Tuberculosis Trends Research Articles

Trend of some Tuberculosis Indices in Iran during 25 yr Period (1990-2014).

Investigation of tuberculosis (TB)-specific indices including prevalence of TB, mortality of TB cases excluding HIV, HIV/TB mortality, incidence of TB (all forms), HIV/TB incidence as well as case detection and related trends is a crucial step in evaluation of program performance and strategies success. Besides, estimating the number and time of change points for TB incidence can help to detect effective factors in TB control. Therefore, the current study aimed to determine the trend of aforementioned indices in Iran during a 25 yr period (1990 to 2014). Data on trend of TB in Iran was extracted from WHO regional office reports during 1990-2014. For determining the trend of TB indices, Annual Percent Changes (APC) and Average Annual Percent Changes (AAPC) was estimated using segmented regression model. AAPC (95% CI) for HIV/TB mortality and HIV/TB incidence were 11.5 (9.3, 13.6) and 14.8 (13.6, 16.1), respectively, which are sign of increasing trend during the period (P<0.05). Other indices showed significantly decreasing trend (P<0.05), except for case detection rate (P =0.803). The incidence, prevalence, and death rates of TB had shown a decreasing trend in general population, regarded as a useful indicator of achievements of Millennium Development Goals (MDGs) and effectiveness of interventional programs. Increasing trend of incidence and mortality of TB in HIV infected patients, needs conducting more intervention strategies in health care programs.

Tuberculosis Epidemiology at the Country Scale: Self-Limiting Process and the HIV Effects.

BackgroundThe global spread of the human immunodeficiency virus (HIV) is the main hypothesis behind tuberculosis (TB) positive trends in the last decades, according to modeling studies and World Health Organization Reports (WHO). On one hand, TB (WHO) reports do not explicitly consider a modeling approach, but cover country and global TB trends. On the other hand, modeling studies usually do not cover the scale of WHO reports, because of the amount of parameters estimated to describe TB natural history. Here we combined these two principal sources of TB studies covering TB High Burden Countries (HBCs) dynamics. Our main goals were: (i) to detect the endogenous component of TB dynamics since 1974 for TB HBCs; and (ii) to explore the HIV exogenous effects on TB models`parameters.Methods and FindingsWe explored the relationship between the TB per capita population rate of change (RI) and the infectious class size following an endogenous/exogenous framework. RI can be affected by intra-population processes (i.e. competition, predation) and exogenous variables like HIV. We found that TB dynamics had always a strong endogenous component, represented by a negative correlation between TB population size and RI, which was captured by the discrete logistic model. Moreover, we explored the HIV exogenous effects on TB models`parameters. We found that overall the TB+HIV logistic model was more parsimonious than TB model alone, principally in the African region. Our results showed that HIV affected principally TB carrying capacity, as expected by the known HIV effects on TB natural-history. We also tested if DOTS (Directly Observed Treatment Short-Course Strategy), poverty levels and BCG (Bacillus Calmette-Guérin) coverage explained the models´ residuals variances, but they did not.ConclusionsSince 1974, TB dynamics were categorized in distinct chronological domains, with different dynamics but nearly the same underlying mechanism: a negative relationship between RI and infected class size (i.e. self-limiting). In the last decades, not only HIV spread represented a new TB chronological domain, but it also has been pushing TB carrying capacity (K) to higher levels. TB has a complex natural-history and imposes real challenges to model its dynamics. Yet, we were able to explore and reveal the main drivers of TB dynamics for HBCs since 1974, through a simple approach. Based on our results, we suggest that the endogenous view should be considered as a plausible hypothesis to model and explain TB dynamics and that future World Health Organization reports could include the endogenous/exogenous framework as a supplement to help to decipher the main drivers of TB dynamics and other diseases.

