Decline In Incidence Of Tuberculosis Research Articles

Shifting from tuberculosis control to elimination: Where are we? What are the variables and limitations? Is it achievable?

Tuberculosis (TB) is a priority in terms of incidence and mortality, with about 10.4 million new incident cases and 1.8 million deaths in 2015. The End-TB strategy recently launched by the World Health Organization in the context of the post-2015 agenda, aimed to achieve TB elimination, represents an evolution of the previous historical strategies originally aimed to achieve TB control. Globally, the current decline in TB incidence is rather slow at approximately 1,5% per year to reach the TB pre-elimination phase by 2035 (A more aggressive approach based on diagnosis and treatment of latently infected individuals has been proposed in the context of TB elimination to ensure future generations free of TB. We describes 4 scenarios which, combined, describe the TB epidemiology in a given setting: 1) in absence of interventions, 2) with early TB diagnosis and effective treatment, 3) with irregular TB treatment, 4) with TB co-infected by HIV not undergoing anti-retroviral treatment. To achieve TB Elimination, a more concerted action by funders and governments will be required for further investments into TB prevention, detection and treatment.

Is systematic screening and treatment for latent tuberculosis infection in HIV patients useful in a low endemic setting?

Objectives: A decreasing incidence of tuberculosis (TB) among HIV patients has been documented in high-income settings and screening for tuberculosis is not systematically performed in many clinics (such as ours). Our objectives are to evaluate whether a same decline of incidence was seen in our Belgian tertiary center and to evaluate whether systematic screening and prophylaxis of tuberculosis should remain part of routine practice.Methods: Between 2005 and 2012, the annual incidence of tuberculosis among adult HIV patients was measured. The impact of demographic characteristics and CD4 nadir on the incidence of active TB was evaluated.Results: Among the 1167 patients who entered the cohort, 42 developed active TB with a significant decrease of annual incidence from 28/1000 patient-years in 2005 to 3/1000 patient-years in 2012. Among the 42 cases, 83% were of sub-Saharan origin. Median CD4 cell count upon HIV diagnosis was significantly lower in TB cases and 60% had a nadir CD4 below 200/μl. Thirty-six percent of incident TB occurred within 14 days after HIV diagnosis.Conclusion: A significant decline of TB incidence in HIV patients was observed. Incident TB occurred mainly in African patients, with low CD4 upon HIV diagnosis. A significant proportion of TB cases were discovered early in follow-up which probably reflects TB already present upon HIV diagnosis. In a low endemic setting, exclusion of active TB upon HIV diagnosis remains a priority and screening for LTBI should focus on HIV patients from high risk groups such as migrants from endemic regions, especially in patients with low CD4 nadir.

Tuberculosis 2015: Burden, Challenges and Strategy for Control and Elimination.

Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide, accounting for about 9.6 million new cases and 1.5 million deaths annually. The poorest and socially excluded groups carry the largest burden of disease, which makes it essential to properly address the social determinants of health through poverty reduction measures and targeted interventions on high-risk populations. The spread of multidrug-resistance TB requires special attention and highlights the need to foster research on TB diagnostics, new drugs and vaccines. Although many advances have been made in the fight against TB over the last twenty years, a lot is still needed to achieve global elimination. The new end-TB strategy that was first launched in 2014 by the World Health Organization, is fully in line with the seventeen Sustainable Development Goals that came into effect since January 2016 and sets ambitious goals for the post-2015 agenda. A 90% reduction in TB-related mortality and an 80% decline in TB incidence within 2030 as well as the abolition of catastrophic expenditures for TB-affected people are the main targets of this strategy. Strong government commitment and adequate financing from all countries together with community engagement and appropriate investments in research are necessary in order to reach these objectives.

Active Case Finding Among Homeless People as a Means of Reducing the Incidence of Pulmonary Tuberculosis in General Population.

