Decline Of Tuberculosis Research Articles

The 1918 influenza pandemic hastened the decline of tuberculosis in the United States: An age, period, cohort analysis

The effect of the 1918 influenza pandemic on other diseases is a neglected topic in historical epidemiology. This paper takes up the hypothesis that the influenza pandemic affected the long-term decline of tuberculosis through selective mortality, such that many people with tuberculosis were killed in 1918, depressing subsequent tuberculosis mortality and transmission. Regularly collected vital statistics data on mortality of influenza and tuberculosis in the US are presented and analyzed demographically. The available population-level data fail to contradict the selection hypothesis. More work is needed to understand fully the role of multiple morbidities in the 1918 influenza pandemic.

Decline in tuberculosis with 19 years of universal directly observed therapy in a comprehensive statewide program [Notes from the field

The Mississippi State Department of Health tuberculosis program serves a rural southeastern US state of 2.9 million people in an area of 121,489 km(2) (46,907 square miles). Statewide, directly observed therapy (DOT) began in 1986. To evaluate the program's effectiveness, trends in Centers for Disease Prevention and Control program indicators for 1981-2005 were compared and found to be significant (P < 0.0001). Inclusion of rifampin and pyrazinamide in the regimens was reviewed. An annual decline in cases and case rates began in 1990, falling by 65% by 2005. Successful DOT is feasible over a large geographic area.

High time to tackle childhood tuberculosis

When Robert Koch published his groundbreaking paper on the aetiology of tuberculosis (TB) in 1882, he reported that about a third of the working population died of TB [1]. World TB Day today should remind us not only about the first identification of the tubercle bacillus but also that the main burden of the TB epidemic has shifted from Europe to other regions in the world. The 329,391 reported TB cases in the WHO European Region in 2009 contribute only 5.6% of all newly detected TB cases and relapses in the world, according to the latest report Tuberculosis surveillance in Europe 2009, jointly published by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe [2]. Furthermore a sustained decline in TB can be noted with a mean annual reduction of 3.8% between 2005 and 2009, mainly attributable to the highand intermediate-burden countries in the European Union (EU) and European Economic Area (EAA).

Airborne diseases: Tuberculosis in the Union Army

This paper examines the medical histories of a sample of 25,000 Union Army soldiers and veterans to study the determinants of diagnosis, discharge, and mortality from tuberculosis. We find that water and airborne diseases during the war contributed significantly to the presence of tuberculosis. Height and a higher body mass index (BMI) are also associated with protection against TB but these effects are not always robust. As an upper bound, we estimate that the contribution of modern gains in height and in BMI to the mortality decline of tuberculosis ranges from one-fourth to one-half with the rest explained by the decline in the prevalence of water and airborne diseases, especially diarrhea, dysentery, and typhoid played. The paper finds weaker support for alternative hypotheses that rely on occupational influences and exogenous changes in the virulence of tuberculosis.

Testing the influenza–tuberculosis selective mortality hypothesis with Union Army data

Using Cox regression, this paper shows a weak association between having tuberculosis and dying from influenza among Union Army veterans in late nineteenth-century America. It has been suggested elsewhere [Noymer, A. and M. Garenne (2000). The 1918 influenza epidemic's effects on sex differentials in mortality in the United States. Population and Development Review 26(3), 565–581.] that the 1918 influenza pandemic accelerated the decline of tuberculosis, by killing many people with tuberculosis. The question remains whether individuals with tuberculosis were at greater risk of influenza death, or if the 1918/post-1918 phenomenon arose from the sheer number of deaths in the influenza pandemic. The present findings, from microdata, cautiously point toward an explanation of Noymer and Garenne's selection effect in terms of age-overlap of the 1918 pandemic mortality and tuberculosis morbidity, a phenomenon I term “passive selection”. Another way to think of this is selection at the cohort, as opposed to individual, level.

