatment success. CONCLUSION MDR-TB is uncommon in Australia. The large number of cases born in Papua New Guinea, and the poorer outcomes in this cohort, represent challenges with cross-border management of MDR-TB in the Torres Strait. Australia has an ongoing role in the prevention and management of MDR-TB locally and in the region.
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Affiliation(s)
- J R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory
| | - P Manchikanti
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory
| | - C C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Telethon Kids Institute, University of Western Australia, Perth, Western Australia
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria
| | - C Lowbridge
- New South Wales Tuberculosis Program, Sydney, New South Wales
| | - C Coulter
- Communicable Diseases Branch, Queensland Health, Brisbane, Queensland
| | - E Donnan
- Communicable Diseases Branch, Queensland Health, Brisbane, Queensland
| | - R Stapledon
- South Australia Tuberculosis Services, Adelaide, South Australia
| | - V L Krause
- Northern Territory Centre for Disease Control, Darwin, Northern Territory
| | - J Waring
- Western Australia Tuberculosis Control Centre, Perth, Western Australia, Australia
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33
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Akkerman O, Aleksa A, Alffenaar JW, Al-Marzouqi NH, Arias-Guillén M, Belilovski E, Bernal E, Boeree MJ, Borisov SE, Bruchfeld J, Cadiñanos Loidi J, Cai Q, Caminero JA, Cebrian Gallardo JJ, Centis R, Codecasa LR, D'Ambrosio L, Dalcolmo M, Danila E, Dara M, Davidavičienė E, Davies Forsman L, De Los Rios Jefe J, Denholm J, Duarte R, Elamin SE, Ferrarese M, Filippov A, Ganatra S, Garcia A, García-García JM, Gayoso R, Giraldo Montoya AM, Gomez Rosso RG, Gualano G, Hoefsloot W, Ilievska-Poposka B, Jonsson J, Khimova E, Kuksa L, Kunst H, Laniado-Laborín R, Li Y, Magis-Escurra C, Manfrin V, Manga S, Marchese V, Martínez Robles E, Maryandyshev A, Matteelli A, Migliori GB, Mullerpattan JB, Munoz-Torrico M, Mustafa Hamdan H, Nieto Marcos M, Noordin NM, Palmero DJ, Palmieri F, Payen MC, Piubello A, Pontali E, Pontarelli A, Quirós S, Rendon A, Skrahina A, Šmite A, Solovic I, Sotgiu G, Souleymane MB, Spanevello A, Stošić M, Tadolini M, Tiberi S, Udwadia ZF, van den Boom M, Vescovo M, Viggiani P, Visca D, Zhurkin D, Zignol M. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: A global feasibility study. Int J Infect Dis 2019; 83:72-76. [PMID: 30953827 DOI: 10.1016/j.ijid.2019.03.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022] Open
Abstract
The World Health Organization launched a global initiative, known as aDSM (active TB drug safety monitoring and management) to better describe the safety profile of new treatment regimens for drug-resistant tuberculosis (TB) in real-world settings. However, comprehensive surveillance is difficult to implement in several countries. The aim of the aDSM project is to demonstrate the feasibility of implementing national aDSM registers and to describe the type and the frequency of adverse events (AEs) associated with exposure to the new anti-TB drugs. Following a pilot study carried out in 2016, official involvement of TB reference centres/countries into the project was sought and cases treated with bedaquiline- and/or delamanid-containing regimens were consecutively recruited. AEs were prospectively collected ensuring potential attribution of the AE to a specific drug based on its known safety profile. A total of 309 cases were fully reported from 41 centres in 27 countries (65% males; 268 treated with bedaquiline, 20 with delamanid, and 21 with both drugs) out of an estimated 781 cases the participating countries had committed to report by the first quarter of 2019.
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Affiliation(s)
- Onno Akkerman
- University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases & Tuberculosis, Groningen, The Netherlands.
| | - Alena Aleksa
- Department of Phthisiology, Grodno State Medical University, GRCC "Phthisiology", Grodno, Belarus.
| | - Jan-Willem Alffenaar
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia; Dept. Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
| | - Nada Hassan Al-Marzouqi
- Preventive Medicine Department, Ministry of Health and Prevention, Dubai, United Arab Emirates.
| | - Miguel Arias-Guillén
- Servicio de Neumología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias CIBER-Enfermedades Respiratorias. Instituto de Salud Carlos III, Oviedo Spain.
| | - Evgeny Belilovski
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Enrique Bernal
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Murcia, Spain.
| | - Martin J Boeree
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Sergey E Borisov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Judith Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - Julen Cadiñanos Loidi
- Internal Medicine Department, Hospital General de Villalba, Collado Villalba, Spain.
| | - Qingshan Cai
- Zhejiang Integrated Traditional and Western Medicine Hospital, Hangzhou, China.
| | - Jose A Caminero
- Pneumology Department, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain; MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France.
| | | | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | | | | | - Margareth Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil.
