Tuberculosis Case Fatality Rates Research Articles

Incidence of pulmonary tuberculosis in suburban Bissau, Guinea-Bissau between 2004 and 2020: a prospective cohort study.

Previous studies have found declining incidence of tuberculosis (TB) in Bissau, Guinea-Bissau. This study aimed to report incidence rates of TB for the period 2004-2020, stratifying by sex, smear-status, and HIV-status, as well as describe developments in TB case fatality rate and diagnostic delay. Data from the Bandim Health Project HDSS and the TB registry from Jan 1st, 2004 to Dec 31st, 2020 were used. Incidence rates were calculated for each year and for smear-positive, smear-negative, HIV-positive, HIV-negative, and unknown HIV-status. Incidence rate ratio and test for trend were done using a one-step Newton approximation to the log-linear Poisson regression coefficient. Overall TB incidence declined only slightly over the period from 294 per 100,000 in 2004 to 273 in 2020. TB/HIV coinfection declined from 108 in 2004 to 14 in 2020, as did incidence among females and smear-negative cases. Incidence of PTB in Bissau, Guinea-Bissau is declining slowly, if at all. TB incidence among females, smear-negative TB, TB case fatality rate, and TB/HIV coinfection and diagnostic delay are declining.

The effect of primary health care on tuberculosis in a nationwide cohort of 7·3 million Brazilian people: a quasi-experimental study

SummaryBackgroundUniversal health coverage is one of the WHO End TB Strategy priority interventions and could be achieved—particularly in low-income and middle-income countries—through the expansion of primary health care. We evaluated the effects of one of the largest primary health-care programmes in the world, the Brazilian Family Health Strategy (FHS), on tuberculosis morbidity and mortality using a nationwide cohort of 7·3 million individuals over a 10-year study period.MethodsWe analysed individuals who entered the 100 Million Brazilians Cohort during the period Jan 1, 2004, to Dec 31, 2013, and compared residents in municipalities with no FHS coverage with residents in municipalities with full FHS coverage. We used a cohort design with multivariable Poisson regressions, adjusted for all relevant demographic and socioeconomic variables and weighted with inverse probability of treatment weighting, to estimate the effect of FHS on tuberculosis incidence, mortality, cure, and case fatality. We also performed a range of stratifications and sensitivity analyses.FindingsFHS exposure was associated with lower tuberculosis incidence (rate ratio [RR] 0·78, 95% CI 0·72–0·84) and mortality (0·72, 0·55–0·94), and was positively associated with tuberculosis cure rates (1·04, 1·00–1·08). FHS was also associated with a decrease in tuberculosis case-fatality rates, although this was not statistically significant (RR 0·84, 95% CI 0·55–1·30). FHS associations were stronger among the poorest individuals for all the tuberculosis indicators.InterpretationCommunity-based primary health care could strongly reduce tuberculosis morbidity and mortality and decrease the unequal distribution of the tuberculosis burden in the most vulnerable populations. During the current marked rise in global poverty due to the COVID-19 pandemic, investments in primary health care could help protect against the expected increases in tuberculosis incidence worldwide and contribute to the attainment of the End TB Strategy goals.FundingTB Modelling and Analysis Consortium (Bill & Melinda Gates Foundation), Wellcome Trust, and Brazilian Ministry of Health.TranslationFor the Portuguese translation of the abstract see Supplementary Materials section.

The Follow-up of 360 Patients with Pulmonary Tuberculosis After 2 Months Treatment With Anti-tubercular Agents in Iran