Primary Tuberculosis Infection in 35 Children at a Swedish Day Care Center

The decline of tuberculosis (TB) in the Swedish population since the middle of the 20th century resulted in decreased awareness of the disease. Increased migration from TB-endemic countries has resulted in new cases and risk of transmission. A day care provider was diagnosed with cavitary TB after being symptomatic for 5 months. We describe the contact tracing at the day care center, the clinical and radiographic findings, and treatment of the infected children. We stratified the children by contact with the source case and examined the most exposed first. Thirty-two of 53 attending and 3 of 84 visiting preschool children were infected. All of them had spent at least 3 days at the center. Symptoms were usually mild and nonspecific. Seventeen children had pulmonary radiographic changes compatible with primary TB, and one had miliary TB. The radiographic resolution was slow, with normalization in 50% after 12 months. Eighteen months after termination of treatment, there have been no relapses. The children with latent infection were treated with rifampin for 4 months and none has developed TB. The manifestations of primary TB in children today are similar to those described 50-70 years ago. The tuberculin skin test is an effective tool for contact tracing in an unvaccinated, previously nonexposed childhood population. Rapid detection of contagious patients and thorough contact investigation remain our most important means to reduce transmission.

The 1918–19 influenza pandemic affected tuberculosis in the united states: Reconsidering Bradshaw, smith, and Blanchard†

Bradshaw, Smith, and Blanchard discuss a number of facets of the decline of tuberculosis and influenza, fascinating and important diseases. Bradshaw, Smith, and Blanchard (2008; hereinafter BSB) make a number of points opposing my 2000 Population and Development Review article with Michel Garenne. I will confine the present discussion to these points. It will be useful to begin with a summary of the relevant points of Noymer and Garenne (2000).

A Framework Action Plan to fight Tuberculosis in the European Union

Many European Union (EU) Member States show a decline in tuberculosis (TB) incidence and many have low incidence rates (15 countries reported less than 10 cases per 100,000 population in 2006). However, despite the progress in curbing the TB epidemic, the disease remains a public health threat in the EU. The epidemiological patterns are still very diverse between countries and control efforts are challenged by problems such as multidrug-resistant (MDR TB) and extensively drug-resistant tuberculosis (XDR TB), TB/HIV co-infection and the concentration of cases within vulnerable groups.

Quantitative Impact of Human Immunodeficiency Virus Infection on Tuberculosis Dynamics

Human immunodeficiency virus (HIV) infection has a major but unquantified impact on the risk of tuberculosis. To quantify the impact of HIV infection on the number of tuberculosis cases in San Francisco. We studied all patients reported with tuberculosis in San Francisco from 1991 to 2002. The initial isolates of Mycobacterium tuberculosis were genotyped using IS6110 restriction fragment-length polymorphism genotyping as the primary method, and clustered cases (identical genotype patterns) were identified. We determined the case number, case rate, and the fraction of tuberculosis attributable to HIV infection. Of 2,991 reported tuberculosis cases, 2,193 (73.3%) had a genotype pattern of M. tuberculosis available. Genotypic clusters with at least one HIV-positive person were larger, lasted longer, and had a shorter time between successive cases relative to clusters with only HIV-uninfected persons (P < 0.00005, P = 0.0009, P = 0.018, respectively). Overall, 13.7% of the tuberculosis cases were attributable to HIV infection and an estimated 405 excess tuberculosis cases occurred. During a period encompassing the resurgence and decline of tuberculosis in San Francisco, a substantial number of the tuberculosis cases were attributable to HIV infection. Coinfection with HIV amplified the local tuberculosis epidemic.

Epidemiological trends of Tubercolosis in Italy, 1990-2004

Background: During the last two decades, tuberculosis (TB) has once again emerged as a significant public health problem in Western Countries. The aim of this study is to describe the epidemiology of TB in Italy in the last fifteen years. All routine information sources available (annual notifications, mortality and hospital discharges) were used, and attempts to investigate gender and geographical differences were made. Methods: Age-standardized annual notification, mortality and hospital discharge rates were calculated. Time trends of annual notifications, mortality and hospital discharges for TB were modelled through Poisson regression, and whenever necessary, negative binomial regression. Results: The analysis of the temporal trend of TB using the three indicators shows an increase until the middle of 1990s and a following decrease. TB is more frequent in men than in women, with a decremental. North to South gradient. There are important geographical and gender differences of the TB decline in Italy, since the decrease of TB frequency is more pronounced in men than in women and it is less evident in the central and, to a lesser extent, the southern parts of the country. Discussion: Italian guidelines for TB control, which are largely consistent with the international recommendations for low-incidence countries, need to be fully implemented throughout the entire country in order to reach the ultimate goal of disease eradication. Given the high number of TB cases among foreignborn persons, a strong public health commitment on TB control for immigrants, which includes screening, prophylaxis and treatment, is urgently needed.