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Masoud Dara
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark.
| | - Edita Davidavičienė
- National TB registry, Public Health Department, Ministry of Health; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Lina Davies Forsman
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health; Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Raquel Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology; Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - Maurizio Ferrarese
- TB Reference Centre, Villa Marelli Institute/Niguarda Hospital, Milan, Italy.
| | - Alexey Filippov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Shashank Ganatra
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | - Ana Garcia
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina.
| | | | - Regina Gayoso
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil.
| | | | - Roscio Gomez Gomez Rosso
- National Institute of Respiratory and Environmental Diseases "Prof. Dr. Juan Max Boettner" Asunción, Paraguay.
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy.
| | - Wouter Hoefsloot
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Jerker Jonsson
- National TB Surveillance Unit, Public Health Agency, Stockholm, Sweden.
| | - Elena Khimova
- Northern State Medical University, Arkhangelsk, Russian Federation.
| | - Liga Kuksa
- MDR-TB department, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia.
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Rafael Laniado-Laborín
- Universidad Autónoma de Baja California, Baja California, Mexico; Clínica de Tuberculosis del Hospital General de Tijuana, Tijuana, Baja California, Mexico.
| | - Yang Li
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
| | - Cecile Magis-Escurra
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Selene Manga
- Department of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Peru.
| | - Valentina Marchese
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV co-infection and for TB elimination, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
| | - Elena Martínez Robles
- Internal Medicine Department, Tuberculosis Hospital de Cantoblanco- Hospital La Paz, Madrid, Spain
| | | | - Alberto Matteelli
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV co-infection and for TB elimination, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | - Jai B Mullerpattan
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | - Marcela Munoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico.
| | | | | | | | | | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy.
| | - Marie-Christine Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Alberto Piubello
- Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France; Tuberculosis Division, Damien Foundation, Niamey, Niger.
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy.
| | - Agostina Pontarelli
- Reference Centre for MDR and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy.
| | - Sarai Quirós
- Pneumology Department, Tuberculosis Unit, Hospital de Cantoblanco- Hospital General Universitario La Paz, Madrid, Spain.
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico.
| | - Alena Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - Agnese Šmite
- MDR-TB department, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia.
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Slovakia.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of z, University of Sassari, Sassari, Italy.
| | | | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese, Italy.
| | - Maja Stošić
- TB Programme and Surveillance Unit, National Public Health Institute, Belgrade, Serbia.
| | - Marina Tadolini
- Unit of Infectious Diseases, Deparment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
| | - Zarir Farokh Udwadia
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | | | - Marisa Vescovo
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina.
| | - Pietro Viggiani
- Reference Centre for MDR and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese, Italy.
| | - Dmitry Zhurkin
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - Matteo Zignol
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
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Borisov SE, D'Ambrosio L, Centis R, Tiberi S, Dheda K, Alffenaar JW, Amale R, Belilowski E, Bruchfeld J, Canneto B, Denholm J, Duarte R, Esmail A, Filippov A, Davies Forsman L, Gaga M, Ganatra S, Igorevna GA, Lazaro Mastrapa B, Manfrin V, Manga S, Maryandyshev A, Massard G, González Montaner P, Mullerpattan J, Palmero DJ, Pontarelli A, Papavasileiou A, Pontali E, Romero Leyet R, Spanevello A, Udwadia ZF, Viggiani P, Visca D, Sotgiu G, Migliori GB. Outcomes of patients with drug-resistant-tuberculosis treated with bedaquiline-containing regimens and undergoing adjunctive surgery. J Infect 2019; 78:35-39. [DOI: 10.1016/j.jinf.2018.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/31/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
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Abraham D, Cash HL, Durand AM, Denholm J, Moadsiri A, Gopalani SV, Johnson E. High Prevalence of Non-Communicable Disease Risk Factors among Adolescents in Pohnpei, Micronesia. Hawaii J Med Public Health 2018; 77:283-288. [PMID: 30416871 PMCID: PMC6218683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Non-communicable disease (NCD) related behaviors among adolescents are on the rise globally and in the Pacific region. To better understand and elucidate the prevalence of NCD risk factors among adolescents in Pohnpei state, Federated States of Micronesia, a cross-sectional study was conducted among secondary school students. Of 2965 students enrolled in the 2015-2016 academic year, 2555 (86.2%) completed the survey, and 2386 (80.5%) were included in the final analysis. Of the survey respondents, 21.7% of students self-reported smoking tobacco in the past 30 days, 30.3% self-reported drinking alcohol in the past 30 days, 40.9% self-reported chewing betel nut in the past 30 days, and 21.2% self-reported chewing tobacco with or without betel nut in the last 30 days. Male students, older students, and public school students had higher prevalence of substance use. Additionally, about 17.3% of students were overweight and 10.1% were obese according to physical measures of height and weight. Female students and private school students had higher prevalence of overweight and obesity than male students, and prevalence of overweight was higher in older age groups. These findings indicate a cohort of adolescents at substantial risk for the development of NCDs and signal an urgent need for public health interventions to address NCD risk factors.
