Cases Of Tuberculosis Infection Research Articles

Mycobacterial Interspersed Repetitive Unit-variable Number Tandem Repeat (MIRU-VNTR) Typing Lacks Discriminatory Power in the Genetic Analysis of Bovine Tuberculosis in Egypt

Tuberculosis (TB) is one of the most important infectious zoonotic diseases of vertebrates worldwide. TB in animals is primarily known from cases in cattle and other bovids for which the disease is generally referred to as bovine TB. The major causative agent of bovine TB is Mycobacterium bovis (M. bovis), a member of the Mycobacterium tuberculosis complex. Animal TB is a disease of high economic relevance within the context of livestock farming as it directly affects animal productivity and also influences international trade of animal products. In this study, we aimed at mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) analysis of cases of TB infection in local cattle in Egypt. Therefore, various samples (milk and blood samples) were collected from cattle farms (in Damietta Province) that were positive for tuberculin test. Mycobacterial isolation was tested on milk samples, but it showed negative result. DNA was extracted from blood samples. Five mycobacterial genes (IS6110, katG, gyrA, oxyR, pncA) were used for further confirmation of field TB infection. All blood samples were positive for Mycobacterial-specific genes. Twelve MIRU-VNTR loci were used to test their discriminatory power in the genetic analysis of TB, but such MIRU-VNTR loci typing failed to show any discriminatory power for the genetic analysis of bovine TB cases.

МОДЕРНИЗАЦИЯ ПРОТИВОТУБЕРКУЛЕЗНОЙ СЛУЖБЫ В НОВЫХ СОЦИАЛЬНЫХ И ЭПИДЕМИЧЕСКИХ УСЛОВИЯХ

In Dagestan as in Russia in general, tuberculosis situation has been stably improving for the last 15 years, which resulted in the reduction of efficiency and cos t-e ffectiveness of regular screening in the adult population. Due to this it is necessary to relocate tuberculosis control resources from standard mass screening to activities targeted at risk groups. First of all, these risk groups include children and adolescents, the HIV infected, those exposed to infectious cases of tuberculosis, patients with remaining pos t-t uberculosis changes and diseases increasing the risk of tuberculosis - those addicted to alcohol and substances, suffering from diabetes, peptic ulcer, chronic no n-s pecific pulmonary diseases as well as those living in poor conditions. It is reasonable to perform work aimed at the upgrade of TB services in the regions with favorable TB situation with the incidence below 40 per 100,000 population.

Using Reports of Latent Tuberculosis Infection Among Young Children to Identify Tuberculosis Transmission in New York City, 2006-2012.

The presence of latent tuberculosis infection (LTBI) in young children indicates recent tuberculosis (TB) transmission. We reviewed surveillance reports of children with LTBI to assess whether more follow-up is needed to prevent TB in this high-risk population. Data on all children under 5 years of age who were reported by health-care providers or laboratories to the New York City Department of Health during 2006-2012 were abstracted from the TB surveillance and case management system, and those with LTBI were identified. Potential source cases, defined as any infectious TB case diagnosed in the 2 years before a child was reported and whose residence was within 0.5 miles (0.8 km) of the child's residence, were identified. Neighborhood risk factors for TB transmission were examined. Among 3,511 reports of children under age 5 years, 1,722 (49%) had LTBI. The children were aged 2.9 years, on average, and most (64%) had been born in the United States. A potential source case was identified for 92% of the children; 27 children lived in the same building as a TB patient. Children with potential source cases were more likely to reside in neighborhoods with high TB incidence, poverty, and population density. The high proportion of children born in the United States and the young average age of the cases imply that undetected TB transmission occurred. Monitoring reports could be used to identify places where transmission occurred, and additional investigation is needed to prevent TB disease.

Knowing how many children to find is the first step in finding them.

