Tuberculosis Deaths Research Articles

Productivity losses associated with tuberculosis deaths in the World Health Organization African region.

BackgroundIn 2014, almost half of the global tuberculosis deaths occurred in the World Health Organization (WHO) African Region. Approximately 21.5 % of the 6 060 742 TB cases (new and relapse) reported to the WHO in 2014 were in the African Region. The specific objective of this study was to estimate future gross domestic product (GDP) losses associated with TB deaths in the African Region for use in advocating for better strategies to prevent and control tuberculosis.MethodsThe cost-of-illness method was used to estimate non-health GDP losses associated with TB deaths. Future non-health GDP losses were discounted at 3 %. The analysis was conducted for three income groups of countries. One-way sensitivity analysis at 5 and 10 % discount rates was undertaken to assess the impact on the expected non-health GDP loss.ResultsThe 0.753 million tuberculosis deaths that occurred in the African Region in 2014 would be expected to decrease the future non-health GDP by International Dollars (Int$) 50.4 billion. Nearly 40.8, 46.7 and 12.5 % of that loss would come from high and upper-middle- countries or lower-middle- and low-income countries, respectively. The average total non-health GDP loss would be Int$66 872 per tuberculosis death. The average non-health GDP loss per TB death was Int$167 592 for Group 1, Int$69 808 for Group 2 and Int$21 513 for Group 3.ConclusionTuberculosis exerts a sizeable economic burden on the economies of the WHO AFR countries. This implies the need to strongly advocate for better strategies to prevent and control tuberculosis and to help countries end the epidemic of tuberculosis by 2030, as envisioned in the United Nations General Assembly resolution on Sustainable Development Goals (SDGs).Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0138-5) contains supplementary material, which is available to authorized users.

Predictors of death among drug-resistant tuberculosis patients in Kuala Lumpur, Malaysia: A retrospective cohort study from 2009 to 2013.

The emergence of drug-resistant tuberculosis (TB) is a major public health threat. However, little is known about the predictors of death in drug-resistant TB in Malaysia. This study aimed to determine the predictors of death in drug-resistant TB patients, including multidrug-resistant TB (MDR-TB), in Kuala Lumpur, Malaysia. This study adopted a retrospective cohort study design and involved laboratory-confirmed drug-resistant TB patients (n=426) from January 2009 to June 2013. A Cox regression model and Kaplan-Meier curves were used to model the outcome measure. Data were analysed by using SPSS v.20.0 for Windows. In this study, 15.3% (n=65) of the patients died. Among the study patients, 70.9% were monoresistant TB cases, 9.4% were poly-resistant TB and 19.7% were MDR-TB. MDR-TB [adjusted hazard ratio (aHR)=2.23, 95% confidence interval (CI) 1.26-3.95], ethnicity [Malay (aHR=5.95, 95% CI 2.30-15.41), Chinese (aHR=4.01, 95% CI 1.38-11.66) and Indian (aHR=3.76, 95% CI 1.19-11.85)], coronary heart disease (aHR=6.82, 95% CI 2.16-21.50), drug abuse (aHR=3.79, 95% CI 2.07-6.93) and treatment non-compliance (aHR=1.81, 95% CI 1.01-3.27) were independent predictors of poorer survival in the multivariate Cox regression analysis. This study suggests that MDR-TB, local ethnicity, coronary heart disease, history of drug abuse and treatment non-compliance are factors predicting poor survival in drug-resistant TB patients. More emphasis should be given to the management of drug-resistant TB patients with these characteristics to achieve better treatment outcomes.

