Tuberculosis Control Measures Research Articles

Impact of WHO-Recommended TB Control Measures on Occupational TB Risk Among Healthcare Workers in a High-Burden Tertiary Hospital in Brazil: A 24-Year Retrospective Analysis.

Tuberculosis (TB) remains a significant public health concern, particularly in low-to-middle-income countries. Healthcare workers (HCWs) are at a higher risk due to prolonged exposure. The World Health Organization (WHO) has proposed guidelines focusing on administrative interventions, structural interventions, and personal protective equipment (PPE) usage to mitigate this risk. Despite these recommendations, data on their efficiency in reducing occupational TB risk in Brazil is lacking. Evaluate the effectiveness of the WHO-recommended measures regarding the risk of developing TB among the HCWs. We conducted a retrospective analysis of TB incidence among patients admitted to a tertiary public Emergency Department (ED), and HCWs from 2000 to 2023. We extracted TB notifications among HCWs and the general population of Ribeirão Preto from a public database. We comparatively analysed the incidence rates between patients and HCWs to evaluate the effectiveness of WHO-recommended measures. From 2000 to 2023, the ED handled an average of 148,496 patients per quadrennium, with 202 TB patients per quadrennium. The prevalence ratio of TB per 100,000 patients increased from 80 to 170 (p=0.035) and the incidence rates rose from 39 to 157 per 100,000 patients (p=0.046). The incidence rate of TB among HCWs in our institution started at 412.0 (85.0;1201.0) and decreased to 179.0 (20.0;619.0). In total, 11 HCWs were diagnosed with TB. The relative risk of having TB between HCWs and the general population was significantly higher before the Program implementation and became equivalent after it. Implementing WHO-recommended TB control measures was demonstrated effective in reducing the incidence rate ratios between HCWs and the general population in a high-burden tertiary hospital in Brazil.

Epidemiological Characteristics and Trends in the Incidence of Newly Diagnosed Pulmonary Tuberculosis in China from 2016 to 2022

Objective: This study was aimed at exploring pulmonary tuberculosis (PTB) epidemiological characteristics and trends in China from 2016 to 2022, to provide evidence for optimizing strategies and measures for tuberculosis prevention and control. Methods: Data on PTB in China reported from 2016 to 2022 were obtained from the Chinese Disease Prevention and Control Information System. Descriptive epidemiological methods were used to analyze the population distribution, and temporal and spatial distribution (also known as the three-dimensional distribution in epidemiology). The chi-square test was used for comparisons between groups. Joinpoint regression was used to analyze the temporal trends in PTB notification rates, and ArcGIS 10.3 software was used to visualize the results. Results: In total, 5,141,468 cases of PTB were reported in China from 2016 to 2022, among which 39.89% were bacteriologically positive. Joinpoint regression analysis indicated that the PTB notification rate showed an overall downward trend from 2016 to 2022, with 2018 as the inflection point. The annual percentage change (APC) was −0.72% (95% CI: −4.78% to 2.96%, P<0.001) from 2016 to 2018, and −9.26% (95% CI: −11.76% to −8.08%, P<0.001) from 2018 to 2022; the overall average annual percentage change (AAPC) was −6.50% (95% CI: −7.56% to −5.51%, P<0.001). The population distribution indicated that the male to female ratio was 2.19:1.00. Individuals older than 65 years accounted for 25.93%. Occupation distribution analysis indicated that farmers accounted for more than 60%. The PTB notification rate showed the following spatial distribution: western region > central region > eastern region. Guangdong province had the highest number of reported PTB cases. Conclusions: From 2016 to 2022, the PTB notification rate showed an overall downward trend in China. Men, older people, and farmers were the majority groups. The western region and Guangdong province were hotspots that must be addressed. In the future, the Tuberculosis prevention and control strategies should be optimized according to epidemiological characteristics.

