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Nababan B, Triasih R, Chan G, Dwihardiani B, Hidayat A, Dewi SC, Unwanah L, Mustofa A, du Cros P. The Yield of Active Tuberculosis Disease and Latent Tuberculosis Infection in Tuberculosis Household Contacts Investigated Using Chest X-ray in Yogyakarta Province, Indonesia. Trop Med Infect Dis 2024; 9:34. [PMID: 38393123 PMCID: PMC10891579 DOI: 10.3390/tropicalmed9020034] [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: 09/27/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
In Indonesia, the implementation of tuberculosis (TB) contact investigation is limited, with low detection rates. We report the yield of and risk factors for TB disease and infection for household contacts (HHCs) investigated using chest X-ray (CXR) screening. We identified HHCs aged five years and above of bacteriologically confirmed index cases from 2018 to 2022 in Yogyakarta City and Kulon Progo. All HHCs were offered screening for TB symptoms; TB infection testing with either tuberculin skin testing or interferon gamma release assay; and referral for CXR. Sputum from those with symptoms or CXR suggestive of TB was tested with Xpert MTB/RIF. Risk factors for active TB disease and latent TB infection (LTBI) were identified by logistic regression models. We screened 2857 HHCs for TB between June 2020 and December 2022, with 68 (2.4%) diagnosed with active TB. Of 2621 HHCs eligible for LTBI investigation, 1083 (45.7%) were diagnosed with LTBI. The factors associated with active TB were age, being underweight, diabetes mellitus, urban living, and sleeping in the same house as an index case. Factors associated with LTBI were increasing age and male gender. Conclusions: Screening for HHC including CXR and TST/IGRA yielded a moderate prevalence of TB disease and infection.
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Affiliation(s)
- Betty Nababan
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman, Yogyakarta 55281, Indonesia
| | - Rina Triasih
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman, Yogyakarta 55281, Indonesia
- Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Dr. Sardjito Hospital, Sleman, Yogyakarta 55281, Indonesia
| | - Geoffrey Chan
- TB Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Bintari Dwihardiani
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman, Yogyakarta 55281, Indonesia
| | - Arif Hidayat
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Sleman, Yogyakarta 55281, Indonesia
| | - Setyogati C. Dewi
- Yogyakarta City Health Office, Yogyakarta, Yogyakarta 55165, Indonesia
| | - Lana Unwanah
- Yogyakarta City Health Office, Yogyakarta, Yogyakarta 55165, Indonesia
| | - Arif Mustofa
- Kulon Progo District Health Office, Yogyakarta, Yogyakarta 55165, Indonesia
| | - Philipp du Cros
- TB Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, VIC 3004, Australia
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Samudyatha UC, Soundappan K, Ramaswamy G, Mehta K, Kumar C, Jagadeesh M, Prasanna Kamath BT, Singla N, Thekkur P. Outcomes and Challenges in the Programmatic Implementation of Tuberculosis Preventive Therapy among Household Contacts of Pulmonary TB Patients: A Mixed-Methods Study from a Rural District of Karnataka, India. Trop Med Infect Dis 2023; 8:512. [PMID: 38133444 PMCID: PMC10748199 DOI: 10.3390/tropicalmed8120512] [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: 10/25/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
The National TB Elimination Programme (NTEP) of India is implementing tuberculosis preventive treatment (TPT) for all household contacts (HHCs) of pulmonary tuberculosis patients (index patients) aged <5 years and those HHCs aged >5 years with TB infection (TBI). We conducted an explanatory mixed-methods study among index patients registered in the Kolar district, Karnataka during April-December 2022, to assess the TPT cascade and explore the early implementation challenges for TPT provision. Of the 301 index patients, contact tracing home visits were made in 247 (82.1%) instances; a major challenge was index patients' resistance to home visits fearing stigma, especially among those receiving care from the private sector. Of the 838 HHCs, 765 (91.3%) were screened for TB; the challenges included a lack of clarity on HHC definition and the non-availability of HHCs during house visits. Only 400 (57.8%) of the 692 eligible HHCs underwent an IGRA test for TBI; the challenges included a shortage of IGRA testing logistics and the perceived low risk among HHCs. As HHCs were unaware of their IGRA results, a number of HHCs actually eligible for TPT could not be determined. Among the 83 HHCs advised of the TPT, 81 (98%) initiated treatment, of whom 63 (77%) completed treatment. Though TPT initiation and completion rates are appreciable, the NTEP needs to urgently address the challenges in contact identification and IGRA testing.
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Affiliation(s)
- U. C. Samudyatha
- Department of Community Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar 563101, India;
| | - Kathirvel Soundappan
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Gomathi Ramaswamy
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad 508126, India;
| | - Kedar Mehta
- Department of Community Medicine, GMERS Medical College, Gotri, Vadodara 390021, India;
| | - Chandan Kumar
- District Health Office, Kolar 536101, India; (C.K.); (M.J.)
| | - M. Jagadeesh
- District Health Office, Kolar 536101, India; (C.K.); (M.J.)
| | - B. T. Prasanna Kamath
- Department of Community Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar 563101, India;
| | - Neeta Singla
- National Institute for Tuberculosis Research and Respiratory Diseases, New Delhi 110030, India;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France;
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Diel R, Nienhaus A. Risk of tuberculosis transmission by healthcare workers to children - a comprehensive review. GMS Hyg Infect Control 2023; 18:Doc26. [PMID: 38025892 PMCID: PMC10665709 DOI: 10.3205/dgkh000452] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background Children <15 years are at elevated risk of becoming infected with M. tuberculosis complex (Mtbc). Objective To assess the magnitude of Mtbc transmission by healthcare workers (HCW) to children. Methods Medline, Google Scholar and Cochrane library were searched to select primary studies in which HCW was the presumed index case and exposed infants and children aged below 15 years were screened for latent TB infection (LTBI). Results Of 4,702 abstracts, 19 original case reports covering one HCW each as presumed source case of Mtbc transmission to children, were identified. In sum, 11,511 children, of those 5,881 infants (51.1%), mostly in newborn nurseries, were considered contact persons and underwent tuberculin skin (TST) or Interferon gamma release assay (IGRA) testing. Test positivity was reported in 492/11,511 children (4.3%) coming from 14 studies. When test results considered falsely positive were excluded, the number of latently infected children decreased to 365/10,171 (3.6%). In all studies, the presumed duration of infectivity of the source case was, but the actual intensity and duration of exposure were not, decisive for the initiation of contact investigations. In only two of the studies, the contact time of the children towards the corresponding source case was estimated. Conclusions The results of our review suggest that the risk of Mtbc transmission from HCW to children in healthcare setting is considerably lower than reported in household settings. However, as the preselection of pediatric contacts appeared in most cases to be vague, the data found in the literature probably underestimates the actual risk.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
- LungClinic Großhansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Albert Nienhaus
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
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Palomares Velosa JE, Figueroa Gómez JE, Rojas Zúñiga CN, Díaz G, Ferro BE, Davis JL, Grau LE. Exploring stakeholders perspectives on TB contact investigation in Cali, Colombia: a qualitative study. Front Public Health 2023; 11:1204862. [PMID: 37564424 PMCID: PMC10411903 DOI: 10.3389/fpubh.2023.1204862] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Contact investigation is a proven intervention for tuberculosis (TB) case finding and prevention. Although widely endorsed by national public health authorities and the World Health Organization, many countries struggle to implement it effectively. The objective of the study is to describe and characterize the barriers and facilitators of TB contact investigation in Cali, Colombia from the perspective and experience of the key stakeholders involved. Methods We collected data from group discussions during two workshop sessions with clinic and public health staff involved in TB contact investigation (June 2019 and March 2020 respectively) and semi-structured interviews with TB cases and their household contacts (July 2019 to April 2020). We undertook an inductive thematic analysis with the RADaR technique to characterize the barriers and facilitators of the TB contact investigation process. Results The two workshops included 21 clinics and 12 public health staff. We also conducted 26 semi-structured interviews with TB cases and their household contacts. Using thematic analysis, we identified four common themes: Healthcare Operations, Essential Knowledge, Time Limitations and Competing Responsibilities, and Interpersonal Interactions. The main barriers to conducting household visits were low data quality, stigma and mistrust, safety concerns for health workers, and limited resources. The main barriers to TB uptake by contacts were competing responsibilities, low TB risk perceptions among contacts, and difficulty accessing diagnostic tests for contacts. In contrast, good communication and social skills among health workers and accurate TB knowledge facilitated successful household visits and TB test uptake, according to key stakeholders. Conclusion This study provides a deeper understanding of TB contact investigation barriers and facilitators in a high-prevalence urban setting in a middle-income country from the perspective and experience of key stakeholders. The study shed light on the barriers that hinder household contacts engagement and TB test uptake such as issues of systemic capacity and TB knowledge. Also, highlighted facilitators such as the importance of interpersonal communication skills among health workers in the public and private sector. The insights from this study can serve as a valuable resource for public health organizations seeking to enhance their contact investigation efforts and improve TB control in similar settings.
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Affiliation(s)
- Jairo E. Palomares Velosa
- Centro Internacional de Entrenamiento e Investigaciones Médicas – CIDEIM, Cali, Valle del Cauca, Colombia
- Universidad Icesi, Cali, Valle del Cauca, Colombia
| | | | | | - Gustavo Díaz
- Centro Internacional de Entrenamiento e Investigaciones Médicas – CIDEIM, Cali, Valle del Cauca, Colombia
- Universidad Icesi, Cali, Valle del Cauca, Colombia
| | - Beatriz E. Ferro
- Departamento de Ciencias Básicas Médicas, Universidad Icesi, Cali, Valle del Cauca, Colombia
| | - J. Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
- Pulmonary Critical Care and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, United States
| | - Lauretta E. Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Katamba A, Gupta AJ, Turimumahoro P, Ochom E, Ggita JM, Nakasendwa S, Nanziri L, Musinguzi J, Hennein R, Sekadde M, Hanrahan C, Byaruhanga R, Yoeli E, Turyahabwe S, Cattamanchi A, Dowdy DW, Haberer JE, Armstrong-Hough M, Kiwanuka N, Davis JL. A user-centred implementation strategy for tuberculosis contact investigation in Uganda: Protocol for a stepped-wedge, cluster-randomised trial. Res Sq 2023:rs.3.rs-3121275. [PMID: 37461631 PMCID: PMC10350172 DOI: 10.21203/rs.3.rs-3121275/v1] [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] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Background Tuberculosis (TB) is among the leading causes of infectious death worldwide. Contact investigation is an evidence-based, World Health Organisation-endorsed intervention for timely TB diagnosis, treatment, and prevention but has not been widely and effectively implemented. Methods We are conducting a stepped-wedge, cluster-randomised, hybrid Type III implementation-effectiveness trial comparing a user-centred to a standard strategy for implementing TB contact investigation in 12 healthcare facilities in Uganda. The user-centred strategy consists of several client-focused components including 1) a TB-education booklet, 2) a contact-identification algorithm, 3) an instructional sputum-collection video, and 4) a community-health-rider service to transport clients, CHWs, and sputum samples, along with several healthcare-worker-focused components, including 1) collaborative improvement meetings, 2) regular audit-and-feedback reports, and 3) a digital group-chat application designed to develop a community of practice. Sites will cross from the standard to the user-centred strategy in six, eight-week transition steps following a randomly determined site-pairing scheme and timeline. The primary implementation outcome is the proportion of symptomatic close contacts completing TB evaluation within 60 days of TB treatment initiation by the index person with TB. The primary clinical effectiveness outcomes are the proportion of contacts diagnosed with and initiating active TB disease treatment and the proportion initiating TB preventative therapy within 60 days. We will assess outcomes from routine source documents using intention-to-treat analyses. We will also conduct nested mixed-methods studies of implementation fidelity and context and perform cost-effectiveness and impact modelling. The Makerere School of Public Health IRB (#554), the Uganda National Council for Science and Technology (#HS1720ES), and the Yale Institutional Review Board (#2000023199) approved the study with a waiver of informed consent for the main trial implementation-effectiveness outcomes. We will submit trial results for publication in a peer-reviewed journal and disseminate findings to local shareholders, including policymakers and representatives of affected communities. Discussion This pragmatic, quasi-experimental implementation trial will inform efforts to find and prevent undiagnosed persons with TB in high-burden setting using contact investigation. It will help assess the suitability of human-centred design and communities of practice for tailoring implementation strategies and sustain evidence-based interventions in low-and-middle-income countries. Trial registration number ClinicalTrials.gov Identifier: NCT05640648.
