Risk Of Tuberculosis Transmission Research Articles

Effectiveness of Using AI-Driven Hotspot Mapping for Active Case Finding of Tuberculosis in Southwestern Nigeria

Background: Nigeria is among the top five countries that have the highest gap between people reported as diagnosed and estimated to have developed tuberculosis (TB). To bridge this gap, there is a need for innovative approaches to identify geographical areas at high risk of TB transmission and targeted active case finding (ACF) interventions. Leveraging community-level data together with granular sociodemographic contextual information can unmask local hotspots that could be otherwise missed. This work evaluated whether this approach helps to reach communities with higher numbers of undiagnosed TB. Methodology: A retrospective analysis of the data generated from an ACF intervention program in four southwestern states in Nigeria was conducted. Wards (the smallest administrative level in Nigeria) were further subdivided into smaller population clusters. ACF sites and their respective TB screening outputs were mapped to these population clusters. This data were then combined with open-source high-resolution contextual data to train a Bayesian inference model. The model predicted TB positivity rates on the community level (population cluster level), and these were visualised on a customised geoportal for use by the local teams to identify communities at high risk of TB transmission and plan ACF interventions. The TB positivity yield (proportion) observed at model-predicted hotspots was compared with the yield obtained at other sites identified based on aggregated notification data. Results: The yield in population clusters that were predicted to have high TB positivity rates by the model was at least 1.75 times higher (p-value < 0.001) than the yield in other locations in all four states. Conclusions: The community-level Bayesian predictive model has the potential to guide ACF implementers to high-TB-positivity areas for finding undiagnosed TB in the communities, thus improving the efficiency of interventions.

A review of bovine tuberculosis transmission risk in European wildlife communities

Abstract Understanding how disease moves through wildlife communities is essential to managing outbreaks of zoonotic diseases across the globe. Bovine tuberculosis is a disease caused by the bacterium Mycobacterium bovis that can threaten domestic and wildlife species. The mechanism by which Mycobacterium bovis is spread between species is still poorly understood. Previous reviews are limited in the breadth of species considered and are primarily concerned with transmission from wildlife to domestic species. We conducted a review and analysis of Mycobacterium bovis prevalence rates in European wildlife species to identify species of concern for the transmission of bovine tuberculosis in a wildlife community. We subsequently conducted a narrative review of these species assessing the risk of Mycobacterium bovis transmission in a wildlife community based on available literature. We calculated weighted mean disease prevalence rates to be highest in fallow deer (Dama dama, 20%), Eurasian badgers (Meles meles, 11%), wild boar (Sus scrofa, 9%) and red foxes (Vulpes vulpes, 4%). We considered these species to be of particular concern for the transmission of Mycobacterium bovis and selected them as the focus of our narrative review and risk assessment. Our risk assessment considered disease pathology, spatiotemporal activity patterns and animal behaviour as factors affecting the likelihood of Mycobacterium bovis transmission between wildlife species. We found that prior research has principally focused on a few individual species, but that Mycobacterium bovis transmission through a wildlife community is likely more complex. We determined that disease transmission between multiple species may compound the severity of an outbreak of bovine tuberculosis. Broad, multi‐species sampling campaigns and standardised Mycobacterium bovis testing protocols should be implemented in future studies. We also determined that an in‐depth analysis of spatiotemporal overlap between species was needed to better assess the risk of transmission between wildlife species.

Biosecurity Challenges: How Defense Strategies Against Tuberculosis In Asean Countries

