Abstract
BackgroundWe investigated the epidemiology and prevalence of potential risk factors of tuberculosis (TB) recurrence in a population-based registry cohort of 8084 TB cases between 1995 and 2013.MethodsAn episode of recurrent TB was defined as a case re-registered in the National Infectious Disease Register at least 360 days from the date of the initial registration. A regression model was used to estimate risk factors for recurrence in the national cohort. To describe the presence of known risk factors for recurrence, patient records of the recurrent cases were reviewed for TB diagnosis confirmation, potential factors affecting the risk of recurrence, the treatment regimens given and the outcomes of the TB episodes preceding the recurrence.ResultsTB registry data included 84 patients, for whom more than 1 TB episode had been registered. After a careful clinical review, 50 recurrent TB cases (0.6%) were identified. The overall incidence of recurrence was 113 cases per 100,000 person-years over a median follow up of 6.1 years. For the first 2 years, the incidence of recurrence was over 200/100000. In multivariate analysis of the national cohort, younger age remained an independent risk factor at all time points, and male gender and pulmonary TB at 18 years of follow-up. Among the 50 recurrent cases, 35 patients (70%) had received adequate treatment for the first episode; in 12 cases (24%) the treating physician and in two cases (4%) the patient had discontinued treatment prematurely. In one case (2%) the treatment outcome could not be assessed.ConclusionsIn Finland, the rate of recurrent TB was low despite no systematic directly observed therapy. The first 2 years after a TB episode had the highest risk for recurrence. Among the recurrent cases, the observed premature discontinuation of treatment in the first episode in nearly one fourth of the recurrent cases calls for improved training of the physicians.
Highlights
We investigated the epidemiology and prevalence of potential risk factors of tuberculosis (TB) recurrence in a population-based registry cohort of 8084 TB cases between 1995 and 2013
Surveillance system and study population The study population consisted of all TB cases in Finland reported from January 1, 1995, to December 31, 2013, to the National Infectious Disease Register (NIDR), maintained at the National Institute for Health and Welfare (THL)
We investigated the epidemiology and the prevalence of risk factors associated with recurrence of TB in Finland in a comprehensive national, register-based cohort of 8084 TB cases from 1995 to 2013, and found in a follow-up of up to 18 years that 0.6% of cases during the study period were recurrent
Summary
We investigated the epidemiology and prevalence of potential risk factors of tuberculosis (TB) recurrence in a population-based registry cohort of 8084 TB cases between 1995 and 2013. Tuberculosis (TB) remains a major global health problem with estimated 10.4 million new TB cases worldwide in 2015. In 2013, 0.3 million TB cases were reported as recurrent [1]. Recurrent TB is estimated to occur in 0–14% of all TB patients within 1–3 years [2]. Recurrence of TB following treatment of an initial disease episode can occur due to endogenous re-activation with the same strain of Mycobacterium tuberculosis (relapse) or exogenous infection with a new strain (re-infection). In low-incidence countries, recurrence rates have varied between 0.4% and in a prospective clinical trial up to 6% [3,4,5]. In high-incidence countries the majority of recurrent cases, up to 77%, are caused by re-infection [6]
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