Tuberculosis mortality in a rural population from South India

General mortality rate (GMR) is an essential indicator for assessing the health status of a community. Tuberculosis (TB) mortality is an indicator for the Millennium Development Goal for 2015. This community-based retrospective survey was conducted in 2007-2008 on a sample of 114,605 rural populations living in 56 villages randomly selected from 218 villages in Tiruvallur district, South India, where the DOTS strategy was implemented in 1999. All the permanent residents of the households were registered and information on occurrence of death was recorded. All the deaths were investigated by verbal autopsy (VA) using standardized methods. A total of 719 deaths were registered. The GMR and tuberculosis mortality rate (TMR) were 648 (95% CI: 568-727) and 39 (95% CI: 25-52) per 100,000 p-yrs, respectively. The GMR increased with age, and was higher in males than females at all ages. The TMR was higher in males than females and the overall male:female ratio was 5:1. TB was the 6th leading cause of death overall and the 2nd leading cause among men in this area. Strategies to reduce TB death should be implemented and the impact should be monitored by repeat VA studies.

Building and Strengthening Infection Control Strategies to Prevent Tuberculosis - Nigeria, 2015.

Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide, accounting for more than 1.5 million deaths in 2014, and is the leading cause of death among persons living with human immunodeficiency virus (HIV) infection (1). Nigeria has the fourth highest annual number of TB cases among countries, with an estimated incidence of 322 per 100,000 population (1), and the second highest prevalence of HIV infection, with 3.4 million infected persons (2). In 2014, 100,000 incident TB cases and 78,000 TB deaths occurred among persons living with HIV infection in Nigeria (1). Nosocomial transmission is a significant source of TB infection in resource-limited settings (3), and persons with HIV infection and health care workers are at increased risk for TB infection because of their routine exposure to patients with TB in health care facilities (3-5). A lack of TB infection control in health care settings has resulted in outbreaks of TB and drug-resistant TB among patients and health care workers, leading to excess morbidity and mortality. In March 2015, in collaboration with the Nigeria Ministry of Health (MoH), CDC implemented a pilot initiative, aimed at increasing health care worker knowledge about TB infection control, assessing infection control measures in health facilities, and developing plans to address identified gaps. The approach resulted in substantial improvements in TB infection control practices at seven selected facilities, and scale-up of these measures across other facilities might lead to a reduction in TB transmission in Nigeria and globally.

Anti-mycobacterial activity of polyketides from Penicillium sp. endophyte isolated from Garcinia nobilis against Mycobacteriumsmegmatis

Objective/backgroundAccording to estimates by the World Health Organization, there were 9.6 million new tuberculosis (TB) cases in 2014: 5.4 million among men, 3.2 million among women, and 1.0 million among children. There were also 1.5 million TB deaths. Although there are potent anti-TB molecules, the misuse of these drugs in addition to inconsistent or partial treatment have led to the development of multidrug-resistant TB and extensively drug-resistant TB. It is established that plants harbor microorganisms, collectively known as endophytes, which also produce metabolites. Exploring the as-yet untapped natural products from the endophytes increases the chances of finding novel and active compounds. The present study was aimed to investigate the antimycobacterial activity of the crude extract and compounds isolated from Penicillium sp. endophyte associated with Garcinia nobilis against Mycobacterium smegmatis. MethodsLiquid culture obtained from the fermentation of Penicillium sp. was extracted using ethylacetate and the liquid chromatography–mass spectrometry monitored fractionation of crude extracts yielded six compounds. Their structures were elucidated with spectroscopic analyses including two-dimensional nuclear magnetic resonance, high resolution mass spectrometry by dereplication using Antibase, and by comparison to literature data. All compounds and the crude extract from the liquid medium were evaluated for their antimycobacterial activity against M. smegmatis. ResultsIn this study, the activity of penialidins A–C (1–3), citromycetin (4), p-hydroxy phenyl glyoxalaldoxime (5), and Brefeldin A (6) were tested against nonpathogenic M. smegmatis. Penialidin C was the most active compound with a minimum inhibitory concentration of 15.6μg/mL. ConclusionIsolated compounds from Penicillium sp. harbored in G. nobilis exhibited promising antimycobacterial activity against M. smegmatis thus supporting the immensity of the potential of antimycobacterial drug discovery from endophytes from medicinal plants. Penialidin C could further be investigated for antimycobacterial drug development.