Dendritic Cell Vaccine Harboring Inactivated Mycobacteria Induces Immune Protection Against Tuberculosis in Murine Models and is Well Tolerated in Humans

The limited success of tuberculosis (TB) control measures reflects the inadequacy of Bacille Calmette‐Guérin (BCG), the only licensed TB vaccine. There is a recent resurgence of interest in intravenous administration of BCG. However, direct injection of live BCG bacteria into the bloodstream of human beings is not likely to be practical due to safety concerns. In this study, it is showed that debris of BCG‐infected macrophages induces activation and maturation of dendritic cells (DCs) in vitro, and an intravenous DCs vaccine phagocytosing noninfective cell debris induces robust antigen‐specific T‐cell immune responses and immune protection against Mycobacterium tuberculosis infection in murine models. Further, an investigator‐initiated clinical trial shows the safety of a DCs vaccine harboring the noninfective Mycobacterium vaccae vaccine. Infusions of naive DCs and DCs harboring Mycobacterium vaccae are well tolerated and safe in six active TB patients. Tests of the peripheral blood mononuclear cells of a patient who receives two doses of DCs vaccine infusion show enhanced secretion of IFN‐γ, IL‐2, IL‐17, and TNF‐α in both CD4 and CD8 T cells. The study provides evidence that DC‐based vaccines harboring inactivated mycobacteria can expand T‐cell immune responses in TB‐infected mice and are well tolerated in patients with active TB disease.

Closing Situations of Tuberculosis Cases in A Municipality in Southeast Matogrosso During the Pandemic Period

Objective: To analyze tuberculosis cases according to the outcome situation in Rondonópolis, Mato Grosso. Method: Ecological and descriptive study carried out with data from the Epidemiological Surveillance database of Rondonópolis, Mato Grosso, from March 2020 to March 2023. The population was all reported cases of tuberculosis according to the outcome situation (cure, treatment abandonment and death from tuberculosis). Death from other causes, transfer and ignored and/or blank cases were excluded. Descriptive statistics used absolute and relative frequencies with the aid of the R software. Study approved by the Research Ethics Committee (Opinion: 6,130,934). Results: A total of 233 cases of tuberculosis with outcome situation were reported (71.67% cure, 23.18% treatment abandonment and 5.15% death). The profile was male, mixed race, high school graduate, new case admission type and chest X-ray with suspicious finding. Cure was prevalent among people aged 61 to 70, while treatment abandonment and death were prevalent among people aged 31 to 40. Research Implications: The study highlights that, despite the high cure rate, treatment abandonment is a challenge. It is essential to continue studies to monitor and improve tuberculosis control measures. Originality/Value: The results highlight the need to propose specific interventions for vulnerable groups, in addition to the importance of complete notifications by health professionals.

Tuberculosis in Times of War and Peace

This chapter provides a comprehensive analysis of tuberculosis (TB) across different historical contexts of war and peace, underscoring the disease’s resilience and adaptability. It highlights the exacerbation of TB transmission due to war-related factors such as mass displacement, malnutrition, and compromised healthcare systems, while also noting periods of peace as opportunities for advancing TB control measures. The chapter examines the impact of major conflicts on TB incidence and management, including World Wars I and II and more recent conflicts like the Ukraine war. It also discusses the evolution of TB control efforts, from the discovery of Mycobacterium tuberculosis to modern strategies against drug-resistant TB, emphasizing the importance of international collaboration and integrated public health strategies to combat this enduring global health challenge.

Endogenous reactivation cases identified by whole genome sequencing of Mycobacterium tuberculosis: Exploration of possible causes in Latvian tuberculosis patients

