Tuberculosis Situation Research Articles

Creation of a regional register of children with latent tuberculosis infection

Background. In the context of the stabilization of the tuberculosis situation in Russia, including the Tyumen region, work with children at risk (with a latent tuberculosis infection) is of particular importance. In the course of previous studies, a number of problematic issues in the field of organizing phthisiatric care for this contingent were identified.
 Aim. To substantiate and develop the structure of the regional register of children with latent tuberculosis infection, as well as the algorithm for collecting and registering information included in it.
 Material and methods. The analysis of domestic and foreign publications, the current regulatory framework in the field of creation and use of registers in medicine and healthcare has been carried out. The study used content analysis, legal, historical and descriptive-analytical methods.
 Results. The analysis of the literature showed that currently the practice of creating registers in medicine is particularly relevant, but there is no unified definition, classification, tasks and approaches to their management, therefore, the structure of the regional register of children with latent tuberculosis infection, the procedure for collecting and registering information were developed by the authors based on the functions inherent in it. The register is necessary for recording and monitoring of children with latent tuberculosis infection, optimization of medical processes, solving organizational and scientific issues in providing anti-tuberculosis care to this category of patients. The register consists of 8 blocks: identification, follow-up medical care, anamnesis vitae, epidemiological anamnesis, vaccination against tuberculosis, immunodiagnostics, radiation diagnostics, preventive treatment. The functions of filling in the blocks are distributed between the primary health care institutions and the phthisiological service, as well as assigned to certain specialists.
 Conclusion. The developed data registration algorithm and the structure of the regional register of children with latent tuberculosis infection contain the data necessary for the implementation of the tasks set, operational and retrospective monitoring of the effectiveness of ongoing activities, as well as management decision-making at all levels of providing phthisiatric care to the children's population of the region.

The Epidemiological Tuberculosis Situation in the Russian Penitentiary System: Main Trends and Challenges

The article describes the current tuberculosis epidemiological situation in institutions of the penitentiary system including the combination of tuberculosis and HIV infection. The epidemic consequences of increased coverage of people living with HIV infection (PLHIV) with antiretroviral therapy (ART) were analyzed. By 2020, tuberculosis incidence dropped to 621 per 100,000. Tuberculosis mortality dropped to 6.8 per 100,000. The incidence of tuberculosis among PLHIV decreased from 3,490.6 per 100,000 population in 2014 to 2,014.2 per 100,000 population in 2020, while coverage of PLHIV with ART increased from 21.7 to 89.6%. The proportion of TB patients among PLHIV decreased from 10.4% in 2014 to 7.2% in 2020. The proportion of PLHIV among newly diagnosed TB patients remained high (34.4% in 2020). The prevalence of multiple drug resistant tuberculosis decreased to 557.6 per 100,000. Thus, in 2020, the epidemiological tuberculosis situation in the Russian penitentiary institutions continued to improve. The strategy to increase coverage of PLHIV with ART proved to be effective for prevention of tuberculosis in penitentiary settings. Multiple drug resistant tuberculosis presents a serious problem which forms the grounds for introduction of modern treatment protocols with innovative drugs to the Russian penitentiary institutions.

Is Serological Monitoring a Fit-for-purpose Tool to Assess the Epidemiological Situation of Tuberculosis in the Sylvatic Species of European Bison (Bison Bonasus) in Poland?

Bovine tuberculosis is one of the most dangerous zoonotic diseases. Despite the near-complete elimination of the disease from cattle breeding in Poland achieved in 2009, its re-emergence is now observed. Globally, the number of human cases is underestimated and the importance of free-living animals as reservoirs of tuberculosis is growing. As a species highly susceptible to Mycobacterium tuberculosis complex infection, the European bison (Bison bonasus) has a role in the transmission of the disease in Poland. The purpose of the investigation was to assess the epidemiological situation of tuberculosis in Polish European bison serologically. A total of 460 serum samples were collected from 436 European bison from 15 out of 26 national populations between 2013 and 2020. An M. bovis ELISA was used, and its sensitivity and specificity were assessed with an eyelid tuberculin skin test (TST) and interferon gamma release assay (IGRA). Mycobacterium bovis antibodies were detected in nine serum samples. The presence of antibodies was found in two animals from the Białowieża Forest (1.2% of the population), and one each from the Borecka Forest (2.4%) and the Warsaw Zoo (14.3%). One European bison among the 14 sampled (7.1%) from Smardzewice was positive on five occasions. Other samples from Smardzewice and the Bieszczady Mountains, where tuberculosis had previously been reported, were negative. ELISA testing is an effective, easy and cost-efficient tool for monitoring of tuberculosis-naïve populations. Serological testing in tuberculosis control programmes can significantly improve the detection of infected herds. Antibody ELISAs may supplement TST and IGRA, but cannot replace them.

