National Tuberculosis Registry Research Articles

Prevalence, Clinical Characteristics and Determinants of Unsuccessful Treatment Outcomes Among Pulmonary Tuberculosis Patients: A 5-Year Registry-Based Retrospective Cohort Study.

Despite the existence of effective medications, pulmonary tuberculosis (PTB) remains a significant global public health concern, The evaluation and feedback of national TB control programs are crucial, requiring diligent monitoring of TB treatment outcomes and analysis of the factors influencing these outcomes. This study aims to provide valuable insights into the challenges faced by TB patients, which can inform better strategies for treatment and management in the future. We conducted a study in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia (KSA), from January 1, 2018 to December 31, 2023. The study was a registry-based retrospective cohort study. Patients' data were sourced from the National Tuberculosis Registry database of Saudi Arabia. Treatment outcomes were determined as either success or failure, considering clinical evaluation, changes in chest X-rays, and the results of subsequent sputum examinations during follow-up. To evaluate the data, SPSS version 28.0 was used. A total of 427 PTB patients participated in the study. The results show successful treatment outcomes among 88.5% of patients. Among the patients, males exhibited a higher likelihood of treatment failure as compared to females (aOR 1.3; 95%Cl 1.2-1.5, p < 0.001). Patients with positive sputum smear (aOR 1.3; 95%Cl 1.1-1.3 p < 0.00) and the presence of cough were associated with an increased risk of treatment failure (aOR1.5; 95%Cl 1.1-1.4, p < 0.001). This study shows that the percentage of unsuccessful treatment outcomes is high, ie, 11.5%, due to patients' deaths and loss to follow-up. Enhanced supervision and treatment monitoring for tuberculosis patients at high risk of treatment failure can lead to improved treatment success rates in Saudi Arabia.

(e)Managing the uncertainty of tuberculosis in the post-Soviet limbo: Tracking prisoners' coerced mobility for treatment in Ukrainian prisons

The collapse of the Soviet Union triggered an escalation of the tuberculosis (TB) epidemic in many post-Soviet countries, including Ukraine. The main reasons for this situation include both the approach to TB care and the concentration of TB cases in prisons. The neoliberal approach to TB care system reform promises the optimization of treatment terms, "dehospitalization" and “despecialization” of the system of care, and a different type of control, established through digital technologies. One such technology is the “e-TB Manager”, which was designated as a national TB registry, including in the prison system in 2012.In prison, where everyone “is to be fixed” and isolated, the uncertainty of patients’ movements seems to be avoided by pre-existing conditions. In practice, however, the vertically aligned, centralized organizational structure of the post-Soviet prison implies a constant need to link its elements together through “coerced” mobility carried out in secrecy. Treatment in exile may not be the primary goal of such a practice, but it becomes the result when prisoners from numerous prison facilities are sent to a limited number of prison TB hospitals. The integration of the e-TB Manager as a tool to enable the tracking of patient movements and, consequently, improve the efficiency of diagnostic and treatment processes in prison, can be seen as both a purely technical measure and a “magic bullet”.In this article, we argue that, in the case of Ukrainian prisons, the neoliberal approach and the Soviet socialist approach to gaining control over TB indeed adapt and reinforce each other but fail to compete meaningfully. The fragmented implementation of one is absorbed by the fundamental and resilient nature of the other to produce and reproduce the state of “post-Soviet limbo”. We use the “post-Soviet limbo” as an overall framework aimed at conceptualizing the post-Soviet transformation as a combination of efforts to avoid and manage the uncertainty of TB treatment, especially in prison. We examine the empirical case of coerced mobility of prisoners who require TB treatment, seeking to trace how this process is reflected in the e-TB Manager. We provide a more in-depth picture of this journey with details gathered from qualitative research materials to situate numbers and variables in their contexts, deconstructing the way the data are recorded according to the logic of the system in which they are produced.

Tuberculosis in Poland in 2021.