Over fifty years ago, large-scale studies undertaken in the United States established that following the diagnosis of tuberculosis (TB) in a source case, household contact investigations were a highly effective strategy to identify previously undiagnosed prevalent cases of TB. Six thousand households were examined, and nearly five hundred contacts had prevalent TB at baseline. Over twenty-five thousand disease-free contacts were then enrolled in a trial comparing isoniazid to placebo. The provision of isoniazid to well household contacts was demonstrated to dramatically reduce the risk of those contacts developing TB disease themselves.1 At about the same time, Katharine Hsu carried out a series of studies in Houston, evaluating TB-affected families identified either through a child with TB or through a child identified as being infected following the diagnosis of TB in an adult. She concluded in 1963 that: ‘…tuberculosis exists in “pools” involving large numbers of cases. Public health efforts should be directed to these pools of infection, and contact investigation has proved very efficient in finding pools.’2 Therefore, we have known for over fifty years that both household contact investigations and preventive therapy for high-risk contacts work effectively. In most high-burden settings, high risk is usually taken to be children aged under five years and those with immune suppression. These strategies are recommended by the World Health Organization (WHO),3,4 and the majority of national TB programmes advise that they are carried out. Yet, in the majority of countries they do not take place, and it is unclear why. Household contact investigations can be seen as time-consuming and resource-intensive. They are often not seen as a priority compared to treating cases of infectious TB. Giving daily preventive therapy for six months to well children is not always easy, and may seem unnecessary to many health care workers and families. Data on the number of household contact investigations undertaken or the number of contacts given preventive therapy are not requested by TB programmes or by the WHO, perhaps sending the message that these activities are unimportant. Finally, health care workers have no idea how many contacts they should be looking for and how many they should be finding. The study by Yuen and colleagues in this issue of Public Health Action addresses this final aspect and provides realistic and tangible targets at a global and national level for the number of children that should be screened and the number that could be expected to have prevalent Mycobacterium tuberculosis infection and disease.5 This is a significant development and one that could be used by local clinic staff, district TB managers, national TB managers and global TB experts to improve the care of children exposed to TB. Not only does knowing the expected number of children that require screening and treatment help to inform resource planning, it also allows an assessment of the programme. By comparing the numbers screened and treated with the numbers expected to need screening and treatment, shortfalls can be identified and addressed. These shortfalls can be compared between clinics, between districts or between countries so that examples of ‘good’ practice (small shortfalls) can inform those with less good practice (larger shortfalls). Yuen and colleagues estimate that seven and a half million children each year live in households with diagnosed cases of infectious pulmonary TB. These children should be screened. Although this is a large number, these children are the low-hanging fruit: the yield from screening in this context is higher than almost any other strategy for trying to find cases of M. tuberculosis infection and disease. Currently only about a third of the one million children who develop TB disease globally each year are diagnosed and treated.6 A far smaller proportion of the children who are eligible for preventive therapy receive it. It is difficult to see how we will improve on these rates without household screening; if we want to find and treat more children we really do not have any other options.

The impact of drug resistance on the risk of tuberculosis infection and disease in child household contacts: a cross sectional study

BackgroundThe relative fitness of organisms causing drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) is unclear. We compared the risk of TB infection and TB disease in young child household contacts of adults with confirmed DS-TB and MDR-TB.MethodsIn this cross-sectional analysis we included data from two community-based contact cohort investigation studies conducted in parallel in Cape Town, South Africa. Children <5 years of age with household exposure to an infectious TB case were included between August 2008 to June 2011. Children completed investigation for TB infection (tuberculin skin test) and TB disease (symptom evaluation, chest radiograph, bacteriology) in both studies using standard approaches. The impact of MDR-TB exposure on each covariate of TB infection and TB disease was assessed using univariable and multivariable logistic regression.ResultsOf 538 children included, 312 had DS-TB and 226 had MDR-TB exposure. 107 children with DS-TB exposure had TB infection (34.3%) vs. 101 (44.7%) of children with MDR-TB exposure (adjusted Odds Ratio [aOR]: 2.05; 95% confidence interval [CI]: 1.34–3.12). A total of 15 (6.6%) MDR-TB vs. 27 (8.7%) DS-TB child contacts had TB disease at enrolment (aOR: 0.43; 95% CI: 0.19–0.97).ConclusionsOur results suggest a higher risk of TB infection in child contacts with household MDR-TB vs. DS-TB exposure, but a lower risk of TB disease. Although potentially affected by residual confounding or selection bias, our results are consistent with the hypothesis of impaired virulence in MDR-TB strains in this setting.