Epidemic situation of multidrug-resistant tuberculosis and change trend in Belt and Road countries

Objective: To analyze the epidemic situation of multidrug-resistant tuberculosis in 2019 and the incidence trends from 2013 to 2019 in the Belt and Road countries. Methods: The 145 countries that have signed cooperation documents of the Belt and Road Initiative with China were selected. Age-standardized incidence and prevalence rate of multidrug-resistant tuberculosis from the Global Burden of Disease Study were used to describe the epidemic situation of multidrug-resistant tuberculosis in 2019. The annual percentage changes of the age-standardized incidence rate were calculated to assess incidence trends of multidrug-resistant tuberculosis from 2013 to 2019. Results: In 2019, of the 145 countries, Somalia had the highest incidence rate (30.42 per 100 000) and prevalence rate (48.86 per 100 000) of multidrug-resistant tuberculosis, while Slovenia had the lowest incidence rate (0.01 per 100 000) and prevalence rate (0.01 per 100 000). The incidence trends of multidrug-resistant tuberculosis in six continents from 2013 to 2019 were as follows: multidrug-resistant tuberculosis incidence rates showed increasing trends in 14 countries (27.45%) and decreasing trends in 22 countries (43.14%) in Africa, showed increasing trends in 2 countries (18.18%) and decreasing trends in 3 countries (27.27%) in North America and showed increasing trends in 2 countries (5.41%) and decreasing trends in 23 countries (62.16%) in Asia. The increasing trends were observed in Europe, Oceania, and South America, but it was found that 26 countries (96.30%) in Europe, 2 countries (18.18%) in Oceania, and 1 country (12.50%) in South America had decreasing trends of multidrug-resistant tuberculosis incidence rates. Conclusion: Multidrug-resistant tuberculosis is endemic in 145 Belt and Road countries with the prevalence increasing year by year in some countries in central and southern Africa and decreasing in European countries except Ukraine.

A retrospective cohort study on the treatment outcomes and genotyping of isoniazid-resistant tuberculosis patients in Eastern China

Isoniazid resistance might be overlooked because of the priority of detection of rifampicin-resistant tuberculosis. It was urgent to reveal the current situation of isoniazid-resistant tuberculosis (HR-TB), including unfavorable outcomes and bacterial factors. A retrospective cohort study was undertaken including 120 patients with HR-TB and 193 patients with drug-sensitive tuberculosis (DS-TB). 24-loci MIRU-VNTR and Spoligotyping were adopted for genotyping. We found 106 cases (88.3%) of HR-TB and 165 cases (85.5%) of DS-TB were treated with the first-line drugs. Meanwhile, 12 (10.0%) patients of the HR-TB group and 7 (3.63%) patients of the DS-TB group involved adverse treatment outcomes (χ2=5.271, P=0.028). Seventy-eight DNA from HR Mycobacterium tuberculosis and 114 DNA from DS M. tuberculosis were available for MIRU-VNTR and Spoligotyping. The clustering rate was 17.9% (14/78) for HR-TB and 16.7% (19/114) for DS-TB, and reached no significant difference (χ2=0.05, P=0.8171). The Beijing family strains accounted for 83.7% (65/78) of HR-TB and 80.0% (91/114) of DS-TB (χ2=0.37, P=0.5407). The adverse treatment outcomes for HR-TB all occurred in patients infected with Beijing family strains (13.8%), but no difference was found between Beijing and non-Beijing genotypes (P=0.342). Adverse outcomes were significantly more frequent in patients with HR-TB than in those with DS-TB, and most of the patients with HR-TB were receiving a standard first-line regimen. Although the clustering rate and Beijing genotype distribution amongst HR-TB and DS-TB showed no significant difference, the Beijing genotype was the dominant genotype and its proportion was slightly higher amongst HR-TB than amongst DS-TB.