What's Driving the Decline in Tuberculosis in Arkansas? A Molecular Epidemiologic Analysis of Tuberculosis Trends in a Rural, Low-Incidence Population, 1997 2003

Incident cases of tuberculosis may result from a recently acquired Mycobacterium tuberculosis infection or from the reactivation of a latent infection acquired in the remote past. The authors used molecular fingerprinting data to estimate the relative contributions of recent and remotely acquired infection to the yearly incidence of tuberculosis in Arkansas, a state with a largely rural population where the incidence of tuberculosis declined from 7.9 cases per 100,000 population to 4.7 cases per 100,000 between 1997 and 2003. The authors used a time-restricted definition of clustering in addition to the standard definition in order to increase the specificity of the clustering measure for recent transmission. The greatest overall declines were seen in non-Hispanic Blacks (from 13.8 cases per 100,000 in 1997 to 6.5 cases per 100,000 in 2003) and persons aged 65 years or more (from 19.9 cases per 100,000 in 1997 to 8.5 cases per 100,000 in 2003). In both groups, the incidence of nonclustered cases declined more dramatically than the incidence of clustered cases. This suggests that the decline in rates resulted primarily from declining rates of disease due to reactivation of past infections. Declines in the overall incidence of tuberculosis in a population may not necessarily result from declines in active transmission.

Tuberculosis in the head and neck: experience in India

With improvement in economic and social conditions and the use of effective anti-tubercular therapy, the developed nations, and most developing nations, have enjoyed a decline in tuberculosis for several decades. It is now seen that extra-pulmonary presentations form a major proportion of new cases, especially since the advent of the acquired immunodeficiency syndrome epidemic. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region and its varied manifestations. We report the increased incidence of isolated head and neck tuberculosis, its various presentations and clinical manifestations over a 10-year period. A 10-year (1995-2004), retrospective study was undertaken by the department of otolaryngology and head and neck surgery, Kasturba Medical College, and its allied hospitals, Mangalore, South India, involving a group of 165 patients with head and neck tuberculosis. Each patient underwent a detailed clinical examination and a battery of investigations. Most patients were treated with anti-tubercular therapy alone; others required surgical intervention followed by Anti-tubercular therapy (ATT). In addition, those with human immunodeficiency virus infection or malignancy were treated with anti-retroviral therapy and radiotherapy, respectively. Of the 165 cases, 121 (73.3 per cent) had isolated tubercular lymphadenitis, 24 (14.5 per cent) had laryngeal tuberculosis, four (2.4 per cent) had tubercular otitis media, three (1.8 per cent) had tuberculosis of the cervical spine, three (1.8 per cent) had tuberculosis of the parotid, eight (5 per cent) had tuberculosis of the oral cavity, one had tuberculosis of the temporo-mandibular joint and one had tuberculosis of the nose. Fine needle aspiration cytology was highly effective in the diagnosis of tubercular lymphadenitis (92 per cent) but not so for other sites. The purified protein derivative (PPD) test was positive in only 20 per cent of cases. Pus for culture and sensitivity was positive only in caries of the spine and mandibular tuberculosis. Excision biopsy and histopathological examination were required to make a diagnosis in tuberculosis of the oral and nasal cavities, salivary glands, ear, temporo-mandibular joint, and mandible. There were 40 cases (24.2 per cent) with coexisting pulmonary tuberculosis and five cases (3 per cent) with coexisting malignancy. Of the 65 patients who were tested, 30 per cent were found to have coexisting human immunodeficiency virus infection. In addition to cervical lymphadenitis, tuberculosis in the head and neck region can produce isolated disease in the oral cavity, ear, salivary glands, temporo-mandibular joint, nose and larynx. Seventy-five per cent of our head and neck tuberculosis patients did not have pulmonary involvement. Fine needle aspiration cytology was highly effective in the diagnosis of nodal tuberculosis, but histopathological examination was required to make the diagnosis in other head and neck sites. The PPD test was not effective as a diagnostic tool. If the otolaryngologist maintains a high index of suspicion, an early diagnosis can be made with the help of simple investigations. Successful outcome depends upon appropriate chemotherapy and timely surgical intervention when necessary.

