Tuberculosis Notification Rates Research Articles

Geographical Patterns of Tuberculosis Notification Rates and Their Associations with Sociodemographic Characteristics in Communes in Phnom Penh, Cambodia

Objective: To identify the patterns of tuberculosis (TB) notification rates in Phnom Penh and examine their relationships with the population density, socioeconomic, residential and occupational characteristics. Methods: The numbers of total TB and smear-positive pulmonary TB cases reported between January 1, 2010 and December 31, 2012 in Phnom Penh were counted for 76 communes in Cambodia according to TB registration records filed under the national TB programme. Population, socioeconomic, residential and occupational characteristics for the communes were obtained from the 2008 General Population Census of Cambodia. The following indicators were developed for individual communes: smear-positive pulmonary TB notification rate (SPTB-NR) (per 100,000 population, in 36 months), population density (per km2), socioeconomic indicators, residential characteristics and occupational characteristics. Geographic patterns of these indicators and characteristics were analysed using ArcGIS. Associations between SPTB-NR and characteristics were analysed. Results: A total of 4102 TB cases were reported in 36 months, including 2046 SPTB cases. SPTB-NR for Phnom Penh was 135 cases per 100,000; median SPTB-NR by commune was 100. SPTB-NR was higher in outlying areas than in city centre communes; population density was high in the centre and low in the outlying areas. SPTB-NR was associated with larger percentage of household members per room (PR: 2.81, 95%CI: 2.68 - 2.93), percentage of population resident in the same commune <5 years (PR: 1.00, 95%CI: 1.00 - 1.01) and percentage of population in 4 of 10 occupational groups, even after excluding the influence of socioeconomic characteristics. Conclusions: The SPTB-NR in Phnom Penh did not follow the pattern of population density. Socioeconomic, residential and occupational characteristics by commune were associated with SPTB-NR. Development of prevention and control programmes by considering commune level characteristics is encouraged.

Partnership in tuberculosis control through involvement of pharmacists in Delhi: An exploratory operational research study.

BACKGROUND:There are over 12,000 chemists registered in the capital city, Delhi to support patient health needs. A study was conducted to improve the tuberculosis (TB) notification rates as conceptualized by the Revised National Tuberculosis Control Program (RNTCP). As part of the end TB mission, the feasibility of capturing data of TB patients coming to buy anti-TB drugs at the licensee level (chemists and drug shop owners) in Central Delhi area was assessed.MATERIALS AND METHODS:The prospective study was conducted from July 2017 to March 2018. TB notification through a paper-based system and self-notification through online mode were the operational modality used for engagement with chemists. A team of paramedical workers was deployed for data collection from those pharmacists who chose to notify through the paper mode. Self-notification through online mode was through the RNTCP's NIKSHAY web-based reporting platform.RESULTS:From the 330 chemists sensitized, 871 TB notifications were received during the study. Younger age groups comprised a majority of these cases with 198 (37.5%) from 21 to 30 years and 122 (23.1%) from 11 to 20 years. By the end of six visits, 28 (46%) of the 61 pharmacies that were eventually successfully sensitized had started returning the Folio cards with filled patient details. A total of 581 (66.6%) prescriptions received by the pharmacists were from government hospitals. The annual TB case notification in Central Delhi showed a significant increase from 271 TB patients/100,000 population to 871 TB patients/100,000 population during the study period when compared with expected trends in the past year (P < 0.05).CONCLUSION:Self-notification of TB engenders successful TB notifications from chemists. This progenitor approach to TB notification in the capital emphasizes the need to categorize pharmacists as an independent private care provider for improving TB notification across high-burden settings.