Decadal impact of Directly Observed Treatment Short course program on age and gender among New Infectious Tuberculosis cases in Delhi

BackgroundBurden of tuberculosis in India remains enormous. The Revised National Tuberculosis Control Programme (RNTCP), based on the Directly Observed Treatment Short course (DOTS) strategy, was launched in 1997 in India. The question of what DOTS has or has not accomplished over the past 15 years is a central technical question. ObjectivesTo assess the decadal impact of DOTS strategy on some epidemiological factors such as age and gender of new sputum positive (NSP) TB patients in Delhi. Material and methodsSecondary Data for Delhi was obtained from the state wise performance of RNTCP (Annual Summary) for the year 2001 and year 2012. Data was analyzed in Microsoft Excel 2007. ResultsThe population of Delhi covered under DOTS has considerably increased over the decade. The case detection rate has also shown a considerable increase from 196/100,000 population in 2001 to 306/100,000 population at the end of Quarter 3 of 2011. The number of NSP male and female patients have increased in all age groups from 2001 to 2011 except in 25–34 years age group. NSP male patients on DOTS aged 15–44 years showed a left ward shift in increase, a significant right ward shift was noted in increase in female NSP patients of similar age group. ConclusionsThe decadal assessment of DOTS in Delhi on TB epidemiology has pointed towards beginning of epidemiological transition in TB control in India.

Individual- and neighborhood-level contextual factors are associated with Mycobacterium tuberculosis transmission: genotypic clustering of cases in Michigan, 2004–2012

PurposeUsing genotyping data of Mycobacterium tuberculosis isolates from new cases reported to the tuberculosis (TB) surveillance program, we evaluated risk factors for recent TB transmission at both the individual- and neighborhood- levels among U.S.-born and foreign-born populations. MethodsTB cases (N = 1236) reported in Michigan during 2004 to 2012 were analyzed using multivariable Poisson regression models to examine risk factors for recent transmission cross-sectionally for U.S.-born and foreign-born populations separately. Recent transmission was defined based on spoligotype and 12-locus-mycobacterial interspersed repetitive unit–variable number tandem repeat typing matches of bacteria from cases that were diagnosed within 1 year of each other. Four classes of predictor variables were examined: demographic factors, known TB risk factors, clinical characteristics, and neighborhood-level factors. ResultsOverall, 22% of the foreign-born cases resulted from recent transmission. Among the foreign-born, race and being a contact of an infectious TB case were significant predictors of recent transmission. More than half (52%) of U.S.-born cases resulted from recent transmission. Among the U.S.-born, recent transmission was predicted by both individual- and neighborhood-level sociodemographic characteristics. ConclusionsInterventions aimed at reducing TB incidence among foreign-born should focus on reducing reactivation of latent infection. However, reducing TB incidence among the U.S.-born will require decreasing transmission among socially disadvantaged groups at the individual- and neighborhood- levels. This report fills an important knowledge gap regarding the contemporary social context of TB in the United States, thereby providing a foundation for future studies of public health policies that can lead to the development of more targeted, effective TB control.