This comprehensive research provides a thorough analysis of tuberculosis (TB) incidence trends and sanitation challenges within the ASEAN region spanning from 2005 to 2021. It underscores the critical need for robust defense strategies against TB, particularly in light of setbacks exacerbated by the COVID-19 pandemic. The research, conducted in Jakarta, Indonesia, from June to July 2023, delved into biosecurity challenges of tuberculosis in ASEAN countries, using a quantitative approach and cross-sectional design. Data from 2005 to 2021, sourced from the ASEAN database, underwent descriptive statistics and trend analysis to explore TB incidence rates, ensuring a comprehensive investigation scope. The study places emphasis on the imperative of implementing comprehensive measures encompassing prevention, screening, swift diagnosis, utilization of advanced treatment regimens, and ensuring robust patient support systems. Moreover, it highlights the pivotal role of addressing sanitation challenges, as substandard conditions significantly heighten the risks of TB transmission. The study's scope encompasses an array of critical subjects, with a central focus on TB incidence rates, as well as the crucial aspects of access to improved sanitation facilities and sanitation services. The conclusion is the ASEAN region, especially the Philippines, faces a notable tuberculosis burden, coupled with uneven access to sanitation. Effective interventions and collaboration are vital for improving public health and sanitation standards in ASEAN countries.

Disentangling wildlife–cattle interactions in multi‐host tuberculosis scenarios: systematic review and meta‐analysis

Abstract Ecological interactions involving wildlife (wild mammals) and cattle Bos taurus are considered fundamental drivers of animal tuberculosis (TB) caused by Mycobacterium bovis at the wildlife–livestock interface. Despite recent insights about the role of direct and indirect interactions on TB dynamics, a mechanistic evaluation of studies addressing patterns of wildlife–cattle interaction at the global level is lacking, and the most likely factors explaining interaction rates under different epidemiological scenarios remain poorly understood. We began by reviewing the main criteria used to define a wildlife–cattle interaction relevant to Mycobacterium bovis transmission under different methodological approaches (camera‐trapping, proximity loggers and Global Positioning System collars). Secondly, we applied a generic framework to estimate and characterise interaction patterns between susceptible wildlife and cattle hosts worldwide, testing the effect of potential ecological and methodological factors on interaction rates. We synthesise two main criteria to define direct interactions and five criteria to define indirect interactions between wildlife and cattle. Using data from 31 studies, our meta‐analysis showed that wildlife–cattle direct interaction rates were low (mean = 0.03 interactions/month per species pair, range: 0.00–0.12). In contrast, indirect interaction rates were 154 times higher than the mean of direct interaction rates (mean = 4.63 interactions/month per species pair, range: 0.16–30.00). To prevent TB transmission to cattle, attention should be given to indirect interactions between wildlife and cattle in shared environments. Indirect interactions significantly increase with increasing wildlife density, which, hypothetically, could result in a higher TB transmission risk for cattle. We outline recommendations to achieve harmonised integration and comparison of results in future studies. Consolidation of knowledge in this field will contribute towards guiding control and biosecurity measures, also applicable to other infectious diseases at the wildlife, domestic species and human interfaces.

Undiagnosed and missed active pulmonary tuberculosis during mass gatherings: a prospective cross-sectional study from the Hajj pilgrimage

Mass gatherings increase the risk of infectious diseases transmission including tuberculosis (TB). The Hajj pilgrimage to Mecca, Saudi Arabia, is attended by over 2 million pilgrims many of whom are from high TB-burden countries, and has been linked to increased risk of TB acquisition among travellers. We investigated the burden of undiagnosed and missed active pulmonary TB (PTB) among Hajj pilgrims symptomatic for cough. The study was conducted among hospitalised and non-hospitalised travellers attending the Hajj pilgrimage in 2016 and 2017. Questionnaires were used to collect relevant data and sputum samples were collected from participants and processed using the Xpert MTB-RIF assay. Non-hospitalised pilgrims (n = 1510) originating from 16 high and medium TB-burden countries were enrolled. Undiagnosed, rifampicin-sensitive, active PTB was identified in 0.7%. Comorbidities (adjOR = 5.9 [95% CI = 1.2-27.8]), close contact with a TB case (adjOR = 5.9 [95% CI = 1.2-27.8]), cough in household (adjOR = 4.46 [95% CI = 1.1-19.5]), and previous TB treatment (adjOR = 10.1 [95% CI = 4.1-98.1]) were independent risk factors for TB. Of the hospitalised pilgrims (n = 304), 2.9% were positive for PTB, and 2.3% were missed, including a rifampicin-resistant case. History of TB treatment was associated with increased risk of TB (adjOR = 8.1 [95% CI = 1.3-48.7]). International mass gatherings may play an important role in the global epidemiology of TB. Preventive measures should be directed to reducing the risk of TB importation and transmission during Hajj and other similar events.