Kenya tuberculosis prevalence survey 2016: Challenges and opportunities of ending TB in Kenya

BackgroundWe aimed to determine the prevalence of pulmonary TB amongst the adult population (≥15 years) in 2016 in Kenya.MethodA nationwide cross-sectional survey where participants first underwent TB symptom screening and chest x-ray. Subsequently, participants who reported cough >2weeks and/or had a chest x-ray suggestive of TB, submitted sputum specimen for laboratory examination by smear microscopy, culture and Xpert MTB/RIF.ResultThe survey identified 305 prevalent TB cases translating to a prevalence of 558 [95%CI 455–662] per 100,000 adult population. The highest disease burden was reported among people aged 25–34 years (716 [95% CI 526–906]), males (809 [(95% CI 656–962]) and those who live in urban areas (760 [95% CI 539–981]). Compared to the reported TB notification rate for Kenya in 2016, the prevalence to notification ratio was 2.5:1. The gap between the survey prevalence and notification rates was highest among males, age groups 25–34, and the older age group of 65 years and above. Only 48% of the of the survey prevalent cases reported cough >2weeks. In addition, only 59% of the identified cases had the four cardinal symptoms for TB (cough ≥2 weeks, fever, night sweat and weight loss. However, 88.2% had an abnormal chest x-ray suggestive of TB. The use of Xpert MTB/RIF identified 77.7% of the cases compared to smear microscopy’s 46%. Twenty-one percent of the survey participants with respiratory symptoms reported to have sought prior health care at private clinics and chemists. Among the survey prevalent cases who reported TB related symptoms, 64.9% had not sought any health care prior to the survey.ConclusionThis survey established that TB prevalence in Kenya is higher than had been estimated, and about half of the those who fall ill with the disease each year are missed.

BIOPSY-PROVEN CENTRAL NERVOUS SYSTEM AND PULMONARY SARCOIDOSIS: FIRST REPORTED CASE IN HONG KONG

SESSION TITLE: Pulmonary SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM INTRODUCTION: Lung is the commonest organ to be involved by sarcoidosis. Nervous system is involved in around 5% of cases only. [1] Due to rarity, neurosarcoidosis has never been reported in Hong Kong Chinese patients. CASE PRESENTATION: A 34-year-old Chinese clerk lady presented with headache and personality changes. CT brain showed hydrocephalus and MRI showed ill-defined T2 hyper-intense lesion without enhancement at superior-dorsal aspect of pons. (Fig.1) Endoscopic third ventriculostomy with brain biopsy found granulomatous inflammation with negative mycobacterial tuberculosis polymerase chain reaction (MTB-PCR). CT thorax showed numerous tiny pulmonary nodules with extensive mediastinal lymphadenopathy. (Figs 2,3)She was managed as miliary tuberculosis (TB) with central nervous system (CNS) involvement. Cognitive symptoms persisted despite 8 months of TB treatment and interstitial involvement worsened on CT thorax. Further investigations with transbronchial biopsy and endobronchial ultrasound guided needle aspiration of station 7 lymph node confirmed granulomatous inflammation with negative MTB-PCR. After multi-disciplinary team discussion, diagnosis was revised to be sarcoidosis. TB medications were stopped and she was started on oral prednisolone. The cognitive problem improved and repeat CT 3 months after steroid treatment showed reduced extent of bilateral lung nodules and lymphadenopathy. DISCUSSION: Sarcoidosis was thought to be rare among Asians. The incidence rate ranged from 0.027 (Taiwan) to 2 (Japan) per 100000. Reports in Chinese patients were scarce. The epidemiology in Hong Kong is unknown but there were a number of case reports over last 30 years showing it is not that rare.Diagnosis remained by exclusion from compatible clinical and radiological picture with histology of noncaseating granuloma. [2] This highlighted the diagnostic challenge: TB notification rate was 58.27 per 100000 in Hong Kong; that is 50-2000 times more common than sarcoidosis. Two diseases can overlap, making it more complicated. [3] Many cases therefore received TB treatment during pursuit of diagnosis. Symptoms and signs are non-specific. Usually patients need to have symptoms for more than 3 months, and require three or more encounters with health care providers before arriving diagnosis.Nervous system sarcoidosis is even rarer but it can be first symptoms before systemic disease. Imaging findings are also non-specific. It is difficult to obtain biopsy and some can only be found in autopsy. It is one of the most fearful complications of sarcoidosis as it can carry mortality up to 18%. More aggressive immunomodulating treatment are needed. CONCLUSIONS: Sarcoidosis is still rare but is likely under-recognized. Diagnosis can be challenging in particular to exclude TB. We presented the first biopsy-proven case of central nervous system sarcoidosis in Hong Kong Chinese patient with successful treatment. Reference #1: 1. Dominique V, Antje P, Hilario N, et al. Sarcoidosis. Lancet 2014; 383: 1155–67 Reference #2: 2. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999; 160: 736–55. Reference #3: 3. Wong CF et al. A case of concomitant tuberculosis and sarcoidosis with mycobacterial DNA present in the sarcoid lesion. Chest 1998; 114:2; 626-9 DISCLOSURES: No relevant relationships by Yu Hong Chan, source=Web Response no disclosure on file for Yiu Cheong Yeung