The incidence of tuberculosis (TB) declined more than two-fold, compared with the national average, in the northeastern region of Poland in the period of 2003-2012. During that time, four programs of active case finding of TB were conducted as part of which a total of 944 homeless individuals were examined and 21 cases of active TB were detected. The objective of the present study was to find out whether the observed beneficial epidemiological trend could be a result of those programs. We addressed the issue of how the active case finding programs in the homeless community affected the TB incidence in the general population using a modified crisscross SIS-type (Susceptible - Infected - Susceptible) model which describes the dynamics of TB spread between the homeless and non-homeless populations. The values calculated from our model proved highly congruent with the actual epidemiological data. Our analysis showed a significant decline in TB incidence within 1year of completion of each active case finding program. The model shows that each identified and cured case in the homeless community reduced the number of new cases in the general population by 3-4 within 1year and by up to 20 within 5years.

Tuberculosis case notification data in Viet Nam, 2007 to 2012.

Tuberculosis (TB) remains a major cause of morbidity and mortality, and Viet Nam ranks 12 among the 22 high-TB burden countries. This study analyses surveillance data of the National Tuberculosis Control Programme in Viet Nam for the six-year period 2007 to 2012. During the study period, 598,877 TB cases (all forms) were notified, and 313,225 (52.3%) were new smear-positive cases. The case notification rate of new smear-positive cases was decreased, from 65 per 100,000 population in 2007 to 57 per 100,000 population in 2012; this decrease was observed for males and females in all age groups except males aged 0-14 and females aged 15-24 years. The male-to-female ratio of new smear-positive TB cases increased from 2.85 in 2007 to 3.02 in 2012. The average annual cure rate of new smear-positive cases was 90.3%. The high male-to-female ratio for new smear-positive TB cases in this notification data was lower than that from the 2007 TB prevalence survey in Viet Nam, suggesting a lower case detection for males. The decrease in new smear-positive case notification rates may reflect a decline in TB incidence in Viet Nam as several programmatic improvements have been made, although further research is required to increase case detection among young males and children.

Molecular and Genetic Research in Tuberculosis Clinical Practice and Epidemiology.

IntroductionTuberculosis (TB) remains a global public health problem. In order for multi-drug resistant tuberculosis (MDR-TB) to be more effectively managed, there is a need for better tools for diagnosis, treatment, and prevention. The decline of TB incidence and mortality in Kazakhstan during last decade was accompanied with consistent growth of MDR-TB. This study aimed to investigate genotype characteristics of Mycobacterium tuberculosis (MT) isolated from TB patients from different regions of the country and its clinical and epidemiological significance.MethodsOver 500 clinical MT isolates from pulmonary TB patients between 2003–2008 were genotyped using spoligotyping, MIRU-VNTR, IS6110 RFLP, and hybridization on an oligonucleotide biochip “TB–biochip.”ResultsOut of 250 isolates with interpretable results, 31 different spoligopatterns were detected. The Beijing genotype was the most predominant lineage detected (71.6%), characterized by heterogenicity on ETR A, B, C, D, and E markers, and 56.6% of them had an allelic profile 42435. The Beijing genotype and dominating variant strains have a high transmission rate, a high rate of primary MDR (associated with infiltrating lung TB and complications), and a high level resistance to rifampicin and izoniazid due to mutation of rpoB531TTG and katG315ACC. MIRU-VNTR–typing by 15 loci of 33 isolates from 13 family TB foci revealed that strains from supposed sources and contact persons completely coincide in only 5 foci in the genomic structure.ConclusionThere is a heterogeneous pool of genotypes that circulate in Kazakhstan, with the Beijing lineage being the most predominant. It appears that at the present stage of circulation, MT Beijing genotype has an endemic character. However, clonal spreading of epidemiologically and clinically significant MDR strains of this genotype is also a serious threat to the population. To increase TB control efficiency and prevent further transmission, it is necessary to compile a modern countrywide system of microbiological monitoring for the agent by use of a computer bank of spoligotyping and MIRU-VNTR-typing profiles of circulating strains.

Epidemiology and control of tuberculosis in the Western Pacific Region: analysis of 2012 case notification data.

