Abstract
BackgroundRecurrent tuberculosis suggests potentially modifiable gaps in tuberculosis treatment and control activities. The frequency of late recurrences following treatment completion has not been well-studied. We determined the frequency of, and risk factors associated with, tuberculosis that recurs at least one year after completion of anti-tuberculosis therapy in California.MethodsThe study population included culture-positive, pulmonary tuberculosis patients reported to the California tuberculosis case registry from 1993 to 2007 who completed anti-tuberculosis therapy. A person with late recurrent tuberculosis was defined as an individual that appeared in the registry more than once, determined by match on name and date-of-birth, with at least one year between treatment completion of the first episode and treatment initiation of the second episode.ResultsAmong 23,517 tuberculosis patients, 148 (0.63%) had a late recurrence. Independent risk factors for recurrence included: infection with a pyrazinamide mono-resistant isolate (adjusted hazard ratio, 2.93; p = 0.019); initiation of an isoniazid- and rifampin-only treatment regimen (adjusted hazard ratio, 2.55; p = 0.0412); sputum smear-positive disease (adjusted hazard ratio, 1.96; p = 0.0003); human immunodeficiency virus infection (adjusted hazard ratio, 1.81; p = 0.0149); and birth in the United States (adjusted hazard ratio, 1.88; p = 0.0002). Infection with an isoniazid mono-resistant isolate was protective (adjusted hazard ratio, 0.25; p = 0.0171).ConclusionsThe low frequency of late recurrent tuberculosis in California suggests that local TB control programs are largely successful at preventing this adverse outcome. Nonetheless, we identified subpopulations at increased risk of late tuberculosis recurrence that may benefit from additional medical or public health interventions.
Highlights
Recurrent tuberculosis (TB) within a population suggests potentially modifiable gaps in TB treatment and control activities
We examined TB recurrence in California to assess its frequency and to identify populations at increased risk that may benefit from specific interventions
The majority of late recurrences occurred within three years from treatment completion, and the hazard of recurrence declined with time from treatment completion (Figure 3)
Summary
Recurrent tuberculosis (TB) within a population suggests potentially modifiable gaps in TB treatment and control activities. We examined TB recurrence in California to assess its frequency and to identify populations at increased risk that may benefit from specific interventions. A recurrence of TB can be due to relapse or re-infection [1]. Populations at high risk of recurrent TB, regardless of the recurrence mechanism, provide an important group for early TB case-finding in high incidence settings [3]. In low incidence settings, targeted case-finding among populations at high risk of recurrence could facilitate TB elimination by preventing transmission. Recurrent tuberculosis suggests potentially modifiable gaps in tuberculosis treatment and control activities. The frequency of late recurrences following treatment completion has not been well-studied. We determined the frequency of, and risk factors associated with, tuberculosis that recurs at least one year after completion of anti-tuberculosis therapy in California
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