Descriptive review of tuberculosis surveillance systems across the circumpolar regions

BackgroundTuberculosis is highly prevalent in many Arctic areas. Members of the International Circumpolar Surveillance Tuberculosis (ICS-TB) Working Group collaborate to increase knowledge about tuberculosis in Arctic regions.ObjectiveTo establish baseline knowledge of tuberculosis surveillance systems used by ICS-TB member jurisdictions.DesignThree questionnaires were developed to reflect the different surveillance levels (local, regional and national); all 3 were forwarded to the official representative of each of the 15 ICS-TB member jurisdictions in 2013. Respondents self-identified the level of surveillance conducted in their region and completed the applicable questionnaire. Information collected included surveillance system objectives, case definitions, data collection methodology, storage and dissemination.ResultsThirteen ICS-TB jurisdictions [Canada (Labrador, Northwest Territories, Nunavik, Nunavut, Yukon), Finland, Greenland, Norway, Sweden, Russian Federation (Arkhangelsk, Khanty-Mansiysk Autonomous Okrug, Yakutia (Sakha Republic), United States (Alaska)] voluntarily completed the survey – representing 2 local, 7 regional and 4 national levels. Tuberculosis reporting is mandatory in all jurisdictions, and case definitions are comparable across regions. The common objectives across systems are to detect outbreaks, and inform the evaluation/planning of public health programmes and policies. All jurisdictions collect data on confirmed active tuberculosis cases and treatment outcomes; 11 collect contact tracing results. Faxing of standardized case reporting forms is the most common reporting method. Similar core data elements are collected; 8 regions report genotyping results. Data are stored using customized programmes (n=7) and commercial software (n=6). Nine jurisdictions provide monthly, bi-annual or annual reports to principally government and/or scientific/medical audiences.ConclusionThis review successfully establishes baseline knowledge on similarities and differences among circumpolar tuberculosis surveillance systems. The similarity in case definitions will allow for description of the epidemiology of TB based on surveillance data in circumpolar regions, further study of tuberculosis trends across regions, and recommendation of best practices to improve surveillance activities.

Trend of Smear-positive Pulmonary Tuberculosis in Iran during 1995-2012: A Segmented Regression Model.

Background:Describing trend in tuberculosis (TB) over time can play an important role to assess the disease control strategies and predict the future morbidity and mortality. This study aimed to determine the incidence trend of smear-positive pulmonary tuberculosis (SPPT) in sub-age and sex groups during the years of 1995–2012.Methods:This retrospective cohort study was performed in 2015 by using the dataset regarding National Statistics of SPPT reported by World Health Organization during 1995–2012. Annual percent changes (APCs) and average annual percent changes (AAPCs) were estimated to determine the summery statistics of trend using segmented regression model.Results:During 1995–2012, there were 96,579 SPPT case notifications in Iran (male to female ratio: 0.99). There was only one change point in 1997 for SPPT incidence in subgroups of age and sex during 1995–2012. The AAPCs for both genders and also all three age groups had a significant descending trend during the time period (P < 0.05).Conclusions:Our results showed a downward trend in the SPPT incidence. It seems that to achieve the set goals and high successful in TB control program especially reduction in SPPT, pay more attention to old age and males should be considered. In addition, improvement of clinical and medical care services and notification processes would be imperative.

TUBERCULOSIS BURDEN IN LEBANON: EVOLUTION AND CURRENT STATUS.

In the absence of surveillance data and consolidated information about tuberculosis (TB) and its drug resistance burden in Lebanon, this retrospective study was conducted to shed light on TB and its other relevant aspects over the last 15 years in this country. To generate the TB data for this retrospective study, two main sources were used: 1) the records of patients in the National Tuberculosis Program (NTP); 2) the results of the Clinical Microbiology Laboratory (CML) at the American University of Beirut Medical Center (AUBMC). The TB data review pertained to its epidemiological aspect, implementation of the directly observed therapy strategy (DOTS) all over, the gender distribution, the impact of high risk groups (non-national population, Syrian refugees, patients with multi-drug resistance-TB [MDR-TB] and the inmate population) on the trend of TB in Lebanon between 1999 and 2013. Reviewed also are TB in children, extrapulmonary tuberculosis and the mycobacterium other than tuberculosis (MOTT). During the last 15 years, 7548 TB cases were diagnosed and evaluated at the NTP. After the decreasing of TB incidence from 13/100 000 population in 2001 to 9/100 000 in 2006, the incidence started to increase in 2007, reaching 20/100 000 in 2013, mostly due to increased cases among non-national population. Fluctuations in TB rates over the years were seen among children, inmates, MDR-TB, and HIV patients. MOTT isolates recovery rates also fluctuated during the study period, M. simiae being the most common. After the decreasing trends of TB incidence between 1999 and 2006, Lebanon has been experiencing an increasing incidence in tuberculosis population since 2007. This is mainly attributed to the dramatic increase of TB patients among non-nationals and the influx of Syrian refugees. The ongoing collaboration between the public and private sectors, improvements of the surveillance system and TB control are important factors for successful elimination of TB in this country.