To evaluate the main features of epidemiology of tuberculosis (TB) in 2021 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2021, data from Statistics Poland on deaths from tuberculosis in 2020, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2021 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." In 2021, 3704 TB cases were reported in Poland. The incidence rate was 9.7 cases per 100,000 with large variability between voivodeships from 5.4 to 12.6 per 100,000. A decrease in the incidence with respect to 2020 was found in 8 voivodeships, the most significant in lubuskie voivodship (42.6%). The number of all pulmonary tuberculosis cases was 3,553 i.e. 9.3 per 100,000. Pulmonary cases represented 95.9% of all TB cases. In 2021, 151 extrapulmonary TB cases were notified (4.1% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,970 cases (83.6% of all pulmonary TB cases, the incidence rate 7.8 per 100,000). The number of smear-positive pulmonary TB cases was 2,085 i.e. 5.5 per 100,000 (58.7% of all pulmonary TB cases). In 2021, there were 54 cases (25 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.9% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with the age group from 0.6 per 100,000 among children (0-14 years) to 15.8 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 11.7 per 100,000. There were 37 cases in children up to 14 years of age (1.0% of the total) and 51 cases in adolescents between 15 and 19 years of age - rates 0.6 and 2.8 per 100,000 respectively. In 2021, there were 2,690 cases of tuberculosis in men and 1,014 in women. The TB incidence in men - 14.6 per 100,000 was almost 3.0 times higher than among women - 5.1. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55-59 years, 30.5 vs. 6.6 and in age group 60 to 64 years, 26.0 vs. 5.7. In 2021, there were 132 patients of foreign origin among all cases of tuberculosis in Poland (3.6%). In 2020, TB was the cause of death for 474 people (mortality rate - 1.2 per 100,000). The incidence of tuberculosis in Poland in 2021 was 10.2% higher than in 2020. The percentage of tuberculosis cases with bacteriological confirmation was 82.6%, higher than the average in EU/EEA countries (72.0%). The percentage of MDR-TB cases was lower than the average in EU/EEA countries (1.9% vs. 3.8%). The highest incidence rates are found in Poland in the older age groups (in EU/EEA countries in people aged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.0%, the average in the EU/EEA countries was 3.5%. The incidence of tuberculosis in men was nearly three times higher than in women in Poland. The impact of migration on the epidemiological situation of tuberculosis in Poland in 2021 was smaller than in the EU/EEA countries (in Poland, the percentage of foreigners among all TB patients was 3.6 vs. 33.8% in the EU/EEA).

Disparities in Tuberculosis Incidence by Race and Ethnicity Among the U.S.-Born Population in the United States, 2011 to 2021 : An Analysis of National Disease Registry Data.

Elevated tuberculosis (TB) incidence rates have recently been reported for racial/ethnic minority populations in the United States. Tracking such disparities is important for assessing progress toward national health equity goals and implementing change. To quantify trends in racial/ethnic disparities in TB incidence among U.S.-born persons. Time-series analysis of national TB registry data for 2011 to 2021. United States. U.S.-born persons stratified by race/ethnicity. TB incidence rates, incidence rate differences, and incidence rate ratios compared with non-Hispanic White persons; excess TB cases (calculated from incidence rate differences); and the index of disparity. Analyses were stratified by sex and by attribution of TB disease to recent transmission and were adjusted for age, year, and state of residence. In analyses of TB incidence rates for each racial/ethnic population compared with non-Hispanic White persons, incidence rate ratios were as high as 14.2 (95% CI, 13.0 to 15.5) among American Indian or Alaska Native (AI/AN) females. Relative disparities were greater for females, younger persons, and TB attributed to recent transmission. Absolute disparities were greater for males. Excess TB cases in 2011 to 2021 represented 69% (CI, 66% to 71%) and 62% (CI, 60% to 64%) of total cases for females and males, respectively. No evidence was found to indicate that incidence rate ratios decreased over time, and most relative disparity measures showed small, statistically nonsignificant increases. Analyses assumed complete TB case diagnosis and self-report of race/ethnicity and were not adjusted for medical comorbidities or social determinants of health. There are persistent disparities in TB incidence by race/ethnicity. Relative disparities were greater for AI/AN persons, females, and younger persons, and absolute disparities were greater for males. Eliminating these disparities could reduce overall TB incidence by more than 60% among the U.S.-born population. Centers for Disease Control and Prevention.

Prevalence, treatment outcomes and determinants of TB/HIV coinfection: A 4-year retrospective review of national tuberculosis registry in a country in a MENA region

BackgroundThe co-occurrence of tuberculosis (TB) and AIDS (HIV) has emerged as a significant public health challenge. This study investigated the epidemiological factors and treatment outcomes of TB in individuals based on their HIV status in Iran. MethodsThe current study was a descriptive-analytical cross-sectional study that focused on new patients diagnosed with TB in Iran between 2018 and 2021. Patients’ data were sourced from the National Tuberculosis Registry database of Iran. A multiple logistic regression model was used to investigate the relationship between the most important influencing factors and TB/HIV coinfection. ResultsOver a 4-year period, a study was conducted on 25,011 new TB patients out of 30,762 registered in the national database. TB and HIV were coinfected in 672 cases (2.68%). The highest number of coinfection cases were found in patients with smear-negative pulmonary tuberculosis (249 patients, 37.05%) and extrapulmonary tuberculosis (123 patients, 18.19%). TB patients with coinfection had a median TB treatment duration of three months longer than others. The success rate of TB treatment was lower in patients with coinfection (437 patients, 65.02%) than in non-coinfection patients (20,302 patients, 83.41%). Treatment success probability in smear-positive pulmonary tuberculosis patients with and without coinfection was lower than other types of TB. Logistic regression analysis showed that having a TB risk factor was the strongest predictor of coinfection, with an odds ratio of 29.73 (95% CI: 22.05–40.07), followed by having an HIV risk factor with an odds ratio of 17.52 (95% CI: 13.68–22.45). ConclusionsThe findings of this research offer significant insights into the potential causes of HIV coinfection in individuals with TB, which could be used to inform the development of policies and strategies aimed at enhancing the identification and treatment of TB patients who are at risk of TB/HIV coinfection and to promote optimal health status for patients with TB.