Assessing the impact of antiretroviral therapy on tuberculosis notification rates among people with HIV: a descriptive analysis of 23 countries in sub-Saharan Africa, 2010\u20132015

BackgroundHIV is a major driver of the tuberculosis epidemic in sub-Saharan Africa. The population-level impact of antiretroviral therapy (ART) scale-up on tuberculosis rates in this region has not been well studied. We conducted a descriptive analysis to examine evidence of population-level effect of ART on tuberculosis by comparing trends in estimated tuberculosis notification rates, by HIV status, for countries in sub-Saharan Africa.MethodsWe estimated annual tuberculosis notification rates, stratified by HIV status during 2010–2015 using data from WHO, the Joint United Nations Programme on HIV/AIDS, and the United Nations Population Division. Countries were included in this analysis if they had ≥4 years of HIV prevalence estimates and ≥ 75% of tuberculosis patients with known HIV status. We compared tuberculosis notification rates among people living with HIV (PLHIV) and people without HIV via Wilcoxon rank sum test.ResultsAmong 23 included countries, the median annual average change in tuberculosis notification rates among PLHIV during 2010–2015 was -5.7% (IQR -6.9 to -1.7%), compared to a median change of -2.3% (IQR -4.2 to -0.1%) among people without HIV (p-value = 0.0099). Among 11 countries with higher ART coverage, the median annual average change in TB notification rates among PLHIV was -6.8% (IQR -7.6 to -5.7%) compared to a median change of -2.1% (IQR -6.0 to 0.7%) for PLHIV in 12 countries with lower ART coverage (p = 0.0106).ConclusionTuberculosis notification rates declined more among PLHIV than people without HIV, and have declined more in countries with higher ART coverage. These results are consistent with a population-level effect of ART on decreasing TB incidence among PLHIV. To further reduce TB incidence among PLHIV, additional scale-up of ART as well as greater use of isoniazid preventive therapy and active case-finding will be necessary.

Tuberculosis-related technical enquiries received by a national level institution in Japan, 2014-2016.

Background: Japan had a tuberculosis (TB) notification rate of 13.9 per 100 000 population in 2016. Objectives: To characterise TB-related enquiries received by the Research Institute of Tuberculosis, Tokyo, Japan, between January 2014 and December 2016. Design: A descriptive study of the time, place and other attributes of the enquiries. Results: A total of 1864 enquiries were listed for analysis. On average, 51.8 enquiries (range 30-77) were received per month. The enquiry rates were highest for Yamanashi (5.87/100 000) and Kochi (5.77) Prefectures, and lowest in Miyazaki (0.45) and Saga (0.48) Prefectures. Enquirers belonged mostly to local governments (n = 1212, 65%) and health care facilities (n = 386, 21%), and included medical doctors (n = 412, 22%), nurses (n = 926, 50%) and the general public (n = 150, 8.0%). Most enquiries concerned TB diagnosis and treatment (n = 475, 25%), including diagnosis in general (n = 38, 2.0%), laboratory diagnosis (n = 83, 4.5%), anti-tuberculosis treatment in general (n = 62, 3.3%) and the management of comorbidities or adverse events (n = 60, 3.2%), followed by contact investigations (n = 371, 20%). Conclusions: As most enquiries concerned the diagnosis and treatment of TB, the Ministry of Health of Japan should maintain a number of specialised TB institutions with TB clinicians to provide technical assistance.