Tuberculosis: Past, Present and Future

Background Tuberculosis (TB) is the second-most common cause of death from infectious disease (after those due to HIV/AIDS). Roughly one-third of the world's population has been infected with M. tuberculosis, with new infections occurring in about 1% of the population each year. People with active TB can infect 10-15 other people through close contact over the course of a year. Materials and Methods The current study is a review survey which was conducted to evaluate of current status of TB prevalence by studying WHO website, Centers for Disease Control and Prevention (CDC), United Nations Children's Fund (UNICEF) and United Nations (UN) websites. Results In 2014, 9.6 million people fell ill with TB and 1.5 million (1.1 million HIV-negative and 0.4 million HIV-positive) died from the disease. Over 95% of TB deaths occur in low- and middle-income countries, and it is among the top 5 causes of death for women aged 15 to 44. One million children (0-14 years) fell ill with TB, and 140 000 children died from the disease in 2014; also, about 80% of reported TB cases occurred in 22 countries. The 6 countries that stand out as having the largest number of incident cases in 2014 were: India, Indonesia, Nigeria, Pakistan, People’s Republic of China and South Africa. The TB death rate dropped 47% between 1990 and 2015. Conclusion Despite the fact that nearly all patients can be cured, TB remains one of the world’s biggest threats. Ending the TB epidemic by 2030 is among the health targets of the newly adopted Sustainable Development Goals.

Patient and Healthcare System Delays in the Start of Pulmonary Tuberculosis Treatment Among Tribal Patients Registered Under DOTS, Odisha.

Tuberculosis (TB) is a highly infectious disease which continues to be an important public health problem worldwide. This study puts an effort to determine patient and health system delay in diagnosis and treatment and association to specific types of delay among tribals in Mayurbhanj district, Odisha. A total of 261 TB patients reporting to 4 TB Units of Mayurbhanj were interviewed using pre-tested structured questionnaire. Extra-pulmonary TB patients and death cases were excluded. Data entry and analysis was carried out in Epi-info 3.32 version. Chi-square test was used to test the association between dependant variable (patient and health system delays) with different independent variables (age, sex, reasons for delay etc.). Median patient, health system and total delay were 24, 3 and 24 days respectively. Risk factors that were significantly associated with patient delay were education (95% CI= 1.01-1.11, p=0.015), cost of treatment/transport (95% CI=0.87-1.01, p=0.020), distance (95% CI=1.00-1.29, p=0.002) and lack of awareness about TB (95% CI=1.01-1.34, p=0.001). Health system delay risk factors were distance (95% CI=0.32-0.96, p=0.043), delay due to administrative verification (95% CI=1.18-57.97, p= 0.005) and delay due to traditional healers/ private practitioners (95% CI=1.61-15.45, p=0.0008). This study revealed longer patient delay compared to health system delay. Therefore, public awareness in tribal dialect about chest symptoms and availability of free diagnostics services should be increased along with involvement of traditional healers.

Socio-demographic profile of TB-HIV co-infected adults and it's association with tuberculosis treatment outcome, in a South Indian city