Tuberculosis infection prevention and control in rural Papua New Guinea: an evaluation using the infection prevention and control assessment framework

BackgroundPapua New Guinea (PNG) is one of the 14 countries categorised as having a triple burden of tuberculosis (TB), multidrug-resistant TB (MDR TB), and TB-human immunodeficiency virus (HIV) co-infections. TB infection prevention and control (TB-IPC) guidelines were introduced in 2011 by the National Health Department of PNG. This study assesses the implementation of this policy in a sample of district hospitals in two regions of PNG.MethodsThe implementation of TB-IPC policy was assessed using a survey method based on the World Health Organization (WHO) IPC assessment framework (IPCAF) to implement the WHO’s IPC core components. The study included facility assessment at ten district hospitals and validation observations of TB-IPC practices.ResultsOverall, implementation of IPC and TB-IPC guidelines was inadequate in participating facilities. Though 80% of facilities had an IPC program, many needed more clearly defined IPC objectives, budget allocation, and yearly work plans. In addition, they did not include senior facility managers in the IPC committee. 80% (n = 8 of 10) of hospitals had no IPC training and education; 90% had no IPC committee to support the IPC team; 70% had no surveillance protocols to monitor infections, and only 20% used multimodal strategies for IPC activities. Similarly, 70% of facilities had a TB-IPC program without a proper budget and did not include facility managers in the TB-IPC team; 80% indicated that patient flow poses a risk of TB transmission; 70% had poor ventilation systems; 90% had inadequate isolation rooms; and though 80% have personal protective equipment available, frequent shortages were reported.ConclusionsThe WHO-recommended TB-IPC policy is not effectively implemented in most of the participating district hospitals. Improvements in implementing and disseminating TB-IPC guidelines, monitoring TB-IPC practices, and systematic healthcare worker training are essential to improve TB-IPC guidelines’ operationalisation in health settings to reduce TB prevalence in PNG.

Tuberculosis Epidemiology and Spatial Ecology at the Cattle-Wild Boar Interface in Northern Spain

Tuberculosis (TB) is a contagious chronic disease due to infection with Mycobacterium tuberculosis complex (MTC) bacteria. Monitoring of wildlife, especially potential reservoirs, is important for detecting changes in disease occurrence and assessing the impact of interventions. Here, we examined whether wild boar (Sus scrofa) may contribute to the re-emergence of TB in Asturias (10,604 km2), northern Spain. Although this province was declared free of TB in cattle in November 2021, MTC bacteria remain prevalent in several “hotspots,” with the European badger (Meles meles) suggested as a TB potential wild reservoir. Drawing on data from the Spanish National Bovine Tuberculosis Eradication Program and the Government of the Principality of Asturias covering the period 2014–2020, we analyzed the prevalence of TB in cattle and wild boar in this region. In hotspots (592 km2), we also investigated the ranging behavior and habitat use of five cows that belonged to farms with a history of TB and six trapped sympatric wild boar. During the observation period, TB prevalence was 0.14% among cattle overall and 0.13–0.41% in hotspots, which was much lower than the prevalence in wild boar, which was 3.15% overall and 5.23–5.96% in hotspots. Infected cattle and infected wild boar in hotspots shared the same strains of M. bovis, and GPS tracking showed spatiotemporal overlap between the species, mainly around pastures during sunrise (06:00–07:00 h) and sunset (19:00–20:00 h). Our results suggest that in addition to cattle and badgers, wild boar possibly help maintain TB in northern Spain, increasing the host richness that influences TB transmission risk in the area, which should be taken into account in monitoring and eradication efforts.