Evaluation of Factors Affecting Patient Delay in the Diagnosis and Treatment of TB among TB Patients Attending in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia

Background: Most tuberculosis (TB) patients are not visiting heath facilities and hence transmit disease to healthy individuals in the community for a longer time in Ethiopia. This study was, therefore, aimed at estimating the duration of delay for initiation of anti-TB treatment in Hiwot Fana Specialized University Hospital (HFSUH) and assessing its determinants factors associated with unacceptable delay for medication. Methods: Facility based cross sectional study was conducted in HFSUH from March 1-May 30, 2016. Convenient sampling was employed to select eligible patients who avail on time of data collection. Data was collected prospectively from 280 TB patients aged 15 years and above and who attended to the hospital using a face to face interview with a predetermined set of questions. Data was analyzed using SPSS version 16. Finally, cross tabulation and Pearson chi-square test were employed for comparison of categorical variables. Results: A large number of extra pulmonary and smear negative pulmonary TB patients delayed more than the World Health Organization (WHO) recommended periods before taking medications. Amongst all TB patients interviewed, half (50%) of them sought treatment after WHO recommended periods (21 days). Fortunately, the median patient delay was found to be the same with WHO cut off point in this study. According to the study, the major reasons for patient delay were related to assuming symptoms are not severe (58%) followed by lack of money (32%) and health facility too far (6%). Moreover, educational status, occupation and residence were among major predictors of patient delay (p<0.05). Conclusion: Poor knowledge of TB signs and symptoms and patients' beliefs about curses as the origin of diseases lead to delaying care-seeking at the hospital level in an area of eastern Ethiopia. These infectious TB cases are transmitting the disease to their families and in the wider community making prevention and control difficult. Those living in the rural area, illiterate and distant from health care settings suffer from TB long time and at the same time transmit the disease in the community.

The diagnostic gap: Characterising the profile of undiagnosed infectious tuberculosis patients in the community

Background. In tuberculosis (TB)-endemic countries, about half the total TB caseload remains undiagnosed within the community. The proportion of such patients that can potentially transmit the disease has been poorly characterised, and there is insufficient data to inform on strategies to target potentially infectious TB cases in the community. Objective. To characterise the nature and profile of smear-positive patients diagnosed with TB in the community. Methods. We analysed data from culture-positive TB cases in the community during the course of an intensified case finding (ICF) study. The parent study was a randomised controlled trial comparing conventional and novel diagnostics for ICF in communities in Cape Town, South Africa and Harare, Zimbabwe, where trained healthcare workers screened patients at transmission hotspots. The results of the parent study are reported elsewhere. Results. A total of 2 261 persons were screened and 875 (39%) met the criteria for diagnostic testing. A total of 53/630 (8.4%) had confirmed tuberculosis. Smear microscopy detected 22/53 (42%) of the culture-positive patients. The specificity, positive predictive value (PPV) and negative predictive value (NPV) for smear microscopy were 98.4%, 70.0% and 95.3%, respectively. No clinical or demographic variable predicted smear positivity. Only decreased culture time-to-positivity was associated with smear grade (odds ratio 0.93, 95% confidence interval 0.91 - 0.96; p<0.001). Conclusion. A considerable proportion of patients with undiagnosed TB in the community (almost half) were smear positive and hence potentially infectious. Interestingly, neither HIV status nor symptoms identified those patients who were potentially infectious, despite them having a higher mycobacterial burden.

Tuberculosis contact investigations associated with air travel in Ireland, September 2011 to November 2014.

The risk of communicable disease transmission during air travel is of public health concern and has received much attention over the years. We retrospectively reviewed information from nine flights (≥ 8 hours) associated with infectious tuberculosis (TB) cases in Ireland between September 2011 and November 2014 to investigate whether possible transmission had occurred. Twenty-four flights notified in Ireland associated with sputum smear-positive pulmonary TB cases with a history of air travel were reviewed. Nine were suitable for inclusion and analysed. Six cases of infectious TB travelled on nine flights. A total of 232 passengers were identified for contact tracing; 85.3% (n = 198) had sufficient information available for follow-up. In total, 12.1% (n = 24) were reported as screened for TB. The results revealed no active TB cases among passengers and 16.7% (n = 4) were diagnosed with latent TB infection (LTBI) all of whom had other risk factors. Despite the limited sample size, we found no evidence of M. tuberculosis transmission from infectious passengers. This study identified challenges in obtaining complete timely airline manifests, leading to inadequate passenger information for follow-up. Receipt of TB screening results from international colleagues was also problematic. The challenge of interpreting the tuberculin skin test results in determining recent vs earlier infection was encountered.

