Number Of New Tuberculosis Cases Research Articles

Relationship between Patients’ Knowledge and Medication Adherence of Tuberculosis at Islamic Hospital Pondok Kopi Jakarta

Background: Tuberculosis (TB) remains a health problem in Indonesia. Currently, the number of new TB cases in Indonesia ranks second after India. Patient compliance in using antituberculosis drugs is critical in achieving successful treatment outcomes, prevent further spread of the bacteria that cause TB and the development of drug resistance. Adherence to taking medication can be influenced by various factors, one of which is the level of knowledge.Objectives: This study was aimed to determine the relationship between the level of knowledge about TB and medication adherence of TB patients at the Jakarta Islamic Hospital Pondok Kopi.Methods: This study was conducted from May to June 2022 with a cross sectional design. The inclusion criteria in this study were TB patients who were over 18 years old, willing to become respondents, and had used antituberculosis drugs for at least one month. The level of knowledge about TB was assessed using a questionnaire and medication adherence was assessed using the MARS-5 questionnaire.Results: The number of respondents in this study was 83 patients. Most patients were male (57.83%), less than 60 years old (83.13%), and had a high school education (53.01%). The results showed that most patients (73.47%) had a good level of knowledge and were compliant with taking medication (77.11%). The level of patient knowledge about TB has a significantly moderate and positive correlation with the level of adherence in taking medication (p 0.001; r 0.517).Conclusion: increasing patients’ knowledge about TB can lead to better patients’ adherence, which may lead to better treatment outcome.

Changes in tuberculosis risk after transplantation in the setting of decreased community tuberculosis incidence: a national population-based study, 2008–2020

BackgroundTransplant recipients are immunocompromised and vulnerable to developing tuberculosis. However, active tuberculosis incidence is rapidly declining in South Korea, but the trend of tuberculosis infection among transplant recipients has not been elucidated. This study aimed to evaluate the risk of active tuberculosis after transplantation, including risk factors for tuberculosis and standardized incidence ratios, compared with that in the general population.MethodsThis retrospective study was conducted based on the South Korean health insurance review and assessment database among those who underwent transplantation (62,484 recipients) between 2008 and 2020. Tuberculosis incidence was compared in recipients treated during higher- (2010–2012) and lower-disease burden (2016–2018) periods. Standardized incidence ratios were analyzed using the Korean Tuberculosis Surveillance System. The primary outcome was the number of new tuberculosis cases after transplantation.ResultsOf 57,103 recipients analyzed, the overall cumulative incidence rate 1 year after transplantation was 0.8% (95% confidence interval [CI]: 0.7–0.8), significantly higher in the higher-burden period than in the lower-burden period (1.7% vs. 1.0% 3 years after transplantation, P < 0.001). Individuals who underwent allogeneic hematopoietic stem cell transplantation had the highest tuberculosis incidence, followed by those who underwent solid organ transplantation and autologous hematopoietic stem cell transplantation (P < 0.001). The overall standardized incidence ratio was 3.9 (95% CI 3.7–4.2) and was the highest in children aged 0–19 years, at 9.0 (95% CI 5.7–13.5). Male sex, older age, tuberculosis history, liver transplantation, and allogeneic hematopoietic stem cell transplantation were risk factors for tuberculosis.ConclusionsTransplant recipients are vulnerable to developing tuberculosis, possibly influenced by their immunocompromised status, solid organ transplant type, age, and community prevalence of tuberculosis. Tuberculosis prevalence by country, transplant type, and age should be considered to establish an appropriate tuberculosis prevention strategy for high-risk groups.Graphical

Lessons Learned from the COVID-19 Pandemic: Simulation of the Tuberculosis Epidemic as a Function of Population Coverage with Screening