Tuberculosis and Infection Control Measures

he goal of tuberculosis (TB) control is to prevent transmission of TB rom infected to uninfected persons and to prevent progression from atent TB infection (LTBI) to active infection among people who have ontracted Mycobacterium tuberculosis infection. The essential steps to control the spread of TB relies on the vigilance of hysicians to recognize and treat LTBI and active TB, as well as the mplementation of effective infection control strategies. This became vident in the late 1980s with the resurgence in cases of TB attributed to everal events including the deterioration of the infrastructure of tuberulosis control programs, the increase in urban homelessness, intravenous rug abuse, and most notably the AIDS epidemic. Since 1992, effective nterventions have led to a steady and dramatic decline in TB in all patient opulations, except for those who are foreign born. Prevention of the pread of TB is of primary importance in health care settings, nursing omes, and other facilities including homeless shelters, prisons, and chools. ode of Spread

Improved Program Activities are Associated with Decreasing Tuberculosis Incidence in the United States

This study was conducted to determine whether improvements in tuberculosis (TB) program activities correlate with incident TB cases. National TB surveillance data and program data from patients with pulmonary and laryngeal TB and their contacts were collected. These data were analyzed using regression models to assess the association between changes in incident TB cases and indicators of program performance (a time series of percent changes in program indices). A total of 1,361,113 contacts exposed to 150,668 TB patients were identified through contact investigations. From 1987 to 1992 (the period of TB resurgence and antedating increased funding), there was a decline in several measures used by TB programs for outcomes of contact investigations. From 1993 to 1998 (the period after increases in TB funds), there was an observable improvement in the program indices. Four program indices for contacts and two for TB cases (directly observed therapy and completion of therapy) were statistically associated (p < or = .01) with the decline in TB incident cases. These analyses suggest that expanded TB program activities resulted in the reduction in national TB cases and underscore the importance of treatment completion for TB disease and latent TB infection. Based on these results, we propose that further improvements in these activities will accelerate the decline of TB in the United States.

喉頭結核2症例

The decline of tuberculosis has resulted in laryngeal tuberculosis becoming rare. We observed only two cases of laryngeal tuberculosis during the past 10 years. A chief complaint of this malady was hoarseness. The patients' chest x-rays showed abnormality. One case had an ulcer lesion in the false vocal fold, and the other had white and granulomatous lesions in the vocal fold and epiglottis. A stroboscopic examination was performed on the case which had a pathological change in their vocal cords. Stroboscopic finding were useful in assessing the presence of laryngeal cancer. Mycobacterium tuberculosis was discharged in the phlegm of one of the cases. As a result, tuberculosis infection in our hospital became a concerm. From experience of two cases, strategies were given consideration to prevent such an infection from spreading through the hospital when a case of laryngeal tuberculosis was suspected. A patient who has a pathological change to their larynx and has a cough is recommended to take a chest x-ray at an early stage. Medical practitioners should presently refresh their knowledge about tubercular diagnosis and prevention.

Japan’s national tuberculosis control strategies with economic considerations

We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese, strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services.

Risk factors for recent transmission of Mycobacterium tuberculosis.

In recent decades, the decline of tuberculosis has stopped in Western Europe, mainly due to increased immigration from high-prevalence countries. The objective of the current study was to identify risk factors for developing tuberculosis following recent infection, in order to better target interventions. Strains from 861 culture-positive cases, diagnosed in Norway in 1994-1999, were analysed by use of restriction fragment length polymorphism (RFLP). A cluster was defined as two or more isolates with identical RFLP patterns. Risk factors for being part of a cluster were identified by univariate and multivariate analysis. A total of 134 patients were part of a cluster. These constituted 5% Asian-born, 18% Norwegian-born, 24% European-born and 29% African-born patients. Four independent risk factors for being part of a cluster were identified: being born in Norway, being of young age, being infected with an isoniazid-resistant strain and being infected with a multidrug-resistant strain. Transmission of tuberculosis may be further reduced by improving case management, contact tracing, preventive treatment, screening of immigrants and access to health services for the foreign-born population.