Inventory study on completeness of tuberculosis case notifications in Poland in 2018.

BackgroundEvaluating tuberculosis (TB) notification completeness is important for monitoring TB surveillance systems, while estimating the TB disease burden is crucial for control strategies.AimWe conducted an inventory study to assess TB reporting completeness in Poland in 2018.MethodsUsing a double-pronged inventory approach, we compared notifications of culture-positive TB cases in the National TB Register to records of diagnostic laboratories. We calculated under-reporting both with observed and capture-recapture (CRC)-estimated case numbers. We further compared the notifications by region (i.e. voivodship), sex, and age to aggregated data from hospitalised TB patients, which provided an independent estimate of reporting completeness.ResultsIn 2018, 4,075 culture-positive TB cases were notified in Poland, with 3,789 linked to laboratory records. Laboratories reported further 534 TB patients, of whom 456 were linked to notifications from 2017 or 2019. Thus, 78 (534 - 456) cases were missing in the National TB Register, yielding an observed TB under-reporting of 1.9% (78/(4,075 + 78) × 100). CRC-modelled total number of cases in 2018 was 4,176, corresponding to 2.4% ((4,176 - 4,075)/4,176 × 100) under-reporting. Based on aggregated hospitalisation data from 13 of 16 total voivodeships, under-reporting was 5.1% (3,482/(3,670 - 3,482) × 100), similar in both sexes but varying between voivodeships and age groups.ConclusionsOur results suggest that the surveillance system captures ≥ 90% of estimated TB cases in Poland; thus, the notification rate is a good proxy for the diagnosed TB incidence in Poland. Reporting delays causing discrepancies between data sources could be improved by the planned change from a paper-based to a digital reporting system.

Stages of implementation of the National Tuberculosis Registry in the Republic of Tajikistan

The implementation of the National TB Registry in the Republic of Tajikistan ensured the high-quality collection, storage and transmission of statistical information from all regions of the country to the State Institution “Republican Center for the Protection of the Population from Tuberculosis”. The National TB Registry has significantly improved the reporting process, including obtaining timely information on various requests: Ensured the collection, storage, processing of data on TB patients with drug-sensitive and resistant forms; Contributed to the generation of standard statistical reports and ensuring the timely exchange of data on TB patients between TB institutions at various levels; Improved information reliability control; Provided a stable mechanism for the exchange of information between laboratories and clinical service; Provided analysis of information for management decisions and in scientific research.The National TB Registry allows timely receipt of laboratory test results, which, in particular, significantly reduces the time interval from the moment of diagnosis to admission for treatment, and contributes to an increase in the reliability of registration of chemotherapy outcomes. The national TB registry has sufficient potential for further improvement.

Tuberculosis in Poland in 2020.

To evaluate the main features of epidemiology of tuberculosis (TB) in 2020 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2020, data from Statistics Poland on deaths from tuberculosis in 2019, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." In 2020, 3,388 TB cases were reported in Poland. The incidence rate was 8.8 cases per 100,000 with large variability between voivodeships from 5.5 to 13.3 per 100,000. A decrease in the incidence was found in 15 voivodeships, the most significant in Śląskie voivodship (63.9%). The number of all pulmonary tuberculosis cases was 3,237 i.e. 8.4 per 100,000. Pulmonary cases represented 95.5% of all TB cases. In 2020, 151 extrapulmonary TB cases were notified (4.5% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,573 cases (79.5% of all pulmonary TB cases, the incidence rate 6.7 per 100,000). The number of smear-positive pulmonary TB cases was 1,771 i.e. 4.6 per 100,000 (54.7% of all pulmonary TB cases). In 2020, there were 38 cases (15 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.6% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with increasing age from 0.7 per 100,000 among children (0-14 years) to 15.0 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 12.1 per 100,000. There were 39 cases in children up to 14 years of age (1.2% of the total) and 49 cases in adolescents between 15 and 19 years of age - rates 0.7 and 2.7 per 100,000 respectively. In 2020, there were 2,506 cases of tuberculosis in men and 882 in women. The TB incidence in men - 13.5 per 100,000 was 3.0 times higher than among women - 4.5. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 26.8 vs. 4.1 and in age group 55 to 59 years - 28.7 vs. 4.8. In 2020, there were 116 patients of foreign origin among all cases of tuberculosis in Poland (3.4%). In 2019, TB was the cause of death for 456 people (mortality rate - 1.2 per 100,000). TB incidence in Poland in 2020 was 36.7% lower than in 2019. Such significant declines in the incidence have not been observed in the last two decades. As in previous years, there were differences in incidence rates between voivodeships with an unexpectedly sharp decrease in incidence in Silesia (Śląskie voivodeship). The percentage of tuberculosis cases with bacteriological confirmation exceeded 78%, more than in EU/EEA countries (67.3%). The percentage of MDR-TB cases was still lower than the average in EU/EEA countries (1.6% vs. 3.8%). The highest incidence rates were found in Poland in the older age groups (EU/EEAaged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.2%, less than the average in EU/EEA countries (3.8%). The incidence of tuberculosis in men was three times higher than in women in Poland, and six times higher in patients aged 50 to 59. The impact of migration on the TB pattern in Poland has not yet become significant in 2020. The percentage of foreigners among TB patients was 3.4% (33% in EU/EEA countries).