Background: Tuberculosis (TB) is a major global health problem. The goal is to end the global TB epidemic. TB treatment averted 49 million deaths globally from 2000 to 2015. If everyone with TB had a timely diagnosis and high-quality treatment, the TB case fatality rate would be lower in all countries. The main source of infection is untreated smear positive pulmonary TB; the next step should be the examination of the sputum for Mycobacterium sp. Bacteriologic evaluation through culture and /smear microscopy is essential to monitor the response to treatment. Monitoring acid-fast bacilli (AFB) smear should be undertaken at 2, 5, and 6 months. The currently recommended treatment for the new cases of drug-susceptible TB is a 6-month regimen of 4 first-line drugs: isoniazid (INH), rifampin (RIF), ethambutol (ETM), and pyrazinamide (PZA). Treatment success rates of at least 85 for new cases of drug-susceptible TB are regularly reported to the world health organization (WHO) by its 194 member states. The global TB drug facility supplies a complete 6-month course for about US 40 per person. Objectives: The current study aimed at evaluating the effectiveness of directly observed treatment short course (DOTS), AFB-negative/AFB-positive sputum after a 2-month treatment with the 4 first-line drugs. Methods: A total of 700 patients with tuberculosis referred to Sanabad Health Center of Mashhad, Iran from March 2005 to March 2008 were retrospectively studied. Then, 360 new smear-positive pulmonary TB were chosen. After 2 months of treatment with 4 anti-tubercular agents, age, gender, nationality, and AFB-negative, AFB-positive of sputum smear were recorded in 2 groups. Results: Females were infected more than males. There were treatment success rates of at least 86.4 for new cases of drug-susceptible TB. Age, gender, and nationality were not related to the changes in sputum (negative-positive). Conclusions: DOTS were effective in the current study. In low-and middle-income countries, in patients with TB cavity, diabetes, malnutrition, immune disorder, and cigarettes smoking, the sputum smear and culture testing on the days 15 and 30 of treatment until the completion of the treatment should be done. © 2017, Archives of Clinical Infectious Diseases.

The tuberculosis case fatality rate and the treatment results of the young adult male patients of the last 9 years (2002-2010)

The tuberculosis case fatality rate and the treatment results of the young adult male patients of the last 9 years (2002-2010)

The Isoniazid Debate

To the Editor. — We read with interest Colice's article 1 in which he repeats our analysis of isoniazid preventive therapy 2 using somewhat different data. We were gratified to find that our model and assumptions were explicated in sufficient detail to allow its independent recreation. We disagree, however, with his analysis because of the rather selective biases in his data. Although Colice correctly used data from young adults 3-5 in estimating the isoniazid-induced hepatitis case-fatality rate for a 30-year-old man, he then inappropriately used data primarily relevant to elderly persons in estimating the tuberculosis case-fatality rate. In the two studies that he cited, 6-7 that rate was much lower (either zero or nearly zero) among young adults. This inconsistency is particularly troubling because reactivation of tuberculosis is most likely to occur in the years proximate to the discovery of the positive tuberculin reaction; the rate of reactivation declines over

Decision Analysis, Public Health Policy, and Isoniazid Chemoprophylaxis for Young Adult Tuberculin Skin Reactors

As part of a plan to eliminate tuberculosis in America, tuberculin skin testing was advised for all US citizens, with isoniazid chemopreventive therapy administered to appropriate positive reactors. Implementation of this plan, however, may be limited by concerns over which skin test reactors should receive isoniazid therapy. Recent decision analyses suggest that, contrary to American Thoracic Society guidelines, asymptomatic skin test reactors under age 35 years with normal chest roentgenograms and no predisposing conditions to tuberculosis reactivation will not benefit from isoniazid chemopreventive therapy. Repeated analysis of these studies reveals that calculated life expectancy depends on estimates of the probability of certain chance outcomes. If the isoniazid-related hepatitis case-fatality rate is below 1%, isoniazid chemopreventive therapy appears to be beneficial. A literature review suggests that this rate is indeed this low. If the tuberculosis case-fatality rate is above 6.7%, also supported by the literature, the advantages of isoniazid therapy are further increased. This repeated analysis should reassure physicians that isoniazid chemoprophylaxis for tuberculin skin test reactors is beneficial to the individual and consonant with public health policies.

Isoniazid Prophylaxis-Reply

In Reply.— The study Dr Moulding refers to, from which we derived the risks of isoniazid hepatitis, was the Public Health Service cooperative surveillance study. 1 The investigators found 0.578 deaths per 1000 isoniazid recipients. We calculated the 95% confidence interval to range from 0.2 to 1.0 deaths per 1000 isoniazid recipients. Among other well-documented studies that were sufficiently large to uncover this low risk, the rates vary from 0.1 to 0.9 deaths per 1000 isoniazid recipients. 2-4 Consequently, we used 0.578 deaths per 1000 isoniazid recipients as our best estimate, and used 0.1 and 1.0 deaths per 1000 isoniazid recipients as the low and high estimates in our sensitivity analysis. Even at the high estimate, the decision favors taking isoniazid. Dr Moulding suggests that the tuberculosis case fatality rate may be lower in people compliant enough to have taken isoniazid chemoprophylaxis. To our knowledge, this hypothesis has not been