Tuberculosis Situation Research Articles

Tuberculosis and society

Brief review is made of the interconnections between tuberculosis and poverty and other social factors, with special emphasis on the current Japan's tuberculosis situation. In pre-war Japan, the tuberculosis had apparently an aspect of a socioecomic problem which led to lively discussions. With the progress in medical technology and control measures after the war, such aspect of the disease has become more masked and difficult to see. Often, it is viewed merely as a problem of a small and special fragment of the population such as homelessness, and its wide and diffuse connections with the society and economy are likely to be overlooked. Studies in tuberculosis, both basic and epidemiological, as well as multidisciplinary, should be further encouraged from such a point of view, in order to lay such interconnections bare, on which the new control strategy should be based.

Estimation of Annual Risk of Infection of Tuberculosis in District Patiala, INDI

PURPOSE: Epidemiological situation of tuberculosis needs to be studied in order to have baseline data and to formulate strategies and to see the impact of such strategies for control of tuberculosis. Various epidemiological indices like tuberculin test, chest X-ray, sputum examination and mortality rate etc. have been used in the past to study the epidemiological situation. However in the given scenario of high prevalence of tuberculosis and large population these methods are found to be expensive and time consuming. Annual risk of infection (ARI) is one epidemiological indices which has been found to be useful to study the epidemiological situation because it is easy to perform and is cost effective. However there is controversy about the study of ARI in BCG vaccinated children. In the era of universal immunization program (UIP) it is very difficult to find sufficient number of non BCG vaccinated children. Therefore ARI was estimated amongst BCG vaccinated and non BCG vaccinated children.

BCG vaccination and tuberculosis in Japan.

This paper summarizes Bacillus Calmette-Guerin (BCG) vaccination and revaccination policies in Japan, its cost-effectiveness, side effects, proposed selective vaccination strategy, and present tuberculosis situation in Japanese perspectives based on Medline database and other published reports. Universal BCG vaccination in infants and revaccination among children were not found economically justifiable. Overall tuberculosis incidence in Japan is higher than that of other developed countries. Trend of decline in tuberculosis incidence is similar to that of the countries where universal BCG vaccination has never been implemented. In the recent years, the number of tuberculosis group infection has been escalating. Since BCG revaccination program has already been discontinued, a consensus on universal BCG vaccination is also essential based on social, political, and economical factors. Side by side, more pragmatic strategies such as well-defined tuberculin test, selective vaccination policy based on tuberculosis incidence in each administrative zone, and early vaccination of high risk groups, should be formulated.

Tuberculosis in Austria 1995–99: geographical distribution and trends

A descriptive analysis of routine surveillance data on tuberculosis (TB) from 1995 to 1999 was performed in Austria. The federal states of Vienna and Upper Austria showed the highest yearly incidences for all five years. In general, however, a decrease of the yearly incidence was observed for all federal states except for Carinthia (where there was a small increase of 3.2 %). In the cities of Vienna, Linz, Wels, Salzburg, Klagenfurt and St-Pölten, as well as in the regions of Eastern Tyrol, Southern Carinthia, and Southern Burgenland, the incidence was above average (>19 cases/100,000 for each). The number of cases per year and per district reported by the statutory reporting system were clearly in excess of those reported by hospitals. The comparison of the two datasets, however, showed a highly significant regional correlation of age standardised morbidity rates at district level. The findings are prone to reporting bias and might not reflect the real TB situation. The responsible health authorities should therefore consider the results as a 'working hypothesis in order to review the reporting behaviour at district level.

A novel TB vaccine; strategies to combat a complex pathogen

Years of intense research aimed at developing a new and improved vaccine against tuberculosis (TB) are now moving from the laboratories and into the field. Many groups have provided strong evidence for the potential of novel vaccines using a variety of different strategies and the most promising are just beginning to enter human safety trials. As research has developed over the years, the complexity of the TB situation at the global level and its influence on vaccine development strategies has become more and more clear. From being mainly focused on the development of a vaccine that could be given at birth and provide lifelong protection, it is now clear that the current goal may need to be a vaccine to be given to a population where the majority is already sensitized either by previous infection, exposure to other mycobacteria or by Bacille Calmette-Guerin vaccination. With the increasing awareness of the different immune mechanisms operating under those circumstances, such a vaccine still represents a significant challenge for immunologists and microbiologists working in this field.