The COVID-19 pandemic has led to the discontinuation of many support programs for tuberculosis patients worldwide, and lower coverage of population with screening for tuberculosis.The objective: To build a model describing the spread of tuberculosis depending on the population coverage with preventive screening, and to obtain a long-term forecast of the infection spread using this model.Subjects and Methods. We analyzed official statistical data on incidence, mortality, preventive screening coverage (PSC), and revalence of sputum smear-positive tuberculosis in the Russian Federation from 2008 to 2021. The model was built up based on fluctuations in those rates in 2020, when there was a sharp reduction in tuberculosis control interventions due to the COVID-19 pandemic. Statistical analysis was performed using the R Software (v.4.2.1).Results. A simple mathematical model describing the dependence of incidence and sputum smear-positive tuberculosis in the current year on sputum smear-positive tuberculosis in the past year and population coverage with preventive screening in the current and past years was built up. The adjusted coefficient of determination of the model (adjusted R-squared) was 0.9969, which meant that the model contained almost no random components. It showed that tuberculosis cases missed due to low population coverage with preventive screening lead to future spread of tuberculous infection and a significant increase in the number of new tuberculosis cases. Comparison of projected rates and data for 2022 demontrated correct formation of models. However, the projected rates were slightly higher than the actual rates for 2022 due to the influence of factors other than the population coverage with preventive screening for tuberculosis.Conclusions. The findings demonstrate the need for mass screening of the population in the context of significant spread of tuberculosis infection for timely detection of patients with sputum smear-positive tuberculosis.

Bridging the Gaps: Investigating the Complex Impact of the COVID-19 Pandemic on Tuberculosis Records in Brazil.

This study aimed to analyze the temporal evolution, spatial distribution, and impact of the COVID-19 pandemic on tuberculosis records in a northeastern state of Brazil. This is an ecological study involving all diagnoses of Tuberculosis (TB) in residents of the state of Pernambuco/Brazil. Data were extracted from the National System of Notifiable Diseases. A pre-pandemic COVID-19 temporal analysis (2001-2019), a spatial analysis before (2015-2019) and during the first two pandemic years (2020-2021), and the impact of the COVID-19 pandemic on cases of TB diagnoses in Pernambuco in the years 2020 and 2021 were performed. Inflection point regression models, Global and Local Moran's statistics, and spatial scan statistics were used. In the period from 2001 to 2019, 91,225 cases of TB were registered in Pernambuco (48.40/100,000 inhabitants), with a tendency of growth starting in 2007 (0.7% per year; p = 0.005). In the pre-pandemic period (2015-2019), 10.8% (n = 20) of Pernambuco municipalities had TB incidence rates below 10/100,000. In 2020, this percentage reached 27.0% (n = 50) and in 2021 it was 17.8% (n = 33). Risk clusters were identified in the eastern region of the state, with five clusters in the pre-pandemic period and in 2021 and six in 2020. In the first year of the pandemic, an 8.5% reduction in the number of new TB cases was observed. In 2021, the state showed a slight increase (1.1%) in the number of new TB cases. The data indicate that the COVID-19 pandemic may have caused a reduction in the number of new TB case reports in the state of Pernambuco, Brazil.

Impact of the COVID-19 pandemic on laboratory diagnosis of tuberculosis in southern Brazil

Background and objectives: to understand the impact of the COVID-19 pandemic on tuberculosis (TB) diagnosis in different settings is essential to guide the establishment of appropriate TB control strategies. This study aimed to assess the influence of COVID-19 pandemic in laboratory diagnosis of TB in patients tested and diagnosed for TB. Methods: a data survey was carried out in the database of laboratories that perform TB diagnosis for the public health system in Rio Grande city (Rio Grande do Sul, Brazil). Results: there was a decrease of 1,368 to 735 (reduction of 46.3%) in the number of patients tested for TB in public diagnostic services in 2019 and 2020, respectively, and a decrease of 197 to 119 (reduction of 39.6%) in the number of new TB cases diagnosed. In contrast, the positivity rate was 14.4% in 2019 and 16.2% in 2020. Moreover, it was observed that the laboratory that performs the diagnostic service for Primary Health Care was the most affected, when compared to Tertiary Health Care. Conclusion: as a consequence of measures to control the spread of SARS-CoV-2, there was a reduction in TB testing and in the detection of new cases, especially in Primary Health Care, where patients with less need for hospitalization are received.