Tuberculosis Situation in the Years of the COVID-19 Pandemic – 2020-2021

The article presents the analysis of changes in preliminary and estimated epidemiological rates: tuberculosis (TB) incidence, TB mortality, and clinical and social structure of new TB cases. It has been found that against the background of continuing improvement of the epidemic situation (reduction of TB incidence and mortality), the clinical structure of TB cases detected in 2020-2021 deteriorated compared to 2015-2019 which was manifested by higher frequency of pulmonary tissue destruction, massive bacterial excretion (by smear), and fibrous cavernous pulmonary TB. The number of TB cases detected post mortem has increased, as well as one-year mortality. These changes indicate low detection of TB cases in 2020. Changes in the incidence of TB/HIV co-infection and the number of new cases with bacterial excretion and multiple drug resistant TB essentially repeat the changes in TB incidence in the resident population during this period.

Efficiency and forecasting of specialized medical care for children and adolescents in the stabilization of the epidemic situation of tuberculosis in the context of epidemics/pandemics

Introduction. The incidence rates regulated by the decree of the Government of the Russian Federation have been achieved in the Russian Federation, but the epidemic situation for tuberculosis in the conditions of the COVID-19 pandemic remains tense, Primarily due to lockdowns, tuberculosis examinations, especially for children and adolescents, may be reduced.The purpose of the study. Analysis of the effectiveness of preventive measures among children and adolescents in the context of ongoing COVID-19 and predicted other epidemics/pandemics.Materials and methods. The statistical data of the Ministry of Health of the Russian Federation for the region over the past 30 years and its own scientific research in the region are considered. The results of clinical and laboratory-instrumental methods for detecting tuberculosis in children and adolescents are analyzed.Results. The article examines the effectiveness of providing medical care for tuberculosis to children and adolescents in the context of the COVID-19 pandemic. There are no trends to the deterioration of the epidemic situation, but there is a decrease in the volume and narrowing of the focus of anti-tuberculosis anti-epidemic measures carried out by the anti-tuberculosis service.Conclusions. Taking into account these features of the functioning of the TB service in the conditions of possible predicted other epidemics/pandemics, it is necessary to reorganize the system of providing TB care to children and adolescents with a change/expansion of its functions and material and technical base. A promising option for the intensification of such assistance in the context of pandemics is the integration of its implementation by all health services for the prevention of socially significant infectious diseases.

Global analysis of tuberculosis dynamical model and optimal control strategies based on case data in the United States

Tuberculosis is a chronic infectious disease with a high death rate, which has attracted worldwide attention. In this paper, we focus on the annual data of tuberculosis in the United States from 1988 to 2019. Firstly, we propose an SVEITR dynamical model with vaccination, fast and slow progression, incomplete treatment, and relapse. Mathematical analyses show that the disease-free equilibrium is globally asymptotically stable (unstable) if R0≤1 (if R0>1). There exists a unique endemic equilibrium that is globally asymptotically stable when R0>1. Next, we use the Markov-chain Monte-Carlo (MCMC) method to acquire the model’s optimal parameters. From R0=1.3763, tuberculosis will not be eliminated without control measures taken in the United States. Through partial rank correlation analysis, the most sensitive parameters to the basic reproduction number are found. Based on this, we take the actual epidemic situation of tuberculosis in the United States into considerations to get the required conditions for optimal control using Pontryagin’s maximum principle and cost-effectiveness analysis. Implementation of three public health measures: tuberculosis prevention and control education, timely treatment, and enhanced efficacy can reduce the prevalence of tuberculosis in the United States. But at present, it is challenging for us to achieve the goal of eliminating tuberculosis by 2030 as called for by WHO.