Background: Human immune deficiency virus (HIV) and tuberculosis (TB) are major public health challenges and are intricately linked to other public health challenges like malnutrition, unemployment, alcoholism, drug abuse, poverty, homelessness and even mortality. In 2013, 360,000 deaths from HIV associated TB equivalent to 25% of all TB deaths, and around 25% of the estimated 1.5 million deaths from HIV/AIDS .Prognosis in these diseases depends on factors such as health seeking behavior and compliance to drug regimen which further depend upon various socio-demographic factors, hence it is decided to study the socio-demographic correlates of TB-HIV co-infected adults and their association with TB treatment outcome in Bangalore Municipality area. Methods: A longitudinal observational study was carried out, from November 1 st 2010 to December 30 th 2011, on HIV-TB co-infected adults receiving Revised National TB control program’s (RNTCP) Directly Observed Treatment Short-course (DOTS) from 5 randomly selected Tuberculosis units of Bangalore Municipality area, by interview method using a questionnaire. Results: Majority of the 162 HIV-TB co-infected adults studied were males (74%), belonging to fourth decade of life, and most came from low socio-economic stratum and most were educated only till middle school (70%). Most common occupation was unskilled labour (17.3%), and among women, 58% were house wives. Disability due to the diseases had led to unemployment of many who were earlier employed. Most patients belonged to Hindu (80.2%) religion, live in nuclear families (67.9%), and come from urban slums (55.8%). Three fourths of the patients were either currently married (103, 63.6%) or had been married. TB treatment success rate was 90.5%. Although there were differences in the proportion of successful and unsuccessful outcomes of TB treatment among groups pertaining to socio-demographic attributes of patients, none of these differences were statistically significant. Conclusions: HIV-TB co-infection was common among males, middle aged adults, low socio-economic class, those with low education and among unskilled labourers, but none of these socio-demographic attributes had significant relation with the TB treatment outcome.

Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia

BackgroundTuberculosis (TB) is among the leading causes of morbidity and mortality worldwide. More than 70% of the deaths of TB patients occur during the first two months of TB treatment. The major risk factors that increase early death of TB patients are being positive for human immunodeficiency virus (HIV), being of old age, being underweight or undergoing re-treatment.ObjectiveTo assess the time of reported deaths and associated factors in a cohort of patients with TB during TB treatment.MethodsAn institution-based retrospective cohort study was analyzed in Dangila Woreda, Northwest Ethiopia from March 1st through March 30, 2014. All TB patients registered in the direct observed treatment (DOTs) clinic from 2008–2012 were included in the study. Data were entered into EpiData and exported to SPSS for analysis. The survival probability was analyzed by the Kaplan Meier method and Cox regression analysis was applied to investigate factors associated with death during TB treatment.ResultsFrom a total of 872 cases registered in TB registry log book, 810 were used for the analysis of which 60 (7.4%) died during the treatment. The overall mortality rate was 12.8/1000 person months of observation. A majority of TB deaths 34 (56.7%) occurred during the intensive phase of the treatment, and the median time of death was at two months of the treatment. Age, HIV status and baseline body weight were independent predictors of death during TB treatment.ConclusionsMost deaths occurred in the first two months of TB treatment. Old age, TB/HIV co-infection and a baseline body weight of <35 kg increased the mortality during TB treatment. Therefore, a special follow up of TB patients during the intensive phase, of older patients and of TB/HIV co-infected cases, as well as nutritionally supplementing for underweight patients may be important to consider as interventions to reduce deaths during TB treatment.

Non-White Race/Ethnicity Is Associated With Central Nervous System Disease Among Tuberculosis Deaths in the United States

Non-White Race/Ethnicity Is Associated With Central Nervous System Disease Among Tuberculosis Deaths in the United States

Childhood tuberculosis: a unified response to a global problem.