The state of tuberculosis in Germany in 2000

Tuberculosis is one of the leading infectious diseases globally besides HIV/AIDS and malaria. Around 8 million people per year develop active tuberculosis, of whom 2 million eventually die of the disease. Of special importance to Germany is the epidemiologic situation in the former Soviet Union, where new infections are rising steeply. This region is also a hot spot for the development of multidrug-resistant tuberculosis. In 2000, the WHO registered already 273 000 cases of multidrug-resistant tuberculosis worldwide. In Germany the tuberculosis situation is stable. 9 064 persons (910 less than 1999) had tuberculosis in the year 2000. 5 271 cases were tuberculosis of the respiratory tract with detection of Mycobacteria tuberculosis. In 2 264 cases registered as tuberculosis of the respiratory tract, Mycobacteria tuberculosis could not be detected. 1 529 persons developed extrapulmonary tuberculosis. The highest incidences were found among the elderly. One third of the tuberculosis patients were born outside Germany. Resistance to antituberculous drugs also increased slowly in Germany. A study of the DZK, although with small numbers, demonstrated an increase of multidrug-resistant tuberculosis from 1.2 % (1996) to 1.7 % (2000), which also influenced the treatment outcome. With rising resistance rates, the treatment success decreased from 77.5 % in fully susceptible to 59.5 % in multidrug-resistant cases.

The tuberculosis situation in Germany in 1999

The tuberculosis situation in Germany in 1999

Evolution of the health sector and tuberculosis control in Brazil.

To summarize the epidemiological situation of tuberculosis (TB) in Brazil, especially as it relates to the evolution of the health sector in recent decades, the process of health sector reform, and current proposals of the Brazilian Ministry of Health. A review was conducted of data from the Ministry of Health of Brazil on tuberculosis in the country over the last 20 years, as well as of the history of changes in the health sector. There have been major changes in the epidemiological situation of TB and also in the structure of the health system in Brazil. The overall prospects are promising for Brazil's National Plan for Tuberculosis Control.

The global tuberculosis situation and the new control strategy of the World Health Organization. 1991.

In 1989/90 the WHO Tuberculosis Unit undertook a special study to determine the nature and magnitude of the global tuberculosis problem by reviewing the official statistics and the available data from both published and unpublished field studies. The findings revealed that about 1700 million people or one-third of the worlds population are or have been infected with Mycobacterium tuberculosis with 8 million new cases found in developing and industrialized countries. It estimated that the disease caused 2.9 million deaths in 1990 making this the largest cause of death from a single pathogen in the world. While the largest number of deaths occurred in the Southeast Asian Region (940000) the Western Pacific Region (890000) and the African Region (660000) it is estimated that more than 40000 deaths still occur annually in the industrialized nations. Given the existing tuberculosis situation in the world the WHO has developed a new tuberculosis control strategy the development of which was based on a series of workshops and case studies in the last 2 years. These strategies include: 1) the introduction of short-course chemotherapy in place of the standard chemotherapy to improve the cure rate; and 2) the expansion of tuberculosis services.

Multi-Sectoral Approach to DOTS–The Only Hope

This article reviews both the global and Kenyan tuberculosis (TB) situations and gives a manager's perspective of the management of a national TB control program with limited resources. It demonstrates how complex it can be to manage a control program with a 500% increase in case load and a 60% decline in real per capita health expenditure during the last 20 y. The picture is complicated even further by a high prevalence of TB among the country's nomadic population inhabiting the arid and semi-arid parts of the country. Acceptable treatment results are achieved through a combination of appropriate strategies. However, the future picture is grim unless more personnel are used to implement the DOTS strategy.

Multi-sectoral approach to DOTS--the only hope.

This article reviews both the global and Kenyan tuberculosis (TB) situations and gives a manager's perspective of the management of a national TB control program with limited resources. It demonstrates how complex it can be to manage a control program with a 500% increase in case load and a 60% decline in real per capita health expenditure during the last 20 y. The picture is complicated even further by a high prevalence of TB among the country's nomadic population inhabiting the arid and semi-arid parts of the country. Acceptable treatment results are achieved through a combination of appropriate strategies. However, the future picture is grim unless more personnel are used to implement the DOTS strategy.

TB across the globe (6). The tuberculosis situation in Zambia.

TB across the globe (6). The tuberculosis situation in Zambia.

Immunology of bacille Calmette-Guérin and related topics.