2000 to 2015: How Far Have We Progressed in Achieving the Health Related Millennium Development Goals?

DEAR EDITOR, Millennium Development Goals (MDGs) are the eight goals formulated by the United Nations (UN) in 2000, to be achieved by 2015 by the UN member states.[1] The member states have committed to effectively tackle the issues of poverty, hunger, illiteracy, gender inequality, mother and child mortality, infectious diseases, environmental degradation, and to encourage partnership between different stakeholders.[1] The MDGs has given policy makers and stakeholders a target to work together and achieve the same within the stipulated time.[1,2] In fact, a set of targets has been proposed to monitor the progress toward all the eight goals by the end of 2015.[1] As 2015 was the last year for countries to accomplish the global targets, the World Health Organization (WHO) has done the analysis of various MDGs, including health-related MDGs.[2] Even though most of the developed nations have revealed a significant progress, the scenario has been quite worrisome for the developing nations [Table 1].[3,4,5,6,7] After a careful analysis, it has been shown that the results have been mixed with some of the targets being achieved (viz., halting and reversing the trends of HIV, malaria and tuberculosis, and increasing accessibility to safe water) and some requiring additional inputs to continuously move in the right direction. In an attempt to move continuously forward, the WHO and UN have together chalked down newer goals under the overview of sustainable development goals, set to be achieved by the year 2030.[2,8] Table 1 Status of MDGs To conclude, the MDGs has enabled the world to successfully progress on the health front, but at the same time it has even highlighted the various gaps present within the health care delivery system. Thus, it is high time that stakeholders should put in sustainable efforts to improve the quality of life of vulnerable sections of society.

STUDY OF THE STATUS OF TUBERCULOSIS CONTROL PROGRAM BASED ON THE IMPLEMENTATION OF THE DIRECTLY OBSERVED TREATMENT SHORT-COURSE STRATEGY (DOTS).

Introduction:Ascendant trend of tuberculosis in the world introduces this disease to be one of the most important infectious diseases in the world. So that every year, 9 million people are afflicted to active TB and about 5.1 million people die of the disease. As the HIV contaminated cases are increased, emergence and spread field of Multidrug-resistant tuberculosis (MDR-TB) bacilli has been provided.Objective:This study aimed to assess the Tuberculosis Control Program from 2005 to 2012 to determine the overall situation of disease epidemiology and prioritized strategies in disease control program within the south of Tehran.Materials and Methods:This cross-sectional study was extracted and analyzed retrospectively on the basis of records of all TB patients in TB health center and TB software in south Tehran in 2005-2012 years.Results:From the total population under protection of health center of south Tehran, 99% are urban and 1% are rural. During 2005-2012, 1242 TB cases have been registered and they were treated by DOTS method. There were 553 cases of new smear-positive pulmonary TB (44%), 222 cases of smear-negative pulmonary TB (18%) and 336 cases of extra-pulmonary tuberculosis (27%), 26 cases of recurrence (2%) and 11 cases of MDR (0.9%). Smear-positive pulmonary tuberculosis has included 67.4% of all tuberculosis patients.Conclusions:The results showed that, in accordance with TB worldwide statistics, at the health center of south Tehran, pulmonary TB is the most common form of the disease (67.4%). The incidence of smear-positive tuberculosis and all forms of TB cases has been an ascending trend over the period between 2005 and 2012.

Revisiting tuberculosis risk in Peace Corps Volunteers, 2006-13.