If we were to stack all the pills required to treat one child with tuberculosis (TB), they would exceed the height of the Taj Mahal. Childhood TB to date has been a hidden epidemic, and the estimated incidence figures may not fully represent the true burden, given the multiple obstacles in reporting, diagnosing and treating TB in children in resource-poor settings. Children and adolescents are at a higher risk than adults for progression from infection to TB disease, with most cases progressing within 2 to 12 months of initial infection. The timeframe to act is limited, and with new paediatric formulations being released, the emphasis should be on implementation as well as translating research into policy. The European and Developing Countries Clinical Trials Partnership (EDCTP) 1 has so far invested nearly E71 million in TB research on treatment, vaccines and diagnostics, and with particular attention to vulnerable populations, including children and human immunodeficiency virus co-infected patients. Successful EDCTP TB paediatric studies include TB CHILD, which developed TAM-TB, the first reliable sputum-independent immunodiagnostic assay to detect active TB in children in a TB-endemic setting. 2 This was done through a close collaboration between multiple research teams in different African and European countries, and the aim is now to make TAM-TB ready for global uptake. The reversal of the childhood TB epidemic needs more of these international collaborations to accelerate the development and introduction of new or improved drugs, vaccines and diagnostics, and efforts must be made to involve policy makers, end-users and communities from the moment of inception of research activities and on to delivery to patients. The End TB Strategy demands a 95% reduction in TB deaths by 2035, 3 but with the introduction of the Sustainable Development Goals (SDG) the research community, industry, funders and policy makers have been given a new and even more ambitious target in the longstanding battle against TB. SDG target 3.3 seeks to end the epidemic of tuberculosis by 2030. To succeed in this mission, a global collaborative effort must be mobilised whereby each stakeholder plays to their strengths and overlaps in investments are avoided to circumvent resource constraints. Results from EDCTP prove that aligning research agendas, pooling financial resources and supporting collaboration across borders can deliver innovative solutions and contribute to the elimination of this centuries old disease.

Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study.

BackgroundHuman immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting.MethodsWe conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment.ResultsOf 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96–9.27), unemployment (HR = 2.24; 95 % CI, 1.55–3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI, 1.10–3.31) were significantly associated with a higher hazard of death.ConclusionsWe demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.

Transient Hyperglycemia in Patients With Tuberculosis in Tanzania: Implications for Diabetes Screening Algorithms.

Diabetes mellitus (DM) increases tuberculosis risk while tuberculosis, as an infectious disease, leads to hyperglycemia. We compared hyperglycemia screening strategies in controls and patients with tuberculosis in Dar es Salaam, Tanzania. Consecutive adults with tuberculosis and sex- and age-matched volunteers were included in a case-control study between July 2012 and June 2014. All underwent DM screening tests (fasting capillary glucose [FCG] level, 2-hour CG [2-hCG] level, and glycated hemoglobin A1c [HbA1c] level) at enrollment, and cases were tested again after receipt of tuberculosis treatment. Association of tuberculosis and its outcome with hyperglycemia was assessed using logistic regression analysis adjusted for sex, age, body mass index, human immunodeficiency virus infection status, and socioeconomic status. Patients with tuberculosis and newly diagnosed DM were not treated for hyperglycemia. At enrollment, DM prevalence was significantly higher among patients with tuberculosis (n = 539; FCG level > 7 mmol/L, 4.5% of patients, 2-hCG level > 11 mmol/L, 6.8%; and HbA1c level > 6.5%, 9.3%), compared with controls (n = 496; 1.2%, 3.1%, and 2.2%, respectively). The association between hyperglycemia and tuberculosis disappeared after tuberculosis treatment (adjusted odds ratio [aOR] for the FCG level: 9.6 [95% confidence interval {CI}, 3.7-24.7] at enrollment vs 2.4 [95% CI, .7-8.7] at follow-up; aOR for the 2-hCG level: 6.6 [95% CI, 4.0-11.1] vs 1.6 [95% CI, .8-2.9]; and aOR for the HbA1c level, 4.2 [95% CI, 2.9-6.0] vs 1.4 [95% CI, .9-2.0]). Hyperglycemia, based on the FCG level, at enrollment was associated with tuberculosis treatment failure or death (aOR, 3.3; 95% CI, 1.2-9.3). Transient hyperglycemia is frequent during tuberculosis, and DM needs confirmation after tuberculosis treatment. Performance of DM screening at tuberculosis diagnosis gives the opportunity to detect patients at risk of adverse outcome.

Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study

Little is known about how long the BCG vaccine protects against tuberculosis. We assessed the long-term vaccine effectiveness (VE) in Norwegian-born individuals. In this retrospective population-based cohort study, we studied Norwegian-born individuals aged 12-50 years who were tuberculin skin test (TST) negative and eligible for BCG vaccination as part of the last round of Norway's mandatory mass tuberculosis screening and BCG vaccination programme between 1962 and 1975. We excluded individuals who had tuberculosis before or in the year of screening and those with unknown TST and BCG status. We obtained TST and BCG information and linked it to the National Tuberculosis Register, population and housing censuses, and the population register for emigrations and deaths. We followed individuals up to their first tuberculosis episode, emigration, death, or Dec 31, 2011. We used Cox regressions to estimate VE against all tuberculosis and just pulmonary tuberculosis by time since vaccination, adjusted for age, time, county-level tuberculosis rates, and demographic and socioeconomic indicators. Median follow-up was 41 years (IQR 32-49) for 83 421 BCG-unvaccinated and 44 years (41-46) for 297 905 vaccinated individuals, with 260 tuberculosis episodes. Tuberculosis rates were 3·3 per 100 000 person-years in unvaccinated and 1·3 per 100 000 person-years in vaccinated individuals. The adjusted average VE during 40 year follow-up was 49% (95% CI 26-65), although after 20 years, the VE was not significant (up to 9 years VE [excluding tuberculosis episodes in the first 2 years] 61% [95% CI 24-80]; 10-19 years 58% [27-76]; 20-29 years 38% [-32 to 71]; 30-40 years 42% [-24 to 73]). VE against pulmonary tuberculosis up to 9 years (excluding tuberculosis episodes in the first 2 years) was 67% (95% CI 27-85), 10-19 years was 63% (32-80), 20-29 years was 50% (-19 to 79), and 30-40 years was 40% (-46 to 76). Findings are consistent with long-lasting BCG protection, but waning of VE with time. The vaccine could be more cost effective than has been previously estimated Norwegian Institute of Public Health and London School of Hygiene & Tropical Medicine.

LATEST LABORATORY DIAGNOSTIC TECHNIQUES AND ANTIBIOGRAM TESTING OF TUBERCULOSIS INFECTION

Tuberculosis (TB) ranks as the second leading cause of death from a single infectious agent, after the human immune-deficiency virus (HIV). Millions of people die because of this disease. Tuberculosis is treatable disease, patients can be saved provided the disease is timely diagnosed. With the ambitious World Health Organization (WHO) goal to end the global TB epidemic, by 2035, with the targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence (both compared with 2015). It becomes essential to focus on rapid laboratory diagnosis of the disease and subsequently starting effective first line treatment. The techniques reviewed in this paper, are conventional to automated culturing procedures. Moreover, among rapid techniques included Loop Mediated Isothermal Amplification, Line Probe Assay, Ligase chain reaction, Real time PCR. The serological techniques include Gamma interferon release assays, Enzyme-linked immunospot (ELISPOT) assays. The old conventional manual techniques for culture have been replaced by more rapid and reliable automated techniques. As long as speed of reporting is concerned the automated culturing procedures have been supplemented by real time PCR which gives report of culture and antibiogram testing report within hours. It has been justified, in order to achieve the goal set by WHO, for the eradication of TB, it is essential to improve detection techniques, including latent forms of the disease as well and timely identification of resistance strains. Real time PCR would fulfil thiscriteria, which can be performed even on OPD basis. This technique can be used as commonly as Acid Fast Bacilli (AFB) staining techniques were once used.

Risk Factors for Central Nervous System Tuberculosis.