Prediabetes and risk of active tuberculosis: a cohort study from Northern Taiwan.

Diabetes mellitus (DM) is a well-established risk factor for active tuberculosis (TB) infection. Despite the worldwide rapid increase in the prevalence of prediabetes, its impact on the risk of active TB remains largely unknown. This study aimed to investigate the relationship between prediabetes and risk of active TB in a large cohort study. A total of 119 352 participants were screened from a community-based health screening programme in Northern Taiwan. Diabetes mellitus and prediabetes were defined by baseline fasting plasma glucose (FPG) and prescription of anti-diabetic drugs. Incident cases of active TB were identified from the National Tuberculosis Registry. Kaplan-Meier curves and Cox regression analysis were employed to estimate the hazard ratios for prediabetes and DM compared with normoglycaemia. Spline regression was performed to investigate the dose-response relationship between FPG level and risk of TB disease. At baseline, 27 404 (22.96%) participants had prediabetes and 10 943 (9.17%) participants had DM. After an average follow-up of 7.2 years, 322 TB cases occurred. The adjusted hazard ratio of developing active TB disease was 0.73 [95% confidence interval (CI) 0.55-0.97] for prediabetic and 1.48 (95% CI 1.11-1.98) for diabetic participants compared with normoglycaemic individuals. Spline regression revealed a U-shaped association between FPG level and risk of active TB disease, with the lowest risk at FPG around110 mg/dl. Sensitivity analyses were conducted to exclude factors such as potential confounders (including body mass index), misclassification of glycaemic level, and selection bias, and results showed that those factors could not explain the lower risk of active TB. Prediabetes was associated with a 27% reduced risk of active TB disease compared with normoglycaemia. The biological mechanism of this inverse association and its implication for global nutrition transition and TB control should be further investigated.

Tuberculosis in Poland in 2019.

To evaluate the main features of epidemiology of tuberculosis (TB) in 2019 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2019, data from Central Statistical Office on deaths from tuberculosis in 2018, data from National Institute of Public Health - National Institute of Hygiene on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2021 - 2019 data". In 2019, 5321 TB cases were reported in Poland. The incidence rate was 13.9 cases per 100,000 with large variability between voivodeships from 8.0 to 20.0 per 100,000. The number of all pulmonary tuberculosis cases was 5075 i.e. 13.2 per 100,000. Pulmonary cases represented 95.4% of all TB cases. In 2019, 246 extrapulmonary TB cases were notified (4.6% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 3926 cases (77.4% of all pulmonary TB cases, the incidence rate 10.2 per 100,000). The number of smear-positive pulmonary TB cases was 2565 i.e. 6.7 per 100,000 ( 48.2% of all pulmonary TB cases). In 2019, there were 41 cases (18 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.1% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with the age group from 1.4 per 100,000 among children (0-14 years) to 23.9 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 19.8 per 100,000. There were 81 cases in children up to 14 years of age (1.5% of the total) and 48 cases in adolescents between 15 and 19 years of age - rates 1.4 and 2.6 per 100,000 respectively. In 2019, there were 3897 cases of tuberculosis in men and 1424 in women. The TB incidence in men - 21.0 per 100,000 was 2.9 times higher than among women - 7.2. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 40.2 vs. 8.1 and in age group 55 to 59 years - 45.1 vs. 9.0. In 2019, there were 121 patients of foreign origin among all cases of tuberculosis in Poland (2.3%). In 2018, TB was the cause of death for 519 people (mortality rate - 1.4 per 100,000). TB incidence in Poland in 2019 was lower than in the previous year. Differences in incidence between voivodships persist. The percentage of TB cases with bacteriological confirmation exceeded 75%, more than in EU/EEA countries (67.1%). In Poland, MDR-TB is less common than the average in the EU/EEA countries. In Poland, the highest incidence rates are found in older age groups. The percentage of children up to 14 years of age among all TB patients was 1.5%, lower than the average in EU/EEA countries (3.9%). The incidence of tuberculosis in men is nearly three times as high as in women. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. The percentage of foreign-born persons among TB patients is low.

Short and long-term outcomes of video observed treatment in tuberculosis patients, the Republic of Moldova.