Improved completing-treatment support among tuberculosis support group members through the CERMAT (Smart Against TB Transmission) program

Tuberculosis (TB) was declared a global emergency for humanity by the World Health Organization in 2015. According to Global Report TB data in 2016, Indonesia is one of the 30 countries in the world that has the highest TB caseload, especially Human Immunodeficiency Virus (HIV)-TB and (Multi Drug Resistant Tuberculosis (MDR) TB) cases during the 2016-2020 period (Global Tuberculosis Report, 2016). The high rise of MDR TB cases has great potential for transmission and an increase in the number of new TB cases. Efforts to optimize the handling of care and treatment, as well as to accelerate the determination of the diagnosis need to be conducted vigilantly on all lines, especially efforts to increase the ability to prevent transmission, provide quality follow-up care, and community-based treatment. Forming support groups is one of community health nursing strategies for TB prevention. A support group provides assistance to increase TB medication adherence and reduce TB transmission. TB control strategies are conducted by implementing CERMAT (Smart Against TB Transmission) to TB support groups that combine education intervention and skills to prevent TB transmission in the community setting. Community health nursing though the nursing process has established a system with recognition of the variables that affect health status and individual behaviors against TB disease. The nursing strategy intervention in the community is done at all levels, such as health education, group process, partnership, and community empowerment. The CERMAT package implemented in the TB support group is an evidence-based nursing practice. It was applied to 70 samples of adult TB clients at Curug, Cimanggis, Depok. The sampling was selected with a non-probability quota sampling technique. This study used an experimental design with paired t-test data analysis to determine the improvement in the skills of the TB support group after the support group intervention was done. It showed there was influence of the CERMAT method on the level of good support for completing TB treatment in Curug Village, with increased the mean of completed treatment by 2.42 with a p value 0.00 (p &lt;0.05). The CERMAT method can be applied as one of the nursing interventions to increase TB clients’ adherence. This intervention can be done by the person who is responsible for the TB program at the Community Health Center. The CERMAT method needs to be continued and evaluated regularly by involving health care volunteers.

Epidemiological Aspects of Tuberculosis in Children and Adolescents from 0 to 17 Years Old during the Improved Tuberculosis Situation

Between 2008 and 2018, the overall tuberculosis incidence in Novosibirsk Region went down with the moderate annual decrease of 3.9% on average. By the end of 2018, the number of new tuberculosis cases decreased, while the incidence of multiple drug resistant tuberculosis increased. Tuberculosis situation in children from 0 to 17 years old was characterized by stabilization of incidence. In adolescents, these rates moderately decreased (-2 .9%), and in children under 14 years old, this rate demonstrated the annual growth of 4.8%. In the context of the large burden of tuberculosis infection (2008), in 61.3% of tuberculosis cases in children aged 0-1 7 years, the index case of tuberculosis infection ( ITBI ) was not identified; by 2018, this rate dropped to 30.3%. However, the family exposure to a tuberculosis case was rather a predictor of the disease in children versus adolescents. And among adolescents, the role of casual contacts with ITBI was high (60.6%). Regardless of the epidemic situation, most of the children from 0 to 17 years old who developed tuberculosis were not covered by tuberculosis control activities, one of the reasons was the late detection of the source of tuberculosis infection.

A structured Markov chain model to investigate the effects of pre-exposure vaccines in tuberculosis control

In this paper, the interest is in a structured Markov chain model to describe the transmission dynamics of tuberculosis (TB) in the setting of small communities of hosts sharing confined spaces, and to explore the potential impact of new pre-exposure vaccines on reducing the number of new TB cases during an outbreak of the disease. The model under consideration incorporates endogenous reactivation of latent tubercle bacilli, exogenous reinfection of latently infected TB hosts, loss of effectiveness of the vaccine protection, and death of hosts due to tubercle bacilli and from causes beyond TB. Various probabilistic measures are defined and analytically studied to describe extreme values and the number of vaccinations during an outbreak, and a random version of the basic reproduction number is used to measure the transmission potential during the initial phase of the epidemic. Our numerical experiments allow us to compare different pre-exposure vaccines versus the level of coverage in terms of these probabilistic measures.

Human immunodeficiency virus infection amongst newly diagnosed tuberculosis patients and their clinico-radiological profile: A prospective study from Western India.