To describe the epidemiology and factors associated with pediatric central nervous system (CNS) tuberculosis (TB) in California from 1993 to 2011. We analyzed California TB registry data for persons aged ≤18 years, comparing CNS TB cases versus non-CNS TB cases reported from 1993 to 2011. Factors associated with CNS TB and TB deaths were identified by using multivariate logistic regression. A total of 200 CNS TB cases were reported. Compared with non-CNS TB case patients, CNS TB case patients were more likely to be aged <5 years (72.0% vs 43.6%; odds ratio [OR]: 3.8 [95% confidence interval (CI): 2.4-5.9]), US-born (82.0% vs 58.2%; OR: 3.3 [CI: 2.3-4.7]), and Hispanic (75.0% vs 63.2%; OR: 1.7 [CI: 1.3-2.4]). Among US-born CNS TB case patients (during 2010-2011), 76.5% had a foreign-born parent. Tuberculin skin test results were negative in 38.2% of 170 CNS TB cases tested. In multivariate analysis, age <5 years (adjusted odds ratio [aOR]: 3.3 [CI: 2.0-5.4]), US birth (aOR: 1.8 [CI 1.2-2.7]), and Hispanic ethnicity (aOR: 1.5 [CI: 1.1-2.1]) were associated with an increased risk of developing CNS TB. For deaths, CNS TB (aOR: 3.8 [CI: 1.4-9.9]) and culture positivity (aOR: 6.2 [CI: 2.2-17.3]) were associated with increased risk of death, whereas tuberculin skin test positivity (aOR: 0.1 [CI: 0.04-0.2]) was associated with decreased risk. Subsets of children are at increased risk for CNS TB in California and may benefit from additional prevention efforts.

Stopping the body count: a comprehensive approach to move towards zero tuberculosis deaths

Stopping the body count: a comprehensive approach to move towards zero tuberculosis deaths

Tuberculosis deaths in Northern Portugal. Predictors of mortality during TB treatment – A five-year analysis (2008–2012)

The burden of tuberculosis in the Northern Region of Portugal remains high despite the implementation of risk group oriented strategies. Therefore characterization of the factors that relate to mortality among tuberculosis patients in this geographical region is relevant and explains the purpose of this study.Records in the national surveillance system for tuberculosis characteristics for patients living in the North of Portugal and who completed tuberculosis treatment between 2008 and 2012 were studied by means of a retrospective case–control study design. Simple and multiple regressions were performed in order to assess the relationship between patient demographic, clinical and social history data with patient survival.Male individuals over 45 years old with prior cancer (OR 4.63, 90% CI 2.66–8.04) and disseminated tuberculosis (OR 1.96, 90% CI 0.48–0.99) were identified as being those with the highest risk of death throughout tuberculosis treatment.

&lt;b&gt;Mortalidade por tuberculose no interior de São Paulo – brasil (2006-2008)/Mortality from tuberculosis in the countryside of São Paulo - Brazil (2006-2008)&lt;b&gt;

This is an epidemiological and descriptive study aiming to characterize the epidemiological profile of deaths due to tuberculosis in the period from 2006 to 2008 of the Regional Health Department III of the State of Sao Paulo, Brazil. The population was selected through reports of tuberculosis cases recorded in the Tuberculosis Patient Control Registers and death certificates with underlying cause of tuberculosis of the residents of the region covered, registered in the Mortality Information System Department. It was observed 640 reported cases in the Tuberculosis System and 34 deaths in the Information System of Mortality. It was possible to identify 22 deaths when both databases were crossed each other. Thus, there were a total of 45 deaths due to tuberculosis, which occurred mostly in male, with a mean age of 30-59 years and the pulmonary form of the disease. Forty-five percent (45%) of the reported cases occurred outside the primary health care, and the mean interval between notification and death indicated a delayed diagnosis in 77% of the cases. In conclusion, the results showed the importance of data entry reviewing in both information systems, beyond of studies to analyze strategies considered for disease control and also to measure the performance of the primary health care in this context.

WHO's End TB Strategy: From stopping to ending the global TB epidemic

The 67th World Health Assembly of 2014 adopted the “End TB Strategy” with a vision of making the world free of tuberculosis (TB) and with the goal of ending the global TB epidemic by the year 2035. World Health Organization's “End TB Strategy” captures this holistic response in its four principles and three pillars. The three high-level indicators of the “End TB Strategy” – reductions in TB deaths, reductions in the TB incidence rate and the percentage of TB patients and their households experiencing catastrophic costs – are relevant to all countries.