The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe. This study compared adherence and short and long-term TB treatment outcomes for TB patients who experienced asynchronous Video Observed Treatment (aVOT) during three months of outpatient treatment versus Directly Observed Treatment (DOT) in operational conditions in 2016-2017 in Chisinau. We used secondary data from the 2016-2017 Randomized Clinical Trial (RCT) that piloted the aVOT Strategy in Chisinau and data from the national TB register. Relative risk was selected as a measure of association in analysis of treatment strategies (aVOT and DOT under operational conditions) and short and long-term treatment outcomes. From 647 TB patients included in the study, 169 followed the treatment strategy in the RCT (83 in aVOT and 86 in DOT) and 478 were on DOT in operational conditions. Those in aVOT were more likely to have favourable short-term outcome than patients with DOT in operational conditions (RR 0.07; p < 0.001). TB recurrence as an indicator for the long-term outcome, was observed in group with DOT in operational conditions (40 cases, p = 0.006). This study demonstrated that the aVOT treatment strategy was associated with better adherence and both short and long-term TB treatment favourable outcomes. aVOT as a new patient-centred approach supporting TB patients on improving treatment adherence and outcomes might be recommended as an alternative to DOT strategy in the Republic of Moldova.

Tuberculosis Death Epidemiology and Its Associated Risk Factors in Sabah, Malaysia.

Tuberculosis (TB) is a leading killer from a single infectious agent globally. In 2019, Malaysia’s TB incidence rate was 92 per 100,000 population, and the TB mortality rate was estimated at 4 cases per 100,000 population per year. However, the state of Sabah had a higher burden of TB with a notification rate of 128 per 100,000 population and a TB case fatality rate of 8% compared to the national figure. This study aims to provide a comprehensive report on TB deaths epidemiology and its associated factors at a sub-national level. This nested case-control study used Sabah State Health Department TB surveillance data from the Malaysia national case-based TB registry (MyTB) between 2014 and 2018. Cases were defined as all-cause TB deaths that occurred before anti-TB treatment completion from the time of TB diagnosis. Controls were randomly selected from TB patients who completed anti-TB treatment. The TB mortality rate had increased significantly from 9.0/100,000 population in 2014 to 11.4/100,000 population in 2018. The majority of TB deaths occurred in the first two months of treatment. TB-related deaths were primarily due to advanced disease or disseminated TB, whereas non-TB-related deaths were primarily due to existing comorbidities. Many important independent risk factors for TB deaths were identified which are useful to address the increasing TB mortality rate.

Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study

Tuberculosis elimination strategies in Brazil might neglect adolescents and young adults aged 10-24 years, hampering tuberculosis control. However, little is known about factors associated with tuberculosis treatment outcomes in this underserved group. In this study, we aimed to investigate social and health factors associated with unfavourable treatment outcomes in young people with tuberculosis in Brazil. A national retrospective cohort study was done using data from Sistema de Informação de Agravos de Notificação (SINAN), the national tuberculosis registry in Brazil. People aged 10-24 years (young people) with tuberculosis registered in SINAN between Jan 1, 2015, and Dec 31, 2018, were included. Unfavourable outcomes were defined as loss to follow-up, treatment failure, and death. Favourable outcome was defined as treatment success. Multiple logistic regression models estimated the association between social and health factors and tuberculosis treatment outcomes. 67 360 young people with tuberculosis were notified to SINAN, and we included 41 870 young people in our study. 7024 (17%) of the 41 870 included individuals had unfavourable treatment outcomes. Young people who received government cash transfers were less likely to have an unfavourable outcome (adjusted odds ratio 0·83, 95% CI 0·70-0·99). Homelessness (3·03, 2·07-4·42), HIV (2·89, 2·45-3·40), and illicit drug use (2·22, 1·93-2·55) were the main factors associated with unfavourable treatment outcome. In this national cohort of young people with tuberculosis in Brazil, tuberculosis treatment success rates were lower than WHO End TB Strategy targets, with almost a fifth of participants experiencing unfavourable treatment outcomes. Homelessness, HIV, and illicit drug use were the main factors associated with unfavourable outcome. In Brazil, strategies are required to support this underserved group to ensure favourable tuberculosis treatment outcomes. Wellcome Trust, UK Medical Research Council, and UK Foreign Commonwealth and Development Office.

The Risk of Developing Tuberculosis in Cancer Patients Is Greatest in Lymphoma: A Large Population-Based Study