Modelling the effect of discontinuing universal Bacillus Calmette-Guérin vaccination in an intermediate tuberculosis burden setting

BackgroundBacillus Calmette-Guérin (BCG) vaccination is a widely-used public health intervention for tuberculosis (TB) control. In Taiwan, like other intermediate TB burden settings, steadily declining TB incidence raises important questions on whether universal BCG vaccination should be discontinued. Recent surveys on adverse events following immunisation, such as BCG-induced osteomyelitis/osteitis, also suggest a need to re-evaluate the vaccination programme. MethodsWe developed an age-structured transmission dynamic model, calibrated to population demography and age-specific TB notification rates in Taiwan. We adopted ‘weak-protection’ and ‘strong-protection’ scenarios, representing a range of characteristics including the duration of BCG protection and vaccine efficacies against TB infection and progression. We estimated averted disability-adjusted life years (DALYs) and incremental costs over 10 years after discontinuing universal BCG vaccination in 2018, 2035, and 2050. We also examined the potential impact of ‘surveillance-guided’ discontinuation, triggered once notification rates fall to a given threshold. ResultsIn the weak-protection scenario, discontinuing BCG would result in 2.8 (95% uncertainty range: 2.3, 3.1) additional notified TB cases and −4.1 (−7.7, 0.8) net averted DALYs over 2018–2027. In the strong-protection scenario, 82.9 (72.6, 91.6) additional cases and −402.7 (−506.6, −301.2) averted DALYs would be reported, suggesting a robustly negative health impact. However, in this vaccine scenario, there could be an overall health benefit if BCG is discontinued once TB notification falls below 5 per 100,000 population. The most influential vaccine characteristic for the net health impact is the vaccine efficacy against progression to pulmonary TB. In financial terms, the eliminated cost of the vaccination programme substantially outweighed the incremental cost for TB treatment regardless of BCG protection. ConclusionsBCG discontinuation may be warranted in intermediate burden settings, depending on the quality of vaccine protection, and the potential for refocusing on other TB control activities for earlier detection and treatment.

Development and validation of a predictive ecological model for TB prevalence.

BackgroundNationally representative tuberculosis (TB) prevalence surveys provide invaluable empirical measurements of TB burden but are a massive and complex undertaking. Therefore, methods that capitalize on data from these surveys are both attractive and imperative. The aim of this study was to use existing TB prevalence estimates to develop and validate an ecological predictive statistical model to indirectly estimate TB prevalence in low- and middle-income countries without survey data.MethodsWe included national and subnational estimates from 30 nationally representative surveys and 2 district-level surveys in India, resulting in 50 data points for model development (training set). Ecological predictors included TB notification and programmatic data, co-morbidities and socio-environmental factors extracted from online data repositories. A random-effects multivariable binomial regression model was developed using the training set and was used to predict bacteriologically confirmed TB prevalence in 63 low- and middle-income countries across Africa and Asia in 2015.ResultsOut of the 111 ecological predictors considered, 14 were retained for model building (due to incompleteness or collinearity). The final model retained for predictions included five predictors: continent, percentage retreated cases out of all notified, all forms TB notification rates per 100 000 population, population density and proportion of the population under the age of 15. Cross-fold validations in the training set showed very good average fit (R-sq = 0.92).ConclusionPredictive ecological modelling is a useful complementary approach to indirectly estimating TB burden and can be considered alongside other methods in countries with limited robust empirical measurements of TB among the general population.

Mixed methods study on elimination of tuberculosis in Hong Kong.