Tuberculosis Situation in Volga Federal District in 2016-2020

The objective of the study: to assess changes in the incidence and prevalence of multiple drug resistant tuberculosis (MDR TB) and TB/HIV coinfection (TB/HIV) in Volga Federal District (VFD) and its regions during 2016-2020.Subjects and Methods. Data from FGSN Forms No. 8, 33, and 61, and analytical reviews of main statistical TB rates in the Russian Federation have been studied. The number of those died is presented as per the Rosstat data.Results. An increase in the incidence and prevalence of MDR TB and TB/HIV coinfection has been detected in certain region of Volga Federal District. Perm Region, the Republic of Bashkortostan, the Republic of Udmurtia, and Orenburg and Samara Regions have the highest prevalence of MDR TB and TB/HIV coinfection. In 2020, the Republic of Bashkortostan was the only region where the incidence and prevalence of MDR TB were growing (164.7% and 47.3%, respectively). The highest incidence and prevalence of TB/HIV coinfection was reported in the Republic of Bashkortostan, Perm Kray, Orenburg Region, the Chuvash and Udmurt Republics. Over the last 5 years, the maximum increase in TB/HIV incidence and prevalence was observed in the Republic of Bashkortostan (38.8% and 41.3%, respectively).

Tuberculosis situation among the pediatric population of Saratov Region (2015-2019)

Subjects and Methods. Incidence and prevalence of tuberculosis among children and adolescents in Saratov Region were retrospectively analyzed for 2015-2019.Results. The incidence of tuberculosis in children reflects general trends in the epidemic situation over the years in Saratov Region. In this region during 10 years of monitoring, tuberculosis incidence among children decreased 4 times by 2019 and it made 2.3 per 100,000 population, and among adolescents, it decreased 1.6 times (16.3 per 100,000 population). The number of children with post-tuberculosis changes detected for the first time increased 3 times in 2019 versus 2015, and the number of adolescents increased 4.5 times not only due to transition to tuberculosis screening in children aged 8-17 years old by skin test with tuberculosis recombinant allergen but also to the examination of children by computed tomography. The incidence in children followed up as Group IVA in 2019 was 15 times higher than this rate in the overall pediatric population. Analysis of the number of children and adolescents who developed tuberculosis and followed up as Groups IV and VI in 2015-2019 showed that the number of children ill with tuberculosis in Group IV was 3 times higher than the number of children in Group VI.

Prevalence and surveillance of tuberculosis in Yemen from 2006 to 2018.

Tuberculosis is a major public health issue in Yemen, a country located at the southwestern tip of the Arabian Peninsula, while the situation of tuberculosis had been further exacerbated since the war started in 2015. The objective of this study is to investigate the incidence of tuberculosis in Yemen before the outbreak of COVID-19, from 2006 to 2018. During the 13-year period, 92 482 patients were enrolled in the TB programme records from the 22 governorates. Almost equal number of cases were diagnosed between males and females (a male to female ratio, 1.03:1). A notable rising incidence was observed in all age groups starting from 2011. The sharpest increase occurred in children under age 15, rising by 8.0-fold from 0.5 in the period 2006-2010 to 4.1 in the period 2011-2018. Paediatric TB accounted for 9.6% of all reported cases. In terms of the patient residence, incidence has more than doubled in Sana'a city, Sana'a Gov., Hajjah and Saadah. Concomitant diseases with tuberculosis included diabetes mellitus (14.0%), brucellosis (6.1%), hepatitis (6.0%), rheumatoid arthritis (4.3%), renal disorders (2.5%) and HIV infection (2.5%). Development of interventions to reduce tuberculosis incidence in children and concomitant communicable diseases is urgently needed.

The trends of spreading of tuberculosis combined with HIV-infection among population the Siberian Federal Okrug

In The Russian Federation, the current epidemic situation of tuberculosis is characterized by stabilization and decreasing of morbidity with simultaneous increasing of number of cases of tuberculosis combined with HIV infection within the structure of newly diagnosed diseases and contingents of patients with tuberculosis. In the Siberian Federal Okrug, the indices of morbidity of tuberculosis combined with HIV infection exceed similar ones by almost twice that testifies significant input into burden of morbidity of tuberculosis in the subjects of the Siberian Federal District and their role in further dynamics of morbidity. The shift in morbidity of tuberculosis combined with HIV infection towards increasing of age both in patients with diagnosed HIV infection for the first time and in entire accumulated contingent of HIV patients. The positive dynamics of indices of efficiency of anti-tuberculosis measures in contingents of HIV-infected patients being registered testifies availability of reserves for improving medical care quality. The priority directions of developing program activities to achieve control over spreading of tuberculosis combined with HIV infection are early detection and increasing of commitment to dispensary observation of patients with HIV infection and decreasing infection of population with tuberculosis and increasing efficiency of treatment of patients with tuberculosis.