Background:Since time immemorial tuberculosis (TB) has been and continues to be one of the most significant infections causing human disease. In tropical countries, TB remains a leading cause of death. Human immunodeficiency virus (HIV) epidemic continues to fuel this global TB epidemic. The rapid growth of the HIV epidemic in many countries has resulted in an equally dramatic rise in the estimated number of new TB cases, which present therefore the integration of HIV and TB testing at the primary level is need of the hour.Methods:A prospective study was conducted on newly diagnosed, untreated TB patients aged 15-45 year and patients were screened for HIV infection. Clinico-radiological spectrum of TB among HIV seropositive and seronegative patients was evaluated.Results:Out of a total of 307 patients screened, 17 (5.54%) were found to be HIV seropositive. Seroprevalence was found significantly (P < 0.01, χ2 9.301) more common in 26-35 year age group and higher in Extrapulmonary TB (EPTB) patients than that in pulmonary TB (PTB) patients (9.90% vs 3.4%). Fever was the most common presenting symptom for TB in HIV seropositive patients. On examination pallor (58.82% vs. 15.86%), oral ulcer (35.3% vs. 0.35%) was found more common and on chest X-ray mid-lower zone involvement and mediastinal lymphadenopathy were more common in HIV seropositive patients.Conclusion:HIV seropositivity rates among newly diagnosed TB patients aged 15-45 year was 5.54 percent. The presentation of TB was more often atypical among these patients. Thus, an integrated model of TB and HIV at primary healthcare service delivery is an efficient use of resources that would address the two very important co-epidemics and thereby result in better management.

MONITORING KASUS TUBERCULOSIS BERBASIS GOOGLE EARTH

Tuberculosis is one of the world's health problems including in Indonesia. In 2017 the number of new tuberculosis cases in the Deli Tua Health Center area reached 143 cases with a success rate of 76% and MDR TB reaching 15%. This decrease in cases was caused by improper drug uptake and MDR TB medication dosage errors and non-compliance with taking medication. To overcome the problem, Google Earth mapping and calendar documentation were applied. The results of the implementation show that there is a difference which means the completeness of treatment before and after the intervention with RR = 2.21; 95% CI: 1.32-3.69, cure rate for tuberculosis cases with RR = 1.87; 95% CI: 1.17-2.99, the dropout rate for treatment with RR = 1.77; 95% CI: 1.07-2.95, and mortality rate. Google Earth-based tuberculosis case intervention increased treatment completeness by 18.3%, improved tuberculosis case recovery by 15.9%, decreased tuberculosis case dropout rates by 12.5% and decreased tuberculosis case fatality rates by 4.4%. It was concluded that the Google Earth-based tuberculosis case monitoring system was effectively implemented in the work area of the Public health center in Deli Tua. It is recommended to use of Google Earth-based tuberculosis monitoring system.

Is Singapore on track to eliminate tuberculosis by 2030? A policy case study.

Tuberculosis remains the top 10 causes of death worldwide in 2015, with the largest number of new tuberculosis cases occurring in Asia. Singapore, a high-income Asian country, still has an intermediate tuberculosis burden. This study is to determine Singapore’s tuberculosis policy with regard to achieving tuberculosis elimination goals. This is a case study of tuberculosis elimination policy in Singapore. Data were collected by policy review and literature review. Policy documents and reports were gathered from the websites of the Ministry of Health and the World Health Organization for policy review. The literature review was carried out through PubMed and Google Scholar to identify articles on epidemiology, treatment, and prevention of tuberculosis in Singapore. Data analysis of policy reports revealed that despite the overall downwards trend in the tuberculosis incidence rates between 2000 and 2015, the tuberculosis incidence rates reversed in 2008. Singapore tuberculosis policies are mostly consistent with the World Health Organization Stop TB Strategy, although over half of the performance indicators were not achieved by 2015. After screening 1014 articles, 18 studies were included in the literature review. The rapidly ageing population, great population mobility, and continuous community transmission were found to be major obstacles to achieving Millennium Development Goals in Singapore. Singapore is lagging in achieving the targets. Scaling up the existing tuberculosis programme to accelerate the tuberculosis decline is required to meet Sustainable Development Goals 2030. Unlike other high-income countries with an intermediate tuberculosis burden in Asia, Singapore has increasing tuberculosis incidence rates. While other countries face the burden of an ageing population, Singapore faces an additional burden of an influx of migrants from high-incidence countries. Singapore will need to control tuberculosis in both these demographic groups to reverse the increasing incidence trend.