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Affiliation(s)
| | | | | | | | | | | | - Leah Nanziri
- Uganda Tuberculosis Implementation Research Consortium
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Kadyrov M, Thekkur P, Geliukh E, Sargsyan A, Goncharova O, Kulzhabaeva A, Kadyrov A, Khogali M, Harries AD, Kadyrov A. Contact Tracing and Tuberculosis Preventive Therapy for Household Child Contacts of Pulmonary Tuberculosis Patients in the Kyrgyz Republic: How Well Are We Doing? Trop Med Infect Dis 2023; 8:332. [PMID: 37505628 PMCID: PMC10386269 DOI: 10.3390/tropicalmed8070332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/21/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Early identification, screening and investigation for tuberculosis (TB), and provision of TB preventive therapy (TPT), reduces risk of TB among child household contacts of pulmonary TB patients (index patients). A cohort study was conducted to describe the care cascade and timeliness of contact tracing and TPT initiation among child household contacts (aged < 15 years) of index patients initiated on TB treatment in Bishkek, the Kyrgyz Republic during October 2021-September 2022. In the register, information on the number of child household contacts was available for 153 (18%) of 873 index patients. Of 297 child household contacts identified, data were available for 285, of whom 261 (92%) were screened for TB. More than 50% were screened after 1 month of the index patient initiating TB treatment. TB was diagnosed in 23/285 (9%, 95% CI: 6-13%) children. Of 238 TB-free children, 130 (55%) were eligible for TPT. Of the latter, 64 (49%) were initiated on TPT, of whom 52 (81%) completed TPT. While TPT completion was excellent, there was deficiency in contact identification, timely screening and TPT initiation. Thus, healthcare providers should diligently request and record details of child household contacts, adhere to contact tracing timelines and counsel caregivers regarding TPT.
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Affiliation(s)
- Meder Kadyrov
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France
| | - Evgenia Geliukh
- International Charitable Foundation "Alliance for Public Health", 01601 Kiev, Ukraine
| | - Aelita Sargsyan
- Tuberculosis Research and Prevention Centre (TBRPC), Yerevan 0014, Armenia
| | - Olga Goncharova
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
| | | | - Asel Kadyrov
- Primary Healthcare Centre #1, Bishkek 720000, Kyrgyzstan
| | - Mohammed Khogali
- Institute of Public Health (IPH), College of Medicine and health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 15551, United Arab Emirates
| | - Anthony D Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Abdullaat Kadyrov
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
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Hanrahan CF, Nonyane BAS, Lebina L, Mmolawa L, Siwelana T, West NS, Albaugh N, Martinson N, Dowdy DW. Household- Versus Incentive-Based Contact Investigation for Tuberculosis in Rural South Africa: A Cluster-Randomized Trial. Clin Infect Dis 2023; 76:1164-1172. [PMID: 36458857 PMCID: PMC10319771 DOI: 10.1093/cid/ciac920] [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: 05/17/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Household contact investigation for people newly diagnosed with tuberculosis (TB) is poorly implemented, particularly in low- and middle-income countries. Conditional cash incentives may improve uptake. METHODS We conducted a pragmatic, cluster-randomized, crossover trial of 2 TB contact investigation approaches (household-based and incentive-based) in 28 public primary care clinics in South Africa. Each clinic used 1 approach for 18 months, followed by a 6-month washout period, after which the opposite approach was used. Fourteen clinics were randomized to each approach. In the household-based arm, we conducted TB screening and testing of contacts at the household. In the incentive-based arm, both index patients and ≤10 of their close contacts (either within or outside the household) were given small cash incentives for presenting to study clinics for TB screening. The primary outcome was the number of people with incident TB who were diagnosed and started on treatment at study clinics. RESULTS From July 2016 to January 2020, we randomized 28 clinics to each study arm, and enrolled 782 index TB patients and 1882 contacts in the household-based arm and 780 index patients and 1940 contacts in the incentive-based arm. A total of 1413 individuals started on TB treatment in the household-based arm and 1510 in the incentive-based arm. The adjusted incidence rate ratio of TB treatment initiation in the incentive- versus household-based arms was 1.05 (95% confidence interval: .97-1.13). CONCLUSIONS Incentive-based contact investigation for TB has similar effectiveness to traditional household-based approaches and may be a viable alternative or complementary approach to household-based investigation.
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Affiliation(s)
- Colleen F Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bareng Aletta Sanny Nonyane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lesego Mmolawa
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, South Africa
| | - Tsundzukani Siwelana
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, South Africa
| | - Nora S West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas Albaugh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neil Martinson
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, South Africa
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lee I, Kang S, Chin B, Joh JS, Jeong I, Kim J, Kim J, Lee JY. Predictive Factors and Clinical Impacts of Delayed Isolation of Tuberculosis during Hospital Admission. J Clin Med 2023; 12:jcm12041361. [PMID: 36835896 PMCID: PMC9966369 DOI: 10.3390/jcm12041361] [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: 01/05/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Delayed isolation of tuberculosis (TB) can cause unexpected exposure of healthcare workers (HCWs). This study identified the predictive factors and clinical impact of delayed isolation. We retrospectively reviewed the electronic medical records of index patients and HCWs who underwent contact investigation after TB exposure during hospitalization at the National Medical Center, between January 2018 and July 2021. Among the 25 index patients, 23 (92.0%) were diagnosed with TB based on the molecular assay, and 18 (72.0%) had a negative acid-fast bacilli smear. Sixteen (64.0%) patients were hospitalized via the emergency room, and 18 (72.0%) were admitted to a non-pulmonology/infectious disease department. According to the patterns of delayed isolation, patients were classified into five categories. Among 157 close-contact events in 125 HCWs, 75 (47.8%) occurred in Category A. Twenty-five (20%) HCWs had multiple TB exposures (n = 57 events), of whom 37 (64.9%) belonged to Category A (missed during emergency situations). After contact tracing, latent TB infection was diagnosed in one (1.2%) HCW in Category A, who was exposed during intubation. Delayed isolation and TB exposure mostly occurred during pre-admission in emergency situations. Effective TB screening and infection control are necessary to protect HCWs, especially those who routinely contact new patients in high-risk departments.
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Affiliation(s)
- Inhan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Soyoung Kang
- Department of Infection Control and Prevention, National Medical Center, Seoul 04564, Republic of Korea
| | - Bumsik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Joon-Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Ina Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Junghyun Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea
| | - Joohae Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Ji Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
- Correspondence:
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Paudel K, Nalutaaya A, Robsky KO, Kitonsa PJ, Nakasolya O, Mukiibi J, Isooba D, Kendall EA, Katamba A, Dowdy D. The impact of time at home on potential yield of home-based TB contact investigation. Int J Tuberc Lung Dis 2023; 27:121-127. [PMID: 36853106 PMCID: PMC9989504 DOI: 10.5588/ijtld.22.0394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND: The yield of TB contact tracing is often limited by challenges in reaching individuals during the screening process. We investigated the times at which index patients and household contacts were typically at home and the potential effects of expanding the timing of home-based contact investigation.METHODS: Index patients and household contacts in Kampala, Uganda, were asked about their likely availability at different day/time combinations. We calculated the "participant identification gap" (defined as the proportion of participants who reported being home <50% of the time) during business hours only. We then estimated the incremental reduction in the participant identification gap if hours were expanded to include weekday evenings, Saturdays, and Sundays. Statistical significance was assessed using McNemar´s tests.RESULTS: Nearly half of eligible individuals (42% of index patients and 52% of contacts) were not likely to be home during contact investigation conducted only during business hours. Expanding to weekday evenings, Saturdays, and Sundays would reduce this participant identification gap to 15% among index patients and 18% among contacts - while also reducing differences by sex and employment.CONCLUSIONS: Expanding hours for conducting contact investigation or other home-based health interventions could substantially reduce the number of individuals missed and address disparities in access to care.
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Affiliation(s)
- K Paudel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Nalutaaya
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - K O Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - P J Kitonsa
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - O Nakasolya
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - J Mukiibi
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Isooba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - E A Kendall
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda, Division of Infectious Diseases Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda, Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - D Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
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Li R, Deutsch-Feldman M, Adams T, Law M, Biak C, Pitcher E, Drees M, Hernandez-Romieu AC, Filardo TD, Cropper T, Martinez A, Wilson WW, Althomsons SP, Morris SB, Wortham JM, Benowitz I, Schwartz NG, White K, Haddad MB, Glowicz JB. Transmission of Mycobacterium tuberculosis to healthcare personnel resulting from contaminated bone graft material, United States, June 2021- August 2022. Clin Infect Dis 2023; 76:1847-1849. [PMID: 36660866 DOI: 10.1093/cid/ciad029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
A nationwide tuberculosis outbreak linked to a viable bone allograft product contaminated with Mycobacterium tuberculosis was identified in June 2021. Our subsequent investigation identified 73 healthcare personnel with new latent tuberculosis infection following exposure to the contaminated product, product recipients, surgical instruments, or medical waste.
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Affiliation(s)
- Ruoran Li
- Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Molly Deutsch-Feldman
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Chinpar Biak
- Indiana Department of Health, Indianapolis, IN, USA
| | - Erika Pitcher
- Allen County Department of Health, Fort Wayne, IN, USA
| | | | - Alfonso C Hernandez-Romieu
- Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas D Filardo
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tracina Cropper
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angelica Martinez
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Wyatt Wilson
- Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandy P Althomsons
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sapna Bamrah Morris
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan M Wortham
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Isaac Benowitz
- Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Noah G Schwartz
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kelly White
- Indiana Department of Health, Indianapolis, IN, USA
| | - Maryam B Haddad
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet B Glowicz
- Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Koura KG, Mbitikon OB, Fiogbé AA, Ouédraogo AR, Kuate Kuate A, Magassouba AS, Soumana A, Hermana G, Gning B, Dogo MF, Andefa M, Badoum G. Programmatic Implementation of Contact Investigation in Eight African Countries. Trop Med Infect Dis 2022; 8. [PMID: 36668936 DOI: 10.3390/tropicalmed8010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
The objective was to implement CI under national tuberculosis programmatic conditions and to advocate for its scaling up. Contact investigation was implemented in 150 Basic Management Units identified across eight countries. The target populations (children <5 years and persons living with HIV (PLHIV)) were evaluated during home and clinic visits using standardized tools, clinical examinations and, according to each country, additional tests. Contacts with active TB received TB treatment and those eligible received TB preventive therapy (TPT). Data were collected each quarter using standardized forms. Meetings were organized with partners to share preliminary results and advocate for scaling up. From October 2020 to December 2021, 9049 home visits were performed. The proportions of children <5 years and PLHIV who were screened and diagnosed with active TB were, respectively, 2.6% and 10.1%. Ninety-three percent of children <5 years and 98% of PLHIV living at home received TPT or TB treatment, respectively. The scale-up for contact investigation partially or at national level in 2022 was effective in six of the eight countries included in the project. These results indicate that CI is feasible under programmatic conditions within the National TB Programs of African countries.