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Affiliation(s)
- Delpihn Abraham
- Department of Health Services, Division of Primary Health Care, Pohnpei, Federated States of Micronesia (DA, EJ)
- Pacific Island Health Officers Association, Honolulu, HI (HLC, AMD)
- Victorian Infectious Diseases Service, Melbourne Health, Parkville, Australia; and Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia (JD)
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji (AM)
- Public Health Division, Pacific Community, Noumea, New Caledonia (SVG)
| | - Haley L Cash
- Department of Health Services, Division of Primary Health Care, Pohnpei, Federated States of Micronesia (DA, EJ)
- Pacific Island Health Officers Association, Honolulu, HI (HLC, AMD)
- Victorian Infectious Diseases Service, Melbourne Health, Parkville, Australia; and Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia (JD)
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji (AM)
- Public Health Division, Pacific Community, Noumea, New Caledonia (SVG)
| | - A Mark Durand
- Department of Health Services, Division of Primary Health Care, Pohnpei, Federated States of Micronesia (DA, EJ)
- Pacific Island Health Officers Association, Honolulu, HI (HLC, AMD)
- Victorian Infectious Diseases Service, Melbourne Health, Parkville, Australia; and Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia (JD)
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji (AM)
- Public Health Division, Pacific Community, Noumea, New Caledonia (SVG)
| | - Justin Denholm
- Department of Health Services, Division of Primary Health Care, Pohnpei, Federated States of Micronesia (DA, EJ)
- Pacific Island Health Officers Association, Honolulu, HI (HLC, AMD)
- Victorian Infectious Diseases Service, Melbourne Health, Parkville, Australia; and Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia (JD)
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji (AM)
- Public Health Division, Pacific Community, Noumea, New Caledonia (SVG)
| | - Ada Moadsiri
- Department of Health Services, Division of Primary Health Care, Pohnpei, Federated States of Micronesia (DA, EJ)
- Pacific Island Health Officers Association, Honolulu, HI (HLC, AMD)
- Victorian Infectious Diseases Service, Melbourne Health, Parkville, Australia; and Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia (JD)
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji (AM)
- Public Health Division, Pacific Community, Noumea, New Caledonia (SVG)
| | - Sameer Vali Gopalani
- Department of Health Services, Division of Primary Health Care, Pohnpei, Federated States of Micronesia (DA, EJ)
- Pacific Island Health Officers Association, Honolulu, HI (HLC, AMD)
- Victorian Infectious Diseases Service, Melbourne Health, Parkville, Australia; and Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia (JD)
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji (AM)
- Public Health Division, Pacific Community, Noumea, New Caledonia (SVG)
| | - Eliaser Johnson
- Department of Health Services, Division of Primary Health Care, Pohnpei, Federated States of Micronesia (DA, EJ)
- Pacific Island Health Officers Association, Honolulu, HI (HLC, AMD)
- Victorian Infectious Diseases Service, Melbourne Health, Parkville, Australia; and Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia (JD)
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji (AM)
- Public Health Division, Pacific Community, Noumea, New Caledonia (SVG)
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Xie O, Tay EL, Denholm J. Trends in Tuberculosis Incidence in the Australian-Born in Victoria: Opportunities and Challenges to Elimination. Trop Med Infect Dis 2018; 3:tropicalmed3040112. [PMID: 30314387 PMCID: PMC6306824 DOI: 10.3390/tropicalmed3040112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/23/2022] Open
Abstract
Australia is a low tuberculosis incidence country. In the setting of increasing migration, we aimed to investigate the epidemiology and trends of tuberculosis in the Australian-born population in the state of Victoria between 1992 and 2017. We performed a retrospective descriptive analysis of demographic, clinical and outcome data extracted from a centralized notifiable disease database. The mean incidence of tuberculosis was 1.19 cases per 100,000 population per year with a small but significant reduction of 0.98% per year. The median age of cases decreased from 67.5 years in 1994 to 17 years in 2017. Among 0–14 year-olds, there was an increase from 0.13 cases per 100,000 population in 1996 to 2.15 per 100,000 population in 2017. Data for risk factors were available from 2002 onwards. The most common risk factor in the 0–14 year age group was a household contact with tuberculosis (85.1%), followed by having a parent from a high tuberculosis incidence country (70.2%). We found the rate of tuberculosis in the Australian-born population in Victoria is low. However, there has been an increase in incidence in children, particularly among those with links to countries with high tuberculosis incidence. This could threaten progress towards tuberculosis elimination in Australia.
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Affiliation(s)
- Ouli Xie
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
| | - Ee Laine Tay
- Department of Health and Human Services, Melbourne, VIC 3000, Australia.
| | - Justin Denholm
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
- Victorian Tuberculosis Program, Melbourne, VIC 3000, Australia.
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia.