120. A Randomized Double-blind Trial Assessing the Efficacy of M72/AS01E Vaccine Against Pulmonary Tuberculosis Disease in Adults With Latent Mycobacterium tuberculosis Infection

BackgroundAn effective tuberculosis (TB) vaccine is urgently needed to support the End TB Strategy to reduce the number of new TB cases by 80% by 2030. M72/AS01E candidate vaccine is an adjuvanted recombinant fusion protein derived from Mycobacterium tuberculosis Mtb32A and Mtb39A proteins.MethodsWe conducted a randomized, double-blind, placebo-controlled phase 2b trial (NCT01755598) in Southern and Eastern Africa to assess M72/AS01E’s efficacy against bacteriologically confirmed pulmonary TB disease in HIV-seronegative (HIV–) adults aged 18–50 years infected with Mtb (defined by a positive IFN-γ release assay). Participants were randomized 1:1 to receive M72/AS01E or placebo at day D0 and D30. Reactogenicity, safety, immunogenicity were assessed, and incident TB disease measured from D30 postdose 2 up to ≥24 months for this analysis (follow-up ongoing up to 37 months). Efficacy against various TB disease case definitions (Figure 1) was estimated. Primary objective: efficacy against culture- or PCR-confirmed pulmonary TB disease in HIV– adults (case definition 1; success criterion: lower limit of 90% 2-sided CI >0%, power: 80%).ResultsDemographic characteristics were similar between M72/AS01E (1786) and placebo (1787) recipients. Efficacy against pulmonary TB disease case definition 1 was 54.0% (90% CI: 13.9, 75.4; P = 0.042); efficacy against other case definitions and a sensitivity analysis are shown in Figure 1. Leading solicited symptoms were pain, fatigue, and headache (Figure 2). In all recipients, unsolicited symptoms (D0–29) were more frequent after M72/AS01E (67.4%) than placebo (45.4%), mainly attributable to increased injection site reactions and flu-like symptoms. Serious adverse events (D0–month 7) incidences were similar between groups (M72/AS01E: 1.6%; placebo: 1.8%). During the study, 24 adults died (14 due to traumatic events); all deaths were unrelated to the trial.ConclusionM72/AS01E presents a clinically acceptable safety profile and significantly reduces bacteriologically confirmed pulmonary TB disease incidence in HIV– adults with latent Mtb infection. Funding. BMGF; Aeras; DFID UK; DGIS; AusAID; GlaxoSmithKline Biologicals SA.Disclosures O. Van Der Meeren, GSK: Employee and Shareholder, Salary. M. Hatherill, Aeras: Investigator, Research grant. R. J. Wilkinson, GSK: Grant Investigator, indirect funding. H. M. Ayles, GSK: Grant Investigator, Research grant. G. Henostroza, Aeras: Investigator, Grant recipient. M. A. Demoitié, GSK: owns stocks and is named inventor on patent applications relating to certain uses of M72/AS01E, Salary. T. Singh, GSK: Employee and Shareholder, Salary. E. J. Akite, GSK: Employee, Salary. A. K. Azam, GSK: Employee, Salary. A. Bollaerts, GSK: Employee, Salary. A. M. Ginsberg, GSK: Collaborator, Research support. BMGF: Grant Investigator, Grant recipient. UK DFID: Grant Investigator, Grant recipient. P. Gillard, GSK: Employee and Shareholder, Salary and stock. D. R. Tait, Aeras: Employee, Salary. GSK: Shareholder, Salary.

Determining quantitative targets for public funding of tuberculosis research and development

South Africa’s expenditure on tuberculosis (TB) research and development (R&D) is insignificant relative to both its disease burden and the expenditure of some comparator countries with a minimal TB incidence. In 2010, the country had the second highest TB incidence rate in the world (796 per 100,000 population), and the third highest number of new TB cases (490,000 or 6% of the global total). Although it has a large TB treatment program (about $588 million per year), TB R&D funding is small both in absolute terms and relative to its total R&D expenditure. Given the risk and the high cost associated with drug discovery R&D, such neglect may make strategic sense. However in this analysis it is shown that TB R&D presents a unique opportunity to the national treasuries of all high-burden countries. Using two separate estimation methods (global justice and return on investment), it is concluded that most countries, including South Africa, are under-investing in TB R&D. Specific investment targets for a range of countries, particularly in areas of applied research, are developed. This work supports the outcome of the World Health Organization’s Consultative Expert Working Group on Research and Development: Financing and Coordination, which has called for “a process leading to the negotiation of a binding agreement on R&D relevant to the health needs of developing countries”.