Risk of tuberculosis (TB) is generally considered to be low for long-term travellers, though risk varies with travel destination, duration and purpose. Peace Corps Volunteers (PCVs) serve for 27 months as community-level development workers in various countries around the world and may be exposed to TB in the course of their service. This study examines recent trends in TB in PCVs and compares rates with a previous analysis published by Jung and Banks. Tuberculosis case data submitted to the Peace Corps' Epidemiologic Surveillance System by Peace Corps Medical Officers and gathered from Federal Employees Compensation Act claims for latent TB infection (LTBI) and active TB between 2006 and 2013 were aggregated and analysed for trends and significance. Overall, there were 689 cases of LTBI and 13 cases of active TB, for a rate of 0.95 cases of LTBI [95% confidence interval (CI) 0.88-1.02] and 0.02 cases of active TB (95% CI 0.01-0.03) per 1000 Volunteer-months. Both are significantly lower than rates presented in the initial study (P < 0.001). Per-country incidence rates for LTBI ranged from 0.00 to 4.52 cases per 1000 Volunteer-months. Per-country active TB rates ranged from 0.00 to 0.78 cases per 1000 Volunteer-months. Among the 13 cases of active TB, there was one successfully treated case of extensively drug-resistant TB. Overall rates of both active and latent TB in PCVs were significantly lower compared with the previous study period. PCVs continue to have statistically significantly higher rates of active TB compared with the general US population but lower rates compared with other long-term travellers.

The epidemiology of tuberculosis in children in Australia, 2003-2012.

To describe the burden of and trends in paediatric tuberculosis (TB) in Australia between 2003 and 2012. A retrospective analysis of TB data from the National Notifiable Diseases Surveillance System (NNDSS) on TB in children (under 15 years of age) during the 10-year period, 2003-2012. TB notifications in Australia during the study period included 538 children (range, 37-66 cases per year), representing 4.6% of the total TB case load during the period (range, 3.8%-5.8% each year). Place of birth was recorded for 524 patients (97.4%); of these, 230 (43.9%) were born in Australia, 294 (56.1%) overseas. The average annual notification rate was 1.31 (95% CI, 1.20-1.43) cases per 100 000 child population. The rate was higher for overseas-born than for Australian-born children (9.57 [95% CI, 8.51-10.73] v 0.61 [95% CI, 0.53-0.69] cases per 100 000 children. The overall rate was highest among those aged 0-4 years. The annual notification rate was three times higher for Indigenous children than for non-Indigenous Australian-born children. Of 427 patients (79.4% of total) for whom the method of case detection was recorded, 37.0% were detected by contact screening, 8.7% by post-arrival immigration screening, and 54.3% by passive case detection. Pulmonary TB was the most common diagnostic classification (64.7% of patients). The most common risk factors were close contact with a TB case and recent residence in a country with a high incidence of TB. Treatment outcomes were satisfactory; 89.4% of children had completed treatment or were cured. The burden of paediatric TB in Australia is low but has not changed over the past decade. The highest rates are among children born overseas, emphasising the important role of immigration screening as Australia aspires to eliminate TB.

Registration and management of community patients with tuberculosis in north-west China

ObjectivesTo describe the registration, management and characteristics of patients with tuberculosis (TB) in north-west China, and investigate whether patients with TB were diagnosed and treated in a timely manner. Study designHealth-facility-based retrospective data were collected from district patient registers and case reports for all patients with TB registered from January 2009 to December 2011 in Xinjiang Uygur Autonomous Region, north-west China. MethodsPatient characteristics and clinical data were collected from the national TB epidemic reporting system using standardized case reporting forms for diagnosis, treatment and outcome. Data were collected and entered by trained health staff in the regional TB clinics. ResultsIn total, data for 20,396 patients with TB were collected; of these, 78.5% were farmers. The age peaks were 20–44 years and 60–74 years. Average health-seeking and diagnostic delays were 32 days and two days, respectively. More than half (54.7%) of the patients with smear-negative TB were diagnosed by chest x-ray. Moreover, 94.3% of patients with TB were treated successfully. From 2009 to 2011, the health-seeking delay decreased significantly (P < 0.05), and the diagnostic delay increased significantly (P < 0.05). A significant decreasing trend in smear-positive TB was observed (P < 0.05), along with an increasing trend in treatment success (P < 0.05). ConclusionsIn north-west China, there is a need to focus on key high-risk populations for prevention and control of TB, such as those aged 20–44 years and 60–74 years, males and farmers. Delays in diagnosis and treatment have a negative effect on cure rates and make it more difficult to control the propagation of TB.