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Borisov SE, D’ambrosio L, Centis R, Dheda K, Alffenaar JW, Amale R, Belilowski E, Bruchfeld J, Canneto B, Denholm J, Duarte R, Esmail A, Filippov A, Davies Forsman L, Gaga M, Ganatra S, Igorevna GA, Lazaro Mastrapa B, Manfrin V, Manga S, Maryandyshev A, Massard G, González Montaner P, Mullerpattan J, Palmero DJ, Pontarelli A, Papavasileiou A, Pontali E, Romero Leyet R, Spanevello A, Tiberi S, Tramontana A, Udwadia ZF, Viggiani P, Visca D, Sotgiu G, Migliori GB. Outcomes of drug-resistant TB cases undergoing bedaquiline (BQ)-treatment and adjunctive surgery. Tuberculosis (Edinb) 2018. [DOI: 10.1183/13993003.congress-2018.pa3672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Clifford V, Tebruegge M, Zufferey C, Germano S, Forbes B, Cosentino L, Matchett E, McBryde E, Eisen D, Robins-Browne R, Street A, Denholm J, Curtis N. Cytokine biomarkers for the diagnosis of tuberculosis infection and disease in adults in a low prevalence setting. Tuberculosis (Edinb) 2018; 114:91-102. [PMID: 30711163 DOI: 10.1016/j.tube.2018.08.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Accurate and timely diagnosis of tuberculosis (TB) is essential to control the global pandemic. Currently available immunodiagnostic tests cannot discriminate between latent tuberculosis infection (LTBI) and active tuberculosis. This study aimed to determine whether candidate mycobacterial antigen-stimulated cytokine biomarkers can discriminate between TB-uninfected and TB-infected adults, and additionally between LTBI and active TB disease. METHODS 193 adults were recruited, and categorised into four unambiguous diagnostic groups: microbiologically-proven active TB, LTBI, sick controls (non-TB lower respiratory tract infections) and healthy controls. Whole blood assays were used to determine mycobacterial antigen (CFP-10, ESAT-6, PPD)-stimulated cytokine (IL-1ra, IL-2, IL-10, IL-13, TNF-α, IFN-γ, IP-10 and MIP-1β) responses, measured by Luminex multiplex immunoassay. RESULTS The background-corrected mycobacterial antigen-stimulated cytokine responses of all eight cytokines were significantly higher in TB-infected participants compared with TB-uninfected individuals, with IL-2 showing the best performance characteristics. In addition, mycobacterial antigen-stimulated responses with IL-1ra, IL-10 and TNF-α were higher in participants with active TB compared those with LTBI, reaching statistical significance with PPD stimulation, although there was a degree of overlap between the two groups. CONCLUSION Mycobacterial antigen-stimulated cytokine responses may prove useful in future immunodiagnostic tests to discriminate between tuberculosis-infected and tuberculosis-uninfected individual, and potentially between LTBI and active tuberculosis.
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Affiliation(s)
- Vanessa Clifford
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia
| | - Marc Tebruegge
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Christel Zufferey
- Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia
| | - Susie Germano
- Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia
| | - Ben Forbes
- Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia
| | - Lucy Cosentino
- Victorian Tuberculosis Program, Peter Doherty Institute, Parkville, VIC 3052, Australia
| | - Elizabeth Matchett
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Emma McBryde
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Damon Eisen
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Roy Robins-Browne
- Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Microbiology and Immunology, University of Melbourne, VIC 3052, Australia
| | - Alan Street
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Justin Denholm
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; Department of Microbiology and Immunology, University of Melbourne, VIC 3052, Australia; Victorian Tuberculosis Program, Peter Doherty Institute, Parkville, VIC 3052, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia.
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Dale K, Tay E, Trauer J, Trevan P, Denholm J. Gender differences in tuberculosis diagnosis and treatment in an industrialised low-incidence setting: Victoria, Australia, 2002-2015. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Snow K, Hesseling AC, Naidoo P, Graham SM, Denholm J, du Preez K. Tuberculosis in adolescents and young adults: epidemiology and treatment outcomes in the Western Cape. Int J Tuberc Lung Dis 2018; 21:651-657. [PMID: 28482959 DOI: 10.5588/ijtld.16.0866] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Western Cape Province, South Africa. OBJECTIVES To characterise tuberculosis (TB) epidemiology, disease presentation and treatment outcomes among adolescents (age 10-19 years) and young adults (age 20-24 years) in the Western Cape. DESIGN A retrospective, cross-sectional review of routine patient-level data from the Electronic TB Register (ETR.Net) for 2013. Site of TB disease, human immunodeficiency virus (HIV) status and TB treatment outcomes were analysed by 5-year age groups (<5, 5-9, 10-14, 15-19, 20-24 and 25 years of age). TB notification rates were calculated using census data. RESULTS Adolescents and young adults comprised 18.0% of all new TB notifications in 2013. The notification rate was 141 TB cases/100 000 person-years (py) among 10-14 year olds, 418/100 000 py among 15-19 year olds and 627/100 000 py among 20-24 year olds. HIV prevalence among TB patients was 10.9% in 10-14 year olds, 8.8% in 15-19 year olds and 27.2% in 20-24 year olds. Older adolescents (age 15-19 years) and young adults (age 20-24 years) with HIV co-infection had poor treatment outcomes: 15.6% discontinued treatment prematurely and 4.0% died. CONCLUSIONS Young people in the Western Cape suffer a substantial burden of TB, and those with TB-HIV co-infection are at high risk of treatment discontinuation.