Tuberculosis (TB) control in the World Health Organization (WHO) Western Pacific Region has seen substantial progress in the last decade, with a 33% reduction in prevalent TB cases since 2000. The burden remains immense, however, and national TB programmes must evolve and adapt to build upon these gains. Through routine surveillance, countries and areas in the Region reported 1.4 million TB cases in 2012. The case notification rate increased in the early 2000s, appears to have stabilized in recent years and is in decline for all forms and new smear-positive cases. The age and sex breakdown for smear-positive TB case rates by country shows generally higher rates with increased age and declining rates over time for all age groups. Treatment success remains high in the Region, with 15 countries reaching or maintaining an 85% success rate. HIV testing among TB patients has increased gradually along with a slow decline in the number of HIV-positive patients found. The trend of TB notification is heavily influenced by programmatic improvements in many countries and rapidly changing demographics. It appears that cases are being found earlier as reflected in declining rates of smear-positive TB and steady rates of TB in all forms. WHO estimates depict a decline in TB incidence in the Region. HIV testing, while still low, has increased substantially in recent years, with essential TB/HIV services expanding in many countries. TB surveillance data, within inherent limitations, is an important source of programmatic and epidemiological information. Careful interpretation of these findings can provide useful insight for programmatic decision-making.

Tuberculosis and noncommunicable diseases: neglected links and missed opportunities

Globally, the incidence of tuberculosis (TB) is declining very slowly, and the noncommunicable disease (NCD) burden for many countries is steadily increasing. Several NCDs, such as diabetes mellitus, alcohol use disorders and smoking-related conditions, are responsible for a significant proportion of TB cases globally, and in the European region, represent a larger attributable fraction for TB disease than HIV. Concrete steps are needed to address NCDs and their risk factors. We reviewed published studies involving TB and NCDs, and present a review and discussion of how they are linked, the implications for case detection and management, and how prevention efforts may be strengthened by integration of services. These NCDs put patients at increased risk for developing TB and at risk for poor treatment outcomes. However, they also present an opportunity to provide better care through increased case-detection activities, improved clinical management and better access to care for both TB and NCDs. Hastening the global decline in TB incidence may be assisted by strengthening these types of activities.

The persistence of tuberculosis in the age of DOTS: reassessing the effect of case detection.

To investigate whether short-term annual declines of 5-10% in the incidence of tuberculosis (TB) can be sustained over the long term by maintaining high case detection rates (CDRs). We constructed a compartmental difference-equation model of a TB epidemic in a hypothetical population of constant size with a treatment success rate of 85%. The impact of CDR on TB incidence was then investigated by generating an equilibrium population with no TB case detection and increasing the smear-positive CDR under two scenarios: (i) rapid expansion by 10% per year to a CDR of 80% after 8 years, and (ii) gradual expansion by 1% per year to a CDR of 90% after 90 years. The model was applied in two hypothetical populations: one without HIV and the other with a stable HIV incidence representative of the African Region. The CDR for smear-negative TB was assumed to be a constant fraction of the smear-positive CDR. In the absence of a TB control programme, the projected annual incidence of TB was 513 cases per 100 000 population, with a point prevalence of 1233 per 100 000 and an annual TB-specific mortality rate of 182 per 100 000. Immediately increasing the TB CDR from 0% to 70% caused a 74% reduction in TB incidence within 10 years. However, once case detection stabilized at any constant level < 80%, projected TB incidence also stabilized. Ten years after a CDR of 70% was reached, the annual decline in TB incidence was < 1.5%, regardless of how rapidly case detection was scaled up and despite wide variation of all model parameters. While improved CDRs have a dramatic short-term effect on TB incidence, maintaining those rates, even at current target levels, may not reduce long-term incidence by more than 1-2% per year. TB control programmes and researchers should vigorously pursue improvements in case detection, regardless of current CDRs.

Reconfiguring a hospital towards general practice: the case of Peamount

The decline in incidence of tuberculosis in Ireland has led Peamount Hospital to reconfigure its services towards the needs of general practice. To ascertain views of local GPs on their current use of Peamount, and how the hospital might best serve their future needs. Self-administered postal questionnaires sent to 151 GPs practicing in Peamount's catchment area, to determine their current use of services, and likely future use of proposed services. Total valid response rate 64% (n = 84). Responses indicated a lack of awareness of many services currently available, with a concomitant under-use of these services. The majority of GPs would use planned future services, particularly expanded radiology services. This survey promoted awareness among GPs of services available at Peamount. It informed the planning of future services and promoted a culture of involving local GPs in the planning of services of which they will be the users.