Introduction: Patients with cancer, especially those diagnosed with hematological malignancies, are considered at higher risk for tuberculosis (TB). Several studies reported that Hodgkin lymphoma (HL) patients have the highest risk for TB among patients with hematological malignancies. These data are relatively old and based mostly on series of patients with malignancies or with TB but often lack statistical rigor and not based on large population-based studies.According to the Israeli regulations, every new diagnosis of cancer must be reported to the Israel National Cancer Registry (INCR) and every new diagnosis of TB to the Israel National Tuberculosis Registry (INTR). We combined both databases and studied epidemiological features of TB among patients with cancer in Israel, in which the incidence of TB in the general population is relatively low. The study objectives were to examine whether patients with hematological malignancies are at increased risk to develop active TB, compared to patients with solid tumors, and to examine whether patients with HL have a higher risk of active TB than patients with other hematological malignancies.Methods: The study population consists of all newly diagnosed cancer cases reported to the INCR from 1993-2013. These data were linked with data from the INTR for the same period. HIV patients were excluded from both databases. Hematologic malignancies were categorized into 5 groups: acute leukemia, HL, non-Hodgkin lymphoma (NHL), myelodysplastic syndrome/myeloproliferative neoplasm and plasma cell dyscrasia. Incidence rates per 100,000 person-years were calculated. Logistic regression was used to analyze the risk of TB following cancer diagnosis among patients with different malignancies.Results: Of 465,429 patients who were diagnosed with cancer during 1993-2013, 676 patients were notified to have TB but in only 321 patients the diagnosis of TB followed cancer diagnosis. The cumulative incidence of TB following cancer diagnosis was 14.4 per 100,000 person-years (PY). The rate of TB incidence following cancer diagnosis was 27.2/100,000 PY for persons diagnosed with hematological malignancies, and 12.7/100,000 PY among those with non-hematological malignancies (p<0.001). The highest TB incidence was found among patients with lymphoma (30.1 TB cases per 100,000 PY). Among lymphoma patients, a higher incidence rate was found in NHL patients than among HL patients, however the difference was not significant (32.1 vs . 21.6, respectively, p=0.378). Accounting for sex, age at diagnosis and ethnicity in logistic regression, the risk of TB among lymphoma patients is significantly higher than in other malignancies (Odds ratio 2.61, p=0.002) and there is no added significant risk for patients with HL (Odds ratio 1.33, p=0.464).Conclusions: 1) In this population-based study of more than 450,000 patients diagnosed with cancer, the incidence of TB following a cancer diagnosis is higher among patients with hematological malignancies than in patients with solid tumors. 2) Lymphoma patients have the highest risk to develop TB. 3) In contrast to common perception, we did not find that patients with HL are at increased risk to develop TB relative to NHL patients. 4) These data suggest for a heightened awareness for latent TB among newly diagnosed patients with lymphoma and for active TB among patients with a background of lymphoma who present with fever or respiratory complains. DisclosuresNo relevant conflicts of interest to declare.

Ethnic disparities in tuberculosis incidence and related factors among indigenous and other communities in ethnically diverse Suriname

BackgroundIn Suriname, a country home to many ethnic groups, a high incidence of tuberculosis (TB) has been found among Indigenous Trio Amerindians. However, whether wider ethnic disparities in TB incidence and its associated risk factors (e.g., diabetes mellitus and HIV) exist in Suriname, is not known. We sought to investigate disparities in TB incidence and its risk factors on ethnicity in Suriname, as this could give way to targeted TB intervention programs. MethodsAnonymized patient data from 2011 to 2015 was extracted from the National TB Registry and analyzed. Differences in the five-year incidence rates of TB for the six largest ethnic groups—Creole, Hindustani, Indigenous, Javanese, Maroon, and Mixed—were assessed using a chi-square goodness-of-fit test, and TB patient differences regarding ethnicity were evaluated for selected factors using a multinomial logistic regression with Creole patients as reference. Results662 Patients were eligible for analyses with the following ethnic makeup: Creole (36.4%), Hindustani (15.6%), Indigenous (8.6%), Javanese (10.6%), Maroon (15.1%), and Mixed ethnicity (13.7%). Differences in five-year incidence rates for TB were significant, χ2(5, N = 662) = 244.42, p < .001, and the highest TB rates were found for Indigenous (280 per 100,000) and Creole people (271 per 100,000). HIV coinfection was a TB risk factor for Creoles (38.2% of these patients were HIV positive). Several variables (i.e., those for drug use) had high levels of incomplete or missing data. ConclusionsOur study has demonstrated that ethnic disparities in tuberculosis incidence exist in Suriname and that they are associated with specific, known risk factors such as HIV (especially for Creole people). For Indigenous people, risk factors may include diminished access to health care facilities and low socioeconomic status. However, direct data on these factors was unavailable. These findings call for targeted national intervention programs—with special attention given to the vulnerabilities of susceptible ethnic groups—and improved data collection.

Who is doing worse? Retrospective cross-sectional study of TB key population treatment outcomes in Kyrgyzstan (2015-2017).

Tuberculosis (TB) is a global public health problem. The incidence of TB is especially high among TB key populations, such as the homeless, people who use drugs, prisoners, and migrants. The study aimed to assess the associations between affiliation to TB key populations and treatment outcome. This retrospective cross-sectional study used data extracted from the National TB Registry of Kyrgyzstan for the region of Chuy (including the city of Bishkek) for 2015-2017. Descriptive statistics was used to summarize the data. Logistic regression was used to assess the associations. The study included 1,526 patients among whom more than half (52.5%) fell into the youngest group (18-35 years old). Migrants were the most highly represented group comprising 67.8% of all TB key populations. Men (63.0%) and patients with pulmonary TB (83.0%) prevailed in the cohort. The proportions of patients who had completed the treatment were high among all the key populations. Logistic regression was used to assess the association between affiliation to a certain TB key population and the TB treatment outcome. Patients who belonged to more than one TB key population were found to have the highest risk of unsuccessful TB treatment outcomes, both in the region of Chuy (OR = 9.9, 95% CI 2.0-48.1, p = 0.04) and the city of Bishkek (OR = 24.9, 95% CI 7.2-86.4, p < 0.001). The homeless, people who use drugs, ex-prisoners, and TB patients who belonged to more than one TB key population were found to have higher risks of unsuccessful TB treatment outcome in comparison to migrants.