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Affiliation(s)
- K Snow
- Centre for International Child Health, University of Melbourne, Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - 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
| | - P Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S M Graham
- Centre for International Child Health, University of Melbourne, Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria, Australia
| | - 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
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Snow KJ, Sismanidis C, Denholm J, Sawyer S, Graham SM. The incidence of tuberculosis among adolescents and young adults: a global estimate. Eur Respir J 2018; 51:51/2/1702352. [DOI: 10.1183/13993003.02352-2017] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/13/2017] [Indexed: 11/05/2022]
Abstract
Historical data show that the risk of tuberculosis increases dramatically during adolescence, and young people face unique challenges in terms of case detection and effective treatment. However, little is known about the burden of tuberculosis among young people in the modern era. This study aimed to provide the first estimates of the global and regional incidence of tuberculosis among young people aged 10–24 years.Using the World Health Organization (WHO) database of tuberculosis notifications for 2012, we estimated the burden of tuberculosis among young people by WHO region. Adjustments were made for incomplete age disaggregation and underreporting, using supplementary data from several countries representing diverse tuberculosis epidemics.We estimate that 1.78 million (uncertainty interval (UI) 1.23–3.00 million) young people developed tuberculosis in 2012, accounting for 17% of all new tuberculosis cases globally. Young people in the WHO South East Asian Region (721 000, UI 473 000–1.35 million) and the WHO African Region (534 000, UI 359 000–912 000) experienced the greatest number of tuberculosis episodes.Young people suffer a considerable burden of tuberculosis. Age-specific burden of disease estimation for this age group is complicated by incomplete age disaggregation of tuberculosis data, highlighting the importance of continued surveillance system strengthening.
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Dale K, Tay E, Trauer JM, Trevan P, Denholm J. Gender differences in tuberculosis diagnosis, treatment and outcomes in Victoria, Australia, 2002–2015. Int J Tuberc Lung Dis 2017; 21:1264-1271. [DOI: 10.5588/ijtld.17.0338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Gender has a significant impact on tuberculosis (TB) diagnosis and outcomes in many settings worldwide. We explored gender differences in Victoria, Australia, a low-incidence setting.METHODS: Retrospective cohort study: 2002–2015. Gender was included as an independent
variable in multivariate statistical analyses assessing TB management.RESULTS: There were 2655 (54.5%) males and 2212 (45.5%) females notified (male:female ratio = 1.2:1). Among cases with pulmonary involvement, males underwent a chest X-ray or CT scan (CXR) sooner (hazard ratio [HR] 1.2,
95%CI 1.04–1.31, P = 0.010), began treatment sooner after presentation (HR 1.2, 95%CI 1.08–1.34, P = 0.001) and were more likely to have a sputum smear sample performed (OR 1.3, 95%CI 1.01–1.55, P = 0.037). Male cases with extra-pulmonary TB sought health
care sooner after symptom onset (HR 1.3, 95%CI 1.03–1.58, P = 0.024) and were more likely to have an abnormal CXR (OR 1.9, 95%CI 1.54–2.32, P < 0.001). Males were more likely to die before or during treatment (OR 1.5, 95%CI 1.06–2.11, P = 0.024).CONCLUSIONS:
Women experienced small delays in management compared with men, with no obvious detriment to assessment results or treatment outcomes. Differences were consistent with the hypothesis that males manifest more severe disease at presentation, which could be related to a range of biological and social factors.
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Affiliation(s)
- K. Dale
- Victorian Tuberculosis Program, Melbourne, Victoria, Australia
| | - E. Tay
- Department of Health and Human Services, Melbourne, Victoria, Australia
| | - J. M. Trauer
- Victorian Tuberculosis Program, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P. Trevan
- Victorian Tuberculosis Program, Melbourne, Victoria, Australia
| | - J. Denholm
- Victorian Tuberculosis Program, Melbourne, Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria, Australia
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Borisov SE, Dheda K, Enwerem M, Romero Leyet R, D’Ambrosio L, Centis R, Sotgiu G, Tiberi S, Alffenaar JW, Maryandyshev A, Belilowski E, Ganatra S, Skrahina A, Akkerman O, Aleksa A, Amale R, Artsukevich J, Bruchfeld J, Caminero JA, Carpena Martinez I, Codecasa L, Dalcolmo M, Denholm J, Douglas P, Duarte R, Esmail A, Fadul M, Filippov A, Davies Forsman L, Gaga M, Garcia-Fuertes JA, Garcia-Garcia JM, Gualano G, Jonsson J, Kunst H, Lau JS, Lazaro Mastrapa B, Lazaro Teran Troya J, Manga S, Manika K, González Montaner P, Mullerpattan J, Oelofse S, Ortelli M, Palmero DJ, Palmieri F, Papalia A, Papavasileiou A, Payen MC, Pontali E, Robalo Cordeiro C, Sadutshang TD, Sanukevich T, Solodovnikova V, Spanevello A, Topgyal S, Toscanini F, Tramontana A, Udwadia ZF, Viggiani P, White V, Zumla A, Migliori GB. Bedaquiline (BQ)-containing regimen at the programmatic level for MDR-TB: preliminary results. Tuberculosis (Edinb) 2017. [DOI: 10.1183/1393003.congress-2017.oa4852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chan E, Nolan A, Denholm J. How much does tuberculosis cost? An Australian healthcare perspective analysis. Commun Dis Intell (2018) 2017; 41:E191-E194. [PMID: 29720069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Tuberculosis (TB) remains a disease of high morbidity in Australia, with implications for both public health and the individual. Cost analyses is relevant for programmatic evaluation of TB. There is minimal published TB cost data in the Australian setting. Patients with drug sensitive active pulmonary TB (DS-PTB) and latent TB (LTBI) were enrolled in a single tertiary referral centre to evaluate healthcare provider costs. The median cost of treating drug susceptible pulmonary TB in this case series was 11,538 AUD. Approximately 50% of total costs is derived from inpatient hospitalisation bed days. In comparison, the average cost of managing latent TB was 582 AUD per completed course. We find the median provider cost of our DS-PTB treatment group comparable to costs from other regions globally with similar economic profiles. A program designed to detect and treat LTBI to prevent subsequent disease may be cost effective in appropriately selected patients and warrants further study.