Risk of tuberculosis transmission by children in Hamburg, Germany

BackgroundData from a prospective molecular-epidemiologic study (1997–2021) in Hamburg, Germany, were evaluated to assess the transmission risk of Mycobacterium tuberculosis complex (Mtbc) by children <15 years in a low-incidence setting. MethodsIsolates of Mtbc were genotyped whole genome sequencing, applying a core genome multilocus sequence typing scheme. Close contacts of culture-confirmed children were examined for latent Mtbc infections (LTBI) with particular focus on IGRA testing. ResultsOut of 3154 culture-confirmed tuberculosis (TB) cases, 79 (2.5%) were children <15 years. Of those, 52 (58%) had pulmonary TB. Genotyping revealed that 35 of the 52 children (67%) were epidemiologically confirmed secondary cluster members; all of their source cases were adults. Six immigrant children presented without a presumed source case; their TB diagnoses came on average 48 weeks (interquartile range [IQR] 71) after their arrival in Germany. Three German-born children were determined to have been infected by adult relatives while visiting their parents' home country. Of the 317 children's close contacts tested with QuantiFERON-TB Gold-In Tube for LTBI, only 21 (6.6%) were positive. Absent a history of prior exposure or immigration from a high-incidence country, none of the contacts of younger (<10 years) TB-afflicted children was latently infected, whereas 2 older children infected 12 of their contacts, children and adults. During a mean observational period of 551 weeks (IQR 735) on average, no secondary TB cases appeared. ConclusionsChildren with pulmonary TB disease, especially those aged below 10 years, rarely transmit Mtbc to their close contacts in a low-incidence setting.

Risk of tuberculosis transmission by healthcare workers to children - a comprehensive review.

Children <15 years are at elevated risk of becoming infected with M. tuberculosis complex (Mtbc). To assess the magnitude of Mtbc transmission by healthcare workers (HCW) to children. Medline, Google Scholar and Cochrane library were searched to select primary studies in which HCW was the presumed index case and exposed infants and children aged below 15 years were screened for latent TB infection (LTBI). Of 4,702 abstracts, 19 original case reports covering one HCW each as presumed source case of Mtbc transmission to children, were identified. In sum, 11,511 children, of those 5,881 infants (51.1%), mostly in newborn nurseries, were considered contact persons and underwent tuberculin skin (TST) or Interferon gamma release assay (IGRA) testing. Test positivity was reported in 492/11,511 children (4.3%) coming from 14 studies. When test results considered falsely positive were excluded, the number of latently infected children decreased to 365/10,171 (3.6%). In all studies, the presumed duration of infectivity of the source case was, but the actual intensity and duration of exposure were not, decisive for the initiation of contact investigations. In only two of the studies, the contact time of the children towards the corresponding source case was estimated. The results of our review suggest that the risk of Mtbc transmission from HCW to children in healthcare setting is considerably lower than reported in household settings. However, as the preselection of pediatric contacts appeared in most cases to be vague, the data found in the literature probably underestimates the actual risk.

Risk of tuberculosis transmission by children to healthcare workers - a comprehensive review.

Healthcare workers (HCWs) are at increased risk of becoming infected with M. tuberculosis complex (Mtbc). To assess the magnitude of Mtbc transmission by children under the age of 15 years to HCW. Medline, Google Scholar and Cochrane library were searched to select primary studies in which a child was the presumed index case and exposed HCW were screened for latent TB infection (LTBI). Of 4,702 abstracts, 15 original case reports covering 16 children with TB were identified. In sum, 1,395 HCW were contact persons and underwent testing. Ten of the studies reported TST conversion, amounting to 35 (2.9%) of the 1,228 HCW tested. In three of the TST-based and both of the studies that used IGRA testing, conversion was absent. 12 of the 15 studies (80%) reported exposure of HCW in neonatal intensive units (NICUs) to premature infants suffering from congenital pulmonary TB. One study including two infants addressed possible pulmonary Mtbc transmission in a general pediatric ward. Extrapulmonary transmission by aerosolized Mtbc was suggested in two patients, an infant with tuberculous peritonitis and a 12-year-old adolescent with pleurisy, and culture-confirmed only after the child had undergone video-assisted thoracoscopic surgery. Routine use of protective facemasks by HCW before exposure was not mentioned in any of the included studies. The results suggest that the risk of Mtbc transmission from children to HCW is low. Particular attention should be paid to infection risk during respiratory manipulations in NICUs. The consistent wearing of facemasks may further reduce the risk of Mtbc transmission.