Changing funding patterns in tuberculosis

Changing funding patterns in tuberculosis

TUBERCULOSIS OF THE BREAST – A RARE FORM OF EXTRAPULMONARY TUBERCULOSIS – CASE REPORT

Background. There is a decline in incidence of tuberculosis in Slovenia. In most patients a tuberculosis occurs in pulmonary form. In one third of patients it appears either as combined pulmonary and extrapulmonary tuberculosis or extrapulmonary form alone, where pleura and lymph nodes are most often affected. Other localizations are rare and therefore sometimes not taken into account. Patient and methods. We present a female patient with tumorous formation in the breast, clinically and radiologicaly suspicious for neoplastic nodule. Citological examinations did not confirm neoplasm. Further microbiological and citological examinations proved the rare form of extrapulmonary tuberculosis. In addition, we also confirmed a pulmonary tuberculosis. At the end of treatment, improvement in radiological picture of the breast, clinical improvement and negativisation of cultures for Mycobacterium tuberculosis were observed. Conclusions. Determination of tumorous formations in the body is crucial because of appropriate treatment and different prognosis. Tuberculosis can grow anywhere in the body.

BCG vaccination and tuberculosis in Japan.

This paper summarizes Bacillus Calmette-Guerin (BCG) vaccination and revaccination policies in Japan, its cost-effectiveness, side effects, proposed selective vaccination strategy, and present tuberculosis situation in Japanese perspectives based on Medline database and other published reports. Universal BCG vaccination in infants and revaccination among children were not found economically justifiable. Overall tuberculosis incidence in Japan is higher than that of other developed countries. Trend of decline in tuberculosis incidence is similar to that of the countries where universal BCG vaccination has never been implemented. In the recent years, the number of tuberculosis group infection has been escalating. Since BCG revaccination program has already been discontinued, a consensus on universal BCG vaccination is also essential based on social, political, and economical factors. Side by side, more pragmatic strategies such as well-defined tuberculin test, selective vaccination policy based on tuberculosis incidence in each administrative zone, and early vaccination of high risk groups, should be formulated.

The dynamics of tuberculosis in response to 10 years of intensive control effort in Peru.

Improved tuberculosis (TB) case detection and cure rates are expected to accelerate the decline in incidence of TB and to reduce TB-associated deaths. Time series analyses of case reports in Peru showed that the per capita TB incidence rate was probably steady before 1991. Case reports increased between 1990 and 1992 as a result of improved case detection. Although diagnostic efforts have continued to increase since 1993, the incidence of new pulmonary TB cases has declined in every department of the country, with a national rate of decline > or =5.8% per year (range, 1.9%-9.7%). This elevated rate of decline suggests that 27% (19%-34%) of cases (158,000) and 70% (63%-77%) of deaths (91,000) among smear-positive patients were averted between 1991 and 2000. This is the first demonstration that a significant number of TB cases can be prevented through intensive short-course chemotherapy in a high-burden country.

Tuberculosis in Europe: another step forward for international surveillance

Spurred on by the reversal or slowing of the decline in tuberculosis incidence in many countries, the threat of the emergence of multidrug resistant strains of Mycobacterium tuberculosis, and possibly by the success of international AIDS surveillance, European collaborators have completed a pilot study (reported in this issue) of the feasibility of standardising tuberculosis surveillance. Although the case definitions used within countries differ, these differences are unlikely to account for the large variations in the incidence of tuberculosis between countries, ranging in 1995 from 3 per 100 000 in Malta to 102/100 000 in Romania. Equally large differences between countries were observed for the proportions of cases who had been born abroad. The establishment of surveillance for Europe as a whole is likely to strengthen national tuberculosis reporting systems and enable multidrug resistance and the relative effectiveness of control programmes to be monitored closely. When standardised case specific data are shared routinely more sophisticated analyses will be possible, which should enable prevention policies to be selected that will hasten the elimination of “the captain of all these men of death”.