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Affiliation(s)
- Eddie Chan
- Victorian Infectious Diseases Service, Melbourne Health, Parkville, Victoria, Australia
| | - Aine Nolan
- Victorian Tuberculosis Program, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Justin Denholm
- Victorian Tuberculosis Program, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Degeling C, Denholm J, Mason P, Kerridge I, Dawson A. Eliminating latent tuberculosis in low-burden settings: are the principal beneficiaries to be disadvantaged groups or the broader population? J Med Ethics 2017; 43:632-636. [PMID: 28143943 DOI: 10.1136/medethics-2016-103424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 12/12/2016] [Accepted: 01/06/2017] [Indexed: 06/06/2023]
Abstract
Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide, and the burdens of this disease continue to track prior disadvantage. In order to galvanise a coordinated global response, WHO has recently launched the End TB Campaign that aims to eliminate TB by 2050. Key to this is the introduction of population screening programmes in low-burden settings to identify and treat people who have latent TB infection (LTBI). The defining features of LTBI are: that it is not an active disease but confers an increased risk of disease; the socially disadvantaged are those most in danger and uncertainty persists as to who will be harmed or benefitted from screening-led prophylactic interventions. Systematic screening programmes that include surveillance, case-finding and treatment of asymptomatic individuals inevitably redistribute the risk of harms and the potential for benefits within a population. The extent to which those targeted within such programmes should be exposed to higher levels of risk in the pursuit of individual or community benefits requires careful consideration prior to implementation. As currently construed, it remains unclear who stands to benefit most from how LTBI screening in high-income countries is being organised, and whose health is being prioritised: members of disadvantaged groups or the broader community. Unless the aims of LTBI screening programmes in these settings are made transparent and their prioritisation ethically justified, there is a significant danger that such a targeted intervention will further disadvantage those who have the least capacity to bear the burdens of TB elimination.
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Affiliation(s)
- Chris Degeling
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in TB Control, Woolcock Institute, Sydney, New South Wales, Australia
- Marie Bashir Institute for Emerging Infectious Disease and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Mason
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in TB Control, Woolcock Institute, Sydney, New South Wales, Australia
| | - Ian Kerridge
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in TB Control, Woolcock Institute, Sydney, New South Wales, Australia
- Marie Bashir Institute for Emerging Infectious Disease and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Angus Dawson
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Emerging Infectious Disease and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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Borisov SE, Dheda K, Enwerem M, Romero Leyet R, D'Ambrosio L, Centis R, Sotgiu G, Tiberi S, Alffenaar JW, Maryandyshev A, Belilovski E, Ganatra S, Skrahina A, Akkerman O, Aleksa A, Amale R, Artsukevich J, Bruchfeld J, Caminero JA, Carpena Martinez I, Codecasa L, Dalcolmo M, Denholm J, Douglas P, Duarte R, Esmail A, Fadul M, Filippov A, Davies Forsman L, Gaga M, Garcia-Fuertes JA, García-García JM, Gualano G, Jonsson J, Kunst H, Lau JS, Lazaro Mastrapa B, Teran Troya JL, Manga S, Manika K, González Montaner P, Mullerpattan J, Oelofse S, Ortelli M, Palmero DJ, Palmieri F, Papalia A, Papavasileiou A, Payen MC, Pontali E, Robalo Cordeiro C, Saderi L, Sadutshang TD, Sanukevich T, Solodovnikova V, Spanevello A, Topgyal S, Toscanini F, Tramontana AR, Udwadia ZF, Viggiani P, White V, Zumla A, Migliori GB. Effectiveness and safety of bedaquiline-containing regimens in the treatment of MDR- and XDR-TB: a multicentre study. Eur Respir J 2017; 49:49/5/1700387. [PMID: 28529205 DOI: 10.1183/13993003.00387-2017] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/16/2017] [Indexed: 11/05/2022]
Abstract
Large studies on bedaquiline used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) are lacking. This study aimed to evaluate the safety and effectiveness of bedaquiline-containing regimens in a large, retrospective, observational study conducted in 25 centres and 15 countries in five continents.428 culture-confirmed MDR-TB cases were analysed (61.5% male; 22.1% HIV-positive, 45.6% XDR-TB). MDR-TB cases were admitted to hospital for a median (interquartile range (IQR)) 179 (92-280) days and exposed to bedaquiline for 168 (86-180) days. Treatment regimens included, among others, linezolid, moxifloxacin, clofazimine and carbapenems (82.0%, 58.4%, 52.6% and 15.3% of cases, respectively).Sputum smear and culture conversion rates in MDR-TB cases were 63.6% and 30.1%, respectively at 30 days, 81.1% and 56.7%, respectively at 60 days; 85.5% and 80.5%, respectively at 90 days and 88.7% and 91.2%, respectively at the end of treatment. The median (IQR) time to smear and culture conversion was 34 (30-60) days and 60 (33-90) days. Out of 247 culture-confirmed MDR-TB cases completing treatment, 71.3% achieved success (62.4% cured; 8.9% completed treatment), 13.4% died, 7.3% defaulted and 7.7% failed. Bedaquiline was interrupted due to adverse events in 5.8% of cases. A single case died, having electrocardiographic abnormalities that were probably non-bedaquiline related.Bedaquiline-containing regimens achieved high conversion and success rates under different nonexperimental conditions.