Direct estimates of absolute ventilation and estimated Mycobacterium tuberculosis transmission risk in clinics in South Africa.

Healthcare facilities are important sites for the transmission of pathogens spread via bioaerosols, such as Mycobacterium tuberculosis. Natural ventilation can play an important role in reducing this transmission. We aimed to measure rates of natural ventilation in clinics in KwaZulu-Natal and Western Cape provinces, South Africa, then use these measurements to estimate Mycobacterium tuberculosis transmission risk. We measured ventilation in clinic spaces using a tracer-gas release method. In spaces where this was not possible, we estimated ventilation using data on indoor and outdoor carbon dioxide levels. Ventilation was measured i) under usual conditions and ii) with all windows and doors fully open. Under various assumptions about infectiousness and duration of exposure, measured absolute ventilation rates were related to risk of Mycobacterium tuberculosis transmission using the Wells-Riley Equation. In 2019, we obtained ventilation measurements in 33 clinical spaces in 10 clinics: 13 consultation rooms, 16 waiting areas and 4 other clinical spaces. Under usual conditions, the absolute ventilation rate was much higher in waiting rooms (median 1769 m3/hr, range 338-4815 m3/hr) than in consultation rooms (median 197 m3/hr, range 0-1451 m3/hr). When compared with usual conditions, fully opening existing doors and windows resulted in a median two-fold increase in ventilation. Using standard assumptions about infectiousness, we estimated that a health worker would have a 24.8% annual risk of becoming infected with Mycobacterium tuberculosis, and that a patient would have an 0.1% risk of becoming infected per visit. Opening existing doors and windows and rearranging patient pathways to preferentially use better ventilated clinic spaces result in important reductions in Mycobacterium tuberculosis transmission risk. However, unless combined with other tuberculosis infection prevention and control interventions, these changes are insufficient to reduce risk to health workers, and other highly exposed individuals, to acceptable levels.

An Investigation of Risk Factors Associated with Tuberculosis Transmission in South Africa Using Logistic Regression Model.

Background: South Africa has a high burden of tuberculosis (TB) disease and is currently not meeting the national and international reduction outcome targets. The TB prevalence rate of South Africa in 2015 was estimated at approximately 690 per 100,000 population per year, with an incidence rate of about 834 per 100,000 population. This study examines risk factors associated with development of TB in South Africa. Materials and Methods: This study utilised readily available open access secondary data of 2019 South African Health and Demographic Survey from Statistics South Africa (StatsSA) website, which was collected from self-reported information relating to TB in the household questionnaire. The factors analysed were of demographic, socio-economic and health nature. Bivariate and binary logistics analyses were carried out from which appropriate inferences were drawn on the association of TB with demographic, socio-economic and health factors. Results: In multivariate analysis the study revealed that age, personal weight, smoke, alcohol, asthma, province of residence, race and usually coughing were significantly associated with an increased risk of having TB. Conclusions and Recommendations: The results strongly suggest that young and older people coming from black and coloured ethic groups, who are asthmatic and cough frequently, and/or smoking and consuming alcohol are at high risk of developing TB. In addition, those who are overweight appear to have an increased risk of TB transmission, with the Western Cape, Eastern Cape, Northern Cape, Free State, North West and Gauteng being the hardest hit provinces. Hence, the study recommends that these factors must be taken into account in the planning and development of TB policies in order to work successfully towards the achievement of sustainable development goal of reducing TB by 80% before 2030.