Historical intensity of natural selection for resistance to tuberculosis.

Infections have long been thought to exert natural selection on humans. Infectious disease resistance is frequently invoked as a mechanism shaping human genetic diversity, but such hypotheses have rarely been quantitatively evaluated with direct measures of disease-related mortality. Enhancement of genetically determined resistance to tuberculosis by natural selection has been proposed as a factor explaining the decline of tuberculosis in Europe and North America in the period 1830-1950 (before the advent of antimicrobial chemotherapy) and the apparently reduced susceptibility of Europeans and their descendants to tuberculosis infection and/or disease. We used Swedish vital statistics from 1891 to 1900 to estimate that individuals who escaped mortality from pulmonary tuberculosis (PTB) during the European tuberculosis epidemic would have enjoyed a fitness advantage of 7-15% per generation compared to individuals who were susceptible to PTB mortality; individuals with 50% protection would have had a selection coefficient of 4-7%/generation. Selection during the peak of the European TB epidemic could have substantially reduced the frequency of already rare alleles conferring increased susceptibility to PTB mortality, but only if the phenotypic effects of these alleles were very large. However, if resistant alleles were rare at the beginning of this period, 300 years would not have been long enough for such selection to increase their frequency to epidemiologically significant levels. Reductions in the frequency of rare susceptibility alleles could have played at most a small part in the decline of the epidemic in the century preceding 1950. Natural selection by PTB deaths during the European TB epidemic alone cannot account for the presently low level of TB disease observed among Europeans and their descendants just prior to the appearance of antibiotic treatment.

The resurgence of disease: social and historical perspectives on the ‘new’ tuberculosis

The resurgence of tuberculosis is one of the most serious global public health challenges of the twenty-first century. This paper argues that the decline of tuberculosis since the nineteenth century is far better understood than its resurgence over the last twenty years. It is suggested that insights gained from the historical study of disease may provide a better analytical framework for understanding the contemporary dynamics of disease epidemiology than the current emphasis on the bio-medical and behavioural characteristics of individual patients. It is concluded that tuberculosis research requires a combination of advances in bio-medical knowledge with a broader understanding of the evolving relationship between disease and modern societies.

Spatial patterns of tuberculosis incidence in Cologne (Germany)

In many European countries, the decline of tuberculosis notification rates levelled off in the mid 1980s. Germany has been facing only a very modest resurgence of tuberculosis (TB) in the early 1990s, but until now, the notification rate does not yet fulfil the WHO definition of a low incidence country. Mainly immigration from high incidence countries is held responsible for the delayed decline and temporary increase of TB. This paper seeks to investigate the inner-urban strength of association between tuberculosis and several potential risk factors in the city of Cologne using geographical and statistical methods within a small-area division based, GIS-supported ecological study, which never before has been conducted for a German city. Standardised annual TB incidence rates for 78 urban subdistricts between 1986 and 1997, disaggregated by age, have been analysed. Twelve independent variables representing contemporary ethnic and socio-economic conditions are used to calculate Poisson regression models. For the entire population and for the <60 age group, a strong positive association was found between tuberculosis incidence and share of immigrants. Interestingly enough the share of German-origin immigrants from eastern Europe was seen not to be instrumental in increasing TB rates. Reflecting strong ecological correlations between variables depicting economic conditions and TB as well as immigration variables, the deprivation of certain ethnicities rather than high prevalence immigration background is inferred to be significant to TB level. As for the 60+ age group regression analysis fails to model the TB incidence patterns sufficiently it seems reasonable to assume an autonomous, spatially disaggregated TB epidemic of the elderly, echoing a severe post-war epidemic by reactivation, only marginally associated with contemporary living conditions, but contributing substantially to the current TB incidence level. This assumption is reinforced by further results of the statistical analysis (deviance of regression null models, testing for Normal distribution, time trends). It could be shown that in Cologne the HIV/AIDS epidemic is not significantly influencing the TB incidence rate of men aged 30–49 being the most AIDS-afflicted population subgroup.