Eleven years of community-based directly observed therapy for tuberculosis

<h3>Objective.</h3> —To evaluate community-based directly observed therapy (DOT) for tuberculosis (TB) control. <h3>Design.</h3> —Ecological study. <h3>Methods.</h3> —Three comparisons were made in this descriptive study. (1) An 11-year retrospective comparison of TB case rates, sputum conversion rates (SCRs), rates of therapy completion, and confounding factors (acquired immunodeficiency syndrome [AIDS], immigration, unemployment, and poverty) in Baltimore, Md, with those of the five major US cities having the highest TB incidence in 1981 but which did not have comprehensive DOT programs. (2) An 11-year trend of TB in Baltimore and the 19 major US cities with the highest TB incidence in 1981. (3) A 7-year trend in TB in both city groups between 1985 and 1992. <h3>Setting.</h3> —Twenty US metropolitan cities with more than 250 000 residents. <h3>Results.</h3> —Since 1981, Baltimore experienced the greatest decline in TB incidence (35.6 cases per 100000 population, 1981; 17.2 cases per 100000 population, 1992 [-51.7%]), and city rank for TB (sixth in 1981,28th in 1992). Conversely, the average incidence of TB increased 2.1% in the five-city cohort and increased 1.8% in the 19-city cohort. Since 1985, TB incidence increased 35.3% in the five-city cohort and 28.5% in the 19-city cohort, but declined 29.5% in Baltimore. From 1986 through 1992, Baltimore's DOT-managed cases had the highest annual SCRs at 3 months (mean, 90.7%), and the highest completion rates for standard anti-TB therapy (mean, 90.1%) when compared with the five cities. These trends could not be attributed to differentials in AIDS, immigration, poverty, or unemployment. Increasingly, more Baltimore cases were treated under DOT (86.5%, 1993) overtime. Disease relapse rates remained low, even among HIV-infected patients. Within Baltimore, the documented SCR was significantly higher among DOT-managed cases compared with non—DOT-managed cases (<i>P</i>&lt;.05); multidrug resistance remains rare (0.57%). Within Maryland, Baltimore accounted for 44.4% of all TB cases in 1981, compared with 28.7% in 1992 (<i>P</i>&lt;.001). <h3>Conclusions.</h3> —In contrast to the national TB upswing during the 1980s, Baltimore experienced a substantial decline in TB following implementation of community-based DOT, despite highly prevalent medicosocial risk factors. Directly observed therapy facilitated high treatment completion rates and bacteriologic evidence of cure. Directly observed therapy could help reduce TB incidence in the United States, particularly in cities with high case rates. (<i>JAMA</i>. 1995;274:945-951)

Eleven Years of Community-Based Directly Observed Therapy for Tuberculosis

To evaluate community-based directly observed therapy (DOT) for tuberculosis (TB) control. Ecological study. Three comparisons were made in this descriptive study. (1) An 11-year retrospective comparison of TB case rates, sputum conversion rates (SCRs), rates of therapy completion, and confounding factors (acquired immunodeficiency syndrome [AIDS], immigration, unemployment, and poverty) in Baltimore, Md, with those of the five major US cities having the highest TB incidence in 1981 but which did not have comprehensive DOT programs. (2) An 11-year trend of TB in Baltimore and the 19 major US cities with the highest TB incidence in 1981. (3) A 7-year trend in TB in both city groups between 1985 and 1992. Twenty US metropolitan cities with more than 250,000 residents. Since 1981, Baltimore experienced the greatest decline in TB incidence (35.6 cases per 100,000 population, 1981; 17.2 cases per 100,000 population, 1992 [-51.7%]), and city rank for TB (sixth in 1981, 28th in 1992). Conversely, the average incidence of TB increased 2.1% in the five-city cohort and increased 1.8% in the 19-city cohort. Since 1985, TB incidence increased 35.3% in the five-city cohort and 28.5% in the 19-city cohort, but declined 29.5% in Baltimore. From 1986 through 1992, Baltimore's DOT-managed cases had the highest annual SCRs at 3 months (mean, 90.7%), and the highest completion rates for standard anti-TB therapy (mean, 90.1%) when compared with the five cities. These trends could not be attributed to differentials in AIDS, immigration, poverty, or unemployment. Increasingly, more Baltimore cases were treated under DOT (86.5%, 1993) over time. Disease relapse rates remained low, even among HIV-infected patients. Within Baltimore, the documented SCR was significantly higher among DOT-managed cases compared with non-DOT-managed cases (P < .05); multidrug resistance remains rare (0.57%). Within Maryland, Baltimore accounted for 44.4% of all TB cases in 1981, compared with 28.7% in 1992 (P < .001). In contrast to the national TB upswing during the 1980s, Baltimore experienced a substantial decline in TB following implementation of community-based DOT, despite highly prevalent medicosocial risk factors. Directly observed therapy facilitated high treatment completion rates and bacteriologic evidence of cure. Directly observed therapy could help reduce TB incidence in the United States, particularly in cities with high case rates.