BackgroundThe recurrence of tuberculosis (TB) continues to place a significant burden on patients and TB programs worldwide. Repeated TB episodes can develop either due to endogenous reactivation of previously treated TB or exogenous reinfection with a distinct strain of Mycobacterium tuberculosis (Mtb). Determining the precise cause of the recurrent TB episodes and identifying reasons for endogenous reactivation of previously successfully treated patients is crucial for introducing effective TB control measures. MethodsHere, we aimed to provide a retrospective individual analysis of the clinical data of pulmonary TB patients with assumed endogenous infection reactivation based on WGS results to identify the reasons for reactivation. Patient medical files were reviewed to describe the provoking factors for endogenous reactivation. ResultsIn total, 25 patients with assumed endogenous TB reactivation were included in the study group, and 30 patients with one TB episode during the study period were included in the control group. There were no statistically significant differences identified between studied patient groups in patients age (t(53) = −1.53, p = 0.13), body mass index (t(53) = 0.82, p = 0.42), area of residency (χ2(1;55) = 0.015, p = 0.9), employment status (χ2(1;55) = 0.076, p = 0.78) and presence of comorbidities (χ2(1;55) = 3.67, p = 0.78). Study group patients had statistically significantly more frequently positive sputum smear microscopy results (χ2(1;55) = 8.72, p = 0.0031), longer time to sputum smear (t(31) = −2.2, p = 0.036) and sputum culture conversion (W (55) = 198.5, p = 0.0029). Smoking was statistically significantly (χ2(1;55) = 5.77, p = 0.016) more frequently represented among study group patients. The median treatment duration for drug susceptible TB was 6 months in both in the control group (IQR 6–6) and among study group patients (IQR 6–7.75). The median treatment duration for multidrug-resistant TB was 20 months (IQR 17–23) in the control group and 19 months (IQR 16–19) in the study group patients. ConclusionPositive SSM for acid-fast bacteria, delayed time to sputum smear and sputum culture conversion, smoking, and incomplete therapy in the study group patients with multidrug-resistant TB should be considered as potential reasons for reactivation in recurrent TB patient group in our study.

Determinants of tuberculosis site among 1035 cases in Frankfurt, 2008-2023: does lineage matter?

Abstract Extrapulmonary tuberculosis (EPTB) presents with nonspecific symptoms which can pose a diagnostic challenge. Currently, there are no clear predictors for EPTB. We aimed to identify these factors for better diagnosis and disease control. We included tuberculosis cases reported in Frankfurt from 2008-2023, with available clinical and whole genome sequencing data. According to WHO criteria, cases with pulmonary or combined pulmonary and extrapulmonary symptoms were categorised as pulmonary tuberculosis, while exclusively extrapulmonary symptoms were categorised as extrapulmonary tuberculosis. We assessed the association between EPTB and M. tuberculosis lineage, comorbidities and demographic characteristics using logistic regression, calculating crude and adjusted odds ratios (aOR). Of the 1035 reported tuberculosis cases, 272 had exclusively extrapulmonary disease and 136 had both pulmonary and extrapulmonary disease. In the univariable analysis, lineages 1 and 3 were significantly associated with extrapulmonary disease compared to lineage 4. However, this association was not observed in the multivariable analysis. In the final regression model, females were more likely to develop EPTB than men (aOR: 1.65, CI: 1.19-2.27). The odds of developing extrapulmonary disease were higher among patients born in the South-East Asian (aOR: 6.48, CI: 3.72-11.43) and Eastern Mediterranean (aOR: 5.54, CI: 3.41-9.11) than in other regions. Among the comorbidities, diabetes was found to be negatively associated with extrapulmonary disease (aOR: 0.50, CI: 0.26-0.91). Our results indicate that host factors such as geographic origin and sex are stronger predictors for extrapulmonary presentation of tuberculosis than a specific lineage. We recommend increasing physicians’ awareness of the nonspecific presentation of EPTB and adapting screening programmes, particularly for patients from South-East Asian and Eastern Mediterranean regions to foster more effective tuberculosis control measures. Key messages • Our study highlights the importance of considering host factors in predicting extrapulmonary tuberculosis, indicating their stronger influence compared to specific M. tuberculosis lineages. • Increased physicians’ awareness of the nonspecific symptoms of EPTB and targeted screening programs for high-risk populations are crucial for enhancing tuberculosis control measures.