Tuberculosis (TB) commonly affects developing countries. Several developed regions in Asian still have a stagnant intermediate TB burden. Information to adequately inform TB strategies is lacking. We conducted a mixed methods study to fill this information gap in Hong Kong. Data from the Hong Kong government were used to analyse trends of TB notification rates compared with World Health Organization (WHO) targets. A review of policy documents and literature was conducted to evaluate TB control and elimination in Hong Kong. Extrapolated trends showed that Hong Kong will be unable to meet the WHO target of a 90% drop in incidence rate by 2030. The policy review showed that the Hong Kong government has not set a clear strategy and timeline for specific goals in TB control and elimination. The literature review found that older adults are largely responsible for the stagnant TB prevalence because of reactivation of latent TB infection (LTBI), while mortality of hospitalised patients with TB is still high because of delayed diagnosis and treatment. Tuberculosis incidence is currently under control in Hong Kong, but further actions are needed if the elimination targets are to be achieved. Improved diagnostic tools are required, and policies targeting LTBI in older adults should be implemented to achieve the WHO target by 2030.

Time-series analysis of tuberculosis from 2005 to 2017 in China.

Seasonal autoregressive integrated moving average (SARIMA) has been used to model nationwide tuberculosis (TB) incidence in other countries. This study aimed to characterise monthly TB notification rate in China. Monthly TB notification rate from 2005 to 2017 was used. Time-series analysis was based on a SARIMA model and a hybrid model of SARIMA-generalised regression neural network (GRNN) model. A decreasing trend (3.17% per years, P < 0.01) and seasonal variation of TB notification rate were found from 2005 to 2016 in China, with a predominant peak in spring. A SARIMA model of ARIMA (0,1,1) (0,1,1)12 was identified. The mean error rate of the single SARIMA model and the SARIMA-GRNN combination model was 6.07% and 2.56%, and the determination coefficient was 0.73 and 0.94, respectively. The better performance of the SARIMA-GRNN combination model was further confirmed with the forecasting dataset (2017). TB is a seasonal disease in China, with a predominant peak in spring, and the trend of TB decreased by 3.17% per year. The SARIMA-GRNN model was more effective than the widely used SARIMA model at predicting TB incidence.

Prevalence of latent tuberculous infection among adults in the general population of Ca Mau, Viet Nam.

The study was conducted in a randomly selected sample of persons aged 15 years living in Ca Mau Province, southern Viet Nam. To estimate the prevalence of latent tuberculous infection (LTBI) in the general adult population of this province of Viet Nam. The secondary objective was to examine age and sex differences in prevalence. A cross-sectional survey was conducted in a cluster-random sample of the population. Clusters were subcommunes. The presence of LTBI was assessed using the QuantiFERON®-TB Gold In-Tube test system. QuantiFERON tests were performed among 1319 persons aged 15 years (77.7% of those selected). The overall prevalence of positive tests was 36.8% (95%CI 33.4-40.3). The prevalence of a positive test was lower in females than in males (31.0% vs. 44.7%, OR 0.57, 95%CI 0.45-0.72, P < 0.0001). The prevalence of positive tests increased with increasing age quintile (P < 0.0001). More than one third of the general adult population in a province in southern Viet Nam have evidence of LTBI. Although LTBI prevalence is higher in males, the sex difference is not as great as that for TB notification rates.

Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study

Tuberculosis continues to disproportionately affect many Indigenous populations in the USA, Canada, and Greenland. We aimed to investigate whether population-based tuberculosis-specific interventions or changes in general health and socioeconomic indicators, or a combination of these factors, were associated with changes in tuberculosis incidence in these Indigenous populations. For this population-based study we examined annual tuberculosis notification rates between 1960 and 2014 in six Indigenous populations of the USA, Canada, and Greenland (Inuit [Greenland], American Indian and Alaska Native [Alaska, USA], First Nations [Alberta, Canada], Cree of Eeyou Istchee [Quebec, Canada], Inuit of Nunavik [Quebec, Canada], and Inuit of Nunavut [Canada]), as well as the general population of Canada. We used mixed-model linear regression to estimate the association of these rates with population-wide interventions of bacillus Calmette-Guérin (BCG) vaccination of infants, radiographic screening, or testing and treatment for latent tuberculosis infection (LTBI), and with other health and socioeconomic indicators including life expectancy, infant mortality, diabetes, obesity, smoking, alcohol use, crowded housing, employment, education, and health expenditures. Tuberculosis notification rates declined rapidly in all six Indigenous populations between 1960 and 1980, with continued decline in Indigenous populations in Alberta, Alaska, and Eeyou Istchee thereafter but recrudescence in Inuit populations of Nunavut, Nunavik, and Greenland. Annual percentage reductions in tuberculosis incidence were significantly associated with two tuberculosis control interventions, relative to no intervention, and after adjustment for infant mortality and smoking: BCG vaccination (-11%, 95% CI -6 to -17) and LTBI screening and treatment (-10%, -3 to -18). Adjusted associations were not significant for chest radiographic screening (-1%, 95% CI -7 to 5). Declining tuberculosis notification rates were significantly associated with increased life expectancy (-37·8 [95% CI -41·7 to -33·9] fewer cases per 100 000 for each 1-year increase) and decreased infant mortality (-9·0 [-9·5 to -8·6] fewer cases per 100 000 for each death averted per 1000 livebirths) in all six Indigenous populations, but no significant associations were observed for other health and socioeconomic indicators examined. Population-based BCG vaccination of infants and LTBI screening and treatment were associated with significant decreases in tuberculosis notification rates in these Indigenous populations. These interventions should be reinforced in populations still affected by tuberculosis, while also addressing the persistent health and socioeconomic disparities. Public Health Department of the Cree Board of Health and Social Services of James Bay.

Tuberculosis notification and treatment outcome among migrant boat arrivals in Malta, 2007-2011.

The annual incidence of tuberculosis (TB) in Malta has remained low, at <20 per 100 000 population per year. However, TB notification among vulnerable groups is on the rise and is a matter of public health concern. We measured the TB notification rate, which ranged from 470 to 880/100 000 among migrant boat arrivals 1 year after arrival, highlighting the need to maintain high treatment success rates. Early case detection and high treatment success were observed due to post-arrival screening; however, the need for pragmatic, patient-friendly approaches that will encourage self-referral and access to treatment among migrant groups could play a significant role in preventing the re-emergence of TB in low-incidence settings.

Migration Flow and Its Impact on Tuberculosis Notification in Portugal

IntroductionTuberculosis notification in Portugal has decreased in the last few years. As a consequence of the economic crisis, emigration has increased and immigration has decreased. Immigrants are a risk group for tuberculosis. Most emigrants are 20–44 years old and belong to the age group most affected by tuberculosis. ObjectiveTo describe the decrease in tuberculosis notification in Portugal over the last years from a demographical point of view. MethodsMathematical analysis was performed to quantify the effect of the migration movements (separately and simultaneously) on tuberculosis notification in Portugal from 2008 to 2014. We calculated the estimated tuberculosis notification for each year during the period of study: 1) fixing immigration rate and tuberculosis rate in immigrants at 2008 values; 2) fixing emigration rate and tuberculosis rate in emigrants at 2008 values; 3) fixing both phenomenons at 2008 values. ResultsThe differences between the observed and the estimated numbers were small (≤0.5 cases/100000 inhabitants). DiscussionImpact of the migration movements on tuberculosis notification rate does not seem to be significant when analyzed for each phenomenon individually and simultaneously, by our model. This might mean that we have to concentrate our efforts in other risk factors for tuberculosis.

Analysis of tuberculosis case report in Hyderabad district of Telangana state.