Trends of sputum-smear positive tuberculosis in Zimbabwe: 2008–2011

BackgroundTuberculosis (TB) has remained one of the major public health problems in Zimbabwe with an estimated incidence rate of 552 per 100,000 persons in 2013. The aim of this study was to describe the trends in acid-fast bacilli (AFB) sputum-smear positive (SSP) TB overall and within subpopulations for the period during 2008–2011 in Zimbabwe. Results of this study will contribute towards the evaluation and implementation of targeted TB control interventions.MethodsA cross-sectional study design was used to analyze 40, 110 SSP TB patient records routinely collected during 2008–2011. Incidence trends of SSP TB were described by province, sex, and age group. A Mantel–Haenszel Chi Statistic was calculated to compare each provincial SSP TB notification rate to the national SSP TB notification rate.ResultsSSP TB notification rates were higher in the two main urban provinces, the western provinces and Manicaland. The 25–44 year age group accounted for the largest proportion of notified SSP TB. However, the 55–64 year and 65+ age groups had SSP TB notification rates in 2011 higher than the 2008 value. Finally, the average SSP TB notification rate in males was 23 % higher than in females.ConclusionThe findings of this study suggest that TB control has successfully decreased the notification rate of SSP TB in Zimbabwe during 2008–2011. However, the disproportionate distribution of SSP TB among different regions and subpopulations of the country highlights the need for more targeted interventions to accelerate the decline of TB in Zimbabwe.

Descriptive Review of Tuberculosis Surveillance Systems across Circumpolar Regions.

Background. Tuberculosis is highly prevalent in many Arctic areas. Members of the International Circumpolar Surveillance Tuberculosis (ICS-TB) Working Group collaborate to increase knowledge about tuberculosis in Arctic regions. Objective. To establish baseline knowledge of tuberculosis surveillance systems used by ICS-TB member jurisdictions. Design. Three questionnaires were developed to reflect the different surveillance levels (local, regional and national); all 3 were forwarded to the official representative of each of the 15 ICS-TB member jurisdictions in 2013. Respondents self-identified the level of surveillance conducted in their region and completed the applicable questionnaire. Information collected included surveillance system objectives, case definitions, data collection methodology, storage and dissemination. Results. Thirteen ICS-TB jurisdictions [Canada (Labrador, Northwest Territories, Nunavik, Nunavut, Yukon), Finland, Greenland, Norway, Sweden, Russian Federation (Arkhangelsk, Khanty-Mansiysk Autonomous Okrug, Yakutia (Sakha Republic), United States (Alaska)] voluntarily completed the survey representing 2 local, 7 regional and 4 national levels. Tuberculosis reporting is mandatory in all jurisdictions, and case definitions are comparable across regions. The common objectives across systems are to detect outbreaks, and inform the evaluation/planning of public health programmes and policies. All jurisdictions collect data on confirmed active tuberculosis cases and treatment outcomes; 11 collect contact tracing results. Faxing of standardized case reporting forms is the most common reporting method. Similar core data elements are collected; 8 regions report genotyping results. Data are stored using customized programmes (n 7) and commercial software (n 6). Nine jurisdictions provide monthly, bi-annual or annual reports to principally government and/or scientific/medical audiences. Conclusion. This review successfully establishes baseline knowledge on similarities and differences among circumpolar tuberculosis surveillance systems. The similarity in case definitions will allow for description of the epidemiology of TB based on surveillance data in circumpolar regions, further study of tuberculosis trends across regions, and recommendation of best practices to improve surveillance activities.

Tuberculosis trends over a five-year period at a tertiary care university-affiliated hospital in Singapore.