Getting bang for buck in the latent tuberculosis care cascade

An important component of the strategy to reduce and eliminate tuberculosis, as outlined by WHO in their post-2015 strategy, is to target preventative therapy at those with presumed latent tuberculosis infection at high risk of future active tuberculosis. 1 Dheda K Barry 3rd, CE Maartens G Tuberculosis. Lancet. 2016; 387: 1211-1226 Summary Full Text Full Text PDF PubMed Scopus (375) Google Scholar In low-burden settings it makes sense to target some groups for screening such as close contacts of index cases with active tuberculosis, immigrants from high-burden countries, and other vulnerable subpopulations who are high risk of infection. 1 Dheda K Barry 3rd, CE Maartens G Tuberculosis. Lancet. 2016; 387: 1211-1226 Summary Full Text Full Text PDF PubMed Scopus (375) Google Scholar Indeed, reactivation of latent tuberculosis infection could account for more than 80% of incident cases in such settings. 2 Cain KP Haley CA Armstrong LR et al. Tuberculosis among foreign-born persons in the United States: achieving tuberculosis elimination. Am J Respir Crit Care Med. 2007; 175: 75-79 Crossref PubMed Scopus (112) Google Scholar By contrast, in high-burden settings, identification and treatment of infectious active tuberculosis cases remains the priority, and the sheer burden of disease and limitation of resources mean that only certain groups at high risk for progression, such as children and people with HIV, are targeted for preventative therapy. 1 Dheda K Barry 3rd, CE Maartens G Tuberculosis. Lancet. 2016; 387: 1211-1226 Summary Full Text Full Text PDF PubMed Scopus (375) Google Scholar Nevertheless, uptake of screening and preventative therapy in HIV-infected people from tuberculosis-endemic countries has been poor 3 Gupta S Granich R Date A et al. Review of policy and status of implementation of collaborative HIV-TB activities in 23 high-burden countries. Int J Tuberc Lung Dis. 2014; 18: 1149-1158 Crossref PubMed Scopus (34) Google Scholar despite recommendations that tuberculin skin testing (TST) not be a prerequisite for preventative therapy, even though it enables better targeting of treatment. 4 WHOGuidelines on the management of latent tuberculosis infection. World Health Organization, Geneva2015 Google Scholar Thus, in both high-burden and low-burden settings, targeted preventative treatment is an important strategy for tuberculosis control. However, once identified, what proportion of this target population undergo medical evaluation, are tested for latent tuberculosis, return for initiation of preventative therapy, and complete therapy; and how much attrition occurs at each step and throughout the process? The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysisWe identify major losses at several steps in the cascade of care for latent tuberculosis infection. Improvements in management of latent tuberculosis will need programmatic approaches to address the losses at each step in the cascade. Full-Text PDF

Prevalence of pulmonary tuberculosis in adult population of Tanzania: a national survey, 2012.

Tanzania is classified as one of the 22 high tuberculosis (TB) burden countries; however, the true burden of TB disease in the country remains unknown. To assess the prevalence of bacteriologically confirmed pulmonary TB (PTB) in the adult population. This was a community-based cluster randomised survey with proportional-to-population-size selection of primary sampling units (districts). Participants were screened for TB using a symptom questionnaire and chest X-ray (CXR). Those with abnormal CXR and/or at least one symptom suggestive of TB were classified as individuals with presumptive TB, and asked to submit three sputum specimens for smear microscopy and culture. The weighted prevalence for sputum smear-positive TB cases was 249 per 100 000 adult population (95%CI 192-305) and that for bacteriologically confirmed TB cases was 293/100 000 (95%CI 228-358). Individuals aged ⩾45 years comprised 55% (71/129) of the identified smear-positive cases, but just 28% (6793/24 648) of the notified TB cases. CXR screening identified more TB cases than symptom screening. When weighted for human immunodeficiency virus prevalence among notified new smear-positive cases, the overall case detection of incident TB cases in 2012 was between 37% and 48%. The prevalence of sputum smear-positive PTB and bacteriologically confirmed PTB in the adult population was higher than previous World Health Organization estimates. There is a potential underestimation of the number of bacteriologically confirmed PTB cases in the adult population. The age distribution of prevalent cases suggests an epidemiological shift towards the older generations, which has been a sign of successful TB control activities in the past. However, the survey shows that many infectious TB cases are currently missed by the National Tuberculosis Programme.