Tuberculosis in Poland in 2018.

To evaluate the main features of tuberculosis (TB) epidemiology in 2018 in Poland and to compare with the situation in the EU/EEA countries. Analysis of case- based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2018, data from National Institute of Public Health- National Institute of Hygiene on HIV-positive subjects for whom TB was an AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from the report " European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2020- 2018 data. Stockholm: European Centre for Disease Prevention and Control, 2020". In 2018, 5487 TB cases were reported in Poland. The incidence rate was 14.3 cases per 100000, with large variability between voivodeships from 7.3 to 23.4 per 100 000. The mean annual decrease of TB incidence in 2014- 2018 was 3.8%. In 2018, 4852 cases were newly diagnosed with no history of previous treatment i.e. 12.6 per 100 000. 635 cases i.e. 1.7 per 100 000 - 11.6% of all registered subjects were previously treated for tuberculosis. In 2018, the number of all pulmonary tuberculosis cases was 5224 i.e. 13.7 per 100000. Pulmonary cases represented 95.2% of all TB cases. In 2018, 243 extrapulmonary TB cases were found i.e. 0.6 per 100 000. In the whole country there were 52 pediatric cases of tuberculosis. TB in children represented 0.9% of all cases notified in Poland in 2018. The incidence rates of tuberculosis were growing along with the age group from 0.9 per 100 000 among children to 24.7 per 100 000 among subjects in the age group 45-64 years (the highest incidence rate). In 2018, the incidence rate in the age group ≥65 years was 21.3 per 100 000. The TB incidence among men i.e. 21.0 per 100 000 was 2.6 times higher than among women i.e. 8.0 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 55 to 59 years - 44.9 vs. 9.8 and in age group 60- 64 years - 43.7 vs. 10.2. The TB incidence in rural population was lower than in urban, respectively 13.4 per 100 000 and 14.9 per 100 000. The number of all registered culture positive TB cases was 4075. Pulmonary tuberculosis was bacteriologically confirmed in 3935 subjects. Cases confirmed by culture represented 74.3% of all TB cases and 75.3% of all pulmonary TB cases. The number of smear-positive pulmonary TB cases reported in 2018 was 2324 i.e. 6.1 per 100 000 accounting for 44.3% of all pulmonary TB cases and 59.1% of pulmonary TB cases confirmed by culture. In all patients with tuberculosis in Poland in 2018 there were 48 cases with MDR-TB (among them 14 foreigners) and 83 patients with resistance to isoniazid only, representing respectively 1.3% and 2.2% of cases with known DST results (DSTs were available in 90.7% of all culture-confirmed TB cases). In 2018, there were 97 patients of foreign origin among all cases of tuberculosis in Poland. TB was AIDS-indicative disease in 14 subjects with HIV co-infection. There were 490 deaths due to tuberculosis reported in 2017 - 1.3 per 100 000; 468 people died from pulmonary and 22 from extrapulmonary tuberculosis. Mortality among males - 2.1 per 100 000 - was 3.6 X higher than among females - 0.5. 40.2% of all TB deaths were cases 65 years old and older - 3.1 per 100 000. In 2017, there was no death from tuberculosis in children and no deaths in adolescents. In 2017, tuberculosis represented 0.1% of total mortality in Poland and 25.4% of mortality from infectious and parasitic diseases. In 2018, the incidence of tuberculosis in Poland was lower than in 2017. Despite a continuous decline it is still higher than the average in the EU/EEA countries. The highest incidence rates were observed in older age groups. The participation of pediatric cases is smaller than average in the EU/EEA countries. The incidence in males was more than 2 times higher than in females. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. In Poland, MDR-TB is less common than the average in the EU/EEA countries.

QuantiFERON®-TB Gold In-Tube test can be used for screening latent tuberculosis before biological treatment in a Bacille Calmette-Guérin (BCG)-vaccinated country: the HUR-BIO single-center real-life results.