Tuberculosis (TB), a potentially fatal infectious disease, poses significant health problems. The objective of this study was to analyse trends among newly diagnosed TB patients seen at the Singapore General Hospital (SGH). This study was a retrospective case record review of notified TB patients at SGH between 2006 and 2010 (inclusive). A total of 1,979 cases of TB were notified over the five years. The number increased from 368 in 2006 to 407 in 2010 (p = 0.51), in tandem with the increasing number of patients seen at the hospital and the rising population in Singapore. Singaporean residents accounted for 82.8% of the cases, while non-Singaporean residents and non-residents made up the remainder. The year-to-year percentage of non-Singaporean residents and non-residents notified remained stable throughout the five years (p = 0.783). The number of male Singaporean residents (70.7%) notified was more than twice that of female Singaporean residents (29.3%). The majority of patients infected with TB (31.9%) were elderly patients aged > 65 years. Although testing for the human immunodeficiency virus increased from 43.8% (2006) to 64.2% (2010), the number detected with coinfection remained stable (14 and 12 patients in 2006 and 2010, respectively). Mortality rates also remained stable at 12.0%. We cannot afford complacency, as there was no downward trend in the number of notified TB cases at SGH from 2006 to 2010. As the elderly contribute significantly to the TB burden, increased efforts are required to manage this vulnerable population.

Trends in Tuberculosis Cases Among Nursing Home Residents, California, 2000 to 2009.

To examine trends in tuberculosis (TB) incidence and to compare demographic and clinical characteristics of nursing home (NH) residents and community-dwelling older adults. Prospective TB surveillance. TB cases reported in California from 2000 to 2009. TB patients aged 65 and older. Trends in TB incidence per 100,000 population were assessed using Poisson regression. Demographic and clinical characteristics were compared using the chi-square or Wilcoxon rank-sum test. Among NH residents, risk factors for death during TB treatment were identified using logistic regression. From 2000 to 2009, TB incidence rates decreased significantly, from 15.9/100,000 to 8.4/100,000 (-44%, 95% confidence interval (CI)=-66% to -7%) for NH residents and from 21.2/100,000 to 15.0/100,000 (-27%, 95% CI=-29% to -24%) for community-dwelling older adults. Overall, 211 TB cases among NH residents and 6,518 cases among community-dwelling older adults were reported. NH residents were more likely than community-dwelling older adults to be older (median age 81 vs 75, P<.001), have a negative acid-fast bacilli sputum smear and positive culture (37% vs 28%, P<.001), and die while undergoing TB treatment (44% vs 14%, P<.001), and were less likely to have a positive tuberculin skin test (TST) (28% vs 44%, P<.001) and have TB care provided by a health department (20% vs 59%, P<.001). In multivariable analysis, NH residents who had a positive TST were less likely to die while undergoing TB treatment (odds ratio=0.39, 95% CI=0.16-0.96). TB incidence rates were lower, and reductions in incidence were greater among NH residents; community-dwelling older adults had higher TB rates and smaller reductions in incidence. Interventions that promote timely detection and treatment of TB infection and disease may be needed to reduce morbidity and mortality among NH residents.

Tuberculosis Laboratory Surveillance Network (TuLSA) study group. The first step for national tuberculosis laboratory surveillance: Ankara, 2011

The most effective method for monitoring country-level drug resistance frequency and to implement the necessary control measures is the establishment of a laboratory-based surveillance system. The aim of this study was to summarize the follow up trend of the drug-resistant tuberculosis (TB) cases, determine the load of resistance and evaluate the capacities of laboratories depending on laboratory quality assurance system for the installation work of National Tuberculosis Laboratory Surveillance Network (TuLSA) which has started in Ankara in 2011. TuLSA studies was carried out under the coordination of National Tuberculosis Reference Laboratory (NRL) with the participation of TB laboratories and dispensaries. Specimens of TB patients, reported from health institutions, were followed in TB laboratories, and the epidemiological information was collected from the dispensaries. One isolate per patient with the drug susceptibility test (DST) results were sent to NRL from TB laboratories and in NRL the isolates were rechecked with the genotypical (MTBDRplus, Hain Lifescience, Germany) and phenotypical (MGIT 960, BD, USA) DST methods. Molecular epidemiological analysis were also performed by spoligotyping and MIRU/VNTR. Second-line DST was applied to the isolates resistant to rifampin. A total of 1276 patients were reported between January 1st to December 31th 2011, and 335 cases were defined as "pulmonary TB from Ankara province". The mean age of those patients was 43.4 ± 20 years, and 67.5% were male. Three hundred seventeen (94.6%) patients were identified as new cases. The average sample number obtained from pulmonary TB cases was 3.26 ± 2.88, and 229 (68.3%) of them was culture positive. DST was applied to all culture positive isolates; 90.4% (207/229) of cases were susceptible to the five drugs tested (ethambutol, isoniazid, pyrazinamide, rifampicin, streptomycin). Eight (3.5%) of the isolates were multidrug-resistant (MDR-TB), while no extensively drug-resistant strains were detected. MDR-TB is likely to occur in 63.3 times more among previously treated cases, and 73.3 times more in legal aliens. The achievement of therapy among pulmonary TB cases was 91.9%. Spoligotyping performed for 221 M.tuberculosis complex isolates, showed that all strains were clustered in nine groups. SIT 41 (105/221; 47.5%) was the most frequent spoligotype detected, and clustering rate based on MIRU-VNTR results were found as 16.3%. All of the clustered strains were sensitive while all of MDR-TB isolates showed specific MIRU-VNTR profiles. In conclusion, TuLSA studies started in Ankara in 2011 and the system is still expanding in the country. Our data obtained with TuLSA have been published as a regional surveillance data in the WHO Global Tuberculosis Report 2011, and as a national surveillance data in Global Tuberculosis Report 2012.