Optimizing tuberculosis control: a comprehensive simulation of integrated interventions using a mathematical model

Tuberculosis (TB) remains a formidable global health challenge, demanding effective control strategies to alleviate its burden. In this study, we introduce a comprehensive mathematical model to unravel the intricate dynamics of TB transmission and assess the efficacy and cost-effectiveness of diverse intervention strategies. Our model meticulously categorizes the total population into seven distinct compartments, encompassing susceptibility, vaccination, diagnosed infectious, undiagnosed infectious, hospitalized, and recovered individuals. Factors such as susceptible individual recruitment, the impact of vaccination, immunity loss, and the nuanced dynamics of transmission between compartments are considered. Notably, we compute the basic reproduction number, providing a quantitative measure of TB transmission potential. Through this comprehensive model, our study aims to offer valuable insights into optimal control measures for TB prevention and control, contributing to the ongoing global efforts to combat this pressing health challenge.

Further analysis of tuberculosis in eight high-burden countries based on the Global Burden of Disease Study 2021 data

BackgroundsMost significant findings from the Global Tuberculosis (TB) Report 2023 indicate that India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of the Congo (DRC) collectively contribute to approximately two-thirds of global TB cases. This study aims to provide crucial data-driven insights and references to improve TB control measures through a comprehensive analysis of these eight high-burden countries.MethodsThe eight high-burden TB countries analyzed in this study include India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the DRC. Age-standardized incidence rates (ASIR) of TB were derived from the Global Burden of Diseases Study 2021 data. Temporal trends were analyzed using Joinpoint regression. An age-period-cohort model was applied to examine the risk ratios (RR) of TB across diverse age groups, periods, and birth cohorts. A Bayesian age-period-cohort framework was employed to predict the ASIR of TB by 2030.ResultsThe study found that the Philippines (average annual percentage change = 3.1%, P < 0.001) exhibited an upward trend from 1990 to 2021. In India, the Philippines, Pakistan, and Bangladesh, the RR of TB incidence exceeded 1 after individuals reached 25 years old. Notably, the RR has shown a consistent upward trend since 2001, peaking during the period of 2017–2021 with an estimated RR of 1.5 (P < 0.001) in the Philippines. Similarly, the highest RR was observed during the period of 2017–2021 reaching 1.1 (P < 0.001) in the DRC. In the Philippines, the markedly increasing RR values for TB have been observed among individuals born after 1997–2001. Projections suggest that the ASIR of TB is expected to follow a continued upward trajectory, with an estimated rate of 392.9 per 100,000 by 2030 in the Philippines; India and Indonesia are projected to achieve less than 20.0% of the target set by the World Health Organization (WHO).ConclusionsAmong the eight high-burden countries, the Philippines, India and Indonesia are diverging from the goals set by the WHO, and the risk of TB in the Philippines and the DRC shows a trend toward affecting younger populations, which suggests that the management strategies for TB patients need to be further strengthened.Graphical

Drug resistance and genomic variations among Mycobacterium tuberculosis isolates from The Nile Delta, Egypt

Tuberculosis is a global public health concern. Earlier reports suggested the emergence of high rates of drug resistant tuberculosis in Egypt. This study included 102 isolates of Mycobacterium tuberculosis collected from two reference laboratories in Cairo and Alexandria. All clinical isolates were sub-cultured on Löwenstein–Jensen medium and analyzed using both BD BACTEC MGIT 960 SIRE Kit and standard diffusion disk assays to identify the antibiotic sensitivity profile. Extracted genomic DNA was subjected to whole genome sequencing (WGS) using Illumina platform. Isolates that belong to lineage 4 represented > 80%, while lineage 3 represented only 11% of the isolates. The percentage of drug resistance for the streptomycin, isoniazid, rifampicin and ethambutol were 31.0, 17.2, 19.5 and 20.7, respectively. Nearly 47.1% of the isolates were sensitive to the four anti-tuberculous drugs, while only one isolate was resistant to all four drugs. In addition, several new and known mutations were identified by WGS. High rates of drug resistance and new mutations were identified in our isolates. Tuberculosis control measures should focus on the spread of mono (S, I, R, E)- and double (S, E)-drug resistant strains present at higher rates throughout the whole Nile Delta, Egypt.

Qualitative system dynamics modelling to support the design and implementation of tuberculosis infection prevention and control measures in South African primary healthcare facilities.