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12
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Rahman MT, Malik AA, Amanullah F, Creswell J. Improving Tuberculosis Case Detection in Children: Summary of Innovations and Findings From 18 Countries. J Pediatric Infect Dis Soc 2022; 11:S117-S124. [PMID: 36103996 DOI: 10.1093/jpids/piac093] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite a growing focus on the plight of tuberculosis (TB) among children, 56% of the 1.2 million children who develop TB annually are not detected and notified. TB REACH is a platform of the Stop TB Partnership that supports innovative interventions to improve TB case detection and preventative treatment. We present summary findings from 27 TB REACH-supported projects in 18 countries. Interventions were designed around intensified case-finding approaches (facility-based systematic screening and contact investigation), capacity building (including decentralized care delivery and supported decision-making), and improving diagnostic methods (ie, introduction of alternative respiratory specimens and new tools to aid the diagnosis). These interventions were evaluated on how they worked to identify children with TB, prevent further transmission of TB among children, and strengthen the health system involved with childhood TB care. Overall, 13 715 children were detected with TB, improving case notifications by 34%. In addition, nearly 5000 eligible contacts were enrolled on TB preventive treatment through these interventions. Focusing efforts and funding on childhood TB can produce marked improvements in case detection.
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Affiliation(s)
- Md Toufiq Rahman
- Innovations & Grants Team, Stop TB Partnership, Geneva, Switzerland
| | - Amyn A Malik
- Yale Institute for Global Health, New Haven, Connecticut, USA.,Interactive Research and Development (IRD) Global, Singapore
| | | | - Jacob Creswell
- Innovations & Grants Team, Stop TB Partnership, Geneva, Switzerland
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13
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Ma HW, Lee HS, Ahn JY. Analysis of Factors Affecting the Rate of Latent Tuberculosis Infection and Management in Pediatrics. Children (Basel) 2022; 9. [PMID: 36291503 DOI: 10.3390/children9101567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
The incidence of tuberculosis remains high in South Korea; the management of latent tuberculosis infection (LTBI) has become the prime target for reducing the infection rate. The management of pediatric LTBI is especially crucial because children can serve as a long-term source of infection upon developing active tuberculosis. Therefore, it is important to assess pediatric LTBI using contact investigation and follow-up. We conducted a retrospective study on children aged between 0 and 18 years who visited our hospital for tuberculosis contact screening from February 2012 to February 2021. Tuberculosis index cases and their clinical characteristics were also reviewed retrospectively. A total of 350 children were investigated, and 68 of 247 (27.5%) were diagnosed with LTBI. The rate of LTBI (r = 7.98, p < 0.001) and the risk of loss to follow-up (r = 27.038, p < 0.001) were higher in cases with close household contact. Sputum (r = 10.992, p < 0.001) and positive acid-fast bacillus (AFB) stain (r = 4.458, p = 0.001) in tuberculosis index cases were related to the diagnosis of LTBI in pediatric contacts. Active management is needed for tuberculosis screening in pediatric contacts, especially when the contacts are older and the index case is within the family, and when the index case has sputum and has tested positive for AFB smear.
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14
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Armstrong-Hough M, Ggita J, Gupta AJ, Shelby T, Nangendo J, Ayen DO, Davis JL, Katamba A. Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation: protocol for a cluster-randomised trial. BMJ Open 2022; 12:e061508. [PMID: 35613785 PMCID: PMC9134160 DOI: 10.1136/bmjopen-2022-061508] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION HIV status awareness is important for household contacts of patients with tuberculosis (TB). Home HIV testing during TB contact investigation increases HIV status awareness. Social interactions during home visits may influence perceived stigma and uptake of HIV testing. We designed an intervention to normalise and facilitate uptake of home HIV testing with five components: guided selection of first tester; prosocial invitation scripts; opt-out framing; optional sharing of decisions to test; and masking of decisions not to test. METHODS AND ANALYSIS We will evaluate the intervention effect in a household-randomised controlled trial. The primary aim is to assess whether contacts offered HIV testing using the norming strategy will accept HIV testing more often than those offered testing using standard strategies. Approximately 198 households will be enrolled through three public health facilities in Kampala, Uganda. Households will be randomised to receive the norming or standard strategy and visited by a community health worker (CHW) assigned to that strategy. Eligible contacts ≥15 years will be offered optional, free, home HIV testing. The primary outcome, proportion of contacts accepting HIV testing, will be assessed by CHWs and analysed using an intention-to-treat approach. Secondary outcomes will be changes in perceived HIV stigma, changes in perceived TB stigma, effects of perceived HIV stigma on HIV test uptake, effects of perceived TB stigma on HIV test uptake and proportions of first-invited contacts who accept HIV testing. Results will inform new, scalable strategies for delivering HIV testing. ETHICS AND DISSEMINATION This study was approved by the Yale Human Investigation Committee (2000024852), Makerere University School of Public Health Institutional Review Board (661) and Uganda National Council on Science and Technology (HS2567). All participants, including patients and their household contacts, will provide verbal informed consent. Results will be submitted to a peer-reviewed journal and disseminated to national stakeholders, including policy-makers and representatives of affected communities. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT05124665.
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Affiliation(s)
- Mari Armstrong-Hough
- Departments of Social and Behavioral Sciences and Epidemiology, New York University, New YorkUSA
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Joseph Ggita
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Amanda J Gupta
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Epideimology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tyler Shelby
- Epideimology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Joanita Nangendo
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | | | - J L Davis
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Epideimology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevetion Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Clinical Epidemiology and Biostatistics Unit, Makerere University College of Health Sciences, Kampala, Kampala, Uganda
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15
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Vasiliu A, Salazar-Austin N, Trajman A, Lestari T, Mtetwa G, Bonnet M, Casenghi M. Child Contact Case Management-A Major Policy-Practice Gap in High-Burden Countries. Pathogens 2021; 11:1. [PMID: 35055949 DOI: 10.3390/pathogens11010001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 01/18/2023] Open
Abstract
The 2021 Global Tuberculosis (TB) report shows slow progress towards closing the pediatric TB detection gap and improving the TB preventive treatment (TPT) coverage among child and adolescent contacts. This review presents the current knowledge around contact case management (CCM) in low-resource settings, with a focus on child contacts, which represents a key priority population for CCM and TPT. Compelling evidence demonstrates that CCM interventions are a key gateway for both TB case finding and identification of those in need of TPT, and their yield and effectiveness should provide a strong rationale for prioritization by national TB programs. A growing body of evidence is now showing that innovative models of care focused on community-based and patient-centered approaches to household contact investigation can help narrow down the CCM implementation gaps that we are currently facing. The availability of shorter and child-friendly TPT regimens for child contacts provide an additional important opportunity to improve TPT acceptability and adherence. Prioritization of TB CCM implementation and adequate resource mobilization by ministries of health, donors and implementing agencies is needed to timely close the gap.
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16
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Bedingfield N, Barss L, Oxlade O, Menzies D, Fisher D. Experiences with latent TB cascade of care strengthening for household contacts in Calgary, Canada. Public Health Action 2021; 11:126-131. [PMID: 34567988 DOI: 10.5588/pha.20.0082] [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: 12/09/2020] [Accepted: 04/11/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Identification, assessment, and treatment of latent TB infection (LTBI), collectively known as the LTBI cascade of care, is critical for TB prevention. OBJECTIVE The objective of this research, conducted within the ACT4 trial, was to assess and strengthen the LTBI cascade of care for household contacts at Calgary TB Services, a clinic serving a predominately foreign-born population in Western Canada. DESIGN Baseline assessment consisted of a retrospective LTBI cascade analysis of 32 contact investigations, and questionnaires administered to patients and health care workers. Four solutions were implemented in response to identified gaps. Solution impact was measured for 6 months using descriptive statistics. RESULTS Pre-implementation, 56% of household contacts initiated treatment. Most contacts were lost to care because the tuberculin skin test (TST) was not initiated, or physicians did not recommend treatment. Evening clinics, a patient education pamphlet, a nursing workshop, and treatment recommendation guidelines were implemented. Post-implementation, losses due to LTBI treatment non-recommendation were reduced; however, the overall proportion of household contacts initiating treatment did not increase. CONCLUSION Close engagement between researchers and TB programmes can reduce losses in the LTBI cascade. To see sustained improvement in overall outcomes, long-term engagement and data collection for ongoing problem-solving are required.
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Affiliation(s)
- N Bedingfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary Foothills Campus, Health Sciences Centre, Calgary, AB, Canada
| | - L Barss
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Campus, Health Sciences Centre, Calgary, AB, Canada
| | - O Oxlade
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - D Menzies
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - D Fisher
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary Foothills Campus, Health Sciences Centre, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Campus, Health Sciences Centre, Calgary, AB, Canada
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17
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Malik AA, Gandhi NR, Lash TL, Cranmer LM, Omer SB, Ahmed JF, Siddiqui S, Amanullah F, Khan AJ, Keshavjee S, Hussain H, Becerra MC. Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan. Emerg Infect Dis 2021; 27:805-812. [PMID: 33624580 PMCID: PMC7920671 DOI: 10.3201/eid2703.203916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Fluoroquinolone-based preventive therapy reduced risk for tuberculosis disease by 65%. In Karachi, Pakistan, a South Asian megacity with a high prevalence of tuberculosis (TB) and low HIV prevalence, we assessed the effectiveness of fluoroquinolone-based preventive therapy for drug-resistant (DR) TB exposure. During February 2016–March 2017, high-risk household contacts of DR TB patients began a 6-month course of preventive therapy with a fluoroquinolone-based, 2-drug regimen. We assessed effectiveness in this cohort by comparing the rate and risk for TB disease over 2 years to the rates and risks reported in the literature. Of 172 participants, TB occurred in 2 persons over 336 person-years of observation. TB disease incidence rate observed in the cohort was 6.0/1,000 person-years. The incidence rate ratio ranged from 0.29 (95% CI 0.04–1.3) to 0.50 (95% CI 0.06–2.8), with a pooled estimate of 0.35 (95% CI 0.14–0.87). Overall, fluoroquinolone-based preventive therapy for DR TB exposure reduced risk for TB disease by 65%.
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18
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Chan G, Triasih R, Nababan B, du Cros P, Wilks N, Main S, Huang GKL, Lin D, Graham SM, Majumdar SS, Bakker M, Khan A, Khan FA, Dwihardiani B. Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia. Public Health Action 2021; 11:41-49. [PMID: 34159059 PMCID: PMC8202624 DOI: 10.5588/pha.20.0071] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.