Applying spatiotemporal models to study risk of smear-positive tuberculosis in Iran, 2001-2012.

Assessing tuberculosis (TB) distribution in regions over time is essential for health officials to have a proper understanding of current status, determine high-risk areas, and improve case management and resource allocation. To evaluate spatial distribution and trends in the risk of smear-positive Mycobacterium tuberculosis in Iran during 2001-2012 using spatiotemporal models. Overall and province-specific trends in TB risk were estimated using a Bayesian spatiotemporal model. We obtained Bayesian posterior probabilities to test the hypothesis of the relative risk (RR) being equal to 1 and the significance of TB trends in each province. Estimated countrywide trends declined at a rate of almost 3% per decade. The RR was the highest in the provinces of Sistan and Baluchestan, followed by Golestan, Khorasan-Razavi, Hormozgan, Qom, Guilan and South Khorasan. Upward temporal trends were observed in nine provinces. TB risk was generally high in provinces bordering high TB burden countries; population movements from high-risk provinces and adjacent countries appear to be the main challenge to TB control. Nevertheless, the declining risk pattern in these provinces indicates good, but inadequate, progress with TB control. Different health policies according to TB risk and trend are required for each province.

To Assess the Burden of and Trends in Extra Pulmonary Tuberculosis at a Tertiary Care Hospital in India

Introduction: Extra pulmonary form of tuberculosis is an important public health disease which cannot be ignored because of its low transmissibility. Data on the exact burden of the disease in developing countries is scarce. Aim: To assess the burden of the disease in a tertiary care hospital of India. To study the clinical trends in the disease, and the utility of various diagnostic modalities for its diagnosis. To identify the Mycobacterial species and perform drug susceptibility test. Materials and Methods: A cross sectional study was carried out for a period of two years. A total of one hundred and forty seven samples were tested for extrapulmonary tuberculosis using a combination of bacteriological, cytological, histological and biochemical techniques to achieve proper diagnosis of the disease. Results: Young adults and females predominated in the study group and positive cases. Original Research Article Fatima et al.; BJMMR, 8(6): 495-502, 2015; Article no.BJMMR.2015.472 496 Microbiologically, 26% of the specimens were positive. Eighteen percent of them were found to be culture positive for M. tuberculosis. Smear by Ziehl Neelsen stain was positive in 9%. A combination of culture media both solid and liquid maximized the yield of Mycobacteria. Lymph node tuberculosis was found to be the predominant type followed by others. Fifteen percent of the strains were found to be resistant to the first line drugs used in treatment of tuberculosis. Cytology and biochemical findings were found to be less specific in diagnosis of extrapulmonary tuberculosis. Conclusion: Extrapulmonary form of tuberculosis is seen in significant number of the suspects. Hence, attention should be paid towards its proper and early diagnosis followed by rational management, as if neglected may lead to associated complications and sequalae.