Tuberculosis infection prevention and control (TB IPC) measures are a cornerstone of policy, but measures are diverse and variably implemented. Limited attention has been paid to the health system environment, which influences successful implementation of these measures. We used qualitative system dynamics and group-model-building methods to (1) develop a qualitative causal map of the interlinked drivers of Mycobacterium tuberculosis (Mtb) transmission in South African primary healthcare facilities, which in turn helped us to (2) identify plausible IPC interventions to reduce risk of transmission. Two 1-day participatory workshops were held in 2019 with policymakers and decision makers at national and provincial levels and patient advocates and health professionals at clinic and district levels. Causal loop diagrams were generated by participants and combined by investigators. The research team reviewed diagrams to identify the drivers of nosocomial transmission of Mtb in primary healthcare facilities. Interventions proposed by participants were mapped onto diagrams to identify anticipated mechanisms of action and effect. Three systemic drivers were identified: (1) Mtb nosocomial transmission is driven by bottlenecks in patient flow at given times; (2) IPC implementation and clinic processes are anchored within a staff 'culture of nominal compliance'; and (3) limited systems learning at the policy level inhibits effective clinic management and IPC implementation. Interventions prioritized by workshop participants included infrastructural, organizational and behavioural strategies that target three areas: (1) improve air quality, (2) improve use of personal protective equipment and (3) reduce the number of individuals in the clinic. In addition to core mechanisms, participants elaborated specific additional enablers who would help sustain implementation. Qualitative system dynamics modelling methods allowed us to capture stakeholder views and potential solutions to address the problem of sub-optimal TB IPC implementation. The participatory elements of system dynamics modelling facilitated problem-solving and inclusion of multiple factors frequently neglected when considering implementation.

Effective Reproduction Number of Smear-Positive Pulmonary Tuberculosis in Iran: A Registry-Based Study (2011-2021).

Tuberculosis (TB) remains a major public health issue in Iran, especially smear-positive pulmonary tuberculosis (SPPTB), due to its high transmission rate. Examining the effective reproduction number(Rt ) of SPPTB and patient characteristics is crucial for crafting targeted TB control measures. This study aimed to assess the Rt of SPPTB in Iran from 2011 to 2021 and profile SPPTB patient demographics, initial smear bacilli density, diagnosis delays, and spatial distribution. Study Design: This is a historical cohort study. A time-dependent method was used to estimate Rt , and monthly data from the national TB registry were scrutinized from 2011 to 2021. A decline was observed in SPPTB incidence rates of 50909 SPPTB cases in Iran from 2011 to 2021. Approximately 29.1% of the cases were diagnosed within a month, while 44.5% experienced a one to three-month delay in diagnosis. The analysis revealed substantial heterogeneity in TB transmission dynamics across various provinces of Iran. Provinces such as Sistan and Baluchestan, Golestan, Guilan, Khuzestan, Tehran, and Khorasan Razavi exhibited the highest effective reproduction numbers. Additionally, there was a decreasing trend in the effective reproduction numbers across all provinces from 2011 to 2020. Effective reproduction numbers declined in most provinces from 2011 to 2020 but increased moderately after the COVID-19 pandemic, highlighting the need for targeted public health interventions. Although SPPTB incidence rates are declining nationally, elevated incidence rates and effective reproduction numbers in regions such as Sistan and Baluchestan, Golestan, Guilan, Khuzestan, Tehran, and Khorasan Razavi signify the need for persistent TB management efforts in Iran.

Tuberculosis Diagnosis in Patients Co-Infected with HIV: A Review

Co-infection with Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) interacts in fundamentally significant ways. Pathophysiological, clinical, and epidemiological evidence all support this connection. HIV-positive and HIV-negative TB patients differ in a few ways that could affect practical diagnostics. When immunosuppression increases, TB becomes more transmissible in nature and more challenging to diagnose using standard diagnostic methods. Better diagnostic methods should be taken into account as TB control measures since TB rates are rising in areas where HIV is widespread. It is necessary to create more approachable methods that can be modified for usage in high-burden and low-income nations. This review focuses on the challenges associated with detecting co-infection between HIV and TB, giving an update on existing diagnostic methods and describing potential developments in light of the HIV pandemic.