Training program for tuberculosis (TB) patients to improve referrals of presumptive TB cases and sputum in Denpasar, Bali, Indonesia

Background and purpose: Tuberculosis (TB) is a global healthproblem and one of the top ten causes of deaths in the world. TB case finding is an important component of TB control. In Indonesia, most case findings were done passively so that the referral coverage for TB sputum was lower than the target. This study aims to determine the effectiveness of training for TB patients as volunteers to increase the active referral of presumptive TB cases. Methods: The pretest-posttest design intervention study was conducted in five public health centers (PHCs) which had the highest number of TB patients in Denpasar. The intervention was carried out for seven weeks (February May 2020). A total of 35 TB patients, who were currently undergoing treatment at the PHCs, met the study criteria and willing to volunteer, were trained through meetings, discussions and demonstrations about the risk of TB transmission, contact investigations and how to collect sputum samples. Before and after the interventions, data on volunteers’ knowledge, the number of presumptive TB and sputum referrals by volunteers were collected through interviews and daily records. A regular reminder was sent in the form of a WhatsApp message once a week. Bivariate data analysis was performed with Chi-square and Wilcoxon Signed Rank Test. Results: Volunteers’ knowledge scores increased significantly after training, with a median score of 13.0 to 15.0 (p&lt;0.001), and there was a significant difference in knowledge improvement amongthose who actively responded to regular reminders compared to those who were less active (p=0.002). A total of 31 presumptive TB cases were successfully referred during the study period (7 weeks). Volunteers managed to refer as many as 30 sputum preparations with good quality, but no positive sputum was found. Conclusion: Recruitment and training of TB patients as volunteers can increase the knowledge and skills of volunteers to identify and refer presumptive TB cases and quality sputum samples. More TB patients should be  trained as volunteers with a longer observation time to increase TB patient detectio

Impact of COVID-19 on tuberculosis detection and treatment in Baja California, México.

In 2020, Mexico reported the lowest tuberculosis (TB) incidence on record, and it is unclear to what extent COVID-19 has impacted TB surveillance, diagnosis, and treatment. It is important to understand COVID-19's impact in Baja California (BC), which has the highest TB burden in Mexico. With the increasing number of migrants and asylum seekers arriving in BC, limited resources and crowded living conditions increase the risk of TB transmission. The purpose of this study was to assess the impact of COVID-19 on TB diagnosis and treatment in BC. We were also interested in health disparities experienced by migrants in BC. We conducted a mixed methods analysis using quantitative surveillance data obtained from the Mexico National TB Program (NTP) and qualitative data collected through in-depth interviews and focus group discussions with TB program directors and personnel in BC's four provincial health jurisdictions. Compared to the year prior, surveillance data from March 2020 - February 2021 revealed that TB incidence in BC declined by 30.9% and favorable TB outcomes (TB cure or treatment completion) declined by 49.8%. Elucidating differences by migrant status was complicated by the lack of standardized collection of migrant status by the NTP. Qualitative analysis revealed that TB diagnostic and treatment supplies and services became limited and disproportionately accessible across jurisdictions since the pandemic began; however, favorable adaptations were also reported, such as increased telemedicine use and streamlined care referral processes. Participants shared that migrant status is susceptible to misclassification and that TB care is difficult due to the transitory nature of migrants. This study did not identify major differences in TB service delivery or access between migrants and non-migrants in BC; however, migrant status was frequently missing. COVID-19 has overwhelmed health systems worldwide, disrupting timely TB diagnostic and treatment services, and potentially caused underdiagnosis of TB in BC. TB programs in BC should quickly restore essential services that were disrupted by COVID-19 while identifying and preserving beneficial program adaptations, such as telemedicine and streamlined care referral processes. Improved methods for documenting migrant status of TB cases are also needed.