Background:The estimated incidence of TB in India was approximately 28,00,000 as per the Global TB report 2017. This accounts for a quarter of the world's TB (Tb) cases. National strategic plan, is a programme which aims at the elimination of Tb by 2018. The programme is crafted in line with other health sector strategies and global efforts, such as the draft National Health Policy 2015, World Health Organization's (WHO) End TB Strategy and the Sustainable Development Goals (SDGs) of the United Nations (UN). Key strategies under National Strategic plan: Private sector engagement, active case finding, drug resistant Tb case management, addressing social determinants including nutrition, robust surveillance system, community engagement and multisectoral approach.Methods:In March 2018, India Tb report was released by RNTCP. An analysis of the report is done in the research article, an attempt to take forward end Tb strategy.Result:According to The India Tb report, 85% of new TB cases were detected, nationwide, where as 90% of new cases were detected in Hyderabad, during the same time period. Tuberculosis (Tb) notification rate (per 100 000 population), in India is 138, where as in Hyderabad district of Telengana it is 100. Both Public and private sector Tb case notification rate, of Hyderabad district was less than that of India (90,10). 6% of Tb cases were paediatric cases both Hyderabad and Nationwide. HIV status was known in 66% cases, in India and 67% in Hyderabad district of Telengana.

Incidence of Active Tuberculosis and Cohort Retention Among Adolescents in Western Kenya.

Siaya County, with the highest tuberculosis notification rates in Kenya. To determine the incidence of active tuberculosis and 1-year cohort retention in 12-18-year-old adolescents, in preparation for phase III tuberculosis vaccine trials. Adolescents were enrolled and followed up for 1-2 years to determine tuberculosis incidence. Adolescents with a positive tuberculin skin test, history of cohabitation with a tuberculosis case or at least 1 tuberculosis symptom received clinical and sputum examination and a chest radiograph. Definite tuberculosis cases were bacteriologically confirmed and clinical cases diagnosed by a clinician based on a suggestive chest radiograph and having clinical symptoms. Risk factors were explored using Poisson regression. Among 4934 adolescents without tuberculosis at baseline, 26 tuberculosis cases were identified during follow-up with a corresponding incidence density of 4.4 [95% confidence interval (CI): 3.0-6.4] events per 1000 person-years of observation, 12 definite tuberculosis cases; incidence density of 2.0 (95% CI: 0.9-3.1). Having previous tuberculosis (rate ratio: 12.5; CI: 1.8-100) and presence of tuberculin skin test conversion (rate ratio: 3.4; CI: 1.5-7.7) were significantly associated with higher risk of tuberculosis. Overall (4086/4925), 83.0% of adolescents were retained in the study after 1 year of follow-up. Being female, older, out of school and being orphaned were significant risk factors for loss to follow-up. The tuberculosis incidence in adolescents will help inform future tuberculosis vaccine trial sample size calculations for this setting. The predictive factors for tuberculosis and retention can be further explored in future trials.

Molecular epidemiology of Mycobacterium tuberculosis strains from prison populations in Santa Catarina, Southern Brazil

The Tuberculosis (TB) notification rates are 5 to 81 times higher in prisons worldwide when compared to the general population. The state of Santa Catarina (SC) has few epidemiological data regarding TB in prisons. The aim of this study was to evaluate the molecular epidemiology of circulating strains in prisons of SC. The study comprised 95 clinical samples from six prisons. Among the cases included, all subjects were male, predominantly caucasians, and young adults, with low education level. The positive smear in the TB diagnosis comprised 62.0% of cases. About 50% of subjects had some condition associated with TB. The Spoligotyping results showed that the most frequent lineages were LAM (50.7%), T (22.2%) and S (11.6%). The 12-loci MIRU generated 62 different genotypes. The MSTs showed evolutionary relationships between Mycobacterium tuberculosis spoligotypes from SC and evolutionary relationships between the prison isolates and studied parameters. This first study on TB in prison units of SC highlighted the predominance of SIT216/LAM5, and SIT34/S. Interestingly, his profile was found to be different from that observed in a previous study performed with the state's general population. This data shows the need for continued surveillance of episodes of TB occurring among prison inmates in an emerging country like Brazil.