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Affiliation(s)
- Sergey E Borisov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.,These authors contributed equally
| | - Keertan Dheda
- UCT Lung Institute, Division of Pulmonology, University of Cape Town, Cape Town, South Africa.,These authors contributed equally
| | - Martin Enwerem
- Amity Health Consortium, Country Club Estate, Johannesburg, South Africa.,These authors contributed equally
| | - Rodolfo Romero Leyet
- Clinical Unit, District Clinical Specialist Team, Springbok, South Africa.,These authors contributed equally
| | - Lia D'Ambrosio
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.,Public Health Consulting Group, Lugano, Switzerland.,These authors contributed equally
| | - Rosella Centis
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.,These authors contributed equally
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy.,These authors contributed equally
| | - Simon Tiberi
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,These authors contributed equally
| | - Jan-Willem Alffenaar
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.,These authors contributed equally
| | - Andrey Maryandyshev
- Northern State Medical University, Arkhangelsk, Russian Federation.,These authors contributed equally
| | - Evgeny Belilovski
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.,These authors contributed equally
| | - Shashank Ganatra
- Dept of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.,These authors contributed equally
| | - Alena Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.,These authors contributed equally
| | - Onno Akkerman
- University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
| | - Alena Aleksa
- Dept of Phthisiology, Grodno State Medical University, GRCC "Phthisiology", Grodno, Belarus
| | - Rohit Amale
- Dept of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India
| | - Janina Artsukevich
- Dept of Phthisiology, Grodno State Medical University, GRCC "Phthisiology", Grodno, Belarus
| | - Judith Bruchfeld
- Unit of Infectious Diseases, Dept of Medicine, Solna, Karolinska Institute, Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jose A Caminero
- Pneumology Dept, Hospital General de Gran Canaria "Dr Negrin", Las Palmas de Gran Canaria, Spain.,MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France
| | | | - Luigi Codecasa
- TB Reference Centre, Villa Marelli Institute/Niguarda Hospital, Milan, Italy
| | | | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Dept of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Paul Douglas
- Health Policy and Performance Branch, Health Services and Policy Division, Dept of Immigration and Border Protection, Sydney, Australia
| | - Raquel Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Dept of Pneumology, Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Aliasgar Esmail
- UCT Lung Institute, Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Mohammed Fadul
- UCT Lung Institute, Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Alexey Filippov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - Lina Davies Forsman
- Unit of Infectious Diseases, Dept of Medicine, Solna, Karolinska Institute, Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital, Athens, Greece
| | | | | | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Jerker Jonsson
- National TB Surveillance Unit, Public Health Agency, Stockholm, Sweden
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jillian S Lau
- Dept of Infectious Diseases, Box Hill Hospital, Victoria, Australia
| | | | | | - Selene Manga
- Dept of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Perù
| | - Katerina Manika
- Pulmonary Dept, 'G. Papanikolaou' Hospital, Aristotle University, Thessaloniki, Greece
| | | | - Jai Mullerpattan
- Dept of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India
| | - Suzette Oelofse
- UCT Lung Institute, Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Antonella Papalia
- AOVV Eugenio Morelli Hospital, Reference Hospital for MDR and HIV-TB, Sondalo, Italy
| | | | - Marie-Christine Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Tatsiana Sanukevich
- Dept of Phthisiology, Grodno State Medical University, GRCC "Phthisiology", Grodno, Belarus
| | - Varvara Solodovnikova
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Antonio Spanevello
- Pneumology Dept, Maugeri Care and Research Institute, Tradate, Italy.,Dept of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | | | - Federica Toscanini
- University Hospital San Martino, Care and Research Institute, National Institute for Cancer Research, Genoa, Italy
| | | | - Zarir Farokh Udwadia
- Dept of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India
| | - Pietro Viggiani
- AOVV Eugenio Morelli Hospital, Reference Hospital for MDR and HIV-TB, Sondalo, Italy
| | - Veronica White
- Dept of Respiratory Medicine, Barts Healthcare NHS Trust, London, UK
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy .,These authors contributed equally
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Globan M, Lavender C, Leslie D, Brown L, Denholm J, Raios K, Sievers A, Kelly H, Fyfe J. Molecular epidemiology of tuberculosis in Victoria, Australia, reveals low level of transmission. Int J Tuberc Lung Dis 2017; 20:652-8. [PMID: 27084820 DOI: 10.5588/ijtld.15.0437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Victoria, Australia. OBJECTIVE To measure the level of Mycobacterium tuberculosis transmission in Victoria. DESIGN Retrospective analysis of mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) typing profiles from all first M. tuberculosis complex (MTC) isolates obtained from patients residing in Victoria from 2003 to 2010 was performed. State TB reference laboratory records were matched with Department of Health notification records to obtain further laboratory, demographic, contact investigation, clinical and treatment data. These data were used to assign patients to one of four categories: 1) no epidemiological link, 2) possible link, 3) likely transmission event and 4) laboratory contamination. RESULTS A total of 2377 MTC isolates were genotyped using 15-locus MIRU-VNTR. Of the 2298 M. tuberculosis isolates, 1029 (44.8%) had unique genotypic profiles and were considered epidemiologically unrelated, while 1269 (55.2%) isolates shared a profile with one or more other strains, defined as a genotypic cluster. Systematic investigation of all 268 genotypic clusters, including 24-locus MIRU-VNTR on selected isolates, led to a further 862 patients being classified as unrelated, bringing the total number of patients with no epidemiological links to 1891 (82.3%). Of the remaining patients, 294 (12.8%) were classified as having possible epidemiological links, 96 (4.2%) were classified as having known epidemiological links representing likely transmission events and 17 (0.7%) as the result of laboratory cross-contamination. CONCLUSIONS There is considerable genotypic diversity among Victorian MTC isolates, and the level of transmission is low.