M. tuberculosis microvariation is common and is associated with transmission: Analysis of three years prospective universal sequencing in England

BackgroundThe prevalence, association with disease status, and public health impact of infection with mixtures of M. tuberculosis strains is unclear, in part due to limitations of existing methods for detecting mixed infections. MethodsWe developed an algorithm to identify mixtures of M. tuberculosis strains using next generation sequencing data, assessing performance using simulated sequences. We identified mixed M. tuberculosis strains when there was at least one mixed nucleotide position, and where both the mixture's components were present in similar isolates from other individuals, compatible with transmission of the component strains. We determined risk factors for mixed infection among isolations of M. tuberculosis in England using logistic regression. We used survival analyses to assess the association between mixed infection and putative transmission. Findings6,560 isolations of TB were successfully sequenced in England 2016–2018. Of 3,691 (56%) specimens for which similar sequences had been isolated from at least two other individuals, 341 (9.2%) were mixed. Mixed infection was more common in lineages other than Lineage 4. Among the 1,823 individuals with pulmonary infection with Lineage 4 M. tuberculosis, mixed infection was associated with significantly increased risk of subsequent isolation of closely related organisms from a different individual (HR 1.43, 95% CI 1.05,1.94), indicative of transmission. InterpretationMixtures of transmissible strains occur in at least 5% of tuberculosis infections in England; when present in pulmonary disease, such mixtures are associated with an increased risk of tuberculosis transmission. FundingPublic Health England; NIHR Health Protection Research Units; European Union.

The characteristics of occupational tuberculosis risk in healthcare workers.

Tuberculosis (TB) remains to be one of the most common causes of morbidity worldwide, but the discourse of its prevention has disproportionately singled out the occupational risks that affect healthcare workers. In this research, we aimed to: (1) investigate the underlying factor structure of Risk Characteristics (RC), specifically the risk of nosocomial TB transmission in health care facilities; (2) estimate the effects of work-related determinants and RC on risk perception; and (3) compare occupational risk perception of contracting TB with expert risk assessment. A paper-based questionnaire was administered to 179 health care workers (HCWs) working at 10 public health centres and two hospitals in Surabaya, Indonesia. We analysed our data using exploratory factor analysis (EFA) to unravel the latent structure of RC and structural equation modelling (SEM) to identify determinants of risk perceptions. EFA revealed a two-factor solution for nine qualitative RC: controllability of damage and knowledge-evoked dread. Our SEM analysis found evidence that the controllability aspect of the TB risk was a more profound determinant in predicting risk perception than knowledge-evoked dread, implying that HCWs might benefit from training aims to increase their beliefs on the controllability of TB risk despite its severity. Although further research is necessary, our study highlights the importance of addressing occupational risk perceptions in health facilities, encouraging HCWs to become more active in advocating for the necessary allocation of resources for their workplaces, and raising communities' awareness of TB transmissions.

Changing patterns of household transmission of tuberculosis in an eastern state of India: The impact of COVID19 pandemic

BackgroundThe COVID-19 Pandemic has affected many components of the Tuberculosis (TB) control program. Due to lockdown and restrictions, people, including TB patients, might have spent more time in the household. There might be an increased TB transmission among the household contacts (HHC). The current study was conducted to measure the household transmission of TB and also find out the relationship with several clinico-social factors. MethodsContact tracing data of West Bengal, India, was extracted from Nikshay portal of Central TB Division, Government of India. The anonymized data was divided into two parts, firstly before the lockdown initiation in India and secondly during the lockdown. A modified Poisson regression model was developed to determine the statistical association between clinico-social variables and the pandemic with household-level secondary TB cases. ResultsThere was a 30% reduction in daily TB case notification, but the proportion of HHC screened was 4% higher during the pandemic than the pre-pandemic period. The secondary attack rate of household TB disease transmission was 34% lower during the pandemic period. Index TB patients aged under ten years, microbiologically positive, Drug-Resistant TB, having three or more HHCs, treatment delay more than seven days, notified from the private sector, and diagnosis during the pre-pandemic period was found to be independently associated with a higher risk of having a secondary TB case at household. ConclusionThe risk of household TB transmission was significantly lower during the pandemic period compared to the pre-pandemic period, which may be due to better infection prevention and control practices.

A Whole-Genome Sequencing-Based Study to Delineate the Risk and Characteristics of Tuberculosis Transmission in an Insular Population Over 10 Years in Shanghai.