Tuberculosis in the autopsy material: analysis of 1500 autopsies performed between 1972 and 1991 in the institute of tuberculosis and chest diseases, Warsaw, Poland

The present study is based on 1500 autopsies done in the Institute of Tuberculosis and Chest Diseases Warsaw, Poland during the years 1972-81 and 1982-91. To assess the correctness of tuberculosis diagnosis before death in the above mentioned time periods. The autopsy reports were examined for the diagnosis of active tuberculosis proved by microscopy. The form and localisation of tuberculosis was assessed. The postmortem diagnosis was compared with clinical diagnosis. In those cases in which tuberculosis was not recognised before death the possible causes of this failure were analyzed. Active tuberculosis was found in 119 cases, 7.9% of all autopsies. It was localised in the lungs exclusively in 72 cases, in lungs and in extrapulmonary sites in 45 and in extrapulmonary sites only in 2. The frequency of active tuberculosis was the same for the two periods under evaluation. Tuberculosis was however not recognised before death in a much higher proportion of cases in 1982-92 (54%) than in 1972-81 (24%). The main cause of diagnostic failure was connected with atypical localisation of lesions on chest X-ray and with dissemination outside the lungs. Previous tuberculosis was a factor which facilitated the diagnosis of tuberculosis. In parallel with the decline of tuberculosis incidence in Poland, many doctors lack experience in diagnosing this disease, especially in cases with atypical X-ray presentation and with extrapulmonary localisation. This may lead to late or even very late diagnosis and have a significant impact on the epidemiological situation.

Need for continuing tuberculosis surveillance in previously screened new immigrants.

Despite the advent of effective chemotherapy and improvement in socioeconomic conditions, tuberculosis remains a highly prevalent disease in certain countries. There are an estimated 30 million cases in the world, with an annual incidence of 10 million and a mortality of 3 million. 1 Although the new case rate in the United States in 1989 was 9.5:100,000, tuberculosis was nevertheless the leading cause of death among the 38 communicable diseases reported to the Centers for Disease Control. 2 The general trend toward a decline in tuberculosis incidence has slowed recendy. This decrease has been attributed in part to the reactivation of tuberculosis in persons immunosuppressed by the human immunodeficiency virus. 3 In the initial postindependence period, Israel experienced a high case rate of tuberculosis (216:100,000 in 1950), largely resulting from massive immigration from non-Western countries.4 More recendy (1980 1985) the risk of infection has gradually declined to an average annual case rate of 6.3:100,000.5•6 In contrast with the low national incidence, Halperin recendy reported a relatively high incidence in an Israeli family practice.7 During a 3-year period (19841986) 10 cases of active tuberculosis occurred among recent Ethiopian immigrants wh~ h~d negative chest radiographs and tuberculosIs skin tests when they entered Israel an average of 1.7 years before diagnosis. In an effort to assess the immigration screening program and find an explanation for these cases, we reviewed the results of the primary screening at entrance. to .the co~­ try of all new immigrants to our dIstnct dunng this period.

Tuberculosis in australia: An analysis of cases identified in reference laboratories in 1986-88

The Special Interest Group in Mycobacteria within the Australian Society for Microbiology has carried out a collaborative study of cases of tuberculosis diagnosed in Australian reference laboratories in the years 1986, 1987 and 1988. Annual totals of 574, 584 and 613 respectively, suggest that the incidence of bacteriologically-positive tuberculosis is continuing at 3-4 cases per 100,000 population. The highest rates were detected in males over 50 and females over 65 years of age. Three-quarters of the total cases relate to pulmonary disease. Resistance to at least 1 anti-tuberculosis drug was detected in 78 (12.7%) of isolates tested in 1988. The negligible decline in incidence of tuberculosis in Australia, the high prevalence in S.E. Asian countries, and the fact that HIV-infection is an important risk factor, make it imperative that Australia's diagnostic and management programmes be maintained.