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Affiliation(s)
- M Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory (VIDRL), Canberra, Australia
| | - C Lavender
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory (VIDRL), Canberra, Australia
| | - D Leslie
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory (VIDRL), Canberra, Australia
| | - L Brown
- Victorian Tuberculosis Program, Melbourne Health, Doherty Institute, Melbourne, Australia
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Doherty Institute, Melbourne, Department of Microbiology and Immunology, University of Melbourne, Parkville, Australia
| | - K Raios
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory (VIDRL), Canberra, Australia
| | - A Sievers
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory (VIDRL), Canberra, Australia
| | - H Kelly
- Epidemiology Unit, VIDRL, Doherty Institute, Melbourne, Victoria, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - J Fyfe
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory (VIDRL), Canberra, Australia
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48
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Denholm J, Coulter C, Bastian I. Defining a tuberculosis cluster or outbreak. Commun Dis Intell (2018) 2016; 40:E356-E359. [PMID: 28278410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Justin Denholm
- Medical Director, Victorian Tuberculosis Program, Melbourne Health, Melbourne, Vicotria
| | - Chris Coulter
- Medical Advisor, Tuberculosis, Communicable Diseases Unit, Chief Health Officer Branch, Queensland Health, Fortitude Valley, Queensland
| | - Ivan Bastian
- Clinical Microbiology Consultant, SA Pathology, Adelaide, South Australia
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49
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Affiliation(s)
- Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia, Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia and
| | - Irani Thevarajan
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
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50
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Andrew EC, Gibney KB, Denholm J, Leder K. Seroprotection to vaccine-preventable diseases among workers at a Victorian tertiary hospital. Aust N Z J Public Health 2016; 40:284-9. [PMID: 27027875 DOI: 10.1111/1753-6405.12508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/01/2015] [Accepted: 11/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine seroprotection for the vaccine-preventable diseases (VPDs) measles, mumps, rubella, varicella and hepatitis B among new employees seen at a Victorian tertiary hospital staff clinic. METHODS Employees who presented to the staff clinic for immunisation assessment between 1 January 2012 and 31 December 2013 were included. Demographic data, self-reported disease history and previous vaccination status were reviewed retrospectively to determine impact on serological results. RESULTS A total of 1,901 new employees were included, 83% of whom were at risk of direct contact with blood or body substances. Overall, the proportion of workers seropositive to measles was 88%, mumps 90%, rubella 78%, varicella 93% and hepatitis B 80%. Staff born before 1966 were more likely to have positive measles or mumps serology but negative rubella or hepatitis B serology (p<0.05 for each). Staff who self-reported measles (99% vs. 93%, p=0.03) or varicella infection (98% vs. 92%, p<0.001) were more likely to be seropositive, but those reporting previous vaccination to measles, mumps or rubella were no more likely to be seropositive. CONCLUSIONS AND IMPLICATIONS This study demonstrated levels of seropositivity of 78-93% for the five VPDs. Despite recognised limitations of serological testing, 10-20% of new employees to a healthcare institution lacking seroprotection represents a potentially unacceptable risk of nosocomial transmission of these VPDs. Our findings support ongoing serological testing of new healthcare staff at risk of direct contact with blood or body substances.
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Affiliation(s)
- Eden C Andrew
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Victoria
| | - Katherine B Gibney
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Victoria.,Department of Epidemiology and Preventive Medicine, Monash University, Victoria
| | - Justin Denholm
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Victoria.,Department of Microbiology and Immunology, University of Melbourne, Victoria
| | - Karin Leder
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Victoria.,Department of Epidemiology and Preventive Medicine, Monash University, Victoria
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