The Turkish population is vaccinated with Bacille Calmette-Guérin (BCG), and the BCG vaccination decreases the specificity of the tuberculin skin test (TST). The purpose of this study was to investigate the incidence of active tuberculosis (TBC) among rheumatic patients who were screened only with the QuantiFERON®-TB Gold In-Tube (QFT-GIT) test for latent TBC prior to biological treatment. The Hacettepe University Biological Database (HUR-BIO) was used for latent TBC assessment. Consecutive patients were evaluated from July 2015 to October 2016 by a questionnaire that included the patients' demographic characteristics, treatment history, and symptoms of active TBC. A total of 664 patients were interviewed by physicians. TBC statuses of the 671 non-interviewed patients were checked from the Turkish National Tuberculosis Registry records. Mean TBC incidence per year was calculated for anti-tumor necrosis factor-alpha (TNF-α) agents. A total of 1335 (58.2% female) patients with the mean age of 44.2 ± 12.9years were included. Of the patients, 836 (62.6%) had spondyloarthropathy, 432 (32.4%) had rheumatoid arthritis, and 67 (5%) had other rheumatologic diseases. The total biological drug exposure was 2292 patient-years (2043 patient-years for anti-TNF-α, 249 patient-years for non-TNF-α inhibitors). Positive and indeterminate QFT-GIT results were found in 258 (19.3%) and 23 (1.7%) patients, respectively. The median follow-up time after the onset of biological agent was 19.4months (IQR = 29.5). Pulmonary TBC was found in 3 (0.2%) of the 1335 patients. The annual incidence of TBC was 147/100,000 patient-years for all TNF-α inhibitors (249/100,000 and 123/100,000 patient-years for QFT-GIT-positive and negative patients, respectively). TBC incidence increased by nearly seven times the Turkish national TBC incidence. The QFT-GIT Test appears acceptable to determine latent TBC before biological agent use. Consequently, the QFT-GIT Test can be appropriately used in BCG-vaccinated countries. Key Points • Our study contributes to filling the gap in the literature by reflecting real-life data about TBC frequency after QFT-GIT use in patients receiving biological agents. • The frequency of active TBC will remain within acceptable limits when only QFT-GIT is used in the screening of latent TBC prior to the use of biological agents in a population where the majority are vaccinated with BCG. • Using the QFT-GIT alone for latent TBC screening prior to biologic treatment in countries with high BCG vaccination rates reduces the number of patients needing isoniazid (INH) treatment.

Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine.

BackgroundDuring adolescence, childhood and adult forms of tuberculosis (TB) overlap, resulting in diverse disease manifestations. Knowing which patient characteristics are associated with which manifestations may facilitate diagnosis and enhance understanding of TB pathophysiology.MethodsIn this cross-sectional study, we included 10–19-year-olds in Ukraine's national TB registry who started TB treatment between 2015 and 2018. Using multivariable regression, we estimated associations between patient characteristics and four presentations of TB: pleural, extrathoracic, cavitary and rifampicin-resistant (RR). We also described the epidemiology of adolescent TB in Ukraine.ResultsAmong 2491 adolescent TB cases, 88.4% were microbiologically confirmed. RR-TB was confirmed in 16.9% of new and 29.7% of recurrent cases. Of 88 HIV-infected adolescents, 59.1% were not on antiretroviral therapy at TB diagnosis. Among 10–14-year-olds, boys had more pleural disease (adjusted OR (aOR) 2.12, 95% CI: 1.08–4.37). Extrathoracic TB was associated with age 15–19 years (aOR 0.26, 95% CI: 0.18–0.37) and HIV (aOR 3.25, 95% CI: 1.55–6.61 in 10–14-year-olds; aOR 8.18, 95% CI: 3.58–17.31 in 15–19-year-olds). Cavitary TB was more common in migrants (aOR 3.53, 95% CI: 1.66–7.61) and 15–19-year-olds (aOR 4.10, 95% CI: 3.00–5.73); among 15–19-year-olds, it was inversely associated with HIV (aOR 0.32, 95% CI: 0.13–0.70). RR-TB was associated with recurrent disease (aOR 1.87, 95% CI: 1.08–3.13), urban residence (aOR 1.27, 95% CI: 1.01–1.62) and cavitation (aOR 2.98, 95% CI: 2.35–3.78).ConclusionsAge, sex, HIV and social factors impact the presentation of adolescent TB. Preventive, diagnostic and treatment activities should take these factors into consideration.

Increased risk of active tuberculosis during pregnancy and postpartum: a register-based cohort study in Sweden.

RationaleStudies investigating the risk of active tuberculosis (TB) in association with pregnancy have not been conclusive. We aimed to investigate this risk in a large retrospective register-based cohort study in Sweden.MethodsData from women of 15–49 years of age who had given birth in Sweden between 2005 and 2013 were extracted from the national childbirth register and linked to the national TB register. Cohort time was divided into three exposure periods: during pregnancy, six months (180 days) postpartum and time neither pregnant nor postpartum. We calculated incidence rates (IRs) per 100 000 person-years for each period and incidence rate ratios (IRRs) with IRs neither pregnant nor postpartum as the reference.ResultsThe cohort included 649 342 women, of whom 553 were registered as cases of active TB, 389 when neither pregnant nor postpartum, 85 during pregnancy and 79 when postpartum. Overall IRs were 9, 12 and 17 cases per 100 000 person-years, respectively, giving IRR 1.4, 95% CI 1.1–1.7 (during pregnancy) and IRR 1.9, 95% CI 1.5–2.5 (when postpartum). Stratification by TB incidence in country of origin showed that the increased risk was concentrated amongst women from countries with a TB incidence of 100 or higher, where IRs per 100 000 person-years were 137 (when neither pregnant nor postpartum), 182 (during pregnancy) and 233 (when postpartum).ConclusionWe show a significant increase in risk of active TB during both pregnancy and postpartum in women from high incidence countries and recommend TB screening in pregnant women belonging to this risk group.