Trends of Tuberculosis and Treatment Outcomes at Mizan Aman General Hospital, Southwest Ethiopia: A Four Year Retrospective Study

Background: Tuberculosis (TB) is a serious global public health problem and is the second most common cause of death from infectious disease. The aim of this study was to assess trends of TB and treatment outcomes in the past four years in Mizan Aman General Hospital, Southwestern Ethiopia. Methods: We analyzed the records of 2150 tuberculosis patients registered at Mizan Aman General Hospital from June 2010 to July 2013. Tuberculosis type and treatment outcome were categorized according to the national tuberculosis control program guideline. Data analysis was performed using the statistical package SPSS for windows, version 20. Results: From the total of 2150 TB patients registered during the indicated period, 2090 (97.2%) were new cases and 60 (2.8%) were re-treated cases. Of which, 1125 (52.3%) were smear negative pulmonary TB (SNPTB) cases and the rest, 532 (24.7%) and 493 (23%) were smear positive pulmonary TB (SPPTB) and extra pulmonary TB (EPTB) cases respectively. Trends of all forms of TB increased from 363 in 2010 to 634 in 2011, and decreased in the year 2012 (330), and then, increased in the year 2013 (823). Regarding treatment outcomes, 561 (26.1%) were successfully treated, 26 (1.2%) defaulted, 49 (2.3%) died, and 1514(70.4%) patients were transferred out. Age and year of enrollment of TB patients were associated with higher treatment success (P<0.05). On the other hand, patient category, HIV status and year of enrollment of TB patients were significantly associated with death rate (P<0.05). Conclusion: TB in the hospital showed a fluctuating pattern for the last four years and the proportion of SNPTB cases was highest compared to cases of SPPTB and EPTB. The treatment success of all types of TB was unsatisfactory, which is a serious public health concern that needs to be addressed.

RISK GROUPS FOR TUBERCULOSIS IN JAPAN: ANALYSIS OF RELATIVE RISK AND POPULATION ATTRIBUTABLE FRACTION

Despite the decreasing trend in tuberculosis (TB) cases reported within the general population, TB incidence remains high in certain high-risk groups in Japan. Many of the previous discussions and studies have concentrated mainly on the elderly and those with clinical risks; however, no comprehensive evaluation has been conducted to date. Our study thus sought to estimate the relative risk (RR) and the population attributable fraction (PAF) of selected risk groups in Japan and discuss their relevance to programming future research needs and policies. PAF and RR were calculated for patients with human immunodeficiency virus infection, diabetes, rheumatoid arthritis, those on dialysis, the elderly, health care workers, the homeless, people receiving public assistance, foreigners, prisoners, smokers, and those with alcohol problems, and were grouped into "high PAF" (PAF ≥ 5%), "middle PAF" (5% > PAF ≥ 1%), and "low PAF" (PAF < 1%) groups. The elderly and patients with diabetes showed the highest PAF and RR and should thus be prioritized for policies.

Analysis of the Molecular Evolution of the Mycobacterium Tuberculosis Drug-Resistant Gene rpoB in Asia Using a Bayesian Evolutionary Method.

Tuberculosis (TB) is a serious communicable disease throughout the world. Re-emergence of the TB epidemic is aggravated by the circulation of multidrug-resistant Mycobacterium tuberculosis strains, and more than half of new cases have occurred in Asia. Therefore, it is important to understand the gene mutations underlying the development of rifampicin resistance in Asia. In this study, we classified the rifampicin-resistant Mycobacterium tuberculosis (MTB) rpoB data downloaded from Genbank, based on 12 mutation points. The relationship between the mutation sites and regional information was analyzed, after which the mutation dates and mutation trends of the rpoB gene were predicted by the Markov Chain Monte Carlo (MCMC) method. We discovered that the mutation sites of the rpoB gene were disparate in different regions of Asia. The results of this study clearly showed that drug-resistant gene mutations in Asia started to increase in 2000 and peaked in 2006, indicating the relationship between drug resistance and outbreak trends of TB. From our analysis, it was not difficult to see the relationship between the mutation rates of the rpoB gene and the outbreak of TB. Hence, to some degree, outbreak trends of TB can be predicted through genotyping based on the rpoB gene.