Impact of strengthening TB diagnostic services in Uttarakhand: A step towards TB elimination

Tuberculosis (TB) poses a significant public health challenge in Uttarakhand, India. To address this, the state has implemented strategic measures aimed at increasing the presumptive TB case examination rate. Key initiatives include the deployment of 40 additional molecular diagnostic machines, facilitated by the Corporate Social Responsibility (CSR), ensuring comprehensive coverage and enhancing field-level testing capabilities. The proactive procurement of molecular diagnostic chips and consumables at the state level has ensured an uninterrupted supply, bolstering testing capacity across all blocks. Additionally, regular fortnightly reviews and monitoring at the block level have been instituted to set targets, involve local leadership, and foster continuous improvement. These combined efforts have significantly improved the diagnostic capacity and operational efficiency of TB control measures in Uttarakhand, demonstrating the state's commitment to effective TB management and eventual elimination.

On the Role of Early Case Detection and Treatment Failure in Controlling Tuberculosis Transmission: A Mathematical Modeling Study

Tuberculosis (TB) remains a pressing global health concern, demanding urgent attention to mitigate its spread and impact. In this study, we present a rigorous mathematical model of TB transmission that incorporates early case detection and addresses the critical issue of treatment failure. Through the development of a system of nonlinear ordinary differential equations, we conduct comprehensive analyses to assess the dynamics of TB transmission and the efficacy of intervention strategies. Our findings underscore the urgent need for effective TB control measures. Mathematical analyses reveal that the model exhibits a TB-free equilibrium, which is globally asymptotically stable only if the control reproduction number falls below one. However, we identify a concerning phenomenon: the model demonstrates a forward bifurcation when the control reproduction number equals one, suggesting that the disease-free equilibrium loses its stability, while simultaneously, the stable unique endemic equilibrium begins to emerge. Moreover, sensitivity analysis highlights the complex interplay between case detection rates, treatment failure probabilities, and TB transmission dynamics. Contrary to expectations, increasing case detection rates and minimizing treatment failure probabilities may not consistently reduce the basic reproduction number or the size of the infected population. Instead, there exists a critical threshold for intervention effectiveness, beyond which TB transmission can be significantly curtailed. Biologically, this phenomenon may occur if there is no balance between case detection and treatment efforts. If treatment quality does not improve, then case detection will not have a significant impact, and in the worst case scenario, it can exacerbate the intervention’s negative effects. These findings underscore the urgency of implementing targeted intervention strategies to combat TB transmission effectively. Failure to meet the critical intervention threshold risks undermining TB elimination efforts and exacerbating the global TB burden. Through numerical simulations, we elucidate potential intervention scenarios necessary for achieving TB elimination goals in human populations. In conclusion, our study highlights the urgent imperative for coordinated action to control TB transmission effectively. By elucidating the dynamics of TB spread and intervention efficacy, we provide valuable insights to inform evidence-based policy decisions and accelerate progress towards TB elimination on a global scale.

Assessing the Impact of Tuberculosis on Economic Growth in ASEAN Countries: A Conceptual Framework and Panel Data Analysis

Tuberculosis (TB) remains a major global health issue, particularly in Southeast Asia, where its impact extends beyond public health to affect economic performance. This study evaluates the economic implications of TB incidence on gross domestic product (GDP) growth across eight ASEAN countries from 2000 to 2020. We employed a panel data regression approach, utilizing Common Effect Model (CEM), Fixed Effects Model (FEM), and Random Effects Model (REM) to analyze the relationship between TB incidence and economic growth. The dataset included annual GDP figures, TB incidence rates, foreign direct investment (FDI), labor force size, and trade openness, sourced from international databases. The most appropriate model was selected based on Chow and Hausman tests, with FEM being the preferred model for its ability to account for country-specific effects. The FEM analysis revealed a significant negative impact of TB incidence on GDP, with a reduction of approximately 6.69% in GDP growth for each unit increase in TB incidence. Simulations showed that countries with high TB prevalence, such as the Philippines and Cambodia, experienced substantial economic losses, while reductions in TB incidence could lead to notable economic gains, particularly in Indonesia and Thailand. The study highlights the considerable economic burden of TB on ASEAN countries and emphasizes the importance of integrating TB control measures into economic development strategies. Effective TB prevention and treatment could substantially mitigate economic losses and promote sustainable growth. Policymakers are encouraged to invest in TB healthcare infrastructure and consider the economic benefits of reducing TB incidence in their health policies.