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Affiliation(s)
- G Chan
- Burnet Institute, Melbourne, VIC, Australia
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - B Nababan
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P du Cros
- Burnet Institute, Melbourne, VIC, Australia
| | - N Wilks
- Burnet Institute, Melbourne, VIC, Australia
| | - S Main
- Burnet Institute, Melbourne, VIC, Australia
| | | | - D Lin
- Burnet Institute, Melbourne, VIC, Australia
| | - S M Graham
- Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S S Majumdar
- Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - M Bakker
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - A Khan
- STOP TB Partnership, Geneva, Switzerland
| | - F A Khan
- STOP TB Partnership, Geneva, Switzerland
| | - B Dwihardiani
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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19
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Moonan PK, Zetola NM, Tobias JL, Basotli J, Boyd R, Click ES, Dima M, Fane O, Finlay AM, Ogopotse M, Wen XJ, Modongo C, Oeltmann JE. A Neighbor-Based Approach to Identify Tuberculosis Exposure, the Kopanyo Study. Emerg Infect Dis 2021; 26:1010-1013. [PMID: 32310058 PMCID: PMC7181937 DOI: 10.3201/eid2605.191568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Contact investigation is one public health measure used to prevent tuberculosis by identifying and treating persons exposed to Mycobacterium tuberculosis. Contact investigations are a major tenet of global tuberculosis elimination efforts, but for many reasons remain ineffective. We describe a novel neighbor-based approach to reframe contact investigations.
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20
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Reichler MR, Khan A, Sterling TR, Zhao H, Chen B, Yuan Y, Moran J, McAuley J, Mangura B. Risk Factors for Tuberculosis and Effect of Preventive Therapy Among Close Contacts of Persons With Infectious Tuberculosis. Clin Infect Dis 2021; 70:1562-1572. [PMID: 31127813 DOI: 10.1093/cid/ciz438] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Close contacts of persons with pulmonary tuberculosis (TB) have high rates of TB disease. METHODS We prospectively enrolled TB patients and their close contacts at 9 US/Canadian sites. TB patients and contacts were interviewed to identify index patient, contact, and exposure risk factors for TB. Contacts were evaluated for latent TB infection (LTBI) and TB, and the effectiveness of LTBI treatment for preventing contact TB was examined. RESULTS Among 4490 close contacts, multivariable risk factors for TB were age ≤5 years, US/Canadian birth, human immunodeficiency virus infection, skin test induration ≥10 mm, shared bedroom with an index patient, exposure to more than 1 index patient, and index patient weight loss (P < .05 for each). Of 1406 skin test-positive contacts, TB developed in 49 (9.8%) of 446 who did not initiate treatment, 8 (1.8%) of 443 who received partial treatment, and 1 (0.2%) of 517 who completed treatment (1951, 290, and 31 cases/100 000 person-years, respectively; P < .001). TB was diagnosed in 4.2% of US/Canadian-born compared with 2.3% of foreign-born contacts (P = .002), and TB rates for US/Canadian-born and foreign-born contacts who did not initiate treatment were 3592 and 811 per 100 000 person-years, respectively (P < .001). CONCLUSIONS Treatment for LTBI was highly effective in preventing TB among close contacts of infectious TB patients. Several index patient, contact, and exposure characteristics associated with increased risk of contact TB were identified. These findings help inform contact investigation, LTBI treatment, and other public health prevention efforts.
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Affiliation(s)
- Mary R Reichler
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Awal Khan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Hui Zhao
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bin Chen
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yan Yuan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joyce Moran
- New York City Department of Health and Charles P. Felton Tuberculosis Center, New York
| | - James McAuley
- Respiratory Lung Association and Rush University, Chicago, Illinois
| | - Bonita Mangura
- New Jersey Medical School National Tuberculosis Center, Newark
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21
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Velen K, Nhung NV, Anh NT, Cuong PD, Hoa NB, Cuong NK, Dung NH, Sy DN, Britton WJ, Marks GB, Fox GJ. Risk factors for TB among household contacts of patients with smear-positive TB in eight provinces of Vietnam: a nested case-control study. Clin Infect Dis 2020; 73:e3358-e3364. [PMID: 33215197 DOI: 10.1093/cid/ciaa1742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to account for significant morbidity and mortality annually. Household contacts (HHCs) of persons with TB are a key population for targeting prevention and control interventions. We aimed to identify risk factors associated with developing TB among HHCs. METHODS We conducted a nested case-control study among HHCs in eight provinces in Vietnam who were enrolled in a randomized control trial of active case finding for TB. Cases were any HHCs diagnosed and registered with TB within the Vietnam National TB programme during two years of follow-up. Controls were selected by simple random sampling from the remaining HHCs. Risk factor data were collected at enrolment and during follow-up. A logistic regression model was developed to determine predictors of TB among HHCs. RESULTS We selected 1,254 HHCs for the analysis; 214 cases and 1,040 controls. Underlying characteristics varied between both groups; cases were older, more likely to be male, higher proportion of reported previous TB and diabetes. Risk factors associated with a TB diagnosis included being male (aOR 1.4; 95% CI: 1.03-2.0), residing in an urban setting (aOR 1.8; 1.3-2.5), prior TB (aOR 4.6; 95% CI: 2.5-8.7), history of diabetes (aOR 3.1; 95% CI: 1.7-5.8), current smoking (aOR 3.1; 95% CI: 2.2-4.4) and prolonged history of coughing in the source case at enrolment (OR 1.6; 95% CI: 1.1-2.3). CONCLUSIONS Household contacts remain and important key population for TB prevention and control. TB programmes should ensure effective contact investigations are implemented for household contacts, particularly those with additional risk factors for developing tuberculosis.
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Affiliation(s)
- Kavindhran Velen
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sydney, Australia
| | | | - Nguyen Thu Anh
- Woolcock Institute of Medical Research, Sydney, Australia
| | - Pham Duc Cuong
- Woolcock Institute of Medical Research, Sydney, Australia
| | - Nguyen Binh Hoa
- National Lung Hospital, Hanoi, Vietnam.,Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Nguyen Kim Cuong
- National Lung Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Warwick John Britton
- Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Sydney, Australia.,Department of Clinical Immunology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Guy Barrington Marks
- Woolcock Institute of Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Greg James Fox
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sydney, Australia
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22
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Li R, Nordio F, Huang CC, Contreras C, Calderon R, Yataco R, Galea JT, Zhang Z, Becerra MC, Lecca L, Murray MB. Two Clinical Prediction Tools to Improve Tuberculosis Contact Investigation. Clin Infect Dis 2020; 71:e338-e350. [PMID: 31905406 PMCID: PMC7643741 DOI: 10.1093/cid/ciz1221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Efficient contact investigation strategies are needed for the early diagnosis of tuberculosis (TB) disease and treatment of latent TB infections. METHODS Between September 2009 and August 2012, we conducted a prospective cohort study in Lima, Peru, in which we enrolled and followed 14 044 household contacts of adults with pulmonary TB. We used information from a subset of this cohort to derive 2 clinical prediction tools that identify contacts of TB patients at elevated risk of progressing to active disease by training multivariable models that predict (1) coprevalent TB among all household contacts and (2) 1-year incident TB among adult contacts. We validated the models in a geographically distinct subcohort and compared the relative utilities of clinical decisions based on these tools to existing strategies. RESULTS In our cohort, 296 (2.1%) household contacts had coprevalent TB and 145 (1.9%) adult contacts developed incident TB within 1 year of index patient diagnosis. We predicted coprevalent disease using information that could be readily obtained at the time an index patient was diagnosed and predicted 1-year incident TB by including additional contact-specific characteristics. The area under the receiver operating characteristic curves for coprevalent TB and incident TB were 0.86 (95% confidence interval [CI], .83-.89]) and 0.72 (95% CI, .67-.77), respectively. These clinical tools give 5%-10% higher relative utilities than existing methods. CONCLUSIONS We present 2 tools that identify household contacts at high risk for TB disease based on reportable information from patient and contacts alone. The performance of these tools is comparable to biomarkers that are both more costly and less feasible than this approach.
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Affiliation(s)
- Ruoran Li
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Francesco Nordio
- TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Chuan-Chin Huang
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | | | - Jerome T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Zibiao Zhang
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonid Lecca
- Socios En Salud, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Bennet R, Nejat S, Eriksson M. Foreign background and older age of children were associated with infection in Swedish tuberculosis contacts. Acta Paediatr 2020; 109:1854-1859. [PMID: 31991008 DOI: 10.1111/apa.15194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 12/12/2022]
Abstract
AIM We present our results using interferon-gamma release assays in any child <18 years or tuberculin skin tests in Bacille Calmette-Guérin unvaccinated children for tuberculosis contact investigation in Stockholm, Sweden. METHODS During 2000-2019, we investigated 892 children with a median age of seven years. We explored associations between TB infection and characteristics such as closeness to contact, age, sex, BCG status and foreign origin. RESULTS The overall rates were for TB infection 10.2% (n = 91) and for TB disease 1.1% (n = 10). In addition to infectiousness of index case and closeness of contact, foreign background, male sex and increasing age were independently associated with infection. In foreign-born children, the rates of tuberculosis infection and disease were 18.7% and 3.9%, respectively. In 18/46 (39%) infected foreign-born children, a baseline negative tuberculosis test supported a diagnosis of recent infection. CONCLUSION Foreign background, older age and male sex were associated with infection. In a significant proportion of infected children, a previous negative test made recent infection likely.
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Affiliation(s)
- Rutger Bennet
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
| | - Sahar Nejat
- Paediatric Public Health Department Sachs Children's Hospital Stockholm Sweden
| | - Margareta Eriksson
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
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24
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Barroso EG. Factors associated with household contacts' tuberculosis testing and evaluation. Public Health Nurs 2020; 37:705-714. [PMID: 32794604 DOI: 10.1111/phn.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/16/2019] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE No research has been done in New York City that shows the demographic characteristics of household contacts testing, evaluation, and treatment of LTBI. The objective of the study was to identify demographic factors associated with household contacts' TB testing, evaluation, and LTBI treatment. DESIGN AND METHODS A retrospective analysis of the New York City (NYC) TB registry data that examined the factors (gender, age, country of birth, race/ethnicity, and borough of residence) associated with TB testing, evaluation, and LTBI treatment. The study sample included all household contacts of TB cases identified from 2010 to 2014 (N = 3,008). The data set was chosen when nurses were the primary case managers at chest centers in the department of health. Descriptive and inferential analysis was used to identify factors associated with testing, evaluation, and LTBI treatment. RESULTS The demographic characteristics of household contacts associated with testing, evaluation, and LTBI treatment were consistent with those of TB cases in NYC from 2010 to 2014. Those not tested, not fully evaluated, and refusing LTBI treatment were most often aged 18-44 years and were non-US born. Males were significantly more likely than females not to be fully evaluated. Among racial/ethnic groups, Asian and Hispanic persons were at higher risk of not being fully evaluated, and residents of Queens had the highest risk among the five boroughs. In multivariate analyses, age was a significant predictor of behavior, such that the older the person the less likely to get TB testing or to accept LTBI treatment. Non-US country of birth was associated with lower likelihood of being fully evaluated but more likely to accept LTBI treatment when fully evaluated, while Asian or Hispanic race/ethnicity was associated with higher likelihood of both behaviors. CONCLUSIONS Findings on age from this study will enable public health agencies and public health nurses to plan for effective strategies that will increase the number of household contacts who accept TB testing and evaluation, as well as the numbers who will accept and complete LTBI treatment.