Epidemiological situation of tuberculosis in children and adolescents in the Kyrgyz Republic

Epidemiological situation of tuberculosis in children and adolescents in the Kyrgyz Republic

Распространение туберкулеза в мире

Currently, according to the World Health Organization (WHO) for 2019, tuberculosis ranks first among human diseases. Every fourth inhabitant of the planet is a carrier of Koch's bacillus. Often, nonspecific reactions to tuberculin are detected in humans and animals sensitized by atypical mycobacteria. That is why tuberculosis has a different degree of spread in individual regions or countries. The spread of tuberculosis is influenced by human non-observance of sanitary and medical standards, and in veterinary medicine – by the lack of feed and unsanitary conditions for animals, which, in turn, leads to an increase in the incidence of tuberculosis among humans and animals. The uncontrolled movement of animals, feed, raw materials and animal products aggravated the epizootic situation of tuberculosis, and hence the epidemiological one. Currently, the fact of evolutionary variability of the causative agent of tuberculosis has been established. Environmentally – technogenic press, as well as the spread of coronavirus infection, all this led to a decrease in immunity in humans and animals and, accordingly, an increase in the incidence and mortality from tuberculosis.

НОВІ ФЕНО-ГЕНОТИПІЧНІ ТЕХНОЛОГІЇ В ДІАГНОСТИЦІ ТУБЕРКУЛЬОЗУ

NEW PHENO-GENOTYPIC TECHNOLOGIES IN DIAGNOSIS OF TUBERCULOSIS O. A. Zhurilo, A. I. Barbova, L. M. Sladkova Abstract Widespread drug-resistant tuberculosis is a global problem and can have a negative impact on the global tuberculosis situation. Rapid diagnosis of the disease and early initiation of effective treatment based on the selection of personalized chemotherapy regimens are the basis for preventing the spread of tuberculosis. Microbiological methods which can justify the etiology of the process and determine the drug susceptibiliity of the pathogen are of particular importance for the diagnosis of tuberculosis. The review is focused on current methods of microbiological diagnosis of tuberculosis, including classical microbiological (diagnostic microscopy; solid and liquid media cultures) and modern molecular genetic tests (DNA strips; GeneXpert; multiplex PCR and other). The article presents data on modern methods of bacteriological and molecular genetic diagnosis of tuberculosis, their effectiveness and role in verifying the diagnosis of tuberculosis. The effectiveness of their integrated use to improve the quality of research and rapid detection of patients with M. tuberculosis has been proven. The place of the described methods in the diagnostic algorithm of tuberculosis laboratories is estimated. Further prospects for the diagnosis of tuberculosis associated with the use of new technologies are considered. The information on the current state of microbiological diagnostics of tuberculosis is generalized, the importance of development and introduction of the latest technologies in the diagnostic process is emphasized. Key words: tuberculosis, mycobacteria tuberculosis, drug resistance, methods of bacteriological diagnostics, molecular genetic technologies, PCR, sequencing.

Tuberculosis in the Children of Ukraine: the Epidemiological Situation and Areas of Improvement of Antituberculosis Care

Introduction. The main thrust of the global tuberculosis response for decades has been focused on tuberculosis (TB) in adults. However, this approach has failed to achieve the expected results in TB control. Therefore, WHO has changed the paradigm of TB control with a focus on childhood TB. Objective. To investigate the epidemiological situation of childhood tuberculosis in Ukraine in dynamics, to define the main factors of negative changes, and to define the directions for improvement of antituberculosis care. Materials and Methods. Epidemiological, clinical, statistical. Results. The epidemiological situation in Ukraine remains difficult. Over the past 10 years, the relapse rate of TB in adults has increased significantly, from 13.6% to 23.0%, and the number of patients with drug-resistant (DR) TB (in children by 11.0% in 2020). The volume of professional examination of children for TB decreased significantly, which led to an increase in the structure of the disease of severe forms requiring surgical treatment, and a significant under-recognition of patients and individuals with latent TB infection. Etiological verification of the diagnosis in children is very difficult. Practically 50.0% of unhealthy inpatients, even with very scrupulous examination, fail to detect MBT by any method (in Ukraine this figure reaches 70.0%). Conclusions. In spite of positive dynamics of morbidity and mortality, WHO estimations show significant underdiagnosis of TB patients in Ukraine. The relapse rate in adults and DR-TB patients of all age groups is increasing; the percentage of children under 14 years old in the age structure is increasing. Early detection of TB infection in children is extremely important for TB control in the country, which requires free access of the child population to systematic screening for TB with the Mantoux test and a new skin test with highly specific TB biomarkers (ESAT-6, CFP-10). Modern methods of molecular-genetic diagnostics of TB are quickly and efficiently implemented in NIFP, treatment of children with DR-TB with new anti-TB drugs was started. For the first time in Ukraine, the Center of surgical treatment of children with tuberculosis of the respiratory organs was established at the Institute. Keywords. TB in children, epidemiological indicators, dynamics of morbidity, drug-resistant TB, improvement of anti-TB care.