Epidemiological characteristics and influencing factors of tuberculosis aggregation in schools in Wuhan, China during 2017-2022.

Wuhan is located in the hinterland of China, in the east of Hubei Province, at the intersection of the Yangtze River and Hanshui River. It is a national historical and cultural city, an important industrial, scientific, and educational base, and a key transportation hub. There are many schools in Wuhan, with nearly a thousand of all kinds. The number of students is ~2.2 million, accounting for nearly one-fifth of the resident population; college or university students account for ~60% of the total student population. The geographical location of these colleges is relatively concentrated, and the population density is relatively high, making it prone to tuberculosis cluster epidemic. This study analyzed the epidemiological characteristics and influencing factors of tuberculosis aggregation in schools in Wuhan, China, during 2017-2022 to provide the basis for the scientific development of tuberculosis prevention and control strategies and measures in schools. This study adopted the methods of descriptive epidemiology to analyze the epidemic characteristics of tuberculosis aggregation in schools in Wuhan from January 2017 to December 2022, collecting the relevant data on tuberculosis prevention and control in all kinds of schools in the city using Questionnaire Star, an application of the China network questionnaire survey, and analyze the influencing factors of tuberculosis aggregation by using multifactor logistic regression analysis. From 2017 to 2022, 54 outbreaks of pulmonary tuberculosis aggregation in schools were reported in Wuhan, which involved 37 different schools, including 32 colleges or universities and five senior high schools; 176 cases were reported, among which 73 were positive for pathogens and 18 were rifampicin or izoniazid resistant. The median duration of a single cluster epidemic was 46 (26,368) days. Universities were more prone to cluster outbreaks than middle schools (χ2 = 105.160, P = 0.001), and the incidence rate among male students was higher than that of female students in cluster epidemics (χ2 = 12.970, P = 0.001). The multivariate logistic regression analysis results showed that boarding in school (OR = 7.60) is the risk factor for a tuberculosis cluster epidemic in schools. The small number of students (OR = 0.50), the location of the school in the city (OR = 0.60), carry out physical examinations for freshmen (OR = 0.44), carry out illness absence and cause tracking (OR = 0.05), dormitories and classrooms are regularly ventilated with open windows (OR = 0.16), strict implement the management of sick student's suspension from school (OR = 0.36), and seeking timely medical consultation (OR = 0.32) were the protective factors for a tuberculosis cluster epidemic in schools. We successfully identified the epidemiological characteristics and influencing factors of tuberculosis aggregation in schools in Wuhan. The results revealed the influence and status of various factors and indicated ways for schools to improve their TB prevention and control measures in their daily activities. These measures can effectively help curb the cluster epidemic of tuberculosis in schools.

Enhanced Glycosylation Caused by Overexpression of Rv1002c in a Recombinant BCG Promotes Immune Response and Protects against Mycobacterium tuberculosis Infection.

Tuberculosis (TB) is a major global health threat despite its virtual elimination in developed countries. Issues such as drug accessibility, emergence of multidrug-resistant strains, and limitations of the current BCG vaccine highlight the urgent need for more effective TB control measures. This study constructed BCG strains overexpressing Rv1002c and found that the rBCG-Rv1002c strain secreted more glycosylated proteins, significantly enhancing macrophage activation and immune protection against Mycobacterium tuberculosis (M. tb). These results indicate that Rv1002c overexpression promotes elevated levels of O-glycosylation in BCG bacteriophages, enhancing their phagocytic and antigenic presentation functions. Moreover, rBCG-Rv1002c significantly upregulated immune regulatory molecules on the macrophage surface, activated the NF-κB pathway, and facilitated the release of large amounts of NO and H2O2, thereby enhancing bacterial control. In mice, rBCG-Rv1002c immunization induced greater innate and adaptive immune responses, including increased production of multifunctional and long-term memory T cells. Furthermore, rBCG-Rv1002c-immunized mice exhibited reduced lung bacterial load and histological damage upon M. tb infection. This result shows that it has the potential to be an excellent candidate for a preventive vaccine against TB.