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Affiliation(s)
- Elvy G Barroso
- New York City Department of Health and Mental Hygiene, New York, NY, USA.,City University of New York, The Graduate Center New York, New York, NY, USA
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25
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Zayar NN, Sangthong R, Saw S, Aung ST, Chongsuvivatwong V. Combined Tuberculosis and Diabetes Mellitus Screening and Assessment of Glycaemic Control among Household Contacts of Tuberculosis Patients in Yangon, Myanmar. Trop Med Infect Dis 2020; 5:E107. [PMID: 32610514 DOI: 10.3390/tropicalmed5030107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/03/2020] [Accepted: 06/19/2020] [Indexed: 01/21/2023] Open
Abstract
Background: This study aimed to identify the prevalence of diabetes mellitus (DM) and tuberculosis (TB) among household contacts of index TB patients in Yangon, Myanmar. Method: Household contacts were approached at their home. Chest X-ray and capillary blood glucose tests were offered based on World Health Organization and American Diabetes Association guidelines. Crude prevalence and odds ratios of DM and TB among household contacts of TB patients with and without DM were calculated. Results: The overall prevalence of DM and TB among household contacts were (14.0%, 95% CI: 10.6–18.4) and (5%, 95% CI: 3.2–7.6), respectively. More than 25% of DM cases and almost 95% of TB cases among household contacts were newly diagnosed. Almost 64% of known DM cases among household contacts had poor glycaemic control. The risk of getting DM among household contacts of TB patients with DM was significantly higher (OR—2.13, 95% CI: 1.10–4.12) than those of TB patients without DM. There was no difference in prevalence of TB among household contacts of TB patients with and without DM. Conclusion: Significant proportions of the undetected and uncontrolled DM among household contacts of index TB patients indicate a strong need for DM screening and intervention in this TB–DM dual high-risk population.
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Du C, Wang S, Yu M, Chiu T, Wang J, Chuang P, Jou R, Chan P, Fang C. Effect of ventilation improvement during a tuberculosis outbreak in underventilated university buildings. Indoor Air 2020; 30:422-432. [PMID: 31883403 PMCID: PMC7217216 DOI: 10.1111/ina.12639] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 06/03/2019] [Revised: 12/01/2019] [Accepted: 12/23/2019] [Indexed: 05/07/2023]
Abstract
The role of ventilation in preventing tuberculosis (TB) transmission has been widely proposed in infection control guidance. However, conclusive evidence is lacking. Modeling suggested the threshold of ventilation rate to reduce effective reproductive ratio (ratio between new secondary infectious cases and source cases) of TB to below 1 is corresponding to a carbon dioxide (CO2 ) level of 1000 parts per million (ppm). Here, we measured the effect of improving ventilation rate on a TB outbreak involving 27 TB cases and 1665 contacts in underventilated university buildings. Ventilation engineering decreased the maximum CO2 levels from 3204 ± 50 ppm to 591-603 ppm. Thereafter, the secondary attack rate of new contacts in university dropped to zero (mean follow-up duration: 5.9 years). Exposure to source TB cases under CO2 >1000 ppm indoor environment was a significant risk factor for contacts to become new infectious TB cases (P < .001). After adjusting for effects of contact investigation and latent TB infection treatment, improving ventilation rate to levels with CO2 <1000 ppm was independently associated with a 97% decrease (95% CI: 50%-99.9%) in the incidence of TB among contacts. These results show that maintaining adequate indoor ventilation could be a highly effective strategy for controlling TB outbreaks.
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Affiliation(s)
- Chun‐Ru Du
- Taipei Regional CenterTaiwan Centers for Disease ControlTaipeiTaiwan
| | - Shun‐Chih Wang
- Institute of LaborOccupational Safety and HealthMinistry of LaborTaipeiTaiwan
| | - Ming‐Chih Yu
- Division of Pulmonary MedicineDepartment of Internal MedicineWan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- School of Respiratory TherapyCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Ting‐Fang Chiu
- Department of PediatricsTaipei City Hospital, Zhongxiao BranchTaipeiTaiwan
| | - Jann‐Yuan Wang
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Pei‐Chun Chuang
- Division of Planning and CoordinationTaiwan Centers for Disease ControlTaipeiTaiwan
| | - Ruwen Jou
- Center for Diagnostics and Vaccine DevelopmentTaiwan Centers for Disease ControlTaipeiTaiwan
- Institute of Microbiology and ImmunologyNational Yang‐Ming UniversityTaipeiTaiwan
| | - Pei‐Chun Chan
- Division of Chronic Infectious DiseasesTaiwan Centers for Disease ControlTaipeiTaiwan
- Division of Pediatric Infectious DiseasesDepartment of PediatricsNational Taiwan University HospitalTaipeiTaiwan
- Institute of Epidemiology and Preventive MedicineCollege of Public HealthNational Taiwan UniversityTaipeiTaiwan
| | - Chi‐Tai Fang
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
- Institute of Epidemiology and Preventive MedicineCollege of Public HealthNational Taiwan UniversityTaipeiTaiwan
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Phyo AM, Kumar AMV, Soe KT, Kyaw KWY, Thu AS, Wai PP, Aye S, Saw S, Win Maung HM, Aung ST. Contact Investigation of Multidrug-Resistant Tuberculosis Patients: A Mixed-Methods Study from Myanmar. Trop Med Infect Dis 2019; 5:E3. [PMID: 31887995 PMCID: PMC7157597 DOI: 10.3390/tropicalmed5010003] [Citation(s) in RCA: 4] [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: 10/20/2019] [Revised: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 12/03/2022] Open
Abstract
There is no published evidence on contact investigation among multidrug-resistant tuberculosis (MDR-TB) patients from Myanmar. We describe the cascade of contact investigation conducted in 27 townships of Myanmar from January 2018 to June 2019 and its implementation challenges. This was a mixed-methods study involving quantitative (cohort analysis of programme data) and qualitative components (thematic analysis of interviews of 8 contacts and 13 health care providers). There were 556 MDR-TB patients and 1908 contacts, of whom 1134 (59%) reached the health centres for screening (chest radiography and symptoms). Of the latter, 344 (30%) had presumptive TB and of them, 186 (54%) were investigated (sputum microscopy or Xpert MTB/RIF®). A total of 27 TB patients were diagnosed (six bacteriologically-confirmed including five with rifampicin resistance). The key reasons for not reaching township TB centres included lack of knowledge and lack of risk perception owing to wrong beliefs among contacts, financial constraints related to loss of wages and transportation charges, and inconvenient clinic hours. The reasons for not being investigated included inability to produce sputum, health care providers being unaware of or not agreeing to the investigation protocol, fixed clinic days and times, and charges for investigation. The National Tuberculosis Programme needs to note these findings and take necessary action.
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Affiliation(s)
- Aye Mon Phyo
- TB Department, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay 15021, Myanmar; (A.S.T.); (P.P.W.); (S.A.)
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75006 Paris, France; (A.M.V.K.); (K.W.Y.K.)
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi 110016, India
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575022, India
| | - Kyaw Thu Soe
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin 05081, Myanmar;
| | - Khine Wut Yee Kyaw
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75006 Paris, France; (A.M.V.K.); (K.W.Y.K.)
- Department of Operational Research, International Union against Tuberculosis and Lung Disease (The Union), Mandalay 15021, Myanmar
| | - Aung Si Thu
- TB Department, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay 15021, Myanmar; (A.S.T.); (P.P.W.); (S.A.)
| | - Pyae Phyo Wai
- TB Department, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay 15021, Myanmar; (A.S.T.); (P.P.W.); (S.A.)
| | - Sandar Aye
- TB Department, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay 15021, Myanmar; (A.S.T.); (P.P.W.); (S.A.)
| | - Saw Saw
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar;
| | - Htet Myet Win Maung
- National Tuberculosis Programme, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar; (H.M.W.M.); (S.T.A.)
| | - Si Thu Aung
- National Tuberculosis Programme, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar; (H.M.W.M.); (S.T.A.)
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Otero L, Battaglioli T, Ríos J, De la Torre Z, Trocones N, Ordoñez C, Seas C, Van der Stuyft P. Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data. Trop Med Int Health 2019; 25:346-356. [PMID: 31758837 DOI: 10.1111/tmi.13350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Contacts of pulmonary tuberculosis (TB) cases are at high risk of TB infection and progression to disease. Close and household contacts and those <5 years old have the highest risk. Isoniazid preventive therapy (IPT) can largely prevent TB disease among infected individuals. International and Peruvian recommendations include TB contact investigation and IPT prescription to eligible contacts. We conducted a study in Lima, Peru, to determine the number of close and household contacts who were evaluated, started on IPT, and who completed it, and the factors associated to compliance with national guidelines. METHODS We conducted a longitudinal retrospective study including all TB cases diagnosed between January 2015 and July 2016 in 13 health facilities in south Lima. Treatment cards, TB registers and clinical files were reviewed and data on index cases (sex, age, smear status, TB treatment outcome), contact investigation (sex, age, kinship to the index case, evaluations at month 0, 2 and 6) and health facility (number of TB cases notified per year, proportion of TB cases with treatment success) were extracted. We tabulated frequencies of contact evaluation by contact and index case characteristics. To investigate determinants of IPT initiation and completion, we used generalised linear mixed models. RESULTS A total of 2323 contacts were reported by 662 index cases; the median number of contacts per case was four (IQR, 2-5). Evaluation at month 0 was completed by 99.2% (255/257) of contacts <5 and 98.1% (558/569) of contacts aged 5-19 years. Of 191 eligible contacts <5 years old, 70.2% (134) started IPT and 31.4% (42) completed it. Of 395 contacts 5-19 years old, 36.7% (145) started IPT and 32.4% (47) completed it. Factors associated to not starting IPT among contacts <5 years old were being a second-degree relative to the index case (OR 6.6 95CI% 2.6-16.5), not having received a tuberculin skin test (TST) (OR 3.9 95%CI 1.4-10.8), being contact of a smear-negative index case (OR 5.5 95%CI 2.0-15.1) and attending a low-caseload health facility (OR 2.8 95%CI 1.3-6.2). Factors associated to not starting IPT among 5-19 year-olds were age (OR 13.7 95%CI 5.9-32.0 for 16-19 vs. 5-7 years old), being a second-degree relative (OR 3.0 95%CI 1.6-5.6), not having received a TST (OR 5.4, 95%CI 2.5-11.8), being contact of a male index case (OR 2.1 95CI% 1.2-3.5), with smear-negative TB (OR 1.9 95%CI 1.0-3.6), and attending a high-caseload health facility (OR 2.1 95%CI 1.2-3.6). Factors associated to not completing IPT, among contacts who started, were not having received a TST (OR 3.4 95%CI 1.5-7.9 for <5 year-olds, and OR 4.3 95%CI 1.7-10.8 for those 5-19 years old), being contact of an index case with TB treatment outcome other than success (OR 9.3 95%CI 2.6-33.8 for <5 year-olds and OR 15.3 95%CI 1.9-125.8 for those 5-19 years old), and, only for those 5-19 years old, attending a health facility with high caseload (OR 3.2 95%CI 1.4-7.7) and a health facility with low proportion of TB cases with treatment success (OR 4.4 95%CI 1.9-10.2). CONCLUSIONS We found partial compliance to TB contact investigation, and identified contact, index case and health facility-related factors associated to IPT start and completion that can guide the TB programme in increasing coverage and quality of this fundamental activity.