Immigrants and the Spread of Tuberculosis in the United States: A Hidden Cost of Immigration

This panel-data study concerns the incidence of newly diagnosed tuberculosis (TB) in specific U.S. metropolitan areas among immigrants and, in turn, the possible transmission of the disease to the native-born population of these same metropolitan areas. The study includes 50 U.S. Metropolitan Statistical Areas as annual observations, 1993–2007. We find that a 10% increase in the number of high-incidence immigrants results in a 2.87% increase in TB among the foreign-born population, and that a 10% increase in the number of foreign-born TB cases increases the number of new TB cases among the native-born by 1.11%. The study concludes with a benefit/cost analysis of the societal cost of TB and suggests that testing all immigrants for TB would be a cost-effective method to limit the amount of TB that enters U.S. from abroad, thus limiting the transmission to both the foreign- and native-born populations.

No Formalin Please, it Could be TB!

Historically, tuberculosis (TB) in the UK was primarily associated with pulmonary infection. However, as the rates of TB in the UK have risen, so has the proportion of extra pulmonary disease. In 1987, the total number of new TB cases was 5,085 and 21% of these were extra pulmonary. By 2009, the annualnumber of TB cases had risen to 9,040 with 46% being extra pulmonary (HPA 2010).

Avaliação da vigilância de contatos de casos novos de tuberculose no Estado de Mato Grosso - Brasil

To evaluate surveillance of contacts of new tuberculosis cases in the state of Mato Grosso from 1999 to 2004. This was a descriptive epidemiological study based on data from the Tuberculosis Case Registry Database. The number of new tuberculosis cases, the number of contacts (estimated, investigated, and uninvestigated), and the tuberculosis incidence rate were analyzed by age bracket. The mean rate of contacts investigated for each case of tuberculosis by age bracket was calculated per year of study. The cases of pulmonary tuberculosis with and without contacts investigated were analyzed by sputum smear microscopy results. In 2004, there were 41.3 cases of tuberculosis per 100,000 inhabitants in the state of Mato Grosso. The south-central region presented the highest incidence rate (57 cases/100,000 inhabitants) and a 15% rate of contacts investigated. Among those younger than 15 years, 63 contacts (60.5%) were investigated, whereas among those aged 15 or older, 389 (8.9%) were investigated. In 1999, the mean rate of contacts investigated statewide was 0.02 (0.5%), and, in 2004, it reached 0.42 (10.5%). The percentage of contacts investigated was 40% higher among the contacts of contagious cases (OR = 1.4; 95% CI: 1.08-1.83). The percentage of contacts investigated is very low, principally among adults. The adoption of the standards for investigation of tuberculosis contacts proposed by the Brazilian National Ministry of Health Department of Health Surveillance has not ensured that this group at highest risk of developing active tuberculosis be given priority at health care facilities in the state of Mato Grosso.

Epidemiology of tuberculosis

In the United States, many people erroneously think that tuberculosis (TB) is a disease of the past--an illness that no longer constitutes a public health threat. In reality, TB is one of the leading global causes of morbidity and mortality. According to the World Health Organization, which compiles annual country profiles of reported TB cases using standardized case definitions, 2.4 million cases were reported in 2001. However, because of underreporting, the number of new TB cases is estimated to be 8.3 million, including 1.8 million deaths. In the United States, after more than 3 decades of steady downward trends, an unprecedented resurgence of TB occurred between 1985 and 1992. This increase was associated with deficient infrastructure, the human immunodeficiency virus (HIV) epidemic, immigration, outbreaks in congregate settings, and widespread occurrence of multidrug resistant TB strains. The resultant increased concerns provided the impetus for the development of a national action plan to combat MDR and the mobilization of new resources. Consequently, the incidence of TB cases has decreased from 1992 through 2002. New challenges are evident and must be addressed to achieve the agreed-on goal of eliminating TB in the United States. This report describes the global epidemiology of TB and the epidemiology in the United States, and outlines future challenges to the elimination of TB in the United States.