This supplement is based on a workshop held in Toronto, Ontario, on 11-13 July 1994, at the site of the sponsor, PasteurMerieux-Connaught Canada. The 3-day workshop focused on immunologic responses to BCG, its use in the prevention of tuberculosis and in the treatment and prophylaxis of bladder cancer, and its potential applications for other cancers. This workshop presented an exciting opportunity to bring together 2 distinct groups of researchers: those in infectious diseases and immunology and those in urologic oncology. It was rare to have these 2 groups in the same room talking together, but this workshop represented an important opportunity for both groups, since the mode of action of BCG in both domains appears to be intimately related. Therefore, we discussed tuberculosis (TB), the use of BCG in superficial bladder cancer, and potential applications of BCG to other cancers. It is well known that the incidence of TB in the United States showed a leveling off rather than the predicted continuous decrease beginning in 1986, largely due to the influence of HIV and/or AIDS on the incidence of active TB disease. However, if the situation is bad in the United States, it is much worse in Africa, where very alarming projections show the expected incidence of TB to be greater because of the different prevalence rates of HIV over the next 10 years. The Venn diagram shown in figure 1 puts the TB situation into perspective. Of the world's 5 billion people, one-third, or 1.7 billion, are infected with TB. Among those with primary TB infection, there is an annual incidence of 8 million cases, of whom 3 million will die. In 1994, it was estimated that 13 million people were infected with HIV, of whom 5 million also have primary TB. Those who are coinfected and who live long enough will develop active TB; each year, there are ~0.5 million HIV-infected people who develop active TB and also have AIDS (TB being an AIDSdefining event). Among HIV-infected people, the incidence of active TB is ~5% per year or 50% over an estimated 10-year life span, 25 times the incidence of TB among people not infected with HIV. To make the point of how timely this is, the local newspaper the other week contained an article describing 40 Canadian soldiers who had returned from the former Yu-

Swedish maternal mortality in the 19th century by different definitions: previous stillbirths but not multiparity risk factor for maternal death

The high maternal mortality levels in today's developing countries were also found throughout the history of currently affluent countries. The parish information system in Sweden offers unique possibilities for research in historical cohorts. Furthermore, vital events surveillance systems are scarce in today's developing countries. This cohort study covers 42,387 mothers who gave birth to 150,932 infants during the 19th century in the Skellefteå and Sundsvall areas. Among these women, 1,237 were dead within one year after delivery. The analysis of the cause of these deaths was done according to the various ICD definitions. Parity five and above was defined as grand multiparity. Maternal mortality ratios, deaths per 100,000 live births were as follows: 256.4 (direct obstetric deaths), 320.7 (direct and indirect obstetric deaths), 489.2 (pregnancy-related deaths), 347.8 (late maternal deaths) and 837.0 (maternal deaths and late maternal deaths). In this study, 59% of all maternal deaths occur within the first 42 days of delivery, two thirds of them having direct and indirect obstetric causes. Of the late maternal deaths, the bulk were infectious or other indirect deaths, mirroring more general female mortality and the pre-existent endemic situation of tuberculosis and other infectious diseases. The combination of previous stillbirth and infant death represented the highest risk ratios, RR 2.77-3.62, while grand multiparity was not associated with increased risk. Urbanized and industrialized areas tended to have higher maternal mortality. In conclusion, this study shows that the mother's reproductive history was the most important risk factor measured for all definitions of maternal death. Grand multiparity did not increase the risk of maternal death. Maternal mortality ratio varied threefold in the study population, depending on the definition used. The high mortality ratios found in this study, only declining by the end of the century, should be interpreted as a general condition of the society since no significant differences could be perceived regarding social class, while unmarried women were more at risk.

Adult tuberculosis overview: African versus Western perspectives.

Tuberculosis is currently an enormous global health problem. In industrialized countries in Western Europe and North America, tuberculosis case rates are low and an increasing proportion of cases now occur in foreign-born individuals and in marginalized populations, including the homeless, prisoners, drug users, and persons with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). In contrast, the burden of tuberculosis in sub-Saharan Africa continues to grow, largely fueled by the HIV pandemic and poor public health infrastructure. Use of the World Health Organization's (WHO) directly observed therapy, short course (DOTS) strategy has been successful in improving outcomes and preventing the emergence of acquired drug resistance in several African countries; however, case rates are increasing throughout most of the region. It is clear that control of tuberculosis in Africa is closely linked to control of HIV and AIDS. Substantial external donor support and innovative approaches to enhance interactions between HIV/AIDS prevention and treatment efforts and tuberculosis control programs will be needed to improve the current tuberculosis situation in Africa. The purpose of this review is to provide a synopsis of recent developments in these areas and to serve as a reference source for interested readers.