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Affiliation(s)
- Larissa Otero
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tullia Battaglioli
- Unit of General Epidemiology and Disease Control, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Julia Ríos
- Dirección de Prevención y Control de la Tuberculosis, Ministry of Health, Lima, Peru
| | - Zayda De la Torre
- Dirección de Salud San Juan de Miraflores Villa María del Triunfo, Ministry of Health, Lima, Peru
| | - Nayda Trocones
- Dirección de Salud San Juan de Miraflores Villa María del Triunfo, Ministry of Health, Lima, Peru
| | - Cielo Ordoñez
- Dirección de Salud San Juan de Miraflores Villa María del Triunfo, Ministry of Health, Lima, Peru
| | - Carlos Seas
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patrick Van der Stuyft
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
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Putra IWGAE, Kurniasari NMD, Dewi NPEP, Suarjana IK, Duana IMK, Mulyawan IKH, Riono P, Alisjahbana B, Probandari A, Notobroto HB, Wahyuni CU. The Implementation of Early Detection in Tuberculosis Contact Investigation to Improve Case Finding. J Epidemiol Glob Health 2019; 9:191-197. [PMID: 31529937 PMCID: PMC7310818 DOI: 10.2991/jegh.k.190808.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/18/2019] [Accepted: 08/03/2019] [Indexed: 11/25/2022] Open
Abstract
The early detection of Tuberculosis (TB) among TB contacts is a strategy to find TB cases in earlier stage and to stop the transmission. This study aimed to assess the implementation of early detection in TB contact investigation to improve TB case finding. This was an operational research study conducted in Badung District, Bali, Indonesia. The samples were TB contacts, identified in the period July through September (third quarter) 2017. Contacts were household members who were living and sharing a room at least for 3 months with infectious TB patients and were not previously diagnosed with TB. Data were collected through face-to-face interview using structured questionnaires and registration reviews using a checklist. We visited 124 TB patients and successfully identified 498 contacts, thus the ratio of contacts to cases is 4:1. All TB contacts were invited to participate in TB screening and evaluation program. A total of 100 (20.1%) contacts have attended at least one examination session and 41 contacts have completed all sessions. Ten TB cases were found among the contacts, of which four of them were adults (three bacteriologically confirmed and one clinically confirmed) and six were children (aged under 15 years). The positivity rate among children was higher (46.2%) compared with adults (14.3%). The positivity rate of confirmed TB among contacts with any TB symptoms was 43.8% and that without symptoms was 12.0%. The contribution of early detection in TB contact investigation to improve TB case finding was 8.1% through all TB patients. The early detection in TB contact investigation yielded additional notified cases, especially among children. A comprehensive education, covering cognitive and psychological aspect, is needed to encourage TB contacts to completely participate in early detection program until their diagnosis is confirmed.
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Affiliation(s)
- I Wayan Gede Artawan Eka Putra
- Faculty of Public Health, Universitas Airlangga, Kampus C, Surabaya, East Java, Indonesia.,School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - Ni Made Dian Kurniasari
- School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | | | - I Ketut Suarjana
- Faculty of Public Health, Universitas Airlangga, Kampus C, Surabaya, East Java, Indonesia.,School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - I Made Kerta Duana
- School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - I Ketut Hari Mulyawan
- School of Public Health, Faculty of Medicine, Universitas Udayana, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - Pandu Riono
- Faculty of Public Health, Universitas Indonesia, Depok City, West Java, Indonesia
| | - Bachti Alisjahbana
- Faculty of Medicine, Universitas Padjajaran, Jl. Professor Eyckman, Bandung, West Java, Indonesia
| | - Ari Probandari
- Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir Sutami, Surakarta City, Central Java, Indonesia
| | - Hari Basuki Notobroto
- Faculty of Public Health, Universitas Airlangga, Kampus C, Surabaya, East Java, Indonesia
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Cinquetti S, Dalmanzio M, Ros E, Gentili D, Ramigni M, Grossi A, Andrianou XD, La Torre LE, Rigoli R, Scotton PG, Taraschi A, Baldo V, Napoletano G, Russo F, Pezzotti P, Rezza G, Filia A. High rate of transmission in a pulmonary tuberculosis outbreak in a primary school, north-eastern Italy, 2019. Euro Surveill 2019; 24:1900332. [PMID: 31213222 PMCID: PMC6582512 DOI: 10.2807/1560-7917.es.2019.24.24.1900332] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Italy is a low-incidence country for tuberculosis (TB). We describe a TB outbreak in a primary school in north-eastern Italy, involving 10 cases of active pulmonary disease and 42 cases of latent infection. The index case was detected in March 2019, while the primary case, an Italian-born schoolteacher, was likely infectious since January 2018. Administration of a pre-employment health questionnaire to school staff with sustained contact with children should be considered in low-incidence countries.
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Affiliation(s)
- Sandro Cinquetti
- Public Health Office , Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Maria Dalmanzio
- Public Health Office , Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Elisa Ros
- Public Health Office , Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Davide Gentili
- Public Health Office , Local Health Unit 2 Marca Trevigiana, Treviso, Italy,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mauro Ramigni
- Epidemiology Office, Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Adriano Grossi
- University Cattolica del Sacro Cuore, Rome, Italy,Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy
| | - Xanthi D Andrianou
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Roberto Rigoli
- Department of Microbiology, Treviso Hospital, Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Pier Giorgio Scotton
- Department of Infectious Diseases, Treviso Hospital, Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Angela Taraschi
- Department of Pediatrics, Oderzo Hospital, Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Vincenzo Baldo
- Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | | | - Francesca Russo
- Prevention Department, Veneto Regional Health Authority, Venice, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy
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Ngamvithayapong-Yanai J, Luangjina S, Thawthong S, Bupachat S, Imsangaun W. Stigma against tuberculosis may hinder non-household contact investigation: a qualitative study in Thailand. Public Health Action 2019; 9:15-23. [PMID: 30963038 DOI: 10.5588/pha.18.0055] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/09/2018] [Indexed: 11/10/2022] Open
Abstract
Setting A northern province in Thailand. Objectives To explore experiences and perspectives on tuberculosis (TB) contact investigations in non-household contacts. Design Focus group discussions and in-depth interviews with eight groups: three groups of former TB patients (teachers, students and hospital staff) and five groups of representatives from congregate settings such as schools and workplaces. Data were analysed using the modified grounded theory. Result Annual health check-ups at the workplace contributed to the early detection of active TB in teachers. Former TB patients were highly exposed to non-household contacts, but contact investigations were limited to household contacts only. Barriers and facilitators for non-household contact investigations are associated with five factors, including information, awareness and knowledge about TB; stigma; empathy; health system response and informing non-household contacts about TB exposure. Stigma may be the main barrier to investigations among non-household contacts because TB patients tend to withhold information about their diagnosis from colleagues. Lack of knowledge and misperceptions regarding TB transmission contributed to stigma. Empathy with other people encouraged TB patients to inform non-household contacts. Conclusion Non-household contact investigations are not performed despite the risk of TB transmission. To promote contact investigations in congregate settings, interventions to overcome TB stigma and improve public knowledge about TB transmission are required.
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Affiliation(s)
| | - S Luangjina
- TB/HIV Research Foundation, Chiang Rai, Thailand
| | - S Thawthong
- TB/HIV Research Foundation, Chiang Rai, Thailand
| | - S Bupachat
- TB/HIV Research Foundation, Chiang Rai, Thailand
| | - W Imsangaun
- Department of Internal Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
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Pan D, Lan R, Graviss EA, Lin D, Liang D, McNeil E, Lin M, Chongsuvivatwong V. Adolescent tuberculosis associated with tuberculosis exposure in classrooms and dorm rooms in Guangxi, China. Int J Infect Dis 2019; 78:8-14. [PMID: 30267940 PMCID: PMC6301067 DOI: 10.1016/j.ijid.2018.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Quantify tuberculosis (TB) risk attributable to dorm room exposure in addition to classroom exposure. METHODS Adolescent school contact investigations were conducted for every reported index TB case, and similar contact investigations were conducted in selected community-control classes from November 2016 to October 2017 in Guangxi, China. RESULTS A total of 6263 contacts of 112 index TB cases and 6130 classmates of 112 controls were investigated. There were 14, 12, and 2 new active TB cases detected among classmates/non-roommates of index cases, classmates/roommates of index cases, and control classmates, respectively. Compared with control contacts, the adjusted relative risk (95% confidence interval (CI)) and population attributable fraction (PAF) for being a classmate/non-roommate of the index case increased the risk of active TB diagnosis to 8.44 (95% CI: 1.31-54.48) and 44.1%. The adjusted RR and PAF for being a classmate/roommate of the index case was 29.37 (95% CI: 3.80, 227.11) and 41.4%. Being classmates/roommates significantly increased the risk of TB compared to a classmate/non-roommate of the index case (RR=3.48, 95% CI: 1.64, 7.40). CONCLUSION The additional risk of TB due to exposure in the dorm room should be taken into account in planning of TB prevention and control in boarding schools.
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Affiliation(s)
- Dongxiang Pan
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China; Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Rushu Lan
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, The Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Dingwen Lin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China
| | - Dabin Liang
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Mei Lin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, China.
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Pan D, Lin M, Lan R, Graviss EA, Lin D, Liang D, Long X, Qin H, Huang L, Huang M, Chongsuvivatwong V. Tuberculosis Transmission in Households and Classrooms of Adolescent Cases Compared to the Community in China. Int J Environ Res Public Health 2018; 15:E2803. [PMID: 30544676 PMCID: PMC6313540 DOI: 10.3390/ijerph15122803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 11/17/2022]
Abstract
The aim of this paper is to evaluate the link between the history of exposure to tuberculosis (TB) in the household and diagnosed TB cases at school, and to compare the detection rate of active TB among household contacts and classroom contacts of adolescent TB cases with the rates among contacts of healthy controls. From November 2016 to December 2017, a prospective matched case-control study was conducted using passively identified index adolescent student cases from the TB surveillance system and healthy controls (matched by county, school type, sex, age and ethnicity). Contacts in households and classrooms of index cases and of controls were investigated. Matched tabulation of 117 case-control pairs revealed exposure to TB in the household as a strong risk factor (odds ratio (OR) = 21.0, 95% confidence interval (CI): 3.4, 868.6). Forty-five (case detection rate 0.69%) and two (case detection rate 0.03%) new active TB cases were detected among 6512 and 6480 classroom contacts of the index cases and controls, respectively. Having an index case in the classroom significantly increased the risk of classmates contracting active TB (OR = 22.5, 95% CI: 5.9, 191.4). Our findings suggested that previous exposure to TB in the household could lead a child to catch TB at school, then spread TB to classmates.
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Affiliation(s)
- Dongxiang Pan
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai 90110, Songkhla, Thailand.
| | - Mei Lin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Rushu Lan
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, The Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX 77030, USA.
| | - Dingwen Lin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Dabin Liang
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Xi Long
- School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Huifang Qin
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Liwen Huang
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
| | - Minying Huang
- Department of Tuberculosis Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530021, Guangxi, China.