Comparative characteristics of the epidemiological situation of chemoresistant tuberculosis in Germany and Ukraine

Objective — to compare the epidemiological situation of chemoresistant tuberculosis in Germany and Ukraine, in addition analyzing the nature and features of chemoresistant tuberculosis in 192 patients treated at the Ternopil Regional TB Dispensary Ukraine during 2017—2018.
 Materials and methods. In order to study the comparative characteristics of the epidemiological situation with chemoresistant tuberculosis in Germany and Ukraine, modern literature sources were used with the search query «epidemiological situation with chemoresistant tuberculosis in Germany», «epidemiological situation with chemoresistant tuberculosis in Ukraine». Separatelly a retrospective cohort study was conducted. The nature and features of the course of chemoresistant tuberculosis in 192 patients who were treated in the Ternopil Regional TB Dispensary during 2017—2018 were analyzed. 
 Results and discussion. Analysis of literature sources showed that multidrug resistant Tuberculosis (MDR-TB) is relatively seldom in Germany with around 100 cases annually. Overall, the epidemiological situation of MDR-TB has been stable since the beginning of the statistical recording of the disease in 2002. In 2013, the highest proportion of MDR TB was registered at 3.3 %. Detailed analysis of notifi cation data shows that the tuberculosis situation in Germany is mainly influenced by migratory movements and demographic changes in the population. Despite the positive overall epidemiological trend with decreasing incidence rates, however, the burden of TB in Ukraine remains significant. According to the latest WHO estimates for 2018, TB incidence in the country(new cases and relapses) is the 4th highest among 53 countries of the WHO European Region.To address the situation, reduce TB prevalence, scale up TB early detection and diagnosis, and ensure effective treatment, Ukraine adopted, in 2019, the 2020–2023 State Strategy for Development of Anti-Tuberculosis Care for the Population.The analysis performed of 192 patients of the MDR/XDR-TB Cohort from the TB-Dispensary Hospital in Ternopil (Ukraine) from 2017—2018, showed that the resistanse of mycobacteria to anti-TB drugs was dominated by cases of MDR-TB — 57.3 %. Among patients first diagnosed were 52.6 %, relapses were 46.4 %. Destruction in the lungs was detected in 71.9 %. 111 patients (57.8 %) had treatment success, and 81 (42.2 %) had poor treatment outcomes or were lost to follow-up.
 Conclusions. The epidemiological situation of tuberculosis in Germany is stable and improving. Despite the positive overall epidemiological trend, the burden of TB in Ukraine remains significant. In 2018, TB incidence in the country (new cases and relapses) was 80 per 100 thousands population. In Ukraine during the period (2015—2018), the proportion of «pre-XDR» and XDR cases increased from 47.4 to 51.3 %. Among patients with chemoresistant tuberculosis, MR TB predominates (57.3 %), with destruction in the lungs and only 57.8% are effectively treated.