Thinking about tuberculosis in Osaka City

The incidence rate of tuberculosis in Osaka City (104.2 per 100,000 population) is extremely high, namely 3 times higher than the national average. Why the tuberculosis situation of Osaka City is so bad? The reason could be summarized as follows: Before the end of the World War II (1945), it was the sequelae of high prevalence observed in the era of Meiji, Taisho and early years of Showa. However, after the World War II, especially from the Heisei era (1989-), it is deeply affected by the influence of socio-economic background in Japan. Osaka City is characterized as the city of merchants and small enterprises. And therefore, the city substantially has the nature of the locality that brings in or produces some kinds of social vulnerability such as temporary laborers and homeless people. Of the tuberculosis patients in Osaka City, about 20% are homeless. In addition, patients of the smear positive infectious tuberculosis are often discovered among temporary laborers who change their residences and job sites from place to place and contact widely with citizens. These two are the most difficult problems in tuberculosis control program of Osaka City. In the meantime, there are many citizens who are careless of their health and do not follow the law or social rule, and this has apparently no direct connection with the problems of tuberculosis. However, it might be one of the factors of an undesirable trend of tuberculosis in Osaka City. In order to improve such a unfavorable tuberculosis situation in Osaka City, effective and strong supporting activities to the tuberculosis program are essentially needed. And these activities must be done from the standpoint of health-promotion, namely, health education for citizens and improvement of social environmental conditions to maintain healthy and cultural life.

A study on the trend of tuberculosis in an area of Shanghai City using mathematical model

A widely-used mathematical model (compartmental model) in epidemiological studies was utilized to analyze the tuberculosis situation in area Y of Shanghai from 1971 till 1994. In this model, the whole population was divided into 5 groups, (susceptible, latent, prevalent, healed and immune). Six parameters (effective BCG coverage, immune loss rate, infection rate, disease risk, cure rate and heal loss rate) were introduced and discussed to describe the transmission of tuberculosis. The computed tuberculosis data from this model agree quite well with the observed data. The results show that the susceptible group is the largest among all groups. In 1994, the annual risk of infection was estimated to be 0.26%. It is predicted that elderly people will comprise an increasing percentage of tuberculosis patients in the future. It is also found that it will still take a long time to eliminate tuberculosis under current medical situations.

Molecular epidemiology of tuberculosis in the Nord Department of France during 1995

In order to determine the current situation and to evaluate the human to human transmission ofMycobacterium tuberculosis in Northern France, the genetic polymorphism of strains was studied by using IS 6110 fingerprint. One hundred and fifty-eight cases of bacteriologically confirmed tuberculosis were analyzed. One hundred and twenty-six patients (82%) were infected with genetically different isolates and 28 isolates (18%) were grouped into 14 clusters. No risk factors for recent Mycobacterium tuberculosis infections such as age, HIV status, immigrants, living in big cities were identified. This study shows that there was no major epidemic situation of tuberculosis in Northern France in 1995. Tuberculosis was characterized by a low proportion of HIV positive patients and a high proportion of elderly patients.

Epidemiology of resistant tuberculosis in Europe

About one-third of the world's population has been infected with Mycobacterium tuberculosis (MTB). Active disease develops in eight to ten million people per year, and tuberculosis is responsible for three million deaths every year. This makes it the leading cause of death due to infections in the world. In 1996, 315,892 cases of tuberculosis were reported in 50 countries of the WHO European region. The notification rate was less than 20 per 100,000 in 21 countries, all of which are situated in the western part of Europe except the Czech Republic and Israel. The rate was 20 cases per 100,000 or more in 29 countries located in the eastern part of Europe except for Portugal and Spain. In addition to the rise of tuberculosis observed worldwide, the emergence of drug-resistant tuberculosis (TB) poses a major threat to TB control efforts. The prevalence of resistance is increasing dramatically, predominantly in eastern Europe. The aim of this article is to describe the situation of resistant TB in Europe, and to point out reasons for the increase of drug-resistant MTB strains.

Tuberculosis statistics among the homeless population in Nagoya City from 1991 to 1995

A survey was conducted to clarify the tuberculosis (TB) situation among the homeless during the period from 1991 to 1995 in Nagoya city, using 5,222 registration cards of TB cases registered at one of Nagoya City's 16 Health Centers. Out of 5,222 TB cases, there were 269 homeless cases (267 male and 2 female). Ninety-seven percent of them were pulmonary TB cases. The incidence and prevalence rates of TB per 100,000 among the homeless were estimated at around 1,500 and around 2,400, respectively, around 20 times higher than those of the non-homeless male over the 19 years of age. A decrease in the incidence rate of TB cases among the homeless was not seen, although the rate among the non-homeless decreased gradually. The percentage of infectious (bacillary and/or cavitary) tuberculous cases among the homeless was higher than in the non-homeless. In the infectious cases, the percentage of smear-positive bacillary cases or far advanced cavitary cases was 52.1% or 9.4% among the homeless compared to 48.1% or 2.6% among the non-homeless, respectively. The detection rate by chest X-ray examination of the homeless was 3.9%.