The relentless spread of tuberculosis in Zambia--trends over the past 37 years (1964-2000).

To review trends in the rates of tuberculosis (TB) case notifications over a 37-year period. A retrospective study of Ministry of Health records on TB notifications between 1 January 1964 and 31 December 2000. Zambia, sub-Saharan Africa. Retrospective analysis of case-notification data for TB of the Zambia Ministry of Health annual returns. Annual TB case-notification rates and trends over the past 37 years. TB case-notification data from 1964 to 2000 show a 12-fold increase over the past two decades, and apparent gains in controlling TB seen in the 1960s and 1970s have been reversed over the past two decades. A stable situation during the period 1964-1984 (case-notification rate remained around 100 per 100,000 population) was followed by an exponential increase since the mid-1980s. The absolute number of new TB cases increased from 8,246 in 1985 (124/100,000) to 38,863 (409/100,000) in 1996 and 52,000 (512/100,000) in 2000. Comparison of case-notification rates over the past 2 decades with neighbouring countries (Zimbabwe, Malawi and Tanzania) show that Zambia has one of the highest case-notification rates in the region. Zambia, like many countries in Africa, is in the midst of a serious TB epidemic and there are no signs that it is abating. This increase was most likely due to the impact of the HIV/AIDS epidemic and subsequent breakdown of TB services. Concerted donor-government efforts should invest appropriately in long-term plans for TB control.

The evolving epidemiology of HIV infection and tuberculosis in northern Thailand.

To examine the association between HIV infection and tuberculosis (TB) and the proportion of TB attributable to HIV in Chiang Rai province, northern Thailand, in response to a rapidly changing incidence of HIV infection. Case-control study covering the period 1990 to 1998. Cases were all new TB patients seen at Chiang Rai Hospital. Controls were antenatal clinic attendees, delivery patients, surgical patients, blood donors, and military conscripts. Odds ratios (ORs) were calculated by year, age group, and sex, using each control group separately. The population attributable fraction was calculated by year. During the study period, the number of new TB cases in Chiang Rai Hospital increased more than threefold. The ORs increased over time compared with all control groups for both sexes but did not vary consistently with age. The proportion of TB cases attributable to HIV rose to 72.0% in male patients and 65.8% in female patients by 1998. The HIV epidemic has a profound and prolonged impact on TB burden. Despite the marked reduction in HIV incidence already seen in Chiang Rai, the HIV prevalence among TB cases and the proportion of cases attributable to HIV continue to rise.

Tuberculosis Transmission in the Family

Objective: To evaluate the risk of tuberculosis (TB) transmission from family members with infectious TB to other family members, and to examine whether household contact investigations had an impact on tuberculosis patterns.Design: Under the direction of the Taipei Municipal Chronic Disease Hospital, 12 full-time public health nurses recruited the household contacts of TB patients. Chest X-ray examination was recommended for adult contacts. Child contacts received the Mantoux tuberculin skin test, and radiography was recommended if the results were positive.Setting: Family contacts of all TB index patients who attended one of 29 hospitals in Taipei, from July 1993 through June 1996. The medical records of index patients were obtained from the National Tuberculosis Registry.Results: During the study period, the families of 3903 index patients, comprising 11873 contacts, were investigated. Among these, 4595 received radiography, for a response rate of 38.7%. Of these, 284 had active pulmonary disease: 188 (66.3%) had minimal disease, 79 (27.8%) had moderately advanced disease, and only 17 (5.9%) had far advanced disease. Overall, the index patients had more advanced TB: only 1261 (32.3%) had minimal disease, while 2022 (51.8%) had moderately advanced disease and 620 (15.9%) had far advanced disease.Conclusions: These data show a relatively high risk of intrafamily TB transmission. Our findings also show that family contact investigations may help to diagnose TB in earlier stages. Such an approach should greatly reduce the number of new TB cases and speed eradication of the disease.