Epidemiological trends in tuberculosis in Ukraine at the beginning of the COVID­-19 pandemic

Objective — to examine the tendencies of the epidemiological situation on tuberculosis in Ukraine at the beginning of the COVID-19 pandemic in 2020. 
 Materials and methods. The analysis of the data of official statistics in 2015—2020, a survey of 157 medical experts and a telephone questionnaire survey of 69 residents of the Volyn region.
 Results and discussion. It was established that the disease of COVID-19 has found its imprint on the epidemiological situation of tuberculosis and on the functioning of the TB care service. In 2020, the rate of decline in the incidence of pulmonary and extrapulmonary tuberculosis was significantly more intensive than in previous years. However, the incidence of tuberculosis among contacts with bacterial excretion in tuberculosis foci increased 1.85 times in each year. The frequency of tuberculosis recurrences is steadily decreasing.The prevalence and mortality from all forms of active tuberculosis among the entire population of Ukraine has a tendency similar to a decrease in morbidity.The effectiveness of treatment of patients of all categories is proportional to the severity of the tuberculosis process, but still insufficient. Mortality in TB care institutions increased in the previous year against the decrease of this indicator in previous years. Against the background of the inaccessibility of the population to TB care, day hospitals are underused, and the sanatorium network needs to be reorganized. The surgical method of treatment of patients is extremely insufficiently realized.
 Conclusions. The dispensary contingent of TB care institutions is decreasing every year. There is a reduction in the infrastructure of the TB care service, and in each year, the largest reduction was in the bed stock of TB care institutions and sanatoriums, as well as a decrease in the number of TB doctors.

Drug Resistant Tuberculosis in the Northern Region of Zambia: A Retrospective Study

BackgroundZambia like many countries in sub-Saharan Africa is affected with drug resistant tuberculosis. However, the drug resistant tuberculosis situation over the years has not been described in various regions of the country. Consequently, this study aims to determine the drug resistant tuberculosis burden in northern regions of Zambia over a four-year period based on data generated from a Regional Tuberculosis Reference Laboratory.MethodTwo hundred and thirty two (232) Tuberculosis Drug Susceptibility Testing results over a four-year period (2016-2019) were reviewed. Data was collected from tuberculosis registers and patient request forms and entered into a pre-tested standardized checklist and later entered in Excel Computer software. Double blinded checking was done by two independent data clerks to minimize duplication of cases. Cleaned data was then imported in R programme for analysis. Bivariant and descriptive statistics were performed and reported.ResultsOf 232 Drug Susceptibility Testing results, 90.9% were drug resistant TB while 9% were drug susceptible. Fifty three percent (53%) of these were multi-drug resistant Tuberculosis and 32% were confirmed as Rifampicin Mono-resistance. Only 1.7% of the Multi-drug resistant Tuberculosis patients were Pre-extensively drug-resistant Tuberculosis. Copperbelt province had the largest proportion (46.0%) of multi-drug resistant tuberculosis patients followed by Luapula (8.1%) and North-Western (4.7%) provinces. In new and previously treated patients, the proportion of Multi-drug resistant tuberculosis was 71.8% and 28.7% respectively. History of previous anti-tuberculosis treatment and treatment failure were associated with multi-drug resistance TB.Conclusion and RecommendationThis study has shown a small increase in the proportions of drug resistant tuberculosis cases over the four years under review with high rates being recorded on the Copperbelt Province. Previous treatment to first line TB treatment and treatment failure were associated with development of Multi-drug resistance. We therefore recommend strengthened routine laboratory surveillance and improved case management of multi-drug resistant tuberculosis patients in the region.

Prediction of the Epidemiological Situation of Tuberculosis in Slovakia by 2040- Data Update.

Background:Despite the available diagnostics and treatment, tuberculosis (TB) is a serious infectious disease currently occurring. Even some high-income countries in the world do not fully control it at this time. The reason for this situation is the lack of elimination programs to address the situation. The aim of the update of the prediction data was to create a presumption of TB development in Slovakia by 2040.Methods:We used the time series prediction method with exponential equalization. The basis for the calculation were historical data on the incidence of TB from 1960 to 2018 in Slovakia (data for the last 58 yr). This time series has a clearly declining level. In view of this trend, we have set a threshold, whether and when the incidence in the future will fall below 5.0 patients per 100,000 inhabitants.Results:In case of a favorable development, the limit of our incidence drop below 5.0 cases per 100 000 inhabitants in 2022, when the incidence will be 4.91 per 100 000 inhabitants. In 2040, the predicted incidence of TB should be 1.78 per 100 000 inhabitants. A gradual decline may also be related to a decrease in the population of the Slovak Republic.Conclusion:Slovakia belongs to those countries of the world where TB is under control. Increased surveillance of high-risk communities through community interventions and countries' readiness for global migration can help to influence factors that may aggravate the epidemiological situation of TB.