Primary and secondary anti-tuberculosis drug resistance in Hitossa District of Arsi Zone, Oromia Regional State, Central Ethiopia.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) drugs which is resistant to the major first-line anti-TB drugs, Isoniazid and Rifampicin, has become a major global challenge in tuberculosis (TB) control programme. However, its burden at community level is not well known. Thus, the aim of study was to assess the prevalence of primary and secondary resistance to any first line anti-TB drugs and MDR TB in Hitossa District of Oromia Regional State, Central Ethiopia.MethodsPopulation based cross- sectional study was conducted on individuals aged ≥15 years. Those with symptoms suggestive of TB were interviewed and two sputum specimens were collected from each and examined using Lowenstein-Jensen (LJ) culture medium. Further, the isolates were confirmed by the Ziehl-Neelsen microscopic examination method. Drug susceptibility test (DST) was also conducted on LJ medium using a simplified indirect proportion method. The resistance strains were then determined by percentage of colonies that grew on the critical concentration of Isoniazid, Streptomycin, Rifampicin and Ethambutol.ResultsThe overall resistance of all forms of TB to any first-line anti-TB drug was 21.7 %. Of the total new and previously treated culture positive TB cases, 15.3 and 48.8 % respectively were found to be a resistant to any of the first-line anti-TB drugs. Further, of all forms of TB, the overall resistance of MDR-TB was 4.7 %. However, of the total new TB cases, 2.4 % had primary while 14.3 % had secondary MDR-TB. Resistance to any of the first-line anti-TB drugs (adjusted odd ratio (AOR), 8.1; 95 % CI: 2.26–29.30) and MDR-TB (AOR), 7.1; 95 % CI: 2.6–43.8) was found to be linked with previous history of anti-TB treatment.ConclusionsThe study has identified a high rate of primary and secondary resistance to any of the first-line anti-TB drugs and MDR-TB in the study area. The resistance may have resulted from sub-optimal performance of directly observed treatment short-course (DOTS) programme in the detecting infectious TB cases and cure rates in the study area. Anti-TB drug resistance is linked with previous TB treatment. There is a need to strengthen DOTS and DOTS-Plus programmes and expand MDR-TB diagnostic facilities in order to timely diagnose MDR-TB cases and provide appropriate treatment to prevent the spread of MDR-TB in Ethiopia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3210-y) contains supplementary material, which is available to authorized users.

Evaluation of the implementation of the directly observed treatment strategy for tuberculosis in a large city.

To assess the degree of implementation of the Directly Observed Treatment, Short-course - DOTS for tuberculosis (TB) in a large city. Assessment of the implementation of the logic model, whose new cases of infectious pulmonary TB were recruited from specialized clinics and followed-up in basic health units. The judgment matrix covering the five components of the DOTS strategy were used. The result of the logic model indicates DOTS was partially implemented. In external, organizational and implementation contexts, the DOTS strategy was partially implemented; and, the effectiveness was not implemented. The partial implementation of the DOTS strategy in the city of Manaus did not reflect in TB control compliance, leading to low effectiveness of the program. Avaliar o grau de implantação da estratégia de tratamento diretamente observado (Directly Observed Treatment, Short-course - DOTS) para tuberculose (TB) em um município de grande porte. Avaliação de implantação por meio de modelo lógico, cujos casos novos de TB pulmonar bacilífera foram recrutados em ambulatórios especializados e acompanhados nas unidades básicas de saúde. Utilizou-se matriz de julgamento que abrange os cinco componentes da estratégia DOTS. O resultado do modelo lógico indica DOTS implantada parcialmente. Nos contextos externo, organizacional e de implantação, a estratégia DOTS está implantada parcialmente; e, na efetividade não está implantada. A implantação parcial da estratégia DOTS, na cidade de Manaus, reflete na não conformidade do controle da TB, levando à baixa efetividade do programa.