Trend and outcome of notified children with tuberculosis during 2011-2015 in Kampala, Uganda

BackgroundThe road map for childhood tuberculosis launched in 2013 provided strong renewed efforts focused towards zero deaths due to tuberculosis in children. From 2010, there were efforts to improve childhood tuberculosis diagnosis in Kampala and this study aimed to document the trend and outcome of tuberculosis in children over the period.MethodsThis was a retrospective study of tuberculosis data for Kampala city for the period 2011–2015. We extracted data from the unit TB registers in the 52 Diagnostic and treatment units (DTUs) in the Kampala. We report on data for children 0 to 14 years.ResultsWe accessed 33,221 TB patient records of which 2333 (7.0% 95% CI 6.7 to 7.3) were children. The proportion of children with pulmonary TB was 80% (1870/2333) (95% CI 76.7 to 83.7 and extra-pulmonary TB accounted for 20% (463/2333) (CI 18.3 to 21.5). Among pulmonary TB cases, the clinically diagnosed were 82% (1530/1870) (95% CI 80.0 to 83.5) while the bacteriologically confirmed were 18% (340/1870) (95% CI 16.5 to 20.0). Among the bacteriologically confirmed, 45% (154/340) (95% CI 40.1 to 50.6) were smear positive. During the study period 2011 through 2015, the childhood TB notification rate declined as follows; 105, 76, 72, 88, and 74 per 100,000 respectively. The treatment success rate increased from 78% in 2011 to 83% in 2015.ConclusionsThe TB notification rate among children in Kampala city showed a large decline during the period 2011 to 2015. There was a slight improvement in the treatment success rate among the children.

Migration Flow and Its Impact on Tuberculosis Notification in Portugal

IntroductionTuberculosis notification in Portugal has decreased in the last few years. As a consequence of the economic crisis, emigration has increased and immigration has decreased. Immigrants are a risk group for tuberculosis. Most emigrants are 20–44 years old and belong to the age group most affected by tuberculosis. ObjectiveTo describe the decrease in tuberculosis notification in Portugal over the last years from a demographical point of view. MethodsMathematical analysis was performed to quantify the effect of the migration movements (separately and simultaneously) on tuberculosis notification in Portugal from 2008 to 2014. We calculated the estimated tuberculosis notification for each year during the period of study: 1) fixing immigration rate and tuberculosis rate in immigrants at 2008 values; 2) fixing emigration rate and tuberculosis rate in emigrants at 2008 values; 3) fixing both phenomenons at 2008 values. ResultsThe differences between the observed and the estimated numbers were small (≤0.5 cases/100000 inhabitants). DiscussionImpact of the migration movements on tuberculosis notification rate does not seem to be significant when analyzed for each phenomenon individually and simultaneously, by our model. This might mean that we have to concentrate our efforts in other risk factors for tuberculosis.

Epidemiology of tuberculosis in Chongqing, China: a secular trend from 1992 to 2015

Chongqing is a southwest city of China with high tuberculosis (TB) burden. An observational retrospective study has been performed based on routine TB surveillance data in Chongqing from 1992 to 2015. The TB notification rate has declined to 70.8 cases per 100,000 population from the peak of 106 cases per 100,000 in 2005. The TB notification rate in population over-65 years has become the highest among all-ages population since 2010. The average proportion of farmers in all notified cases from 2008 to 2015 was 62.5%, and the notification rate of farmers has become the highest among all occupations since 2011. The TB notification showed a regional disparity in Chongqing. Despite the improvement achieved since 1992, the TB control efforts has been threatened by new challenges such as the demographic shift towards an aging population, the prevalence of MDR-TB and TB/HIV co-infection, and the regional disparity of TB notification. More effective interventions should be implemented. Our study can serve as a guidance for the future development of TB control in Chongqing, and we believe it has general relevance to TB control in other regions with similar situations.