Analysis of Drug Resistance Characteristics of Mycobacterium Tuberculosis in Anhui Province, 2016-2022.

To preliminarily assess the prevalence and control effect of tuberculosis and drug-resistant tuberculosis (TB) in Anhui province, and analyze the trends in the changing drug resistance spectrum of Mycobacterium tuberculosis (Mtb) isolated in Anhui province from 2016 to 2022. From 2016 to 2022, a total of 2336 culture-positive tuberculosis strains were collected from four drug resistance monitoring sites. Patient demographic information was collected and drug susceptibility testing was conducted. Among the 2336 Mycobacterium tuberculosis complex strains, 1788 (76.54%) were from male patients and 548 (23.46%) were from female patients. The majority were of Han ethnicity, from rural areas, and employed in agriculture, with 12.54% (285/2273) having diabetes. A total of 1893 (81.04%) strains were sensitive to all six anti-TB drugs tested, and 443 (18.96%) strains were resistant to at least one or more anti-TB drugs. The drug resistance rate for patients undergoing initial treatment was 16.80% (348/2071), and 35.85% (95/265) for those receiving retreatment. Among the six anti-TB drugs, the resistance rates from highest to lowest were: INH (10.55%, 236/2336), SM (8.18%, 183/2336), OFX (6.53%, 146/2336), RFP (5.95%, 133/2336), EMB (2.37%, 53/2336), KM (1.97%, 44/2336). Significant differences were observed in MDR strains across different ages, types, with or without diabetes, and geographical sources (χ2=14.895,76.534,6.032,5.109, all P<0.05). The tuberculosis prevention and control measures have controlled the drug resistance rate of Mycobacterium tuberculosis to a certain extent. However, there are still statistical differences in drug resistance rates among TB patients with different categories, age groups, regions, and diabetic diseases. Early detection and prompt treatment of patients with drug-resistant TB remain critical to controlling the spread of this disease.

Genetic Diversity of Mycobacterium tuberculosis Strains Isolated from HIV-Infected Patients in Mexico.

There has been very limited investigation regarding the genetic diversity of Mycobacterium tuberculosis (MTb) strains isolated from human immunodeficiency virus (HIV)-infected patients in Mexico. In this study, we isolated 93 MTb strains from pulmonary and extrapulmonary samples of HIV-infected patients treated in a public hospital in Mexico City to evaluate the genetic diversity using spoligotyping and mycobacterial interspersed repetitive unit-variable-number tandem-repeat (MIRU-VNTR) typing (based on 24 loci). The cohort comprised 80 male and 13 female individuals. There was a positive correlation between a high HIV viral load (>100,000 copies) and extrapulmonary tuberculosis (TB) (r = 0.306, p = 0.008). Lineage 4 was the most frequent lineage (79 strains). In this lineage, we found the H clade (n = 24), including the Haarlem, H3, and H1 families; the T clade (n = 22), including T1 and T2; the X clade (n = 15), including X1 and X3; the LAM clade (n = 14), including LAM1, LAM2, LAM3, LAM6, and LAM9; the S clade (n = 2); Uganda (n = 1); and Ghana (n = 1). We also found 12 strains in the EAI clade belonging to lineage 1, including the EAI2-Manila and EAI5 families. Interestingly, we identified one strain belonging to the Beijing family, which is part of lineage 2. One strain could not be identified. This study reports high genetic diversity among MTb strains, highlighting the need for a molecular epidemiological surveillance system that can help to monitor the spread of these strains, leading to more appropriate measures for TB control in HIV-infected patients.