Risk factors for Mycobacterium tuberculosis infection in 2-4 year olds in a rural HIV-prevalent setting.

SUMMARYBACKGROUND: Mycobacterium tuberculosis infection in children acts as a sentinel for infectious tuberculosis.OBJECTIVE: To assess risk factors associated with tuberculous infection in pre-school children.METHOD: We conducted a population-wide tuberculin skin test (TST) survey from January to December 2012 in Malawi. All children aged 2–4 years residing in a demographic surveillance area were eligible. Detailed demographic data, including adult human immunodeficiency virus (HIV) status, and clinical and sociodemographic data on all diagnosed tuberculosis (TB) patients were available.RESULTS: The prevalence of M. tuberculosis infection was 1.1% using a TST induration cut-off of 15 mm (estimated annual risk of infection of 0.3%). The main identifiable risk factors were maternal HIV infection at birth (adjusted OR [aOR] 3.6, 95%CI 1.1–12.2), having three or more adult members in the household over a lifetime (aOR 2.4, 95%CI 1.2–4.8) and living in close proximity to a known case of infectious TB (aOR 1.6, 95%CI 1.1–2.4), modelled as a linear variable across categories (>200 m, 100–200 m, <100 m, within household). Less than 20% of the infected children lived within 200 m of a known diagnosed case.CONCLUSION: Household and community risk factors identified do not explain the majority of M. tuberculosis infections in children in our setting.

Consequences of tuberculosis among asylum seekers for health care workers in Germany.

BackgroundImmigrants have been contributing to the incidence of tuberculosis (TB) in Germany for many years. The current wave of migration of asylum seekers to Germany may increase that figure. Healthcare workers (HCW) who look after refugees not only in hospitals and medical practices but also in aid projects may be exposed to cases of TB.MethodsThe incremental TB cases arising from imported TB as well as from TB cases that developed later in refugees were calculated in a Markov model over a period of 5 years. Infectious and non-infectious susceptible TB and multidrug-resistant TB (MDR-TB) cases were determined separately. In addition, the total amount of latent TB in contact persons and the risk of infection by HCW were estimated. Due to uncertainty of future refugee flows to Europe, different scenarios were considered in univariate and multivariate sensitivity analysis.ResultsAssuming a decrease in immigration by half each year to the bottom line of 2014, and in light of the current number of 800,000 asylum seekers, we calculated an additional 10,090 TB cases by the end of the fifth year (5976 cases of infectious pulmonary TB and 143 cases of pulmonary MDR-TB). In case of an unchanging influx of asylum seekers over the 5-year period, 19,031 TB cases would arise, 377 of which infectious MDR-TB. Eighty -seven ensuing TB cases would develop in HCW in the same period, 3 of which MDR-TB cases.ConclusionsAlthough the total number of TB cases in HCW expected to ensue from the current influx of asylum seekers is rather small, the 3 MDR-TB cases we calculated have to be taken seriously. We consider it essential to increase awareness of protective measures such as respiratory masks and, in the event of documented exposure, of supply-oriented occupational health screening.

Border Lookout: Enhancing Tuberculosis Control on the United States-Mexico Border.