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Shelby T, Meyer AJ, Ochom E, Turimumahoro P, Babirye D, Katamba A, Davis JL, Armstrong-Hough M. Social determinants of tuberculosis evaluation among household contacts: a secondary analysis. Public Health Action 2018; 8:118-123. [PMID: 30271727 PMCID: PMC6147061 DOI: 10.5588/pha.18.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/20/2018] [Accepted: 07/25/2018] [Indexed: 12/25/2022] Open
Abstract
Setting: Seven public sector tuberculosis (TB) units and surrounding communities in Kampala, Uganda. Objective: To evaluate the influence of household-level socio-economic characteristics on completion of TB evaluation during household contact investigation. Design: A cross-sectional study nested within the control arm of a randomized, controlled trial evaluating home-based sputum collection and short messaging service communications. We used generalized estimating equations to estimate the association between completion of TB evaluation and socio-economic determinants. Results: Of 116 household contacts referred to clinics for TB evaluation, 32 (28%) completed evaluation. Completing evaluation was strongly clustered by household. Controlling for individual symptoms, contacts from households earning below-median income (adjusted risk ratio [aRR] 0.28, 95%CI 0.09-0.88, P = 0.029) and contacts from households in which the head of household had no more than primary-level education (aRR 0.40, 95%CI 0.18-0.89, P = 0.025) were significantly less likely to complete evaluation for TB. Conclusion: Socio-economic factors such as low income and education increase the risk that household contacts of TB patients will experience barriers to completing TB evaluation themselves. Further research is needed to identify specific mechanisms by which these underlying social determinants modify the capability and motivation of contacts to complete contact investigation.
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Affiliation(s)
- T Shelby
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - A J Meyer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Babirye
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - J L Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
| | - M Armstrong-Hough
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
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Seto J, Wada T, Suzuki Y, Ikeda T, Mizuta K, Yamamoto T, Ahiko T. Mycobacterium tuberculosis Transmission among Elderly Persons, Yamagata Prefecture, Japan, 2009-2015. Emerg Infect Dis 2018; 23:448-455. [PMID: 28221133 PMCID: PMC5382749 DOI: 10.3201/eid2303.161571] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In many countries with low to moderate tuberculosis (TB) incidence, cases have shifted to elderly persons. It is unclear, however, whether these cases are associated with recent Mycobacterium tuberculosis transmission or represent reactivation of past disease. During 2009–2015, we performed a population-based TB investigation in Yamagata Prefecture, Japan, using in-depth contact tracing and 24-loci variable-number tandem-repeat typing optimized for Beijing family M. tuberculosis strains. We analyzed 494 strains, of which 387 (78.3%) were derived from elderly patients. Recent transmission with an epidemiologic link was confirmed in 22 clusters (70 cases). In 17 (77.3%) clusters, the source patient was elderly; 11 (64.7%) of the 17 clusters occurred in a hospital or nursing home. In this setting, the increase in TB cases was associated with M. tuberculosis transmissions from elderly persons. Prevention of transmission in places where elderly persons gather will be an effective strategy for decreasing TB incidence among predominantly elderly populations.
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Godoy P, Alsedà M, Falguera M, Puig T, Bach P, Monrabà M, Manonelles A. A highly transmissible tuberculosis outbreak: the importance of bars. Epidemiol Infect 2017; 145:3497-504. [PMID: 29179780 DOI: 10.1017/S0950268817002588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The transmission of tuberculosis (TB) in bars is difficult to study. The objective was to describe a large TB outbreak in a company's bar and other leisure settings. A descriptive study of a TB outbreak was carried out. Contacts were studied in the index case's workplace bar (five circles of contacts) and other recreational areas (social network of three bars in the index case's neighbourhood). Chest X-rays were recommended to contacts with positive tuberculin skin tests (TST) (⩾5 mm). The risk of latent tuberculosis infection (LTBI) was determined using an adjusted odds ratio. The dose-response relationship was determined using the chi-square test for linear trend. We studied 316 contacts at the index case's workplace and detected five new cases of TB. The prevalence of LTBI was 57·9% (183/316) and was higher in the first circle, 96·0% (24/25), and lower in the fifth, 46·5% (20/43) (P < 0·0001). Among 58 contacts in the three neighbourhood bars, two TB cases were detected and the LTBI prevalence was 51·7% (30/58). Two children of one secondary TB company patient became ill. Bars may be transmission locations for TB and, as they are popular venues for social events, should be considered as potential areas of exposure.
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Volkmann T, Okelloh D, Agaya J, Cain K, Ooko B, Malika T, Burton D. Pilot implementation of a contact tracing intervention for tuberculosis case detection in Kisumu County, Kenya. Public Health Action 2016; 6:217-219. [PMID: 28123956 DOI: 10.5588/pha.16.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/05/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
Leveraging an existing community health strategy, a contact tracing intervention was piloted under routine programmatic conditions at three facilities in Kisumu County, Kenya. Data collected during a 6-month period were compared to existing programmatic data. After implementation of the intervention, we found enhanced programmatic contact tracing practices, noting an increase in the proportions of index cases traced, symptomatic contacts referred, referred contacts presenting to a facility for tuberculosis screening, and eligible contacts started on isoniazid preventive therapy. As contact tracing is scaled up, health ministries should consider the adoption of similar contact tracing interventions to improve contact tracing practices.
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Affiliation(s)
- T Volkmann
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - D Okelloh
- Kenya Medical Research Institute, Kisumu County, Kenya
| | - J Agaya
- Kenya Medical Research Institute, Kisumu County, Kenya
| | - K Cain
- Division of Global HIV & Tuberculosis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - B Ooko
- Division of Leprosy, Tuberculosis and Lung Diseases, Ministry of Health, Kisumu County, Kenya
| | - T Malika
- Division of Leprosy, Tuberculosis and Lung Diseases, Ministry of Health, Kisumu County, Kenya
| | - D Burton
- Division of TB Elimination, CDC, Atlanta, Georgia, USA
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Mollers M, Jonges M, Pas SD, van der Eijk AA, Dirksen K, Jansen C, Gelinck LBS, Leyten EMS, Thurkow I, Groeneveld PHP, van Gageldonk-Lafeber AB, Koopmans MP, Timen A. Follow-up of Contacts of Middle East Respiratory Syndrome Coronavirus-Infected Returning Travelers, the Netherlands, 2014. Emerg Infect Dis 2016; 21:1667-9. [PMID: 26291986 PMCID: PMC4550153 DOI: 10.3201/eid2109.150560] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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
Notification of 2 imported cases of infection with Middle East respiratory syndrome coronavirus in the Netherlands triggered comprehensive monitoring of contacts. Observed low rates of virus transmission and the psychological effect of contact monitoring indicate that thoughtful assessment of close contacts is prudent and must be guided by clinical and epidemiologic risk factors.
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Merte JL, Kroll CM, Collins AS, Melnick AL. An epidemiologic investigation of occupational transmission of Mycobacterium tuberculosis infection to dental health care personnel: infection prevention and control implications. J Am Dent Assoc 2014; 145:464-71. [PMID: 24789240 DOI: 10.14219/jada.2013.52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors describe an investigation of a dental hygienist who developed active pulmonary tuberculosis (TB), worked for several months while infectious and likely transmitted Mycobacterium tuberculosis in a dental setting in Washington state. METHODS Clark County Public Health (CCPH) conducted an epidemiologic investigation of 20 potentially exposed close contacts and 734 direct-care dental patients in 2010. RESULTS Of 20 close contacts, one family member and two coworkers, all of whom were from countries in which TB is endemic, had latent TB infection (LTBI). One U.S.-born coworker experienced a tuberculin skin test (TST) conversion from 0 to 8 millimeters. Of the 305 of 731 (41.7 percent) potentially exposed patients who received a single TST, 23 (7.5 percent) had a positive TST result of at least 5 mm. Among the subset of 157 patients tested by CCPH staff, 16 (10.2 percent) had a positive TST result. The dental office did not have infection prevention and control policies related to TB identification, prevention or education. CONCLUSIONS The coworker's TST conversion indicated a recent infection, likely owed to occupational transmission. The proportion of dental patients with positive TST results was greater than the 1999-2000 National Health and Nutrition Examination Survey prevalence estimate in the general population, and it may reflect transmission from the hygienist with active TB or a prevalence of LTBI in the community. Practical Implications All dental practices should implement administrative procedures for TB identification and control as described in this article, even if none of their patients are known to have TB.
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Chou KH, Kam KM, Ieong SK, Yip CW, Ip PK, Yew WW, Leung CC, Wong NS, Lau SM, Lee SS. Concurrent Outbreaks of Tuberculosis in a School and the Wider Community in Macau. J Pediatric Infect Dis Soc 2015; 4:359-62. [PMID: 26582875 DOI: 10.1093/jpids/piu031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/25/2014] [Indexed: 11/14/2022]
Abstract
Between 2009 and 2012, 22 adolescents of age 15-20 from a day school in Macau were diagnosed with tuberculosis. Detection of multiple molecular clusters may suggest the presence of concurrent outbreaks, and could reflect also ongoing transmissions in the community. Careful interpretation of molecular epidemiology data is crucial in contact investigations.
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Affiliation(s)
- Kuok Hei Chou
- Tuberculosis Prevention and Treatment Centre, Health Bureau, Macau Special Administrative Region (SAR), People's Republic of China
| | - Kai Man Kam
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Sao Kun Ieong
- Tuberculosis Prevention and Treatment Centre, Health Bureau, Macau Special Administrative Region (SAR), People's Republic of China
| | - Chi Wai Yip
- Tuberculosis Laboratory, Centre for Health Protection, Department of Health, Hong Kong SAR, People's Republic of China
| | - Peng Kei Ip
- Laboratory of Public Health, Health Bureau, Macau SAR, People's Republic of China
| | - Wing Wai Yew
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Chi Chiu Leung
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong SAR, People's Republic of China
| | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Suk Ming Lau
- Tuberculosis Prevention and Treatment Centre, Health Bureau, Macau Special Administrative Region (SAR), People's Republic of China
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
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Pan SW, Kou YR, Hu TM, Wu YC, Lee YC, Feng JY, Su WJ. Assessment of latent tuberculosis infection in psychiatric inpatients: A survey after tuberculosis outbreaks. J Microbiol Immunol Infect 2016; 49:575-83. [PMID: 26694909 DOI: 10.1016/j.jmii.2015.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/29/2015] [Accepted: 10/22/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE To investigate risk factors of latent tuberculosis infection (LTBI) among inpatients of chronic psychiatric wards with tuberculosis (TB) outbreaks. METHODS In April 2013, inpatients of four all-male wards with TB outbreaks were tested for LTBI using the QuantiFERON-TB Gold in Tube (QFT) method. Based on this investigation, a retrospective study was conducted to assess risk factors for LTBI. Inpatients exposed to cluster-A or cluster-B TB cases were defined as contacts of cluster-A or cluster-B, and others, as nonclustered contacts. RESULTS Among 355 inpatients with TB exposure, 134 (38%) were QFT-positive for LTBI. Univariate analysis showed that significant predictors for QFT-positivity were age, case-days of exposure to all TB cases (TB-all) and to sputum smear positive cases, number of source cases with cough, and exposure to cluster-A TB cases. Independent risk factors for LTBI were higher age [adjusted odds ratio (OR) 1.03, 95% confidence intervals (CI: 1.01-1.05)], TB-all exposure case-days ≥ 200 [adjusted OR 2.04 (1.06-3.92)] and exposure to cluster-A TB cases [adjusted OR 2.82 (1.30-6.12)] after adjustment for the sputum smear positivity, and cough variables of the source cases. The contacts of cluster-A had a greater risk of LTBI than did those of cluster-B, especially in the younger population (≤50 years) after adjustment [adjusted OR 2.64 (1.03-6.76)]. CONCLUSION After TB outbreaks, more than one third of inpatients were QFT-positive for LTBI. Our findings suggest that, beside the infectiousness of source cases, intensity of exposure, and age of contacts, exposure to TB cases in potential genotyping clusters may be predictive for LTBI in this male psychiatric population.