BackgroundTuberculosis (TB) has remained a tough problem in China. This study aims to identify the risk of tuberculosis transmission and to assess its characteristics.MethodsWe performed a molecular epidemiological study for patients with culture-positive Mycobacterium tuberculosis (M. tuberculosis) in Shanghai, from 2009 to 2018. Demographic information was obtained from the Tuberculosis Information Management System. Whole-genome sequencing (WGS) was conducted with a threshold of 12 single-nucleotide polymorphisms (SNPs) to distinguish the genomic cluster. To analyze the characteristics of TB transmission, the contact investigation for clustered cases was performed.ResultsIn total, 94 (27.25%) of the 345 enrolled patients were grouped into 42 genomic clusters, indicating local transmission of M. tuberculosis strains. Compared to a health system delay <14 days, patients with a health system delay ≥14 days [adjusted odds ratios (AOR) = 2.57, 95% confidence interval (CI): 1.34–4.95] were more likely to be clustered. Patients under 65 years old (AOR = 3.11, 95% CI: 1.76–5.49), residents (AOR = 2.43, 95% CI: 1.18–4.99), and Beijing genotype strains (AOR = 3.35, 95% CI: 1.32–8.53) were associated with increased risk of clustering. Interestingly, patients with resistance to isoniazid (AOR = 2.36, 95% CI: 1.15–4.88) had a higher risk of transmission. Sixteen confirmed/probable epidemiological links were identified. Local transmission of imported cases and household transmission were prominent.ConclusionHealth system delay is a crucial factor for TB transmission. Patients with resistance to isoniazid should be priority targets for contact investigation to reduce transmission.

Concordance of TST and QFT-Plus, Sensitivity and Specificity of TST and QFT-Plus in Detection of LTBI in MDR TB Contact

Background: Tuberculosis (TB) is an infectious disease and the main cause of world health problems. Not all individuals infected with Mycobacterium tuberculosis (Mtb) develop active TB. Latent tuberculosis infection (LTBI) is a state of persistent immune response to stimulation of the Mtb antigen with no evidence of clinically manifest active TB. Closed contact and household contact with MDR TB patients increases the risk of MDR TB transmission. There is no gold-standard test for LTBI. Tuberculin Skin Test (TST) and Quantiferon Gold Plus (QFT-Plus) examinations are used for LTBI diagnosis.Methods: A cross-sectional diagnostic test of 32 MDR TB contacts, consisting of 16 household contacts and 16 close contacts, was conducted in April 2020 at Dr. Moewardi Surakarta Hospital.Results: Positive TST results among MDR TB contacts were 18.8%, while QFT-Plus positive was 25%. The concordance level of TST and QFT-Plus was nearly perfect (κ=0.818, p&lt;0.001). The sensitivity and specificity of QFT-Plus with household contacts as the gold standard were 37.5% and 87.5%, respectively. The sensitivity and specificity of TST with household contacts as the gold standard were 25% and 87.5%, respectively.Conclusion: The concordance level of TST and QFT-Plus in the detection of LTBI in MDR TB contacts was very good. The TST can be used in place of QFT-Plus although QFT-Plus has better sensitivity. Both tests are useful for confirming TB infections. Both of these tests are not diagnostic, however they can be used to screen for LTBI in MDR TB contacts. 

Application of Bottle SOSA And Promotions To Reduce The Risk Of Transmission Of Pulmonary TB In Men's Prison, Deli Serdang District

Tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis. A report from the Ministry of Law and Human Rights of North Sumatra Province stated that during the period 2009-2011, new cases of pulmonary TB in prison / remand centers tended to increase every year, the increase was an average of 7.2%. Based on the above background, dedication needs to be done to apply the SOSA bottle along with the promotion of prevention of pulmonary TB transmission in an effort to reduce the incidence of pulmonary TB in assisted residents in the Male Prison, Deli Serdang Regency. Community service activities have been carried out with the socialization of the SOSA bottle application method which is carried out by the method of providing counseling videos and training for the introduction of SOSA bottles as a promotional medium in reducing the risk of pulmonary TB transmission. The WBP was recruited to attend training and become a Training of Trainer (TOT) by forming a peer group of 10 small groups in each prison. It is hoped that the service activities can continue with good cooperation with partners.