We evaluated the use of federal public health intervention tools known as the Do Not Board and Border Lookout (BL) for detecting and referring infectious or potentially infectious land border travelers with tuberculosis (TB) back to treatment. We used data about the issuance of BL from April 2007 to September 2013 to examine demographics and TB laboratory results for persons on the list (N = 66) and time on the list before being located and achieving noninfectious status. The majority of case-patients were Hispanic and male, with a median age of 39 years. Most were citizens of the United States or Mexico, and 30.3% were undocumented migrants. One-fifth had multidrug-resistant TB. Nearly two-thirds of case-patients were located and treated as a result of being placed on the list. However, 25.8% of case-patients, primarily undocumented migrants, remain lost to follow-up and remain on the list. For this highly mobile patient population, the use of this novel federal travel intervention tool facilitated the detection and treatment of infectious TB cases that were lost to follow-up.

Strategies to improve tuberculosis case finding in children.

Strategies to improve tuberculosis case finding in children.

"Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy".

IntroductionBy the summer of 2014, the Syrian crisis resulted in a regional humanitarian emergency with 2.9 million refugees, including 608,000 in Jordan. These refugees access United Nations High Commissioner for Refugees (UNHCR)-sponsored clinics or Jordan Ministry of Health clinics, including tuberculosis diagnosis and treatment. Tuberculosis care in Syria has deteriorated with destroyed health infrastructure and drug supply chain. Syrian refugees may have undiagnosed tuberculosis; therefore, the UNHCR, the International Organization for Migration (IOM), the National Tuberculosis Program (NTP), and the Centers for Disease Control and Prevention developed the Public Health Strategy for Tuberculosis among Syrian Refugees in Jordan. This case study presents that strategy, its impact, and recommendations for other neighboring countries.Case descriptionUNHCR determined that World Health Organization (WHO) criteria for implementing a tuberculosis program in an emergency were met for the Syrian refugees in Jordan. Jordan NTP assessed their tuberculosis program and found that access to Syrian refugees was the one component of their program missing. Therefore, a strategy for tuberculosis control among Syrian refugees was developed. Since that development through work with IOM, UNHCR, and NTP, tuberculosis case detection among Syrian refugees is almost 40 % greater (74 cases/12 months or 1.01/100,000 monthly through June 2014 vs. 56 cases/16 months or 0.73/100,000 monthly through June 2013) using estimated population figures; more than two fold the 2012 Jordan tuberculosis incidence. Additionally, the WHO objective of curing ≥85 % of newly identified infectious tuberculosis cases was met among Syrian refugees.Discussion and evaluationTuberculosis (TB) rates among displaced persons are high, but increased detection is possible. High TB rates were found among Syrian refugees through active screening and will probably persist as the Syrian crisis continues. Active screening can detect tuberculosis early and reduce risk for transmission. However, this strategy needs sustainable funding to continue and all activities have not been realized.ConclusionsInitial assessment found that tuberculosis among Syrian refugees was at a high incidence rate. Through partnership, a cohesive Jordanian tuberculosis strategy was developed for Syrian refugees and it has potential to inform treatment and control efforts for other regional countries impacted by the Syrian crisis.

Tuberculosis-related stigma leading to an incomplete contact investigation in a low-incidence country.

A contact investigation following a case of infectious tuberculosis (TB) reported in a call centre in Milan (Italy) led to the identification of three additional cases that had occurred in employees of the same workplace during the previous 5 years, one of whom was the probable source case. Thirty-three latent infections were also identified. At the time of diagnosis, the source case, because of fear of stigma related to TB, claimed to be unemployed and a contact investigation was not performed in the workplace. Cases were linked through genotyping of Mycobacterium tuberculosis. TB stigma has been described frequently, mainly in high-incidence settings, and is known to influence health-seeking behaviours and treatment adherence. The findings in this report highlight that TB-associated stigma may also lead to incomplete contact investigations. Little is known about the causes and impact of TB-related stigma in low-incidence countries and this warrants further exploration. Research is also needed to evaluate the effectiveness of specific interviewing techniques and training interventions for staff in reducing feelings of stigma in TB patients. Finally, the outbreak emphasizes the importance of integrating routine contact investigations with genotyping.