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Sanderson JM, Proops DC, Trieu L, Santos E, Polsky B, Ahuja SD. Increasing the efficiency and yield of a tuberculosis contact investigation through electronic data systems matching. J Am Med Inform Assoc 2015; 22:1089-93. [PMID: 25888587 DOI: 10.1093/jamia/ocv029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/22/2014] [Accepted: 03/08/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Electronic health data may improve the timeliness and accuracy of resource-intense contact investigations (CIs) in healthcare settings. METHODS In September 2013, we initiated a CI around a healthcare worker (HCW) with infectious tuberculosis (TB) who worked in a maternity ward. Two sources of electronic health data were employed: hospital-based electronic medical records (EMRs), to identify patients exposed to the HCW, and an electronic immunization registry, to obtain contact information for exposed infants and their providers at two points during follow-up. RESULTS Among 954 patients cared for in the maternity ward during the HCW's infectious period, the review of EMRs identified 285 patients (30%) who interacted with the HCW and were, thus, exposed to TB. Matching infants to the immunization registry offered new provider information for 52% and 30% of the infants in the first and second matches. Providers reported evaluation results for the majority of patients (66%). CONCLUSION Data matching improved the efficiency and yield of this CI, thereby demonstrating the usefulness of enhancing CIs with electronic health data.
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Affiliation(s)
- Jennifer M Sanderson
- CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA
| | - Douglas C Proops
- CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA
| | - Lisa Trieu
- CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA
| | - Eloisa Santos
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Bruce Polsky
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Mount Sinai Roosevelt, New York, NY, USA
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Wang W, Mathema B, Hu Y, Zhao Q, Jiang W, Xu B. Role of casual contacts in the recent transmission of tuberculosis in settings with high disease burden. Clin Microbiol Infect 2014; 20:1140-5. [PMID: 24941878 DOI: 10.1111/1469-0691.12726] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 04/19/2014] [Revised: 06/14/2014] [Accepted: 06/14/2014] [Indexed: 01/18/2023]
Abstract
Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide. It is expected that combining multiple molecular methods will further help in focusing contact investigations. We performed a population-based molecular epidemiological study in six sites in China between 1 June 2009 and 31 December 2010. A genotyping method combining 7-loci MIRU-VNTR and IS6110-based RFLP was employed to determine predictors of recent transmission. A second interview was performed with the clustered patients to identify potential epidemiological links. The molecular clustering analysis revealed that 187 isolates (15.3%) were clustered by sharing identical VNTR-IS6110 combined patterns, with an estimated recent transmission index being 8.9%. None of these patients reported having contacts with other members within the same cluster. Nineteen of 121 reported having a history of contact with a TB case within 2 years before the current TB diagnosis. Additionally, geographical correlation was established for 19 cases in nine clusters, while only one possible epidemiological link was established in secondary interview. The results underscore the role of casual contact or reactivation of latent TB as a driving factor maintaining the current endemicity in rural China, with high disease burdens of tuberculosis.
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Affiliation(s)
- W Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China; Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China
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Johnston J, Admon A, Ibrahim A, Elwood K, Tang P, Cook V, Fitzgerald M. Long term follow-up of drug resistant and drug susceptible tuberculosis contacts in a Low incidence setting. BMC Infect Dis 2012; 12:266. [PMID: 23088397 PMCID: PMC3524765 DOI: 10.1186/1471-2334-12-266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 02/08/2012] [Accepted: 10/18/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Studies examining the transmission of multidrug-resistant tuberculosis (MDR-TB) strains have yielded conflicting results. METHODS We examined transmission of MDR-TB strains using contact tracing data from a low incidence setting. Contacts of MDR-TB cases diagnosed in British Columbia, Canada, from 1990-2008 were identified through a provincial tuberculosis (TB) registry. Tuberculin skin test (TST) results and TB disease incident rates were determined for contacts. For comparison, TB disease incident rates and TST results were measured in close contacts of isoniazid mono-resistant (HMR-TB) and drug susceptible TB (DS-TB) cases. RESULTS Of 89 identified close contacts of MDR-TB patients, 5 patients (6%) developed TB disease and 42 (47%) were TST positive. The incidence rate of TB disease (3%, p = 0.31) and TST positivity (49%, p = 0.82) were similar in contacts of HMR-TB cases. Compared with MDR-TB contacts, DS-TB contacts had lower incidence rate of TB disease (2%, p = 0.04) and TST positivity (32%, p < 0.01). All MDR-TB contacts with culture positive TB diagnosed in follow-up were drug-susceptible; three of six HMR-TB contacts with culture positive TB were HMR-TB. Multivariate analysis demonstrated that contact with MDR-TB (adjusted OR 1.72; 95%CI 1.05-2.81) and HMR-TB (adjusted OR 1.99; 95%CI 1.48-2.67) was associated with TST positivity. In addition, adult age, male gender, BCG positivity, source case sputum smear positivity, foreign birth and fewer contacts per source case were significantly associated with TST positivity in the multivariate model. CONCLUSION Contacts of MDR-TB and HMR-TB patients in a low incidence setting show high rates of TST positivity and TB disease but low rates of drug resistance.
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Affiliation(s)
- James Johnston
- Division of Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Admon
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Amir Ibrahim
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Elwood
- Division of Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Patrick Tang
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Cook
- Division of Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark Fitzgerald
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Abstract
BACKGROUND Health departments require an efficient strategy to investigate individuals exposed to Mycobacterium tuberculosis. The contact priority model (CPM) uses a decision rule to minimize testing of low-risk contacts; however, its impact on costs and disease control is unknown. METHODS A cost-effectiveness analysis compared the CPM with the traditional concentric circle approach (CCA) in a simulated population of 1000 healthy, community-dwelling adults with a 10% background rate of latent tuberculosis (TB) infection. The analysis was conducted from the perspective of the Alabama Department of Public Health. Model inputs were derived from the literature and the Alabama Department of Public Health. Lifetime costs (2004 dollars) and outcomes were discounted 3 percent annually. Incremental cost-effectiveness ratios were used to compare the strategies. RESULTS Over the lifetime of 1000 simulated contacts, the CPM saved $45,000 but led to 0.5 additional TB cases and 0.24 fewer years of life. The CCA is more effective than the CPM, but it costs $92,934 to prevent one additional TB case and $185,920 to gain one additional life year. CONCLUSIONS The CPM reduces costs with minimal loss of disease control and is a viable alternative to the CCA under most conditions.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Gerald LB, Bruce F, Brooks CM, Brook N, Kimerling ME, Windsor RA, Bailey WC. Standardizing contact investigation protocols. Int J Tuberc Lung Dis 2003; 7:S369-74. [PMID: 14677825 PMCID: PMC1609960] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
SETTING The State of Alabama Department of Public Health Division of Tuberculosis Control. OBJECTIVE To standardize contact investigation protocols and implement an intervention to increase TB field worker adherence to the protocols with the goal of promoting efficiency and effectiveness in contact investigations. DESIGN A process evaluation of existing data collection and management systems and protocols was performed. Standardized protocols and an intervention to increase TB field worker adherence to the protocols were created and pilot tested. These were then implemented and formative evaluation data were collected. RESULTS The process evaluation revealed considerable variance among field workers with regard to protocols and definitions of variables related to contact investigations. Protocols were standardized and an intervention targeted at TB field workers was developed. The intervention consisted of a training workshop and the development of a computer-based contact investigation module. This was successfully implemented throughout the state. CONCLUSIONS To perform effective contact investigations and conduct studies to improve the effectiveness of these investigations, TB control programs must pay careful attention to precisely defining variables and concepts related to the contact investigation. Furthermore, protocols must be standardized and resources devoted to training of TB field workers to ensure adherence to protocols.
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Affiliation(s)
- L B Gerald
- Lung Health Center, University of Alabama at Birmingham, Birmingham 35233-7337, USA.
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Abstract
To better understand the molecular epidemiology of tuberculosis (TB) transmission for culture-confirmed patients <5 years of age, data were analyzed from a population-based study conducted in seven U.S. sites from 1996 to 2000. Mycobacterium tuberculosis isolates were genotyped with IS6110-based restriction fragment length polymorphism analysis and spoligotyping. Case-patient data were obtained from the Centers for Disease Control and Prevention s national tuberculosis registry and health department records. Routine public health investigations conducted by local health departments identified suspected source patients for 57 (51%) of 111 culture-confirmed patients <5 years of age. For 8 (15%) of 52 culture-confirmed patients <5 years of age and their suspected source patients with complete genotyping results, genotypes suggested infection with different TB strains. Potential differences between sources for patients <5 years of age and source patients that transmitted TB to adolescent and adult patients were identified.
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Affiliation(s)
- Sumi J Sun
- California Department of Health Services, Berkley, CA, USA.
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Wilce M, Shrestha-Kuwahara R, Taylor Z, Qualls N, Marks S. Tuberculosis contact investigation policies, practices, and challenges in 11 U.S. communities. J Public Health Manag Pract 2002; 8:69-78. [PMID: 12463053 PMCID: PMC5444206 DOI: 10.1097/00124784-200211000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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] [Indexed: 11/27/2022]
Abstract
To describe the policies and procedures used by 11 urban tuberculosis control programs to conduct contact investigations, written policies were reviewed and semistructured interviews were conducted with program managers and staff. Qualitative analysis showed that contact investigation policies and procedures vary widely. Most policies address risk factor assessment and contact prioritization; however, none of the policies provide comprehensive guidance for the entire process. Staffing patterns vary, but, overall, staff receive little formal training; informal monitoring practices predominate. Comprehensive guidelines and programmatic support are needed to improve the quality of contact investigation processes.
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Affiliation(s)
- Maureen Wilce
- Division of Tuberculosis Elimination, Centers for Disease, Control and Prevention (CDC), Atlanta, Georgia, USA
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Bennett DE, Onorato IM, Ellis BA, Crawford JT, Schable B, Byers R, Kammerer JS, Braden CR. DNA fingerprinting of Mycobacterium tuberculosis isolates from epidemiologically linked case pairs. Emerg Infect Dis 2002; 8:1224-9. [PMID: 12453346 PMCID: PMC2738550 DOI: 10.3201/eid0811.020420] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [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] [Indexed: 12/01/2022] Open
Abstract
DNA fingerprinting was used to evaluate epidemiologically linked case pairs found during routine tuberculosis (TB) contact investigations in seven sentinel sites from 1996 to 2000. Transmission was confirmed when the DNA fingerprints of source and secondary cases matched. Of 538 case pairs identified, 156 (29%) did not have matching fingerprints. Case pairs from the same household were no more likely to have confirmed transmission than those linked elsewhere. Case pairs with unconfirmed transmission were more likely to include a smear-negative source case (odds ratio [OR] 2.0) or a foreign-born secondary case (OR 3.4) and less likely to include a secondary case <15 years old (OR 0.3). Our study suggests that contact investigations should focus not only on the household but also on all settings frequented by an index case. Foreign-born persons with TB may have been infected previously in high-prevalence countries; screening and preventive measures recommended by the Institute of Medicine could prevent TB reactivation in these cases.
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Affiliation(s)
- Diane E Bennett
- Centers for Disease control and Prevention, Atlanta, GA 30333, USA.
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